Arch Dermatol, 2005 Jan, 141(1), 57 - 9 Absence of Ribosomal RNA of Mycobacterium tuberculosis Complex in Sarcoidosis; Marcoval J et al.; OBJECTIVE: To determine whether Mycobacterium tuberculosis ribosomal RNA (rRNA) is present in fresh tissue specimens from patients with sarcoidosis . DESIGN: A prospective study . SETTING: A university-based hospital.Patients Thirty-five patients diagnosed as having sarcoidosis at the University Hospital of Bellvitge, Barcelona, Spain, were included in the study . Fresh tissue samples with granulomatous inflammation were prospectively collected between 1997 and 2001 from all patients . For each sample tested, approximately 1 negative control was included . MAIN OUTCOME MEASURES: Mycobacterium tuberculosis rRNA was detected using an isothermal enzymatic amplification system of target rRNA of M tuberculosis complex via DNA intermediates . Smears for acid-fast staining and mycobacteriological cultures were also obtained . RESULTS: A total of 78 biopsy specimens (57 skin, 10 lymph node, 3 lacrimal gland, 2 spleen, 2 lung, 2 muscle, 1 bone, and 1 nerve) collected from 74 patients (35 patients with sarcoidosis and 39 control patients) were included in the study . Stains for acid-fast bacilli and mycobacterial cultures were negative for organisms in all cases . Mycobacterium tuberculosis rRNA was not detected in the specimens from any patients with sarcoidosis or in those from control patients whose cultures were negative for organisms . Ribosomal RNA was detected in 6 tissue specimens from patients with cultures that were positive for M tuberculosis and that were processed in parallel to the samples included in the study . CONCLUSIONS: Although previous studies have reported that mycobacterial antigens may play a role in granuloma formation in some patients with sarcoidosis, our results suggest that M tuberculosis cannot be considered to be the etiologic agent of the disease. Chest, 2005 Jan, 127(1), 205 - 12 Delays in Suspicion and Isolation Among Hospitalized Persons With Pulmonary Tuberculosis at Public and Private US Hospitals During 1996 to 1999; Rozovsky-Weinberger J et al.; BACKGROUND: While prior studies have shown that public and private hospitals differ in their rates of suspicion and isolation of patients who are at risk for tuberculosis (TB), no study has investigated whether this variation is due to differences in the impact of patient case-mix on hospitals or to variations attributable to specific hospital practice patterns . OBJECTIVE: To investigate patient-level and hospital-level factors associated with delays in TB suspicion and isolation among inpatients with pulmonary TB disease . DESIGN: Retrospective cohort study of patients hospitalized with culture-positive pulmonary TB during 1996 to 1999 . SETTING: Patients with culture-proven pulmonary TB treated at three public hospitals (765 patients) and seven not-for-profit private hospitals (172 patients) in Chicago, Los Angeles, and southern Florida that provided care for five or more patients with TB per year during the study period . MEASUREMENTS: Two-day rates (within 48 h from admission) of acid-fast bacilli (AFB) smear orders and 1-day rates (within 24 h from admission) of TB isolation . RESULTS: Two-day rates of ordering AFB smears were > 80% at three public and two private hospitals vs 65 to 75% at five private hospitals . One-day rates of TB isolation at the three public hospitals were 64%, 79%, and 86%, respectively, vs 39 to 58% at the seven private hospitals . Delays of > 2 days in ordering AFB smears were associated with patient-level factors: absence of cough (adjusted odds ratio {AOR}, 6.02; 95% confidence interval {CI}, 3.82 to 9.52), cavitary lung lesion (AOR, 5.17; 95% CI, 1.98 to 13.50), night sweats (AOR, 3.38; 95% CI, 1.90 to 5.99), chills (AOR, 1.70; 95% CI, 1.01 to 2.88), and female gender (AOR, 1.66; 95% CI, 1.06 to 2.60) . Delays of > 1 day in ordering pulmonary isolation were associated with patient-level factors: absence of cough (AOR, 3.40; 95% CI, 2.31 to 5.03), cavitary lung lesion (AOR, 2.66; 95% CI, 1.57 to 4.50), night sweats (AOR, 1.98; 95% CI, 1.35 to 2.92), and history of noninjecting drug use (AOR, 1.86; 95% CI, 1.16 to 2.99) and one hospital-level factor: receiving care at a nonpublic hospital . Even after adjustment for patient-level factors, TB patients at private hospitals were half as likely as those at public hospitals to be placed in pulmonary isolation (AOR, 0.47; 95% CI, 0.30 to 0.72), while odds of suspecting TB in these same patients were similar at both hospitals . CONCLUSION: Private hospitals should order TB isolation for all patients for whom AFB smears are ordered, a policy that has been instituted previously at public hospitals in our study. Nippon Geka Gakkai Zasshi, 2004 Dec, 105(12), 745 - 50 {Surgical treatment of pulmonary tuberculosis}; Nakajima Y; The indications for the surgical treatment of pulmonary tuberculosis are mainly for multidrug-resistant tuberculosis (MDR-Tb) . In Fukujuji Hospital there have been 91 pulmonary resections for 83 MDR-Tb cases during the past 20 years . Of those resections, upper lobectomies with or without partial resection of other lobes comprised 55%, segmentectomies 10%, and pneumonectomies 30% . The following major postoperative complications occurred: prolonged air leakages in 19%, empyema in 9%, and respiratory failure in 6% . However, there were no operative deaths . After pulmonary resection for MDR-Tb, immediate negative conversion rate of expectoration of tuberculous bacilli was 98%, reexpectoration rate of them was 12%, The final cure rate was 92% . Surgical treatment is worth consideration for the treatment of refractory pulmonary tuberculosis. Rinsho Shinkeigaku, 2004 Nov, 44(11), 846 - 8 {Bacterial meningitis: determination of pathogens and therapeutic management}; Kamei S; Recent aspects of pathogen determination and therapeutic management are reviewed based on a clinical analysis of 50 of our adult patients with bacterial meningitis (BM) . The sensitivity for detecting pathogens using gram-stained smears and cultures of CSF was high in untreated patients, but low in patients previously treated with antibiotics . Latex agglutination for antibodies of pathogens is rapid and has a potential for determining pathogens in partially treated meningitis . The PCR also has a potential for determining pathogens in pre-treated, culture-negative cases and for detecting whether the bacterial pathogen is resistant or sensitive to antibiotics . The initial empiric regimen of antibiotics has been modified with elevation in the detection rate of drug-resistant bacilli . The proportion of patients undergoing treatment with VCM and/or Carbapenems has recently increased at our department . A combination of dexamethasone under administration of antibiotics has also been established as effective in adult BM . On admission, some patients are difficult to diagnose as BM rather than herpes simplex encephalitis (HSVE) . A serum CRP value of >2.0 mg/dl proved useful for such different diagnosis in our patients . The predictors of a poor outcome based on multivariate logistic analysis in our BM patients were level of unconsciousness and sepsis. Dis Aquat Organ, 2004 Nov 23, 62(1-2), 121 - 32 Ultrastructure of Mycobacterium marinum granuloma in striped bass Morone saxatilis; Gauthier DT et al.; An emerging epizootic of mycobacteriosis currently threatens striped bass Morone saxatilis populations in Chesapeake Bay, USA . Several species of mycobacteria, including Mycobacterium marinum, species resembling M . avium, M . gordonae, M . peregrinum, M . scrofulaceum and M . terrae, and the new species M . shottsii have been isolated from diseased and healthy bass . In this study, we describe the ultrastructure of developing M . marinum granulomas in experimentally infected bass over a period of 45 wk . The primary host response to injected mycobacteria was formation of large macrophage aggregations containing phagocytosed bacilli . M . marinum were always contained within phagosomes . Close association of lysosomes with mycobacterial phagosomes, as well as the presence of electron-opaque material within phagosomes, suggested phagolysosomal fusion . Development of granulomas involved epithelioid transformation of macrophages, followed by appearance of central necrosis . Desmosomes were present between mature epithelioid cells . The necrotic core region of M . marinum granulomas was separated from overlying epithelioid cells by several layers of flattened, electron-opaque spindle-shaped cells . These cells appeared to be formed by compression of epithelioid cells and, aside from a flattened nucleus, did not possess recognizable organelles . Following the development of well-defined, paucibacillary granulomas, secondary disease was observed . Recrudescence was marked by bacterial replication followed by disruption of granuloma architecture, including loss of epithelioid and spindle cell layers . In advanced recrudescent lesions, normal tissue was replaced by macrophages, fibroblasts, and other inflammatory leukocytes . Large numbers of mycobacteria were observed, both intracellular and suspended in cellular debris. Eur J Gastroenterol Hepatol, 2005 Jan, 17(1), 27 - 31 Bacterial translocation and its consequences in patients with cirrhosis; Guarner C et al.; Bacterial translocation is the passage of viable bacteria from the intestinal lumen to mesenteric lymph nodes and other extraintestinal sites.Spontaneous bacterial peritonitis is the main clinical consequence of bacterial translocation in cirrhosis.Translocation of bacterial products of viable or non-viable bacteria, such as endotoxin and/or bacterial DNA, through the intestinal wall could stimulate the immune system and the hyperdynamic circulatory state in cirrhosis with clinical consequences that are under evaluation.Bacterial translocation is currently considered the passage of viable gut flora across the intestinal barrier to extraluminal sites . Aerobic Gram-negative bacilli are the most common translocating bacteria . Intestinal bacterial overgrowth, impairment in permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences are the major mechanisms postulated to favour bacterial translocation in cirrhosis . Bacterial translocation is a key step in the pathogenesis of spontaneous bacteraemia and spontaneous bacterial peritonitis in cirrhosis . Translocation of intestinal bacterial products from viable or non-viable bacteria, such as endotoxin and bacterial DNA, has recently been associated with pathophysiological events, such as activation of the immune system and derangement of the hyperdynamic circulatory status in cirrhosis . Clinical consequences of these effects of bacterial products are presently under investigation. Clin Diagn Lab Immunol, 2005 Jan, 12(1), 130 - 4 Effects of Thalidomide on Intracellular Mycobacterium leprae in Normal and Activated Macrophages; Tadesse A et al.; Thalidomide is an effective drug for the treatment of erythema nodosum leprosum (ENL) . ENL is an inflammatory reaction that may occur in multibacillary leprosy patients . Its cause(s) as well as the mechanism of thalidomide in arresting this condition are not fully understood . It has been suggested that ENL is an immune complex-mediated hypersensitivity precipitated by the release of Mycobacterium leprae from macrophages . The released antigen may complex with precipitating antibodies, initiating complement fixation and the production of inflammatory cytokines like tumor necrosis factor alpha (TNF-alpha) . Thalidomide has been shown in vitro to reduce antigen- or mitogen-activated macrophage production of TNF-alpha . We investigated if thalidomide could also influence the viability of intracellular M . leprae . Mouse peritoneal macrophages were infected with M . leprae, activated with gamma interferon and endotoxin, or nonactivated, and treated with thalidomide . Intracellular bacilli were recovered, and metabolic activity was assessed by a radiorespirometric procedure . Thalidomide did not possess antimicrobial action against M . leprae in normal and activated host macrophages . This suggests that thalidomide does not retard the release of mycobacterial antigens, a possible prelude or precipitating factor for ENL . A distinct sequence of events explaining the mechanism of action for thalidomide's successful treatment of ENL has yet to be established. Bull World Health Organ, 2004 Nov, 82(11), 836 - 843 Epub 2004 Dec 14. Tuberculosis situation among tribal population of Car Nicobar, India, 15 years after intensive tuberculosis control project and implementation of a national tuberculosis programme; Murhekar MV et al.; OBJECTIVE: To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986 . METHODS: The entire population of Car Nicobar was enumerated through a house-to-house survey . Children aged <14 years were tuberculin tested and read for reaction sizes . Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms . Sputum samples were examined for presence of acid-fast bacilli . FINDINGS: Among the 4543 children enumerated, 4351 (95.8%) were tuberculin tested and read . Of the 981 children without bacille Calmette-Guerin scars, 161 (16.4%) were infected with TB . A total of 77 cases who were smear-positive for TB were detected from among 10 570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100 000 . The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100 000, respectively . CONCLUSION: The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002 . Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community . The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures . High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures. Infect Genet Evol, 2005 Mar, 5(2), 145 - 56 Mycobacterium tuberculosis molecular evolution in western Mediterranean Islands of Sicily and Sardinia; Sola C et al.; In this study, a total of 204 Mycobacterium tuberculosis DNAs from Sicily (n = 144) and Sardinia (n = 60) were studied by three genotyping methods . Results were analyzed both within and across islands, to define the phylogeographical specificities of the genotypes, look for their diversity and infer a molecular evolutionary scenario . A strong link between geography and tuberculosis genotypes was observed in Sardinia . The results were also matched against a world-wide genetic diversity database to compare the population structure of the tubercle bacilli in the islands . Eight common genotypes between Sicily, Sardinia and continental Italy were found which underlines the influences of the Italian mainland on the population structure on the islands and vice versa . A unified evolutionary scenario of M . tuberculosis evolution was built using numerical taxonomy and maximum parsimony (MP) methods . The finding of multiple families of M . tuberculosis strains (S, T, LAM, Haarlem), their presumed links with the major genetic groups (MGG) of M . tuberculosis complex, supports the view of independent introduction of several ancestral genotypes in Sicily and in Sardinia . We conclude that the two PCR-based genotyping combination (spoligotyping-VNTR) is an excellent tool to reconstruct M . tuberculosis phylogeny, that may be used to construct global and local evolutionary scenarios of the M . tuberculosis complex . The results obtained are paradigmatic of the complex interplay that exists between epidemic dynamics and evolutionary genetics of M . tuberculosis. Lancet, 2005 Jan 8, 365(9454), 130 - 4 Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study; Zar HJ et al.; BACKGROUND: For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful . We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis . METHODS: We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa . Sputum induction and gastric lavage were done on three consecutive days according to a standard procedure . Specimens were stained for acid-fast bacilli; each sample was cultured singly for M tuberculosis . FINDINGS: Median age of children was 13 months (IQR 6-24) . A positive smear or culture for M tuberculosis was obtained from 62 (25%) children; of these, 58 (94%) were positive by culture, whereas almost half (29 {47%}) were smear positive . Samples from induced sputum and gastric lavage were positive in 54 (87%) and 40 (65%) children, respectively (difference in yield 5.6% {1.4-9.8%}, p=0.018) . The yield from one sample from induced sputum was similar to that from three gastric lavages (p=1.0) . Microbiological yield did not differ between HIV-infected and HIV-uninfected children (p=0.17, odds ratio 0.7 {95% CI 0.3-1.3}) . All sputum induction procedures were well tolerated; minor side-effects were increased coughing, epistaxis, vomiting, or wheezing . INTERPRETATION: Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children . This technique is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfected infants and children. Korean J Ophthalmol, 2004 Dec, 18(2), 190 - 5 A case of primary lid tuberculosis after upper lid blepharoplasty; Yang JW et al.; Primary lid tuberculosis after lid surgery is a very rare condition and is likely caused by the introduction of bacilli through epithelial injury . Secondary infection, due to direct hematogenous spread or contiguous spread from adjacent structures are more common presentations of lid tuberculosis . The authors experienced a case of primary lid tuberculosis occurring in a 19 year old female after blepharoplasty for making a eyelid crease . Her upper lid skin showed a reddish and non-tender mass lesion measured 3x1 cm, which was diagnosed as the tuberculosis through typical histopathological findings (caseous necrosis), acid-fast bacilli stain and PCR, and treated with anti-tuberculosis medications. J Clin Microbiol, 2005 Jan, 43(1), 439 - 41 Evaluation of an accelerated protocol for detection of extended-spectrum beta-lactamase-producing gram-negative bacilli from positive blood cultures; Navon-Venezia S et al.; We evaluated a protocol for the accelerated detection of extended-spectrum beta-lactamases (ESBLs) in gram-negative bloodstream pathogens . Two hundred eighty-three blood culture bottles were subjected to direct ESBL testing by inoculating samples directly from blood culture bottles onto agar plates containing cefotaxime and ceftazidime disks, with and without clavulanate . Standard ESBL testing in accordance with the NCCLS guidelines after subculturing on agar plates was performed in parallel . Results of the direct ESBL testing were reported 2.3 days sooner and were comparable to those of the standard NCCLS method with sensitivity, specificity, and positive and negative predictive values of 100, 98, 94, and 100%, respectively. J Clin Microbiol, 2005 Jan, 43(1), 174 - 8 Detection and identification of Mycobacterium tuberculosis in joint biopsy specimens by rpoB PCR cloning and sequencing; Yun YJ et al.; Osteoarticular tuberculosis (OAT) is an extrapulmonary tuberculosis and accounts for 1 to 3% of all tuberculosis cases . We used an rpoB PCR-plasmid TA cloning-sequencing method to detect and identify tubercle bacilli in surgical specimens from patients suspected of having OAT . By comparing the similarities of the rpoB sequences determined with those in GenBank, Mycobacterium tuberculosis was detected in 23 of 43 samples . Three of the 23 positive samples had mutations at codon 531, which are commonly observed in rifampin-resistant M . tuberculosis strains . Our results suggest that the rpoB PCR-TA cloning-sequencing method developed, which detects M . tuberculosis and which simultaneously determines its rifampin susceptibility, can also be used efficiently for the diagnosis of OAT. Zhonghua Jie He He Hu Xi Za Zhi, 2004 Nov, 27(11), 767 - 70 {Clinical features of 23 cases of AIDS complicated by tuberculosis.}; Yuan J et al.; OBJECTIVE: To discuss the clinical features, treatment and prognosis of patients with AIDS complicated by tuberculosis(TB) . METHODS: The clinical features of 23 patients with AIDS complicated by tuberculosis admitted from 1997 to July 2004 were retrospectively analyzed . RESULTS: Of the 23 patients, most (94.3%) were young or middle-aged, and 11 (47.8%) died within half a year . The main HIV transmission was via sexual contact in 15 (65.2%) patients . Loss of body weight by 5 - 15 kg was present in all patients, cough for over 1 month in 15 (65.2%), and multiple opportunistic infections were complicated in most cases . Out of the 23 cases, 14 (60.9%) showed only pulmonary TB, and 8 (34.8%) showed lymph node TB . In 12 cases with infiltrated pulmonary TB, X-ray showed bilateral infiltration and no cavity formation was found . Slightly positive PPD test was found in 2 (8.7%) cases, and positive acid-fast bacilli was detected in sputum in 1 case (4.4%) . The pre-treatment CD(4)(+) cell number in 23 patients was much lower than that in AIDS patients without complicated TB (P < 0.05) . The pre-treatment CD(4)(+) cell number in patients died shortly after diagnosis was much lower than that in survived patients (P < 0.05) . The HIV RNA level in the 23 patients was much higher than that in patients without complication of TB (P < 0.05) . The mortality in patients treated with therapy against both TB and HIV was much lower than that in patients untreated or treated only with anti-TB therapy (P < 0.05) . CONCLUSIONS: For patients with AIDS complicated by TB, the high negative rate in PPD test and the atypical chest X-ray manifestations are common . However, lymph node TB is quite common with high mortality . The pre-treatment CD(4)(+) level decreases significantly, and is associated with mortality . The TB bacilli may accelerate HIV virus duplication . It is suggested that the patients be treated with a combination of anti-TB and anti-HIV therapies. Kekkaku, 2004 Oct, 79(10), 587 - 604 {Reform of Japan's NTP and its technical perspectives}; Mori T; The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation . The law is also challenged with the shift of the paradigm for the National Tuberculosis (TB) Programme . In order to respond properly to these changes, the Tuberculosis Panel of the Health Science Council of the Ministry of Health, Labor and Welfare submitted its report for the amendment of the law in March 2002 . Based on this report, a new Tuberculosis Control Law was passed in Parliament last June, and related decrees of the Cabinet and the Ministry are now being revised in preparation for it's enactment in April 2005 . In this special lecture, the main points and framework of the revisions were discussed with the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation . 1 . Case detection . There will be a shift from the current "indiscriminate" screening scheme to a selective one regarding periodic mass health examination . Only subjects aged 65 or older will be eligible for the screening, supplemented with selected occupational groups who are considered to be at a higher risk of TB, or may be a danger to others if they develop TB, such as health-care providers and school teachers . In addition, local autonomies are responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses . This means that the efforts of the autonomies are critical for the new system to be effective . The extra-ordinary examination will be limited to only the patient's contacts, and will be mandatory for those contacts so they cannot refuse to be examined by the Health Center . The public services used in the contact investigations will be greatly facilitated by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection using whole-blood interferon-gamma determination (QuantiFERON) . The quality of clinical diagnosis and monitoring of treatment should also be improved by introducing an external quality assurance system of commercial laboratory services . 2 . Chemoprophylaxis . Although not explicitly defined in the new legislation, the expansion and improvement of chemoprophylaxis to cover anyone with any risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago . These technical innovations in diagnosis of TB infection will be very helpful . Development of new drug regimens for the preventive treatment is also badly needed . 3 . Immunization . Prior to the amendment of the Law, the BCG vaccination of students entering primary and junior high schools has been already abandoned . In order to encourage the early primary vaccination for infants, the new Law will adopt the direct vaccination scheme in which babies will be given the BCG vaccine without tuberculin testing . This program will be implemented safely, only if it is given to young babies, e.g., less than one year old, as defined by the decree . It is essential to maintain the high level of vaccination coverage under the new program . The autonomy may encounter difficulty mobilizing client babies shortly after their birth (only one year, as compared with the current four years) . To avoid the possible, though very rare, adverse health effects due to the vaccination of infected babies, careful questioning should be conducted regarding the risk of exposure to infection prior to vaccination . A ready course of treatment and examinations for abnormal reactions after vaccination (Koch's phenomenon) is also warranted . 4 . Treatment and patient care: The revised Law clearly states the governmental responsibility for treating TB patients in close cooperation with a doctor . This is an important legal basis for the expansion of the DOTS Japan version . While the development of new anti-tuberculosis drugs will be realized in the near future, Japan still has to overcome the issue of improper practice of treatment, as well as the government's slow process for approving new drugs to be used for multi-drug resistant TB and non-tuberculous mycobacterioses . 5 . Prefectural TB Control Plan: In order to resolve the problems specific to the respective prefectures in terms of epidemiological parameters or available resources, the new Law requests every prefecture to develop its own TB control plan . In order for the new TB Control Law to be effective, strong government commitment supported by technological innovation is mandatory . It is for that reason that the Japanese Society of Tuberculosis should aggressively join the global movement to stop TB along with the general public of Japan. Kekkaku, 2004 Oct, 79(10), 569 - 71 {A case of pulmonary tuberculosis in late stage of pregnancy}; Nakanishi N et al.; A 28-year-old woman who was a nurse was admitted to our hospital because her sputum was positive for M . tuberculosis . She was pregnancy of 35 weeks . First, she was administered INH, RFP, PZA and was treated with cesarean section on the 21st day after starting tuberculosis chemotherapy . The operation was done in operating room of negative pressure ventilation . The patient returned to the tuberculosis ward, and the newborn infant entered to a newborn nursery room after confirming negative tubercle bacilli in amnionic fluid by PCR examination . EB was added to the regimen of chemotherapy after childbirth . In general hospitals, infection control is an important issue as seen in this case. Indian J Pediatr, 2004 Dec, 71(12), 1063 - 8 Tuberculin sensitivity among children vaccinated with BCG under universal immunization programme; Chadha VK et al.; A tuberculin survey was conducted among 45988 children with BCG scar and 54227 children without BCG scar between 1-9 years of age and residing in selected rural areas of three defined zones of India . About 45-60% of the BCG-vaccinated children elicited reactions < 5 mm in size and about 70-80% had reactions < 10 mm . Therefore, in the majority of children (showing tuberculin reaction of < 10 mm), BCG-induced tuberculin sensitivity does not interfere with interpretation of tuberculin test . The study also revealed that a proportion of reactions among BCG vaccinated children in 5-9 mm, 10-14 mm and 15-19 mm range may be attributable to BCG vaccination . Therefore, reactions between 10-14 mm and especially 15-19 mm among the vaccinated children must be interpreted carefully . However, 19 mm was observed as the upper limit for BCG induced tuberculin sensitivity and all reactions >- 20 mm in size may be considered to be due to infection with tubercle bacilli, irrespective of the BCG vaccination status. Clin Lab Sci, 2001 Spring, 14(2), 85 - 8 Modified Middlebrook 7H9 broth for the rapid detection of mycobacteria; Flournoy D et al.; OBJECTIVE: To compare the growth of acid-fast bacilli on classically formulated Lowenstein-Jensen media and Middlebrook 7H11 agar to modified Middlebrook 7H9 broth . DESIGN: Microbiology culture results were evaluated to determine the number of days required to detect growth of acid-fast bacilli from clinical specimens inoculated on different media . DATA: Three thousand one hundred fifty-seven acid fast bacilli cultures were performed from May 1996 through May 1999 . There were 140 positive cultures . Initial growth was detected only on Lowenstein-Jensen medium and/or Middlebrook 7H11 agar for 108 cultures, Lowenstein-Jensen medium and/or Middlebrook 7H11 agar and 7H9 for 12 cultures, and only modified Middlebrook 7H9 broth for 20 cultures . Of the 20 cultures that were initially detected only in 7H9, 11 grew in a mean time of 21.1 days compared with 32.5 days for the later growing solid media . The remaining nine grew in a mean time of 26.0 days but did not grow on solid media within the eight-week incubation period . Mycobacterium avium grew in a higher proportion of broth than solid medium cultures, suggesting a preference for the broth . CONCLUSION: The modified Middlebrook 7H9 broth was inexpensive to prepare, allowed for quick and easy growth interpretation, required no special appliances, e.g., ultraviolet light, and allowed for faster growth of some cultures . Although Lowenstein-Jensen medium and Middlebrook 7H11 agar remained the main-stays of our routine acid fast bacilli culture protocol, modified Middlebrook 7H9 broth provided earlier or additional positive results in 14% of the positive cultures . We recommend the use of modified Middlebrook 7H9 broth as described in this paper for improving early detection of acid fast bacilli by culture. Med Mal Infect, 2004 Aug-Sep, 34(8-9), 375 - 81 {Treatment of tuberculosis-disease} {Treatment of latent tuberculosis-infection: aiming at a change of practices in France} {No authors listed} Treatment indications for tuberculosis-infection depend on each case, but also on public health policy in each country . This policy usually made at the national level depends on tuberculosis epidemiology of the population concerned and on the country's socio-economic level of development, and more especially of its health system . Eradicating tuberculosis, in the Fifties, by treating all the sick patients or those only infected by the tuberculosis bacillus failed due to the context . Public health decision makers and large world organizations propose more realistic objectives, aiming at gradually eradicating the disease then the infection in each country by defining specific objectives for each one according to the local requirements . Thus, in developing countries, only a part of TB patients is diagnosed and treated: "those who carry enough bacilli to be positive on direct examination (BAAR+) and who thus present with the disease and are risk for their relatives" . In countries with intermediate development, the recommendation is to treat all the cases of tuberculosis-disease, but not to treat tuberculosis-infection. Rev Port Pneumol, 2004 Sep-Oct, 10(5), 383 - 91 {Endobronchial tuberculosis -- clinical and bronchoscopic features}; Sucena M et al.; Endobronchial tuberculosis (ET) is a serious complication of pulmonary tuberculosis and is a major cause of morbidity . The aim of our retrospective study was to characterize the clinical, radiological, microbiological and bronchoscopic features of ET . Between January 1999 and June 2002 a total of 14 patients were diagnosed as having ET in our hospital . There were 8 (57%) men and 6 women with a median age of 39.6 +/- 18.1 years (range from 20 to 78 years) . Cough was the most common complain and it was present in 71.4% of patients . Only 5 patients were sputum smear positive . Five patients (35.7%) had parenchymal infiltration and this was the most common roentgenographic appearance . Forms of ET were classified into subtypes: actively caseating (n=4), granular (n=3), tumorous (n=3), edematous-hyperemic (n=2) and ulcerative (n=2) . The upper lobes were affected in 9 (64.3%) patients . Nine patients had involvement of the left bronchial tree, 3 of the right and in 2 there were bilateral lesions . The diagnosis could be established in 11 (78.6%) cases by bronchial biopsy . All patients had positive bronchial lavage cultures for acid-fast bacilli . Clinical manifestations and roentgenographic appearance of ET are not specific and so bronchoscopy is mandatory for the prompt diagnosis and follow-up of its evolution. Leuk Lymphoma, 2005 Mar, 46(3), 471 - 5 Hodgkin's lymphoma and tuberculosis coexistence in cervical lymph nodes; Centkowski P et al.; We describe the case of a 47-year-old man admitted to the Department of Hematology because of fever, enlarged cervical and supraclavicular lymph nodes, hepatosplenomegaly and non-specific lung infiltrations . The histopathological examination of the cervical lymph node revealed Hodgkin's lymphoma (HL) NS type I . Clinical evaluation revealed stage IVB according to Ann Arbor classification and the presence of 5 unfavorable prognostic factors according to the International Prognostic Index . Despite BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), the enlarged lymph nodes, lung infiltrations and fever persisted . Microbiological and serological tests did not lead to the identification of any viral or bacterial pathogens . Bronchoscopy showed chronic inflammation and post-tuberculosis (TB) scars in bronchi without acid-fast bacilli in bronchoalveolar lavage (BAL) in culture and polymerase chain reaction (PCR) tests . However, the biopsy of the supraclavicular lymph node revealed multiple, caseating and necrotizing granulomatous lesions with scattered Reed - Sternberg (R - S) cells . The auramin staining presented acid-fast bacilli and allowed the diagnosis of productive and caseating TB coexisting with HL . The 4 tuberculostatics regimen and ABVD chemotherapy (adriamycin, bleomycin, vincristine, dacarbazine) resulted in a complete clinical response after 3 months of treatment . In conclusion, the association between HL and TB must be considered, especially in countries where the latter is endemic . The diagnosis may be difficult due to similarities in the clinical course, laboratory tests and imaging procedures. Clin Infect Dis, 2005 Jan 1, 40(1), 58 - 66 Epub 2004 Dec 08. Measurement of immunoglobulin G against Mycobacterial antigen A60 in patients with cystic fibrosis and lung infection due to Mycobacterium abscessus; Ferroni A et al.; BACKGROUND: The diagnosis and prognosis of lung infections due to the emerging nontuberculous mycobacterium (NTM) Mycobacterium abscessus are difficult to establish in children with cystic fibrosis . METHODS: We evaluated the usefulness of an enzyme-linked immunosorbent assay for detecting serum IgG antibodies against the ubiquitous mycobacterial antigen A60 . RESULTS: A total of 186 patients with cystic fibrosis (mean age+/-SD, 12.0+/-5.0 years) were studied, including 15 M . abscessus-positive patients who fulfilled American Thoracic Society (ATS) criteria for NTM infection (M . abscessus-infected patients), 7 M . abscessus-positive patients who did not fulfill ATS criteria, 20 patients positive for various other NTM who did not fulfill ATS criteria, and 144 NTM-negative control patients; mean IgG titers (+/-SD) for these 4 groups were 718+/-342 U, 193+/-113 U, 129+/-49 U, and 121+/-53 U, respectively (M . abscessus-infected patients vs . each of the other groups, P<.005) . The A60 IgG test was both sensitive (approximately 87%) and specific (approximately 95%) if adapted cutoff values were used (150 U and 250 U for patients aged <or=10 years and patients aged >10 years, respectively) and correlated well with results of acid-fast bacilli smears . CONCLUSION: Measurement of anti-A60 IgG may be useful for both the diagnosis and assessment of activity of M . abscessus lung infection in persons with cystic fibrosis. Cytojournal . 2004 Dec 21;1(1):6 {Epub ahead of print} FNAC OF Bacillus- Calmette-Guerin lymphadenitis masquerading as langerhans cell histiocytosis; Gupta N et al.; Bacillus Calmette Guerin (BCG) lymphadenitis is a well known entity . Disseminated BCG infection usually presents as generalized lymphadenopathy, skin rash and hepatosplenomegaly and at times, can pose a diagnostic challenge to clinicians . There are only a few published studies on the cytological findings of BCG lymphadenitis . In this letter we report the fine needle aspiration cytology (FNAC) of BCG lymphadenitis clinically masquerading as Langerhans cell histiocytosis (LCH) . FNA smears showed sheets of foamy macrophages and many polymorphs in a dirty necrotic background with many macrophages as well as polymorphs showing negatively stained rod like structures within their cytoplasm . Zeihl Neelson stain revealed that these cells were heavily loaded with acid fast bacilli (AFB) . In the index case, AFB were also seen within the cytoplasm of polymorphs, which has not been documented earlier in the literature. Med Princ Pract, 2005 Jan-Feb, 14(1), 55 - 7 Listeria monocytogenes meningitis in an immunocompetent adult patient; Jamal WY et al.; OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes in an immunocompetent adult . PATIENT AND METHODS: A previously healthy 25-year-old man presented with typical clinical features of meningitis . Cerebrospinal fluid (CSF) was obtained on the day of admission for biochemical and microbiological investigations . In addition, blood was also taken for culture and hematological studies . Antibiotic susceptibility test was performed using the Etest method . Microscopic examination of the CSF showed pleocytosis, which was predominantly lymphocytic, while the biochemical investigation revealed raised concentrations of protein and lactic acid as well as decreased glucose concentration . A 24-hour culture yielded pure growth of gram-positive bacilli identified by standard methods as L . monocytogenes . It was susceptible to ampicillin and trimethoprim-sulfamethoxazole . The patient was treated with intravenous ampicillin combined with gentamicin and made a complete recovery . CONCLUSION: This presentation describes an unusual case of meningitis caused by L . monocytogenes in a previously healthy young adult with no risk factor . Only a few similar cases have been reported in the literature. J Vet Med B Infect Dis Vet Public Health, 2004 Dec, 51(10), 464 - 6 Disseminated Mycobacterium avium-intracellulare Infection in a Persian Cat; Knippel A et al.; Summary This report describes a disseminated infection with mycobacteria of the avium/intracellulare complex in a Persian cat in the absence of cutaneous lesions . Postmortem examination revealed severe granulomatous inflammation with numerous intrahistiocytic acid-fast bacilli in multiple organs . A gastrointestinal port of entry seems likely, as the ileocaecal lymph node was most severely affected. Eur J Clin Microbiol Infect Dis, 2004 Dec, 23(12), 892 - 8 Accuracy of identification and susceptibility results by direct inoculation of Vitek 2 cards from positive BACTEC cultures; Kerremans JJ et al.; Rapid identification of bacteria and prompt acquisition of susceptibility results are valuable for patient care . The objective of the present study was to determine the accuracy of direct inoculation of Vitek 2 cards from positive BACTEC cultures compared to inoculation of the cards from subculture plates . Positive BACTEC cultures sampled between March 2001 and June 2002 were included . The results of direct inoculation were compared with the results of inoculation of Vitek 2 cards from subcultures . Of 161 gram-negative bacilli, 129 (80%) were correctly identified by direct inoculation compared to 145 of 161 (90%) by subculture . Susceptibility testing was performed on 2,862 antibiotic-isolate combinations . The essential agreement was 98.7% . The number of very major, major, and minor errors was 1 (0.2% of resistant strains), 1 (0.04% of susceptible strains), and 68, respectively . Direct identification of Staphylococcus spp . was not performed, but antimicrobial susceptibility was tested using 6,042 antibiotic-isolate combinations . The essential agreement was 95.2% . The number of very major, major, and minor errors was 73 (4.5% of resistant strains), 32 (0.8% of susceptible strains), and 106, respectively . Eighty-four percent of the very major errors occurred with trimethoprim-sulfamethoxazole . The results show that direct inoculation of Vitek cards is valuable as a rapid routine method for identification and susceptibility testing of gram-negative bacilli . For Staphylococcus spp., the susceptibility results obtained after direct inoculation of Vitek 2 cards are also acceptable except for those obtained with trimethoprim-sulfamethoxazole . Susceptibility results for this antibiotic, if obtained using direct inoculation, should not be reported to the clinician. Indian J Chest Dis Allied Sci, 2000 Oct-Dec, 42(4), 325 - 39 Prevalence of pulmonary nocardiosis in a tuberculosis hospital in Amritsar, Punjab; Singh M et al.; The prevalence of pulmonary nocardiosis in a tuberculosis and chest diseases hospital in Amritsar is reported . Of 1510 sputum samples cultured from 1016 patients, 67 sputa originating from 16 patients were found to be positive for the Nocardia asteroides species complex . Based upon repeated isolation of N . asteroides from the respiratory tract, its microscopic demonstration in KOH wet mounts or stained smears of sputum and clinical evaluation of patients, 14 cases of pulmonary nocardiosis were diagnosed . This gave a prevalence of 1.4% pulmonary nocardiosis in the tuberculosis hospital . The prevalence of the disease was found to be 1.3% in the males as against 1.5% in the females . Of the various clinical categories of patients investigated, pulmonary tuberculosis with sputum negative for acid-fast bacilli (AFB) yielded the highest prevalence of 3.2%, followed by 1.3%, 1.2%, 1.1% and 0.5% in pneumonia, chronic obstructive pulmonary disease (COPD), bronchiectasis and pulmonary tuberculosis with sputum positive for AFB, respectively . Type IV cutaneous hypersensitivity to nocardin was observed in 19 of 908 (2%) patients tested, whereas only a solitary positive reactor was found among 260 healthy volunteers . Twelve of 19 nocardin positive reactors (63%) had unequivocally proven pulmonary nocardiosis . The nocardin skin test gave false negative results in two nocardiosis patients . More comprehensive investigations are warranted in order to evaluate the nocardin skin test as an additional aid for the diagnosis of nocardiosis . Barring a solitary exception, the nocardiosis patients were successfully treated with sulphadiazine or trimethoprim-sulphamethoxazole (TMP-SMZ) combination . To the best of our knowledge, this is the largest series of pulmonary nocardiosis patients in a prospective study as yet reported from India . The observations underscore the point that nocardiosis warrants greater attention in the differential diagnosis of bronchopulmonary diseases. Am J Clin Oncol, 2004 Oct, 27(5), 522 - 8 The influence of intravesical therapy on progression of superficial transitional cell carcinoma of the bladder: a metaanalytic comparison of chemotherapy versus bacilli Calmette-Guerin immunotherapy; Huncharek M et al.; OBJECTIVE: Currently, the true impact of intravesical chemotherapy or immunotherapy (bacilli Calmette-Guerin {BCG}) on the rate of progression of superficial transitional cell carcinoma of the bladder to muscle invasive disease is unclear . A metaanalysis was performed to statistically compare the efficacy of these treatments in preventing tumor progression in this disease setting . METHODS: A prospective protocol outlining the metaanalysis noted here was developed followed by a thorough search of the existing published literature using strict eligibility criteria . Eight randomized, controlled trials were found that met protocol specifications . These reports contained data on 2427 patients who were statistically pooled using a fixed-effects model (Peto) . The outcome of interest was the proportion of patients progressing to muscle invasive or metastatic disease expressed as a summary odds ratio (ORp) . An ORp greater than unity favored BCG versus chemotherapy . RESULTS: Initial pooling of these 8 trials gave a nonstatistically significant summary odds ratio of 1.24 (0.95-1.61) without evidence of statistical heterogeneity . Analysis by drug type showed significant attenuation of the ORp when the effects of mitomycin C were compared with BCG, ie, 1.04 (0.76-1.42) suggesting that: 1) mitomycin is probably more active than the other chemotherapeutics used in the available trials and 2) BCG is not clearly superior to mitomycin C . Sensitivity analyses also demonstrated that failure to control for prior intravesical drug treatment in all but 2 of the analyzed studies produces a spurious result favoring BCG over intravesical chemotherapy . CONCLUSION: The available data fail to support a clear superiority of intravesical BCG over intravesical chemotherapy in preventing progression of superficial transitional cell carcinoma of the bladder . Mitomycin C appears more effective than the other commonly used drugs, and failure to control for prior intravesical chemotherapy in most of available studies results in a spurious finding of greater clinic effect of BCG over chemotherapy. Semin Ophthalmol, 2004, 19(3-4), 101 - 4 Clinicopathologic case report: scleral buckle associated nontuberculous mycobacterial scleritis; Nielsen J et al.; Nontuberculous mycobacterial (NTM) infections have become increasingly important in ophthalmology, particularly with keratorefractive surgery . We report a case of scleral buckle associated NTM scleritis occurring in a 69-year-old male after silicone sponge explant removal . Purulent scleral ulceration with nodule formation persisted despite topical antimicrobial therapy, buckle removal, and surgical debridement . Eventually, tissue biopsy revealed noncasseating granulomas with acid-fast bacilli that were identified in culture as Mycobacterium chelonae . The infection resolved only after administration of systemic antibiotics . NTM are important pathogens in scleral buckle associated scleritis and should be considered in persistent cases . Surgical therapy remains the cornerstone of therapy, but antimicrobials, particularly newer fourth generation fluoroqunilones, may have an important role in treating scleral buckle associated NTM scleritis. Indian Heart J, 2004 Jul-Aug, 56(4), 299 - 306 Homograft valve bank: our experience in valve banking; Verghese S et al.; BACKGROUND: A cardiac homograft valve bank with cryopreservation facility was established at the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai in July 1995 . METHODS AND RESULTS: During the last 7 1/2 years of its existence, from July 1995 to March 2003, 588 hearts were processed . The valves harvested were 390 aortic, 400 pulmonary and 39 others including mitral valve, aortic conduits, pericardium etc.; 176 (29.9%) hearts were discarded for various reasons which included failure to sterilize, HBV, HIV, HCV, treponema pallidum hemagglutination test positivity, atheromatous/fatty streaks, incompetent valves, and dissection mistakes . The valves were sterilized using an antibiotic cocktail of vancomycin, amikacin, streptomycin, cefotaxime and amphotericin B in Hank's balanced salt solution . Of the 585 valves issued for clinical use, 247 were aortic, 323 pulmonary and 15 others (mitral valve, pericardium, conduits) . Gram negative bacilli were the predominant contaminants from the hearts during the first half (July 1995 to February 1999) and gram positive organisms were the predominant contaminants during the later half (March 1999 to March 2003) of the study period . A variety of fungal contaminants like candida, aspergillus, penicillium and other fungi were also isolated from the homograft hearts at procurement . The valves were used most commonly for Rastelli procedure/right ventricular-pulmonary artery conduit (48.71%) followed by Ross procedure (23.41%) . The other procedures were aortic valve replacement (6.15%), truncus repair (5.81%), unifocalization with conduit repair (6.49%), aortoplasty (0.512%), left ventricular-pulmonary artery conduit (0.512%), pulmonary valve replacement (0.512%), aneurysm repair (0.34%), Norwood repair (0.34%), mitral valve replacement (0.17%) and other procedures (7%) . CONCLUSIONS: We have established a viable and functioning cardiac homograft valve bank to suit Indian conditions and till date, have issued 585 homograft valves for clinical use. ORL J Otorhinolaryngol Relat Spec, 2004, 66(5), 275 - 80 Mycobacterial cervical lymphadenitis; Bayazit YA et al.; Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections . The incidence of mycobacterial cervical lymphadenitis has increased . It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck . It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings . A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis . A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur . A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture . It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different . Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication . Atypical infections can be addressed as local infections and are amenable to surgical therapy . Int J Tuberc Lung Dis, 2004 Nov, 8(11), 1330 - 6 The cost of medical care and people's health-seeking behaviour before being suspected of tuberculosis in three local health systems, Nicaragua; Macq J et al.; OBJECTIVE: To assess the medical costs incurred by users and delay between first contact with a care provider and sputum test for acid-fast bacilli (AFB) in three areas of Nicaragua . METHODS: Directed interviews of consecutive series of tuberculosis (TB) suspects whose sputum had been examined for AFB . RESULTS: Of 252 TB suspects interviewed, 52% used more than one type of care giver and 35% used private practitioners . As a consequence, 18%, 21% and 29% of the interviewees in Carazo, El Viejo and Matagalpa, respectively, spent more than 1 month of the country's median income per inhabitant on medical care between the first visit to a care provider and the first sputum examination . Furthermore, more than 3 months elapsed on that part of the care pathway for 30%, 17% and 3% of interviewees in Matagalpa, El Viejo and Carazo, respectively . CONCLUSION: This study sheds light on the costs and delays incurred by TB suspects before reaching a laboratory for sputum smear examination . Both costs are lower for those suspects who exclusively use first-line governmental health services (FLGHS) . This has been relatively little documented in Latin America to date and could be used as an argument to develop strategies to strengthen the credibility of FLGHS. Eur Respir J, 2004 Dec, 24(6), 1044 - 51 On the nature of Mycobacterium tuberculosis-latent bacilli; Cardona PJ et al.; Mycobacterium tuberculosis-latent bacilli are microorganisms that adapt to stressful conditions generated by the infected host against them . By slowing metabolism or becoming dormant, they may counterbalance these conditions and appear as silent to the immune system . Moreover, the dynamic turnover of the infected cells provokes a constant reactivation of the latent bacilli when the environmental conditions are favourable, or an activation after being dormant in necrotic and fibrotic lesions for a long period of time . Since there is no in vivo nor in vitro evidence for quick resuscitation of dormant bacilli, the current authors strongly favour the possibility that latent tuberculosis infection can be maintained for no longer than approximately 10 yrs, which is, nowadays, a time period very close to that considered for "primary" tuberculosis . This concept may also be helpful for newer epidemiological considerations regarding the real impact of reinfection in tuberculosis. J Coll Physicians Surg Pak, 2003 Dec, 13(12), 694 - 6 Clinical and morphological evaluation of tuberculous peripheral lymphadenopathy; Hussain M et al.; OBJECTIVE: To analyze clinical presentations in patients of tuberculous peripheral lymphadenopathy . DESIGN: a descriptive observational study . PLACE AND DURATION OF STUDY: Department of Chest medicine, Jinnah Postgraduate Medical Centre and National Institute of Child Health from January to June 2002 . SUBJECTS AND METHODS: Patients presenting with peripheral lymphadenopathy with the confirmed diagnosis of tuberculous were included in the study . The diagnosis of tuberculosis was made on finding acid fast bacilli on smear examination and / or histological demonstration of caseating epithelioid cell granulomas in the specimen obtained by fine needle aspiration cytology (FNAC) or excision biopsy . Patients in whom definite diagnosis of tuberculosis was not established on the basis of microscopy or histopathology examination were excluded from the study . History and physical examination findings were recorded on pre-designed proforma . RESULTS: the maximum number of patients (68.75 %) was in pediatric age group . The duration of illness was more than a year in 43.75% of the patients . Cervical region was the commonest affected in 70.83 % patients . In majority of cases (89.58 %) glands were multiple and in 66.7% glands were matted . In 83% cases diagnosis was achieved by FNAC subjected for cytology and acid fast bacilte (AFB) smear examination . CONCLUSION: In local setting tuberculous etiology should be strongly suspected in a young patient presenting with peripheral lymphadenopathy, with prolonged duration of illness, and involvement of cervical glands with multiple and matted appearance . FNA is a reliable tool of diagnosis. Transpl Infect Dis, 2004 Sep, 6(3), 132 - 5 Successful kidney re-transplantation in a patient with previous allograft kidney tuberculosis; Siu YP et al.; Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients . We report a 39-year-old man who underwent a cadaveric renal transplant . Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment . The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid-fast bacilli (AFB) . His systemic symptoms responded well to a complete course of anti-tuberculous therapy, but his renal function continued to deteriorate . Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later . He remained well and asymptomatic thereafter . No signs of recurrence of tuberculous infection were noted up until the present time . This case illustrates that TB remains an important threat to transplant recipients . Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible . The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant . The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship . While diagnosing TB in post-transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols . However, no consensus has been reached on the safety of re-transplantation . Also, the need for graft nephrectomy and chemoprophylaxis remains unclear. Nihon Kokyuki Gakkai Zasshi, 2004 Oct, 42(10), 919 - 23 {A case of bronchial ulcer due to infection by Mycobacterium abscessus}; Kasai S et al.; We present a rare case of tracheobronchitis caused by Mycobacterium abscessus . The patient was a 79-year-old man with a previous history of tuberculosis . For smear examinations, he repeatedly expectorated many acid-fast bacilli . Bronchoscopic examination revealed the presence of ulceration on the lower end of the trachea and extending to the right main bronchus . Mycobacterial cultures were used to grow Mycobacterium abscessus . Following an antimicrobial regimen of clarithromycin, amikacin, and cefoxitin, the patient exhibited marked improvement . After initial multidrug therapy, the patient was placed on clarithromycin for 10 months . No relapse has occurred to date. Int J Antimicrob Agents, 2004 Dec, 24(6), 599 - 604 Chemotherapeutic efficacy of poly (DL-lactide-co-glycolide) nanoparticle encapsulated antitubercular drugs at sub-therapeutic dose against experimental tuberculosis; Sharma A et al.; The present study was designed to evaluate the chemotherapeutic efficacy of poly (DL-lactide-co-glycolide) (PLG) nanoparticles (NP) encapsulating three front-line antitubercular drugs (ATDs: rifampicin, RIF; isoniazid, INH and pyrazinamide, PZA) at 2/3rd therapeutic dose . PLG nanoparticles prepared by the double emulsion and solvent evaporation technique were administered orally at 2/3rd therapeutic dose to guinea pigs . A single oral administration of the formulation resulted in sustained drug levels in the plasma for 7-12 days and in the organs for 11-14 days with a significant improvement in mean residence time as well as drug bioavailability . The administration of PLG nanoparticles every 10 days (five doses) to Mycobacterium tuberculosis H(37)Rv infected guinea pigs led to undetectable bacilli in the organs, as did 46 conventional doses . Therefore, nanoparticle based antitubercular chemotherapy forms a sound basis for a reduction in dosing frequency and also offers the possibility of reducing the drug dosage. Kekkaku, 2004 Sep, 79(9), 531 - 5 {A case of pubic tuberculous osteomyelitis and pericarditis during anti-tuberculosis chemotherapy}; Ohkouchi M et al.; 56 year-old man was referred to the department of orthopedics in our hospital for further investigation on right inguinal pain . The patient was initially diagnosed as bacterial myelitis in right pubic bone and was treated with antibiotics . Since his symptom did not improve, the curettage was performed . Histological examination of the pubic bone obtained during the operation showed epithelioid cell granulomas with caseous necrosis, supporting the diagnosis of tuberculous osteomyelitis . Chest X-ray film revealed small nodular lesions in both upper lung fields . Sputum was positive for acid-fast bacilli and Amplified Mycobacterium Tuberculosis Direct Test (TB-MTD) was positive . The diagnosis of pubic tuberculous osteitis and pulmonary tuberculosis was confirmed . Specimens from the pubic bone and sputum were both culture positive for Mycobacterium tuberculosis, and bacilli were sensitive to anti-tuberculosis drugs . The antituberculosis chemotherapy was started with INH, RFP, SM and PZA . Symptoms had gradually improved, however 3 months after starting treatment, high fever developed and chest X-ray revealed heart enlargement and bilateral pleural effusion . Pericardial effusion showed exudative nature with lymphocyte predominancy and high level of ADA, 98.4 U/l . Pleural effusion was transudate . TB-MTD and culture were negative both in pericardial and pleural effusion . Paradoxical reaction was thought to be the cause of pericarditis . TB chemotherapy was continued and pericardial drainage was performed . One month later, fever improved, and pleural effusion and pericardial effusion disappeared . Transient elevated transaminase was observed, and was thought to be the side effect of anti TB drugs . All symptoms gradually improved, and he was discharged after 6 months TB chemotherapy. Kekkaku, 2004 Sep, 79(9), 509 - 18 {Transmission of tuberculosis (I)}; Aoki M; BCG vaccination has been given to infants and children so extensively and repeatedly for more than 55 years in Japan that it is very difficult, or often impossible to diagnose tuberculosis infection by tuberculin testing . On the other hand, as the treatment of latent tuberculosis infection has become more and more important recently, diagnosis of infection is becoming more and more important at the occasions of contact survey . However, understanding of the health care workers about transmission of tuberculosis is incomplete frequently at present . This is the reason why the author has written this review . The author has described on the history of the progress of droplet nuclei infection theory, infectivity of tuberculosis by bacteriological status of the patients, importance of cough, susceptibility of the host, and environmental factor concerning transmission of tubercle bacilli in this issue. BMC Infect Dis . 2004 Nov 17;4(1):51. Mycobacterium tuberculosis from chronic murine infections that grows in liquid but not on solid medium; Dhillon J et al.; BACKGROUND: Old, stationary cultures of Mycobacterium tuberculosis contain a majority of bacteria that can grow in broth cultures but cannot grow on solid medium plates . These may be in a non-replicating, dormant growth phase . We hypothesised that a similar population might be present in chronic, murine tuberculosis . METHODS: Estimates of the numbers of viable M . tuberculosis, strain H37Rv, in the spleens and lungs of mice in a 7-day acute infection and in a 10-month chronic infection were made by conventional plate counts and, as broth counts, by noting presence or absence of growth in serial replicate dilutions in liquid medium . RESULTS: Plate and broth counts in 6 mice gave similar mean values in the acute infection, 7 days after infection . However, the broth counts were much higher in 36 mice with a chronic infection at 10 months . Broth counts averaged 5.290 log10 cfu /organ from spleens and 5.523 log10 cfu/organ from lungs, while plate counts were 3.858 log10 cfu/organ from spleens and 3.662 log10 cfu/organ from lungs, indicating that the total bacterial population contained only 3.7% bacilli in spleens and 1.4% bacilli in lungs, capable of growth on plates . CONCLUSION: The proportion growing on plates might be a measure of the "dormancy" of the bacilli equally applicable to cultural and animal models. Eur J Radiol, 2004 Dec, 52(3), 300 - 9 Tuberculous arthritis of the appendicular skeleton: MR imaging appearances; Parmar H et al.; Tuberculosis {TB} of the appendicular skeleton is an uncommon infection caused by the tuberculous bacilli and constitutes only 1-3% of all tuberculosis infections . MR imaging features of tuberculous arthritis include bone marrow oedema, cortical erosions, synovitis, joint effusion, tenosynovitis, soft tissue collections, and myositis . These imaging features are at times non-specific, but in the correct clinical context help in diagnosis of tuberculosis . We present the various pathological manifestations of TB arthritis involving the different joints of appendicular skeleton and discuss their MR imaging appearances. J Mol Biol, 2004 Dec 3, 344(4), 907 - 18 Highly ordered supra-molecular organization of the mycobacterial lipoarabinomannans in solution . Evidence of a relationship between supra-molecular organization and biological activity; Riviere M et al.; The complex mycobacterial mannosylated lipoarabinomannans (ManLAMs) are currently considered to be the major virulence factors of the pathogenic Mycobacterium tuberculosis . The recognition and the interaction of ManLAMs with immune system receptors have been shown to promote M.tuberculosis phagocytosis but also to down-regulate the bactericidal immune response of the host in favor of the survival of the pathogenic bacilli . To date these original biological activities were mainly associated to the presence of mannose residues capping the non-reducing ends of the ramified polysaccharide moiety of these complex lipoglycans . However, we demonstrated recently that the molecular recognition of ManLAM terminal mannose units by human pulmonary surfactant protein A (hSP-A) carbohydrate recognition domains depends on the presence of the lipid moiety of the ManLAMs as proposed by Sidobre et al . in 2002 . Thus, we investigated the putative role of the ManLAM aglycon moiety . The data presented here, indicate that the hydrophobic aglycon part of ManLAM is associated to a characteristic concentration-dependent supra-molecular organization of these complex molecules . Furthermore, we observed that the deacylated ManLAMs or the lipid-free mannosylated arabinomannans, which do not exhibit characteristic ManLAM activities, do not display this supra-molecular organization . These observations strongly suggest that the ManLAMs immunomodulatory activities might be associated to their particular organization . Finally, the determination of the critical micellar concentration of ManLAMs obviously supports the notion that this supra-molecular organization may be responsible for the specific biological activities of these complex molecules. Curr Pharm Des, 2004, 10(26), 3285 - 95 Predictive in vitro models of the sterilizing activity of anti-tuberculosis drugs; Mitchison DA et al.; Sterilizing drugs kill Mycobacterium tuberculosis that persists during chemotherapy . Predictive models should mimic the conditions causing persistence in the lesions of cavitary disease, and should grade current anti-tuberculosis drugs according to their sterilizing activity determined in clinical trials . Models should start with old, stationary cultures grown micro-aerophilically . In these, persistent bacilli occur in different populations in which there is no appreciable cell division . Population 1 . Grows in liquid culture medium but not on solid medium . Killed by rifampicin . Population 2 . Grows on solid culture medium . Killed by rifampicin . Population 3 . Grows in liquid medium but not on solid medium . Tolerant of rifampicin . Population 4 . Bacilli from Cornell model mice, after treatment with pyrazinamide and isoniazid, cannot grow in liquid or on solid culture medium . Some of these populations are incorporated in models which start with 100-day liquid medium cultures . In model 1 (population 2) the new drug is added and colony counted after 7 days incubation . In models 2 and 3, 100 mg/L rifampicin is added to the 100-day culture when the bacilli lose their ability to grow on solid culture medium (population 3) . After re-suspension in rifampicin-free liquid medium for 7 days, the bacilli recover growth on solid medium, when a colony count is done . The new drug is added during incubation with rifampicin in model 3 and at the start of recovery in drug-free medium in model 2 . Models 1 and 3 grade isoniazid, rifampicin and pyrazinamide according to their sterilizing activity determined by clinical trials. Curr Pharm Des, 2004, 10(26), 3239 - 62 Prospects for clinical introduction of nitroimidazole antibiotics for the treatment of tuberculosis; Barry CE 3rd et al.; Nitroaromatic antibiotics have a long and controversial history in human and veterinary medicine . This controversy lies behind the presumption of many pharmaceutical companies that nitroaromatic compounds should be filtered from the list of drug-like compounds but stands at odds with the remarkably safe clinical record of use of such compounds . In this review, we will describe the whole-cell structure-activity relationships that have been reported for antimycobacterial nitroimidazoles as well as the available in vivo data supporting efficacy with a particular emphasis on nitroimidazo{2,1-b}oxazines such as PA-824 . We will also explore the unique potential of such compounds to shorten the course of tuberculosis therapy by exerting a bactericidal effect on non-replicating bacilli . We will consider the mode of action of such compounds in sensitive organisms and discuss the mechanisms by which resistance may emerge . Finally, we will review the pharmacokinetics, toxicology and laboratory and animal studies linking nitroimidazoles with carcinogenicity and mutagenicity and assess the prospects for the clinical introduction of nitroimidazoles for the treatment of tuberculosis. Eur J Heart Fail, 2004 Oct, 6(6), 753 - 6 NT-brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates; Tomcsanyi J et al.; BACKGROUND: Pleural effusion is not pathognomic and distinguishing between transudates and exudates often presents a diagnostic dilemma . The purpose of our study was to examine whether the inclusion of pleural fluid brain natriuretic peptide (BNP) measurement into the analysis improves the diagnostic accuracy of pleural effusion . METHODS: The pleural effusion of 14 patients with CHF (group A) and 14 subjects with different pleural pathology (group B) were analyzed . Samples of pleural fluid and serum were obtained from all patients on admission and biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture and cytology were performed on the pleural fluid . In vitro quantitative determination of N-terminal pro-Brain natriuretic peptide (NT-proBNP) in serum and pleural fluid were performed by electrochemiluminescence immunoassay proBNP method on an Elecsys 2010 (Roche) analyzer . RESULTS: The median NT-proBNP levels in groups A and B were 6295 pg/ml and 276 pg/ml, respectively: (P=0.0001) . There was no overlap between the two groups . While the Light's criteria had a sensitivity of 93% and specificity of 43% for transudates, the pleural fluid NT-proBNP level accurately differentiated between the two groups . CONCLUSIONS: The pleural NT-proBNP levels were elevated in all patients who had transudate . Therefore if the NT-proBNP levels of pleural effusion are within the normal range, transudate resulting from congestive heart failure can be ruled out . Our results suggest that the inclusion of pleural fluid NT-proBNP measurement in the routine diagnostic panel would enhance discrimination among the different causes of pleural effusions. Med J Malaysia, 2004 Mar, 59(1), 56 - 64 Pulmonary tuberculosis--a review of clinical features and diagnosis in 232 cases; Ismail Y; The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology . We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002 . All age groups were affected with a male predominance (Male:Female ratio = 60:40) . Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%) . Nearly half (45.3%) of patients had symptoms for more than one year . Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms . Fifteen percent of the patients presented with extrapulmonary diagnosis . Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done . The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical' . Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture . Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes . Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture) . In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis . In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical . Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis . In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial. World J Gastroenterol, 2004 Dec 15, 10(24), 3647 - 9 Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature; Uzunkoy A et al.; AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis . METHODS: The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed . RESULTS: Ascites was present in all cases . Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%) . The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125) . Elevated levels of cancer antigen CA-125 were determined in four patients . Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2 . CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2 . Only one patient had a chest radiograph suggestive of a new TB lesion . Two had a positive family history of pulmonary TB . None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two . Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2 . In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white 'miliary nodules' or plaques, enlarged lymph nodes, ascites, 'violin string' fibrinous strands, and omental thickening . Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes . Both were negative for acid-fast bacilli by staining . PCR of ascitic fluid was positive for Mycobacterium tuberculosis (M . tuberculosis) in all cases . CONCLUSION: Abdominal TB should be considered in all cases with ascites . Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention. Pneumologie, 2004 Nov, 58(11), 773 - 6 {Tuberculosis induced by Bacillus Calmette-Guerin immuno-prophylaxis -- case study}; Frickmann H et al.; We describe a case of miliary tuberculosis induced by Bacillus Calmette-Guerin (BCG) as a complication of an infection after BCG-instillation therapy into the bladder because of bladder carcinoma . Bacilli surely entered blood circulation via an urethral lesion because of a difficult catheterisation . The 60 year old patient was administered to the hospital with septic temperature 4 four days after BCG instillation . CT showed a miliary patten and the diagnosis was confirmed by bronchoscopy: transbronchial biopsy showed granulomatous infiltration and an acid-fast rod-bacterium was detected in bronchial slime . Symptoms vanished after a consequent antituberculous triple therapy regime and the patient left hospital in a good general state of health. Am J Respir Crit Care Med . 2004 Nov 5; {Epub ahead of print} Systemic Inflammatory Response and Progression to Severe Sepsis in Critically Ill Infected Patients; Alberti C et al.; Rationale: The systemic inflammatory response syndrome (SIRS) has low specificity to identify infected patients at risk of worsening to severe sepsis or shock . Objective: To examine the incidence of and risk factors for worsening sepsis in infected patients . Methods: A one-year inception cohort study in 28 intensive care units of patients (n=1,531) having a first episode of infection on admission or during the stay . Measurements and main results: The cumulative incidence of progression to severe sepsis or shock was 20% and 24% at days 10 and 30, respectively . Variables independently associated {hazard ratio, HR} with worsening sepsis included: temperature >38.2 degrees C {1.6}, heart rate >120/min {1.3}, systolic blood pressure <110 mmHg {1.5}, platelets <150.109/L {1.5}, serum sodium >145 mMol/L {1.5}, bilirubin >30 microMol/L {1.3}, mechanical ventilation {1.5}, and 5 variables characterizing infection (pneumonia {HR 1.5}, peritonitis {1.5}, primary bacteremia {1.8}, and infection with gram positive cocci {1.3} or aerobic gram negative bacilli {1.4}) . The 12 weighted variables were included in a score (RISSC, ranging from 0 to 49), summarized in 4 classes of 'low' (score 0 to 8) and 'moderate' (8.5 - 16) risk (9% and 17% probability of worsening, respectively), and of 'high' (16.5 to 24) and 'very high' (score > 24) risk (31% and 55% probability, respectively) . Conclusions: One of four patients presenting with infection/sepsis worsen to severe sepsis or shock . A score estimating this risk, using objectively defined criteria for SIRS, could be used by physicians to stratify patients for clinical management and to test new interventions. J Clin Microbiol, 2004 Nov, 42(11), 5053 - 7 Mycobacterium africanum genotyping using novel spacer oligonucleotides in the direct repeat locus; Brudey K et al.; This study involves a first evaluation of 25 novel spacer oligonucleotides in addition to the 43 routine spacers for molecular characterization of a panel of 65 isolates of tubercle bacilli from different geographic origins that were initially classified as Mycobacterium africanum based on phenotypic characters . The 68-spacer format defined four additional patterns, and three groups were identified . The relatively homogeneous groups A1 and A2 included strains from West Africa, and A3-1 included strains from East Africa . The presence of deletion region RD9 confirmed the reclassification of the M . africanum subtype II spoligopattern within group A3-1 as Mycobacterium tuberculosis . These isolates may represent a diverging branch of M . tuberculosis in Africa . The use of new spacers also suggested an undergoing evolution of M . africanum subtype I in West Africa . Our results showed that the strain differentiation within the M . tuberculosis complex is improved by using novel spacers, and extensive studies using new-generation spoligotyping may be helpful to better understand the evolution of M . africanum. Int J Tuberc Lung Dis, 2004 Oct, 8(10), 1234 - 41 Quality assessment of smear microscopy for acid-fast bacilli in the Argentine tuberculosis laboratory network, 1983-2001; Kusznierz GF et al.; SETTING: Tuberculosis Laboratory Network, Argentina . OBJECTIVES: 1) To evaluate the technical quality of smear microscopy for acid-fast bacilli (AFB) supervised in 1983-2001, and 2) to analyse the effect of procedural errors on the results . DESIGN: Registers of technical evaluation results for AFB microscopy were analysed . The quality of specimens, smears, staining and readings were evaluated, as was the relationship between these parameters . RESULTS: The proportion of good quality specimens was considered acceptable . A direct relationship was demonstrated between positivity in results and mucopurulent sputum . The proportion of thin smears was relatively high . Positivity and bacillary count were lower in thin smears . Staining quality was considered good . The average agreement in readings throughout the country was 98% . Nevertheless, the false-positive rate was considered significant, and 46% of false-positive results were associated with defective staining . CONCLUSIONS: The technical quality and agreement in the laboratory network were satisfactory . Nevertheless, improvements need to be made in the following: the quality of the smears, staining and reading, coverage, decentralisation of supervision, the slide selection method and data registration . Operational research on the storage and preservation of slides is also necessary. Gene Ther . 2004 Nov 04; {Epub ahead of print} Immunotherapy with plasmid DNA encoding mycobacterial hsp65 in association with chemotherapy is a more rapid and efficient form of treatment for tuberculosis in mice; Silva CL et al.; Tuberculosis (TB) remains a threat for public health, killing around 3 million people a year . Despite the fact that most cases can be cured with antibiotics, the treatment is long and patients relapse if chemotherapy is not continued for at least 6 months . Thus, a better characterization of the working principles of the immune system in TB and identification of new immunotherapeutic products for the development of shorter regimens of treatment are essential to achieve an effective management of this disease . In the present work, we demonstrate that immunotherapy with a plasmid DNA encoding the Mycobacterium leprae 65 kDa heat-shock protein (hsp65) in order to boost the efficiency of the immune system, is a valuable adjunct to antibacterial chemotherapy to shorten the duration of treatment, improve the treatment of latent TB infection and be effective against multidrug-resistant bacilli (MDR-TB) . We also showed that the use of DNA-hsp65 alone or in combination with other drugs influence the pathway of the immune response or other types of inflammatory responses and should augment our ability to alter the course of immune response/inflammation as needed, evidencing an important target for immunization or drug intervention.Gene Therapy advance online publication, 4 November 2004; doi:10.1038/sj.gt.3302418. Niger J Med, 2004 Oct-Dec, 13(4), 393 - 7 HIV sero-prevalence among newly diagnosed adult pulmonary tuberculosis patients in Sagamu; Daniel OJ et al.; BACKGRBUND: The association between Tuberculosis (TB) and Human immunodeficiency virus (HIV) has been described in several studies . TB was well represented in the first description of AIDS in Africa . In 1999, 25% of TB cases were attributable to the spread of HIV/AIDS . Frequencies of between 54-79% were recorded in medical in-patients in our hospital . The objective of the study is to assess the frequency of HIV in TB outpatients attending the tuberculosis and leprosy control centre in Sagamu . METHODS: A cross-sectional study of adult tuberculosis patients admitted into the DOTS programme of the TB and leprosy control centre, Olabisi Onabanjo University Teaching Hospital, Sagamu between January 2001 and December 2002 was undertaken . Free anti tuberculosis drugs were provided by the German leprosy Relief Association . Data was collected using interviewer-administered questionnaire . HIV screening, packed cell volume and sputum microscopy for acid fast bacilli were carried out on all patients . RESULTS: A total of 269 cases of pulmonary T.B were registered at the clinic of which 40 (14.9%) were HIV sero-positive . The peak age prevalence was in the 3d decade accounting for 42.5% of cases, followed by 32.5% in the 2rd decade . There was a statistically significant difference in the bacillary count and packed cell volume between HIV positive and negative TB patients . The mean weight at presentation, sputum positivity rate and sputum conversion rate at the end of two months of therapy was similar in both HIV positive and negative TB patients . CONCLUSION: This study has demonstrated a frequency of 14.9% of HIV sero-prevalence amongst our TB population . Efforts should be intensified to ensure adherence to INH prophylaxis among HIV infected individuals in TB endemic areas as well as strengthening preventive measures. Niger J Med, 2004 Oct-Dec, 13(4), 388 - 92 Tuberculosis in Rivers state: autopsy and surgical pathology study in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt (1990-2002); Seleye-Fubara D et al.; BACKGROUND: A 13 year (1st January 1990 - 31st December 2002) retrospective study of 138 surgical and autopsy specimens diagnosed as Tuberculosis (Tb) was studied in Port Harcourt, based on the age, sex, affected tissue and the immune status of the patients . METHOD: The tissues were initially fixed in 10% formal saline, processed and embedded in paraffin wax . The tissue were sectioned, mounted on glass slide and stained with hematoxylin and eosin (H & E) . In some cases (12.3%) special stains were used to confirm the bacilli and to exclude parasitic or fungal agents . The immune status and the causes of death were extracted from the request forms, case notes and autopsy reports . RESULTS: Of the 138 specimens, 37 (26.8%) and 101(73.2%) were obtained from autopsy and surgery respectively . Male to female ratio was 2:1 . The youngest was a 3 year old male and the eldest was a 83 year old female . Children below 11 years contributed the highest specimens at autopsy while the highest frequency of surgical specimens were removed from 41-50 years age group (23.8%) . The commonest cause of death was pulmonary tuberculosis with respiratory failure . The commonest tissue affected was the lymph node presenting either singly or matted together . Primary tuberculosis accounted for 15.9% (22) of cases while secondary tuberculosis was 116 (84.1%) presenting in different forms . HIV screening was positive in 39 (28.3%) cases . CONCLUSION: Despite the preventive measures and treatment of tuberculosis, the disease is still on the increase in this environment . The upsurge may be associated with HIV infection and immunodeficiency . It is therefore necessary to screen all tuberculosis patients for possible HIV positivity. Otolaryngol Head Neck Surg, 2004 Nov, 131(5), 762 - 4 Nasopharyngeal tuberculosis: manifestations between 1991 and 2000; Srirompotong S et al.; OBJECTIVES/HYPOTHESIS: To present the clinical manifestation of nasopharyngeal tuberculosis . STUDY DESIGN: Clinical analysis of 23 patients with pathologically confirmed nasopharyngeal tuberculosis was carried out retrospectively . SETTING: Srinagarind Hospital, Khon Kaen University . Thailand . RESULTS: The most common presenting symptom was cervical lymphadenopathy (91.3%) . The common locations of nodes were the superior and middle cervical . The abnormalities of the nasopharynx were found in 16 patients . The pathological findings were caseous granuloma with positive acid-fast bacilli (AFB) in 15 cases, caseous granuloma with negative AFB in 3 cases, and chronic granulomatous inflammation with negative AFB in 5 cases . Pulmonary tuberculosis was found in 8 of 18 patients . Sixteen patients who received complete treatment responded well . CONCLUSION: Nasopharyngeal tuberculosis commonly presents with cervical lymphadenopathy . The differential diagnosis of tuberculosis from nasopharyngeal carcinoma is difficult . In the patients who have cervical lymphadenopathy and no other identified causes, biopsy of nasopharynx would give an additive information for diagnosis. Indian J Med Res, 2004 Oct, 120(4), 418 - 28 Newer diagnostic techniques for tuberculosis; Katoch VM; Diagnosis of tuberculosis is mainly based on clinical features, histopathology, demonstration of acid fast bacilli (AFB) and isolation of Mycobacterium tuberculosis from the clinical specimens . These techniques have limitations of speed, sensitivity and specificity . During the last two decades several rapid techniques for detection of early growth (5-14 days as compared to 2-8 wk with conventional methods) have been described which can help in obtaining the culture and sensitivity reports relatively early . Prominent among such methods are BACTEC, mycobacterial growth indicator tuber (MGIT), Septi-chek, MB/ BacT systems . This growth can be established by rapid methods based on lipid analysis and specific gene probes, PCR-RFLP methods and ribosomal RNA sequencing . Advances in knowledge about genetic structure of tubercle bacillus helped develop gene probes and gene amplification methods for identification and detection of tubercle bacillus, from culture or directly in clinical specimens and molecular detection of drug resistance . While the gene probes can help in rapid identification of isolates, gene amplification methods (PCR as well as isothermal) developed for diagnosis of tuberculosis are demonstrably highly sensitive specially in culture negative specimens from different paucibacillary forms of disease . With these molecular methods drug resistant mutants for drugs like rifampicin can be detected with reasonable certainty within hours . These gene probes, gene amplification methods and in situ approaches offer unparalleled capability to enhance the diagnosis of tuberculosis in near future. Indian J Med Res, 2004 Oct, 120(4), 290 - 304 Infections due to non-tuberculous mycobacteria (NTM); Katoch VM; The membership list of genus mycobacterium is ever expanding and it has grown to 95 in year 2003 . While leprosy and tuberculosis are specific diseases caused by mycobacteria, other members are usually saprophytes but can be opportunistic and at times deadly pathogens . These other mycobacteria are referred to as atypical mycobacteria, non-tuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT) . These organisms can produce localized disease in the lungs, lymph glands, skin, wounds or bone . Occasionally they may produce disseminated disease . Of the more than 90 known species of NTM, about one third have been associated with disease in humans . The species causing human disease are : Mycobacterium avium, M . intracellulare, M . kansasii, M . paratuberculosis, M . scrofulaceum, M . simiae, M . habana, M . interjectum, M . xenopi, M . heckeshornense, M . szulgai, M . fortuitum, M . immunogenum, M . chelonae, M . marinum, M . genavense, M . haemophilum, M . celatum, M . conspicuum, M . malmoense, M . ulcerans, M . smegmatis, M . wolinskyi, M . goodii, M . thermoresistible, M . neoaurum, M . vaccae, M.palustre, M . elephantis, M . bohemicam and M . septicum . Isolation of these mycobacteria from representative specimens and their rapid identification is very important as the treatment strategy for tuberculosis and other mycobacterioses is different . Several biochemical, chemical (lipid) and molecular techniques have been developed for rapid identification of these species . Along with suggestive clinical features, poor response to antitubercular treatment and repeated isolation of the organisms from the clinical specimens these techniques can help in establishing correct diagnosis . Further, many drugs like rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat these infections. Indian J Med Res, 2004 Oct, 120(4), 233 - 47 Molecular epidemiology of tuberculosis; Narayanan S; Molecular epidemiology (ME), a blend of molecular biology and epidemiology, is very useful to study the spread of tubercle bacilli in mini epidemics, outbreaks, to analyse the transmission dynamics of tuberculosis (TB) and to determine the risk factors for TB transmission in a community . ME has a great role in distinguishing between exogenous reinfection and endogenous reactivation . In the laboratory, molecular epidemiology can be used to identify cross contamination . Many new DNA typing methods have been introduced after the initial introduction of restriction fragment length polymorphism (RFLP) in 1993 . An internationally accepted, standardized protocol for RFLP typing of the Mycobacterium tuberculosis complex using IS6110 was published in 1993 and is still used today . Most of the newer DNA typing methods are PCR based and microarray based methods are also available . This will enable individual strains of M . tuberculosis or clonal groups to be identified by specific phenotypic traits . ME will continue to be a useful tool in future to measure the impact of any public health intervention strategy for control of tuberculosis in the community. Indian J Med Res, 2004 Oct, 120(4), 213 - 32 Immunology of tuberculosis; Raja A; Tuberculosis is a major health problem throughout the world causing large number of deaths, more than that from any other single infectious disease . The review attempts to summarize the information available on host immune response to Mycobacterium tuberculosis . Since the main route of entry of the causative agent is the respiratory route, alveolar macrophages are the important cell types, which combat the pathogen . Various aspects of macrophage-mycobacterium interactions and the role of macrophage in host response such as binding of M . tuberculosis to macrophages via surface receptors, phagosome-lysosome fusion, mycobacterial growth inhibition/killing through free radical based mechanisms such as reactive oxygen and nitrogen intermediates; cytokine-mediated mechanisms; recruitment of accessory immune cells for local inflammatory response and presentation of antigens to T cells for development of acquired immunity have been described . The role of macrophage apoptosis in containing the growth of the bacilli is also discussed . The role of other components of innate immune response such as natural resistance associated macrophage protein (Nramp), neutrophils, and natural killer cells has been discussed . The specific acquired immune response through CD4 T cells, mainly responsible for protective Th1 cytokines and through CD8 cells bringing about cytotoxicity, also has been described . The role of CD-1 restricted CD8(+) T cells and non-MHC restricted gamma/deltaT cells has been described although it is incompletely understood at the present time . Humoral immune response is seen though not implicated in protection . The value of cytokine therapy has also been reviewed . Influence of the host human leucocyte antigens (HLA) on the susceptibility to disease is discussed . Mycobacteria are endowed with mechanisms through which they can evade the onslaught of host defense response . These mechanisms are discussed including diminishing the ability of antigen presenting cells to present antigens to CD4(+) T cells; production of suppressive cytokines; escape from fused phagosomes and inducing T cell apoptosis . The review brings out the complexity of the host-pathogen interaction and underlines the importance of identifying the mechanisms involved in protection, in order to design vaccine strategies and find out surrogate markers to be measured as in vitro correlate of protective immunity. Indian J Med Res, 2004 Oct, 120(4), 207 - 12 Genomics of Mycobacterium tuberculosis: old threats & new trends; Ahmed N et al.; Tuberculosis (TB) has been declared as a global health emergency by the World Health Organization (WHO) . This has been mainly due to the emergence of multiple drug resistant strains and the synergy between tubercle bacilli and the human immunodeficiency virus (HIV) . Genomic analysis of strains for outbreak investigations is in vogue for about a decade now . However, information available from whole genome sequencing efforts and comparative genomics of laboratory and field strains is likely to revolutionize efforts towards understanding molecular pathogenesis and dissemination dynamics of this dreaded disease . Genomic information is also going to fuel discovery projects where new targets will be identified and explored towards a new drug for TB . Besides this, efforts of information technologists, chemists, population biologists, freelance workers, media persons, non-governmental organizations and administrators to needed to handle the problem of tuberculosis to prevent it from becoming a pandemic. J Small Anim Pract, 2004 Oct, 45(10), 485 - 94 Infections of the subcutis and skin of dogs caused by rapidly growing mycobacteria; Malik R et al.; Nine dogs with panniculitis due to rapidly growing mycobacteria (RGM) were examined over 17 years . Dogs were two to 15 years; five were male, four were female . All were obese or in good condition . Antecedent injury, typically a dog bite or vehicular trauma, could be identified in some patients, while one bitch had hyperadrenocorticism . Infections involved different locations, although the cervicothoracic region, dorsum or flank were most often affected . Patients were systemically well, apart from one dog with pyrexia and two with pain or lameness . Cytology demonstrated pyogranulomatous inflammation, but in only one case was it possible to see acid-fast bacilli (AFB) in smears . Histology demonstrated chronic active pyogranulomatous panniculitis and dermatitis; AFB could be detected in only four specimens . Culture of aspirates or resected tissues demonstrated RGM in all cases, comprising six Mycobacterium smegmatis group and three Mycobacterium fortuitum group isolates . Resection of infected tissues, perioperative injectable antimicrobials and long courses of oral antimicrobials chosen according to susceptibility data generally effected a cure, although some cases recurred. Rev Inst Med Trop Sao Paulo, 2004 Sep-Oct, 46(5), 291 - 4 Epub 2004 Oct 22. Orbital tuberculosis diagnosed by immunohistochemistry: case reports; Oliveira BF et al.; PURPOSE: To describe three cases of orbital tuberculosis, with their clinical characteristics and respective diagnostic procedures, showing the importance of histopathology for the correct diagnosis . PATIENTS AND METHODS: Three patients diagnosed and treated for orbital tuberculosis, in the "Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo" during the years of 1999 and 2001 . RESULTS: All of the patients were female and referred a chronic evolution of swelling of one eyelid associated or not with other symptoms . They had not HIV infection . Two of them had positive epidemiology for tuberculosis . However, the search for systemic evidence of the disease and staining for bacilli (Ziehl-Neelsen method) were negative in all three patients . In all the cases, only the biopsy with immunohistochemical analysis could confirm the diagnosis . COMMENTS: Orbital involvement is a rare ocular manifestation of tuberculosis . Even in a tertiary hospital, few cases, if any, are diagnosed per year . However, the global incidence and prevalence of M . tuberculosis infections is not under control yet, and it has been a serious public health problem . Thus, one must be aware of the possibility of tuberculosis among the orbital diseases. J Clin Pathol, 2004 Nov, 57(11), 1185 - 92 Molecular strain identification of the Mycobacterium tuberculosis complex in archival tissue samples; Zink AR et al.; AIMS: To investigate the use of different molecular analyses that can identify distinct strains of human pathogenic mycobacteria in formalin fixed and paraffin wax embedded archival tissue samples to see whether it is possible to differentiate between the members of the Mycobacterium tuberculosis complex (M tuberculosis, M bovis, M africanum, M microti, or M canettii) and/or substrains in a high number of samples . This would be of interest for identifying individual infection traits and superinfection by different mycobacterial strains . METHODS: Forty nine archival tissue samples with clinically and/or histologically suspected tuberculosis infection were subjected to molecular DNA analysis . RESULTS: The molecular analysis revealed the presence of M tuberculosis complex DNA in 20 samples, whereas acid fast bacilli could be detected by Ziehl-Neelsen staining in only eight samples . All IS6110 positive samples were further characterised by spoligotyping and seven cases provided M tuberculosis specific signatures, whereas M bovis specific signatures were obtained in four cases . The analysis of mtp40, oxyR, and pncA partial gene sequences confirmed the presence of M tuberculosis in six cases and M bovis in one case . The amplification and sequencing of four further genetic regions (katG, gyrA, TbD1, RD9) characterised six "modern" M tuberculosis strains belonging to genetic groups 2 or 3 . CONCLUSION: This study provides clear evidence that archival paraffin wax embedded material can be used for further studies on the strain identification of M tuberculosis complex strains and can therefore unequivocally be used for the study of the epidemiology and evolution of tuberculosis pathogens. Lepr Rev, 2004 Sep, 75(3), 242 - 53 Clinical, electroneuromyographic and morphological studies of pure neural leprosy in a Brazilian referral centre; Jardim MR et al.; Nineteen patients with pure neural leprosy were analysed with clinical examination, electroneuromyography and histopathology of nerve biopsies . Clinical examination showed sensory loss (78.9%), paresis (78.9%), nerve enlargement (68.4%) and nerve pain (42.1%) . Electroneuromyographic study revealed an axonal pattern in 18 patients (94.7%) and a demyelinating pattern in one (0.5%) . Mononeuropathy multiplex was the most frequent presentation (78.9%), followed by mononeuropathy simplex (10.5%) and polyneuropathy (10.5%) . The histopathological study showed the presence of inflammatory infiltrate composed of epithelioid granuloma (42.1%), mononuclear infiltrate (36.8%) or macrophages positive for bacilli (21%) . Fibrosis was present in 78.9% of the biopsies . Examination of semithin sections revealed, besides inflammatory infiltrate, myelinated fibre loss (94.7%), remyelination (42%), axonal degeneration (10%) as well as regeneration (31.5%) . Based on these results, the pathogenesis of leprosy neuropathy in this group of patients is briefly discussed. Commun Dis Intell, 2003, 27(4), 459 - 65 Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 2002: a report of the Australian Mycobacterium Reference Laboratory Network; Lumb R et al.; The Australian Mycobacterium Reference Laboratory Network collected and analysed laboratory data on new cases of disease caused by Mycobacterium tuberculosis complex in the year 2002 . A total of 712 cases were identified by bacteriology, representing an annual reporting rate of 3.6 cases of laboratory-confirmed tuberculosis per 100,000 population . The most commonly encountered culture-positive specimens were sputum (n=325), lymph node (n=142) and bronchoscopy (n=100) . Smears containing acid fast bacilli were present in sputum (53.2%), bronchoscopy (37.9%) and lymph node (21.2%) . Eight children (male n=3, female n=5) under 10 years of age had bacteriologically-confirmed tuberculosis . A total of 55 isolates (7.7%) of M . tuberculosis were resistant to at least one of the standard anti-tuberculosis agents . Resistance to at least isoniazid and/or rifampicin was noted for 53 isolates (7.4%), with multidrug-resistance (MDRTB) observed in 12 (1.9%) isolates . Of the 12 MDRTB isolates, eight were from the respiratory tract and five were from smear positive specimens . Of the patients with drug resistant M . tuberculosis isolates, 51/55 (92.7%) were classified as having initial resistance, none had acquired resistance during treatment in Australia . The country of birth was known for 54 of 55 such patients; four were Australian-born, and 50 (90.9%) had migrated from a total of 17 countries . Nucleic acid amplification testing (NAAT) was performed on 139 (19.5%) of the 712 culture-positive specimens . Of smear positive respiratory specimens, 74/80 (92.5%) were NAAT positive . For smear negative respiratory specimens, 12/17 (70.6%) reported a NAAT positive result . Importantly, false-negative NAAT results were obtained from 1/16 and 5/64 of smear positive bronchoscopy and sputum specimens respectively. Antimicrob Agents Chemother, 2004 Nov, 48(11), 4293 - 300 Rapid direct detection of multiple rifampin and isoniazid resistance mutations in Mycobacterium tuberculosis in respiratory samples by real-time PCR; Marin M et al.; Rapid detection of resistance in Mycobacterium tuberculosis can optimize the efficacy of antituberculous therapy and control the transmission of resistant M . tuberculosis strains . Real-time PCR has minimized the time required to obtain the susceptibility pattern of M . tuberculosis strains, but little effort has been made to adapt this rapid technique to the direct detection of resistance from clinical samples . In this study, we adapted and evaluated a real-time PCR design for direct detection of resistance mutations in clinical respiratory samples . The real-time PCR was evaluated with (i) 11 clinical respiratory samples harboring bacilli resistant to isoniazid (INH) and/or rifampin (RIF), (ii) 10 culture-negative sputa spiked with a set of strains encoding 14 different resistance mutations in 10 independent codons, and (iii) 16 sputa harboring susceptible strains . The results obtained with this real-time PCR design completely agreed with DNA sequencing data . In all sputa harboring resistant M . tuberculosis strains, the mutation encoding resistance was successfully detected . No mutation was detected in any of the susceptible sputa . The test was applied only to smear-positive specimens and succeeded in detecting a bacterial load equivalent to 10(3) CFU/ml in sputum samples (10 acid-fast bacilli/line) . The analytical specificity of this method was proved with a set of 14 different non-M . tuberculosis bacteria . This real-time PCR design is an adequate method for the specific and rapid detection of RIF and INH resistance in smear-positive clinical respiratory samples. BMC Infect Dis . 2004 Oct 22;4(1):44. Adjuvant interferon gamma in patients with drug - resistant pulmonary tuberculosis: a pilot study; Suarez-Mendez R et al.; BACKGROUND: Tuberculosis (TB) is increasing in the world and drug-resistant (DR) disease beckons new treatments . METHODS: To evaluate the action of interferon (IFN) gamma as immunoadjuvant to chemotherapy on pulmonary DR-TB patients, a pilot, open label clinical trial was carried out in the Cuban reference ward for the management of this disease . The eight subjects existing in the country at the moment received, as in-patients, 1 x 10(6) IU of recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to the indicated chemotherapy, according to their antibiograms and WHO guidelines . Sputum samples collection for direct smear observation and culture as well as routine clinical and thorax radiography assessments were done monthly . RESULTS: Sputum smears and cultures became negative for acid-fast-bacilli before three months of treatment in all patients . Lesion size was reduced at the end of 6 months treatment; the lesions disappeared in one case . Clinical improvement was also evident; body mass index increased in general . Interferon gamma was well tolerated . Few adverse events were registered, mostly mild; fever and arthralgias prevailed . CONCLUSIONS: These data suggest that IFN gamma is useful and well tolerated as adjunctive therapy in patients with DR-TB . Further controlled clinical trials are encouraged. Nihon Kokyuki Gakkai Zasshi, 2004 Sep, 42(9), 831 - 6 {A case of pulmonary Mycobacterium intracellulare infectious disease with a solitary pulmonary nodule in the peripheral lung field}; Kobashi Y et al.; A 63-year-old woman was admitted to our hospital because of a solitary nodule (20 x 20 mm) in the right S3 which was first detected during a health examination . Because radiological findings for the nodule, such as pleural indentation and spicula on chest CT led us to suspect a pulmonary adenocarcinoma, we could not completely rule out lung cancer and performed a bronchoscopic examination on the third day after admission . However, no definite diagnosis could be made . Therefore, video-assisted thoracic surgery (VATS) was performed, and a caseating epitheloid granuloma with acid-fast bacilli was found . Initially, we administered antituberculous drugs for pulmonary tuberculoma, but then changed to combined chemotherapy using RFP, EB, CAM and SM after identification of Mycobacterium intracellulare by a culture test of resected tissue . We report a rare case with a solitary nodule caused by pulmonary Mycobacterium intracellulare infectious disease which is indicative of lung cancer. Intern Med, 2004 Sep, 43(9), 855 - 60 Pulmonary Mycobacterium avium disease with a solitary pulmonary nodule requiring differentiation from recurrence of pulmonary adenocarcinoma; Kobashi Y et al.; A 56-year-old man with a past history of surgical resection of a primary pulmonary adenocarcinoma in the right upper lobe was admitted to our hospital because of a rapidly increasing solitary nodule (50x30 mm) in the right S5 followed on the chest computed tomography (CT) for three months . Although we suspected recurrence of the pulmonary adenocarcinoma and performed a CT-guided lung biopsy, we could not make a definite diagnosis . Therefore, to rule out recurrence of the primary pulmonary adenocarcinoma completely, a partial surgical resection of the right middle lobe was performed and a caseating epitheloid granuloma with acid-fast bacilli was found . As the causative pathogen, Mycobacterium avium complex (MAC) disease should be considered in the differential diagnosis of a rapidly increasing solitary nodule through this peculiar case of pulmonary MAC disease. J Microbiol Immunol Infect, 2004 Oct, 37(5), 295 - 300 Drug resistance of Mycobacterium tuberculosis complex in central Taiwan; Liu CE et al.; The prevalence of drug resistance to Mycobacterium tuberculosis complex (MTBC) shows marked geographic difference and is the key to determining drugs of choice for the initial treatment of tuberculosis (TB) . This retrospective study investigated the MTBC resistance rate and its contributing factors based on the review of medical records from a hospital in central Taiwan . TB culture and antimicrobial susceptibility test were performed using the BACTEC MGIT 960 System . Isoniazid, rifampin, ethambutol and streptomycin were tested . Molecular detection