Mol Microbiol, 2003 May, 48(3), 833 - 43 Rv3133c/dosR is a transcription factor that mediates the hypoxic response of Mycobacterium tuberculosis; Park HD et al.; Unlike many pathogens that are overtly harmful to their hosts, Mycobacterium tuberculosis can persist for years within humans in a clinically latent state . Latency is often linked to hypoxic conditions within the host . Among M . tuberculosis genes induced by hypoxia is a putative transcription factor, Rv3133c/DosR . We performed targeted disruption of this locus followed by transcriptome analysis of wild-type and mutant bacilli . Nearly all the genes powerfully regulated by hypoxia require Rv3133c/DosR for their induction . Computer analysis identified a consensus motif, a variant of which is located upstream of nearly all M . tuberculosis genes rapidly induced by hypoxia . Further, Rv3133c/DosR binds to the two copies of this motif upstream of the hypoxic response gene alpha-crystallin . Mutations within the binding sites abolish both Rv3133c/DosR binding as well as hypoxic induction of a downstream reporter gene . Also, mutation experiments with Rv3133c/DosR confirmed sequence-based predictions that the C-terminus is responsible for DNA binding and that the aspartate at position 54 is essential for function . Together, these results demonstrate that Rv3133c/DosR is a transcription factor of the two-component response regulator class, and that it is the primary mediator of a hypoxic signal within M . tuberculosis. Int J Dermatol, 2003 Apr, 42(4), 281 - 6 Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli; Hsiao PF et al.; BACKGROUND: Cutaneous tuberculosis is especially difficult to distinguish from other granulomatous dermatoses . We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and atypical mycobacterial infection in formalin-fixed, paraffin-embedded tissues with unspecified granulomatous inflammation and negative results for acid-fast bacilli (AFB), and analyzed the pattern of cutaneous tuberculosis in this group of patients . METHODS: A total of 38 specimens which had been collected from 36 patients and fulfilled the criteria for tissues described above were used in this study . Two different primer pairs targeting the gene encoding for 16S ribosomal RNA (common to all mycobacteria) and the insertion sequence IS6110 (specific for M . tuberculosis complex) were used in the PCR assays . The clinical characteristics, histopathologic findings, and culture results of the patients were also analyzed . RESULTS: Four specimens were excluded from the analysis due to the lack of internal control testing . Of the remaining 34 specimens, 22 were PCR positive for the 16S rRNA gene . Among them, 18 specimens were PCR positive for both the 16S rRNA gene and IS6110 . Cutaneous tuberculosis could be diagnosed in these 18 cases (56.2%) . Out of the 18 cases, there were 8 women and 10 men . The age range was 15-77 years (mean: 44.2 years) . After reviewing their clinical presentation, 11 cases were considered as tuberculosis verrucosa cutis, 6 cases as lupus vulgaris, and 1 case as erythema induratum . The remaining 4 cases (12.5%) positive only for 16S rRNA gene were considered as possible atypical mycobacteria infection . CONCLUSIONS: These results show that in paucibacillary form of cutaneous tuberculosis with unclassical clinical and histological presentation, this PCR system provides rapid and sensitive detection of M . tuberculosis DNA in formalin-fixed, paraffin-embedded specimens . Cutaneous tuberculosis represents a significant proportion in specimens showing granulomatous inflammation . In areas like Taiwan, where prevalence of pulmonary tuberculosis is still high, tuberculosis verrucosa cutis and lupus vulgaris are common forms of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection. J Assoc Physicians India, 2003 Jan, 51, 28 - 32 Current status of drug resistance among gram-negative bacilli isolated from admitted cases in a tertiary care centre; Chitnis SV et al.; AIMS: To study the prevalence of drug resistance among gram-negative bacilli and susceptibility to the Cefoperazone + Sulbactam and Piperacillin + Tazobactam combination among the hospital isolates resistant to all other antimicrobial agents . METHODS: A total of 367 gram-negative bacilli isolated from various pathological samples were tested for susceptibility to antimicrobial agent by the disc diffusion technique and 300 isolates of gram-negative bacilli which were resistant to all the other antibiotics were checked for sensitivity to piperacillin + tazobactam and cefoperazone + sulbactam combination . RESULTS: Resistance to ampicillin and amoxicillin + clavulanic acid ranged from (72.1-83.8%) which was highest . Resistance to cotrimoxazole, gentamicin, netilmycin, quinolones and all the generation of cephalsporins was often above 50% . piperacillin + tazobactam combination had the lowest incidence of resistance (14 to 20.5%) . CONCLUSION: Drug resistance for most of the antimicrobial agents was greater than 50% including the various generations of cephalosporins . Inefficiency of amoxicillin + clavulanic acid (resistance among 72-79.5% isolates) suggests the presence of extended spectrum beta-lactamases among the isolates . Addition of sulbactam to cefoperazone showed increased activity (resistance 27 to 34%) but piperacillin + tazobactam was the most effective combination in vitro. Nihon Kokyuki Gakkai Zasshi, 2003 Jan, 41(1), 14 - 8 {A Mycobacterium abscessus infection complicated with lipoid pneumonia}; Matsunaga S et al.; A 64-year-old man was admitted to our hospital because of productive cough and fever . Chest radiography on admission revealed air space consolidation in the right middle and lower lung fields and ground-glass opacity in the left middle lung field . He had been constipated for several years and had taken mineral oil for about a year . Sputum smears demonstrated acid bacilli, and cultures disclosed Mycobacterium abscessus . The transbronchial lung biopsy specimen showed granulomatous inflammation and numerous lipoid-laden macrophages in the alveolar spaces . Mycobacteria were present within the mineral oil and lipid-laden macrophages . It is likely that the mineral oil increased the pathogenicity of the mycobacteria. Crit Care Med, 2003 Apr, 31(4), 1088 - 93 Restriction of third-generation cephalosporin use decreases infection-related mortality; Du B et al.; OBJECTIVE: To determine the effect of restriction of third-generation cephalosporin use on antibiotic resistance and the outcome of patients with infection . DESIGN: A prospective, before-after comparative study . SETTING: A general intensive care unit with 14 beds at a university-affiliated teaching hospital . PATIENTS: All patients admitted to the intensive care unit within 2 yrs . INTERVENTIONS: A new antibiotic treatment strategy was implemented during phase II . All patients with confirmed or suspected Gram-negative bacterial infections were treated mainly with antibiotics other than third-generation cephalosporins . MEASUREMENTS AND MAIN RESULTS: Antibiotic resistance among common Gram-negative bacilli and infection-related hospital mortality during phase I were compared with phase II . A 26.6% reduction in third-generation cephalosporin use (from 168.2 +/- 48.0 to 123.5 +/- 39.3 g/month, p =.021), accompanied by a 277.7% increase in cefepime use (from 10.3 +/- 19.2 to 38.9 +/- 31.7 g/month, p =.014) occurred in phase II compared with phase I . This was accompanied by a significant decrease in reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins (p <.05), mainly because of the improved susceptibility of Escherichia coli and Klebsiella species (p <.05) . Infection-related hospital mortality was significantly lower in phase II (19.3% vs . 36.3%, p =.014) . Multiple logistic regression analysis demonstrated lower respiratory tract infection, the status of immunocompromise, and continuous veno-venous hemofiltration as independent risk factors for infection-related hospital mortality (p <.05), whereas infection with E . coli or Klebsiella species (p =.039) and restriction of third-generation cephalosporin use (p =.025) were associated with a significantly lower mortality rate . CONCLUSIONS: Restriction of third-generation cephalosporin use may improve the antibiotic susceptibility and reduce infection-related hospital mortality in critically ill patients. Singapore Med J, 2002 Nov, 43(11), 570 - 5 Audit of transthoracic fine needle aspiration of the lung: cytological subclassification of bronchogenic carcinomas and diagnosis of tuberculosis; Tan KB et al.; INTRODUCTION: Transthoracic fine-needle aspiration cytology (FNAC) is a useful tool for evaluating neoplastic and inflammatory lung nodules . In view of the relative paucity of published audit studies regionally, such a study was undertaken to assess the use of the technique in our centre . METHODS: One hundred and fourteen FNACs were performed during 1997-1999 . Immediate assessment for specimen adequacy was done . Diagnoses were correlated with clinical-pathological information and selective blind review performed . RESULTS: Cytologically, 65.8% of cases were malignant, 1.8% were atypical, 25.4% were inflammatory/non-malignant and 7% were inadequate . Cytological-histological tumour diagnostic concordance was 94.4% . Diagnostic sensitivity for malignancy: 93.4%, specificity: 95.8%, accuracy: 94% . Eight inadequate/ benign cases (7%) proved to be malignant with clinical-pathological follow-up . Tuberculosis was confirmed (acid-fast bacilli detected) in six cases (5.3%) and suggested in a further 10 cases (8.8%) . The cytological review showed 96% concordance with the original benign/malignant diagnoses . Pneumothorax rate was 18% . CONCLUSION: FNAC is an accurate and safe method for the evaluation of lung nodules and it enables subclassification of bronchogenic carcinomas in the vast majority of cases . It is also useful for the diagnosis of tuberculous pulmonary nodules . Immediate assessment optimises specimen adequacy; inadequate/non-malignant smears in particular, need clinical correlation, close follow-up and re-biopsy, if necessary. Leuk Lymphoma, 2002 Sep, 43(9), 1755 - 62 Results of first salvage therapy for patients refractory to a fludarabine regimen in chronic lymphocytic leukemia; Keating MJ et al.; Resistance to purine analogs is emerging as a major problem in the management of patients with chronic lymphocytic leukemia (CLL) . Most of these patients have already been exposed to and have become refractory to alkylating agents . To define the natural history of fludarabine (Fludara) refractory patients with CLL, we reviewed the response to first salvage therapy of 147 patients who were refractory to Fludara or had a remission less than six months in duration after a Fludara-containing regimen . Thirty-three (22%) patients responded to their first salvage attempt . However, the median survival was only 10 months . Responders survived significantly longer than non-responders . The most effective salvage regimens were combinations of purine analogs and cyclophosphamide . Patients still possibly sensitive to alkylating agents had a superior response than alkylating agent resistant or naive patients . Subsequent salvage therapy was administered to 61 patients . The most promising results noted in the group were transplantation and the use of Campath-1H antibody . The major morbidity and cause of death were associated with infections . The probability of infection was most strongly associated with the response to salvage therapy . Gram-positive organisms were most commonly associated with infection . However, gram-negative bacilli or opportunistic infection such as fungi, Pneumocystis carinii, acid-fast bacilli and legionella were prominent causes of infection . Fludara-refractory patients are a poor prognosis group and need more effective therapeutic regimens and well-designed infection prophylactic regimens. Indian J Chest Dis Allied Sci, 2003 Jan-Mar, 45(1), 19 - 23 Role of gallium arsenide laser irradiation at 890 nm as an adjunctive to anti-tuberculosis drugs in the treatment of pulmonary tuberculosis; Puri MM et al.; BACKGROUND: Tuberculosis is a global emergency with about nine million people developing disease every year . The long duration of treatment has emerged as a major obstacle in the control of tuberculosis . There is a need for development of new drugs and or shortened therapy . METHODS: The present study was carried out to explore whether any benefit could be achieved by the addition of low level energy laser therapy (LLLT) to the conventional anti-tubercular chemotherapy . One-hundred-thirty new sputum smear positive patients of pulmonary tuberculosis were enrolled to evaluate the bio-stimulatory effects of Gallium Arsenide laser irradiation at 890 nm, as an adjuvant therapy . These patients were randomly divided into two groups to receive either LLLT or sham irradiation (control) concomitantly with anti-tuberculosis chemotherpy . RESULTS: The patients treated with semiconductor laser as an adjuvant therapy along with anti-tuberculosis drugs had a faster clearance of tubercle bacilli from the sputum as compared to the control group (P value at :45 days=0.1392, 60 days=0.0117, 75 days=0.00805, 90 days=0.00739) . CONCLUSIONS: These findings provide preliminary evidence that low level laser therapy with Gallium Arsenide laser may be a promising adjunctive therapy for patients with tuberculosis . Faster conversion of sputum should prevent the development of resistant mutants. Gerontology, 2003 May-Jun, 49(3), 173 - 6 Acute stroke predisposes to oral gram-negative bacilli -- a cause of aspiration pneumonia? Millns B, Gosney M, Jack CI, Martin MV, Wright AE. OBJECTIVES: To assess any change in the oral flora in the mouths of stroke patients during the acute and rehabilitation phases and to determine whether this is related to episodes of aspiration pneumonia and clinical outcome . MATERIALS AND METHODS: This observational study was carried out in hospital wards in a University teaching hospital . The subjects were patients immediately post-stroke and during the rehabilitation period, acute admissions and a group of healthy volunteers . An assessment of dentition and swallow in the presence or absence of oral aerobic gram-negative bacilli (AGNB) was correlated . RESULTS: Of the acute stroke patients 52% had an unsafe swallow . AGNB carriage was documented in 34% of the acute stroke group . Of the 11 patients who died 55% had AGNB, 73% had an unsafe swallow and 36% had a combination of both . CONCLUSION: AGNB is a common finding in acute stroke patients . It is not a consequence of age or acute hospitalisation and is associated with an unsafe swallow and a higher mortality . J Gastroenterol, 2003, 38(3), 222 - 8 Utility and limitations of a method for detecting Helicobacter pylori-specific antigens in the stool; Matsuda M et al.; BACKGROUND: Recently, a method for detecting Helicobacter pylori-specific antigens in the stool (HpSA) has been proposed to be useful clinically . The aim of this study was to determine the accuracy of HpSA for the diagnosis of H . pylori infection, including early assessment after eradication treatment, and the potential for quantitative evaluation of H . pylori in the stomach . METHODS: The subjects were 85 patients with gastroduodenal disorders who underwent endoscopic examination . Of these, 36 were treated for eradication of H . pylori infection and reassessed 4-8 weeks after treatment . HpSA was tested by enzyme immunoassay . For the definitive diagnosis of H . pylori infection, biopsy specimens were taken endoscopically and examined by quantitative culture, rapid urease test, and immunohistostaining . In addition, serum antibody against H . pylori was tested before the eradication treatment and a (13)C-urea breath test was conducted after treatment . The results of these reference tests were compared with those obtained by HpSA . RESULTS: The sensitivity and specificity of HpSA were 90.4% and 100% before eradication treatment and 57.1% and 100% after the treatment . There was a positive correlation between the optical density of HpSA and the number of H . pylori bacilli evaluated by quantitative culture . CONCLUSIONS: The HpSA test is considered to be an accurate method for the diagnosis of H . pylori infection, with high specificity . However, there may be problems of false negativity if HpSA is used for the early assessment of treatment efficacy . Furthermore, HpSA is suggested to have potential for the quantitative evaluation of H . pylori status in the stomach. Int J Pharm, 2003 Apr 14, 255(1-2), 43 - 8 Design and evaluation of an aerosol infection chamber for small animals; Bhaskar S et al.; In this report, we describe the design of an aerosol exposure chamber to reproducibly produce uniformly distributed clouds of droplet nuclei . The device can deliver desired number of bacilli (20-2000) in lungs of mice . All safety measures to handle infectious bacteria have been incorporated in the design and it is controlled remotely by a personal computer . It is an indispensable device to study the protective efficacy of vaccine candidates against Mycobacterium tuberculosis infection . This device would also be useful to study immunization and drug delivery by nasal route in experimental animals. Br J Cancer, 2003 Apr 7, 88(7), 1012 - 6 Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial; Stokman MA et al.; Mucositis is an acute inflammation of the oral mucosa because of radiotherapy and/or chemotherapy . All patients receiving radiotherapy in the head and neck region develop oral mucositis . The aim of this study was to analyse the effects of selective oral flora elimination on radiotherapy-induced oral mucositis, in a double-blind, randomised, placebo-controlled trial . Sixty-five patients with a malignant tumour in the head and neck regions to be treated with primary curative or postoperative radiotherapy participated in this study . The patients received either the active lozenges of 1 g containing polymyxin E 2 mg, tobramycin 1.8 mg and amphotericin B 10 mg (PTA) (33 patients) or the placebo lozenges (32 patients), four times daily during the full course of radiotherapy . Mucositis, changes in the oral flora, quality of feeding and changes of total body weight were assessed . Mucositis score did not differ between the groups during the first 5 weeks of radiotherapy . Nasogastric tube feeding was needed in six patients (19%) of the placebo group and two patients (6%) of the PTA group (P=0.08) . Mean weight loss after 5 weeks of radiation was less in the PTA group (1.3 kg) (s.d.: 3.0) than in the placebo group (2.8 kg) (s.d.: 2.9) (P=0.05) . Colonisation index of Candida species and Gram-negative bacilli was reduced in the PTA group and not in the placebo group (P<0.05) . No effect on other microorganisms was detected . In conclusion, selective oral flora elimination in head and neck irradiation patients does not prevent the development of severe mucositis. Ann Dermatol Venereol, 2003 Feb, 130(2 Pt 1), 184 - 6 {Evaluation of the clinical classification of new cases of leprosy . Study conducted at the Marchoux Institute in Bamako, Mali}; Keita S et al.; INTRODUCTION: The difficulties related to the bacilloscopic diagnosis of leprosy, providing a more reliable classification of cases, in 1995 led the WHO to recommend the use of a new classification, in endemic countries, based on clinical criteria alone, in order to simplify the poly-chemotherapeutic regimens . According to our experience in the Marchoux Institute, this classification may lead to errors in diagnosis through overzealous or mis-interpretation of the two forms of leprosy . The aim of our study was to evaluate the concordance between this clinical classification and that based on a bacilloscopic examination . PATIENTS AND METHODS: We conducted a descriptive study of new cases of leprosy seen at the Marchoux Institute, without distinction in gender or age, from January to December 2000 . All the patients included underwent clinical examination and a bacilloscopic exploration to provide a double classification . The concordance between the two classifications was assessed using the Kappa test.RESULTS: Two hundred new cases of leprosy were included . Out of 126 clinically multi-bacillary cases, 61 were confirmed bacteriologically, and 65 were false positives . Out of 74 clinical cases with few bacilli, 2 were bacteriologically multi-bacilli . The concordance between the two classifications was average (Kappa=0.40) . There was a significant difference between the percentages of multi-bacilli observed in both classifications (p<10(-8)) . DISCUSSION: The clinical classification may well overestimate the multi-bacillary form . In the absence of a reliable bacilloscopic apparatus, a more detailed clinical classification of leprosy forms must be developed. J Int Acad Periodontol, 2002 Jan, 4(1), 19 - 25 Connective tissue and bacterial deposits on rubber dam sheet and ePTFE barrier membranes in guided periodontal tissue regeneration; Apinhasmit W et al.; The aim of this study was to compare the connective tissue and bacterial deposits on rubber dam sheets and expanded polytetrafluoroethylene membranes used as barrier membranes in guided tissue regeneration for periodontal treatment . Twenty patients having intrabony defects and/or furcation defects were surgically treated by guided tissue regeneration employing either rubber dam sheets (10 patients) or expanded polytetrafluoroethylene membranes (10 patients) as barrier membranes . Four to six weeks after the first operation, membranes were retrieved from the lesion sites and processed for scanning electron microscopy . The lesion-facing surfaces of membranes were examined for the presence of connective tissue and bacterial deposits . The differences between the numbers of fields and the distributions of connective tissue and bacteria on both types of membranes were analysed by the Chi-square test at the level of 0.05 significance . The results showed a lot of fibroblasts with their secreted extracellular matrices, known as components of the connective tissue on rubber dam sheets and expanded polytetrafluoroethylene membranes . There was no significant difference in the total number of connective tissue on both types of membranes (P = 0.456) . Many bacterial forms including cocci, bacilli, filaments and spirochetes with the interbacterial matrices were identified . The total number of bacteria on rubber dam sheets was statistically less than that on expanded polytetrafluoroethylene membranes (P < 0.001) . The comparable number of connective tissue on both types of membranes suggests that the healing process under both types of membranes was also comparable . Therefore, the rubber dam sheet might be used as a barrier membrane in guided tissue regeneration. Curr Opin Investig Drugs, 2003 Feb, 4(2), 117 - 27 Antibacterial agents: patent highlights July to December 2002; Phillips OA; Forty-five patents dealing with disclosures on the different classes of antibacterial agents, reported between July and December 2002, are selected for review . Disclosures dealing with novel derivatives of known antibacterials (beta-lactam, oxazolidinone, macrolide, quinolone, tetracycline and peptide derivatives), development of new processes and formulations to improve cost, activity and stability are highlighted . In addition, patent disclosures on novel oxazolidinone derivatives with broad-spectrum activity extended against fastidious Gram-negative bacilli are highlighted in comparison to linezolid . Novel antibacterial agents (peptide-deformylase inhibitors) that could serve as potential lead compounds are also presented. Chin J Traumatol, 2003 Apr, 6(2), 118 - 23 Neuroprotective effects of nimodipine and MK-801 on acute infectious brain edema induced by injection of pertussis bacilli to neocortex of rats; Chen LH et al.; OBJECTIVE: To explore the mechanism and type of acute infectious brain edema induced by injection of pertussis bacilli (PB) in rat neocortex, to study the neuroprotective effect of non-competitive antagonist of N-methl-D-aspartate (NMDA) receptor (MK-801) and antagonist of Ca(2+) channels (nimodipine) on brain edema, and to investigate the relationship between percentage of water content and cytosolic free calcium concentration ({Ca(2+) }(i)) in synaptosomes or content of Evans Blue (EB) . METHODS: 95 SD rats were randomly divided into five groups, ie, normal control group, sham-operated control group, PB group, nimodipine treatment group and MK-801 pretreatment group . The acute infectious brain edema was induced by injection of PB into the rats . Quantitative measurements of water content and the concentration of EB were performed . {Ca(2+) }(i) was determined in calcium fluorescent indication Fura-2/AM loaded neuronal synaptosome with a spectrofluorophotometer . To observe the effect of MK-801 and nimodipine, we administered MK-801 48 hours and 24 hours before the injection of PB in MK-801 pretreatment group, and nimodipine after the injection of PB in nimodipine treatment group . The specific binding of NMDA receptor was measured with {(3)H}-MK-801 in the neuronal membrane of cerebral cortex . RESULTS: The levels of water content and EB content of brain tissues, and {Ca(2+) }(i) in the neuronal synaptosomes increased more significantly in the PB-injected cerebral hemisphere in the PB group than those of normal control group and sham-operated control group (P<0.05) . The water content and {Ca(2+) }(i) increased with the duration of infectious brain edema . Nimodipine administered after the injection of PB could significantly decrease the water content, EB and {Ca(2+) }(i) (P<0.05) . MK-801 could significantly decrease the water content, EB and {Ca(2+) }(i) in 4 h and 24 h groups (P<0.05) . The Kd values were 30.5 nmol/L+/-3.0 nmol/L and 42.1 nmol/L+/-4.2 nmol/L in PB group and NS group respectively (P<0.05), and Bmax were 0.606 pmol/mg.pro+/-0.087 pmol/mg.pro and 0.623 pmol/mg.pro+/-0.082 pmol/mg.pro respectively, without statistical significance (P>0.05) . CONCLUSIONS: The changes in the permeability of blood-brain barrier (BBB) and Ca(2+)-overload may participate in the pathogenesis of infectious brain edema . Treatment with nimodipine can dramatically reduce the damage of brain edema and demonstrate neuroprotective effect on brain edema by inhibiting the excess of Ca(2+) influx and reducing the permeability of BBB . MK-801 pretreatment may inhibit the delayed Ca(2+) influx into the neurons . The infectious brain edema is not only cytotoxic brain edema (intracellular edema) but also vasogenic brain edema (extracellular edema) followed by earlier BBB breakdown, so infectious brain edema is complicated with brain edema. Vet Clin Pathol, 1997, 26(2), 85 - 89 Disseminated Mycobacterium avium complex infection in a cat: presumptive diagnosis by blood smear examination; Latimer KS et al.; Disseminated mycobacteriosis was diagnosed in a 4-year-old, castrated male Domestic Shorthair cat following the observation of one to three retractile, non-staining bacilli in neutrophils and monocytes on a Wright-Leishman-stained blood smear Organisms were bright red following acid-fast staining by Kinyoun's technique . The cat had a history of progressive weight loss, anemia, fever, and sporadic vomiting after eating . In addition to blood smears, mycobacteria also were observed in bone marrow aspirates . During necropsy, multiple small white nodules were observed in the spleen and liver . An enlarged sternal lymph node and ascites also were present . In histologic sections, mycobacteria were observed in granulomas within the lungs, liver, spleen, colon, mesenteric and sternal lymph nodes, omentum, and kidney . Mycobacterium avium complex was isolated from cultures of liver, spleen, lung, and kidney . Occult feline leukemia virus infection, detected by immunofluorescent testing of bone marrow aspirates, may have predisposed this cat to bacterial infection . The serum ELISA test for group-specific feline leukemia virus antigen was negative. Kekkaku, 2003 Jan, 78(1), 27 - 31 {A case of pulmonary tuberculosis initially presented with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)}; Nishizawa Y et al.; A 90-year old man was admitted to a hospital because of consciousness loss with hyponatremia . Although his symptom promptly improved with Na supply, his chest X-ray film showed pulmonary infiltration and direct microscopy of sputum smear was positive for acid-fast bacilli, then he was referred our hospital and was admitted . We made a clinical diagnosis of pulmonary tuberculosis with SIADH based on detailed examinations . But he should neither respiratory symptoms nor fever . He was medicated with the standard antituberculosis drugs with fluid restriction, and his tuberculosis and hyponatremia were improved gradually . We should be more careful about pulmonary tuberculosis irrespective of its severity as a cause of SIADH. Infect Immun, 2003 Apr, 71(4), 1953 - 60 Synthetic peptides identify promiscuous human Th1 cell epitopes of the secreted mycobacterial antigen MPB70; Al-Attiyah R et al.; MPB70 is a secreted protein of Mycobacterium bovis and Mycobacterium tuberculosis which stimulates both cellular and humoral immune responses during infection with bovine and human tubercle bacilli . In addition, vaccination with MPB70 has been shown to induce Th1 cell responses and protection in animal models of tuberculosis . The present study was carried out to map the dominant human Th1 cell epitopes of MPB70 in relation to major histocompatibility complex (MHC) class II restriction in healthy subjects showing strong T-cell responses to complex mycobacterial antigens . Peripheral blood mononuclear cells (PBMC) from HLA-DR-typed donors were tested with complex mycobacterial antigens (whole-cell M . tuberculosis and M . tuberculosis culture filtrates), with MPB70 purified from the culture filtrate of M . bovis BCG Tokyo, and with 13 synthetic peptides (25-mers overlapping by 10 residues) covering the sequence of MPB70 . The donors that responded to the complex antigens and MPB70 also responded to the cocktail of synthetic MPB70 peptides . Testing of PBMC with individual peptides showed that peptides p5 (amino acids {aa} 61 to 85), p6 (aa 76 to 100), p8 (aa 106 to 130), p12 (aa 166 to 190), and p13 (aa 181 to 193) were most frequently recognized in proliferation and gamma interferon (IFN-gamma) assays . Testing of antigen-specific CD4(+) T-cell lines with the individual peptides of MPB70 confirmed that peptides p8, p12, and p13 contain immunodominant Th1 cell epitopes of MPB70 . MHC restriction analysis with HLA-typed donors showed that MPB70 and its immunodominant peptides were presented to T cells promiscuously . The T-cell lines responding to MPB70 and peptides p8, p12, and p13 in IFN-gamma assays mediated antigen-peptide-specific cytotoxic activity against monocytes/macrophages pulsed with the whole-protein antigen or the peptides . In conclusion, the promiscuous recognition of MPB70 and its immunodominant peptide defined epitopes (aa 106 to 130 and 166 to 193) by IFN-gamma-producing Th1 cells supports possible application of this secreted antigen to subunit vaccine design. Infect Immun, 2003 Apr, 71(4), 1929 - 37 The Apa protein of Mycobacterium tuberculosis stimulates gamma interferon-secreting CD4+ and CD8+ T cells from purified protein derivative-positive individuals and affords protection in a guinea pig model; Kumar P et al.; The search to identify Mycobacterium tuberculosis antigens capable of conferring protective immunity against tuberculosis has received a boost owing to the resurgence of tuberculosis over the past two decades . It has long been recognized that lymphoid cells are required for protection against M . tuberculosis . While traditionally the CD4(+) populations of T cells were believed to predominantly serve this protective function, a pivotal role for CD8(+) T cells in this task has been increasingly appreciated . We show that the 50- to 55-kDa Apa protein, specified by the Rv1860 gene of M . tuberculosis, can elicit both lymphoproliferative response and gamma interferon (IFN-gamma) production from peripheral blood mononuclear cells (PBMC) of purified protein derivative (PPD)-positive individuals, with significant differences recorded in the levels of responsiveness between PPD-positive healthy controls and pulmonary tuberculosis patients . Flow cytometric analysis of whole blood stimulated with the recombinant Apa protein revealed a sizeable proportion of CD8(+) T cells in addition to CD4(+) T cells contributing to IFN-gamma secretion . PBMC responding to the Apa protein produced no interleukin-4, revealing a Th1 phenotype . A DNA vaccine and a poxvirus recombinant expressing the Apa protein were constructed and tested for their ability to protect immunized guinea pigs against a challenge dose of virulent M . tuberculosis . Although the DNA vaccine afforded little protection, the poxvirus recombinant boost after DNA vaccine priming conferred a significant level of protective immunity, bringing about a considerable reduction in mycobacterial counts from the challenge bacilli in spleens of immunized guinea pigs, a result comparable to that achieved by BCG vaccination. Antimicrob Agents Chemother, 2003 Apr, 47(4), 1228 - 32 Isolation of three Mycobacterium ulcerans strains resistant to rifampin after experimental chemotherapy of mice; Marsollier L et al.; By use of a murine model for Buruli ulcer, Mycobacterium ulcerans was found to be susceptible to rifampin, with the MIC being 0.5 to 1 micro g/ml . Three mutants were isolated after rifampin monotherapy . Two were resistant to rifampin at 8 micro g/ml, and one was resistant to rifampin at 32 micro g/ml . The mutants harbored Ser416Phe mutations and His420Tyr mutations in the rpoB gene, and these mutations have also been found to be responsible for rifampin resistance in the leprosy and tubercle bacilli . The results indicate that while rifampin may be active against M . ulcerans, it should never be used as monotherapy in humans. Arch Pathol Lab Med, 2003 Mar, 127(3), 326 - 30 Comparison of polymerase chain reaction with histopathologic features for diagnosis of tuberculosis in formalin-fixed, paraffin-embedded histologic specimens; Park do Y et al.; Objective.-To investigate the relationship between various histopathologic features and the results of the tuberculosis (TB)-polymerase chain reaction (PCR) method in routinely submitted histologic specimens for the histopathologic diagnosis of TB . Design.-We used 95 formalin-fixed, paraffin-embedded tissue blocks from 81 patients who were clinically suspected of having TB . We assessed the presence of histopathologic features including well-formed granuloma, poorly formed granuloma, caseous necrosis, and Langhans-type giant cells . We performed nested PCR for IS6110 and Ziehl-Neelsen staining for acid-fast bacilli (AFB) . Results.-Of the 81 patients studied, 53 patients had chronic granulomatous inflammation, whereas 28 patients had only chronic inflammation without definite granulomatous inflammation . Of the 53 cases with chronic granulomatous inflammation, 17 (32%) were AFB positive and 36 (68%) were TB-PCR positive . Among cases with chronic granulomatous inflammation, the percentage that were positive and negative by TB-PCR differed significantly with the presence of various histopathologic features . All of the 13 cases with well-formed granuloma, caseous necrosis, and Langhans-type giant cells were TB-PCR positive; however, 10 (36%) of the 28 cases with chronic inflammation without granulomatous lesions were also TB-PCR positive . Conclusions.-TB-PCR is a rapid, sensitive method for the diagnosis of TB in routinely processed formalin-fixed, paraffin-embedded histologic specimens and is readily available in histopathology laboratories . We recommend use of TB-PCR when TB is suspected clinically, especially in cases of chronic inflammation without definite evidence of granulomatous inflammation. Med Eng Phys, 2003 May, 25(4), 341 - 7 Development and evaluation of an automated stainer for acid-fast bacilli; Kim SC et al.; The current strategy for the control of tuberculosis (TB) relies on early diagnosis, and smear microscopy is an essential component of the laboratory diagnosis of TB in most countries with a high prevalence of the disease . However, even simple smear microscopy examination is far from satisfactory because staining results can vary among individual technicians . In an effort to minimize variations in manual staining procedures, we developed an automated stainer for AFB and evaluated its usefulness in comparison with manual staining . The key feature of our automated stainer is a heating apparatus required for fixation and carbol-fuchsin staining . After smear slides are placed into the machine, the entire staining process is fully automated, from fixation to final washing and drying . With the automated methods, five slides can be fixed and stained in 21 min at consistent high quality . Using sputum samples from 91 TB patients, the staining results of the automated stainer were compared blindly with those of manual staining . The concordance rate between the two methods was 94.5% . In addition, there was no significant difference in the rate of detection of AFB in the sputum samples . Although further optimization of the auto staining procedures is required, the results indicate that the automated AFB stainer developed in this study looks promising for use in clinical mycobacteriology laboratory in order to minimize personal variation during AFB staining. Postgrad Med, 2003 Mar, 113(3), 99 - 102, 105-6, 111-2 Aspiration pneumonia . Recognizing and managing a potentially growing disorder; Johnson JL et al.; Gross aspiration of liquid or particulate matter into the lung can result in severe hypoxemia, pulmonary infiltrates in dependent lung regions, fever, and leukocytosis . The initial lung injury is primarily due to inflammatory mediators rather than infection . The responsible bacterial pathogens differ between community-acquired and nosocomial aspiration pneumonia . Many aspiration pneumonias are mixed aerobic-anaerobic infections . Enteric gram-negative bacilli and S aureus are more common in nosocomial aspiration pneumonia . Current treatment guidelines support initial empirical antibiotic therapy in patients with severe aspiration pneumonia pending culture results . Appropriate initial treatment improves outcome . Antimicrobial therapy for aspiration pneumonia is often empirical and should be based on patient characteristics, the setting in which aspiration occurred, the severity of pneumonia, and available information regarding local pathogens and resistance patterns. Clin Nucl Med, 2003 Apr, 28(4), 286 - 9 Multifocal Pott's disease (tuberculous spondylitis) incidentally detected on Tc-99m MDP bone and Ga-67 citrate scintigraphy in a patient with diabetes; Kim SJ et al.; Pott's disease is an uncommon extrapulmonary form of tuberculosis . Delay in diagnosis and management may cause serious complications . The authors describe Pott's disease incidentally detected on Tc-99m MDP bone and Ga-67 imaging in a patient with diabetes . Tc-99m MDP bone scintigraphy showed intensely increased uptake in the lower cervical spine and lumbosacral regions . Ga-67 scintigraphy revealed intensely increased uptake corresponding to the areas noted on Tc-99m MDP bone scintigraphy . Magnetic resonance imaging showed destructive lesions in the C5-C6 and L5-S1 intervertebral discs with destruction of adjacent end plates . Biopsy of the lumbosacral area was guided by computed tomography, and histologic examination of the bone specimen showed caseation, giant cells, and acid-fast bacilli . Posterior decompression and posterolateral spinal fusion with bone grafts were performed . Antituberculous chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol was started . The patient showed remarkable relief of symptoms during a period of 9 months of therapy . Both Tc-99m MDP bone and Ga-67 imaging can offer the convenience of screening the entire body to detect multiple sites of Pott's disease. J Clin Invest, 2003 Mar, 111(5), 681 - 9 CD44 is a macrophage binding site for Mycobacterium tuberculosis that mediates macrophage recruitment and protective immunity against tuberculosis; Leemans JC et al.; Cell migration and phagocytosis are both important for controlling Mycobacterium tuberculosis infection and are critically dependent on the reorganization of the cytoskeleton . Since CD44 is an adhesion molecule involved in inflammatory responses and is connected to the actin cytoskeleton, we investigated the role of CD44 in both these processes . Macrophage (Mphi) recruitment into M . tuberculosis-infected lungs and delayed-type hypersensitivity sites was impaired in CD44-deficient (CD44(-/-)) mice . In addition, the number of T lymphocytes and the concentration of the protective key cytokine IFN-gamma were reduced in the lungs of infected CD44(-/-) mice . The production of IFN-gamma by splenocytes of CD44(-/-) mice was profoundly increased upon antigen-specific stimulation . Flow cytometry analysis revealed that soluble CD44 can directly bind to virulent M . tuberculosis . Mycobacteria also interacted with Mphi-associated CD44, as reflected by reduced binding and internalization of bacilli by CD44(-/-) Mphis . This suggests that CD44 is a receptor on Mphis for binding of M . tuberculosis . CD44(-/-) mice displayed a decreased survival and an enhanced mycobacterial outgrowth in lungs and liver during pulmonary tuberculosis . In summary, we have identified CD44 as a new Mphi binding site for M . tuberculosis that mediates mycobacterial phagocytosis, Mphi recruitment, and protective immunity against pulmonary tuberculosis. Am J Ophthalmol, 2003 Mar, 135(3), 393 - 5 Mycobacterium chelonae interface infection after endokeratoplasty; Busin M et al.; PURPOSE: To report a case of interface infection by Mycobacterium chelonae in a patient who underwent endokeratoplasty . DESIGN: Interventional case report . SETTING: Clinical practice . METHODS: Two weeks after endokeratoplasty, a 74-year-old woman developed multiple enlarging interface infiltrates in her right eye . Cultures performed on the preservation medium grew Mycobacterium chelonae . Penetrating keratoplasty (PK) surgery was performed after failure of conservative antibiotic therapy, including topical and systemic clarithromycin . RESULTS: Five months after PK surgery, the graft was clear and no signs of extraocular or intraocular inflammation were present . Cultures taken from the corneal interface at the time of PK surgery confirmed the presence of M . chelonae . Acid-fast bacilli were seen in the excised corneal button . CONCLUSIONS: M . chelonae should be ruled out as a possible etiologic agent when postoperative infection of the corneal interface occurs . Surgical intervention can lead to eradication of the infection when conservative treatment fails . J Microbiol Methods, 2003 Apr, 53(1), 107 - 12 Development of a new antigen detection dot-ELISA for diagnosis of tubercular lymphadenitis in fine needle aspirates; Jain A et al.; A sandwich dot enzyme-linked immunosorbent assay (ELISA) was standardized to detect mycobacterial antigen in fine needle aspirates of patients with tubercular lymphadenitis (TBLN) . The assay was performed on nitrocellulose paper by using antibodies raised in mice and rabbits against crude soluble protein (CSP) of Mycobacterium tuberculosis . The test was able to detect as low as 5 ng protein/ml . A total of 225 suspected cases of tubercular lymphadenopathy were screened, out of which 96 were cytomorphologically confirmed as cases of tubercular lymphadenitis (50 acid-fast bacilli (AFB)-positive and 46 AFB-negative) . These were considered as positive controls . Only 28 cases were proven to be of nontubercular etiology and were considered as negative controls . In the remaining 101 (39 scanty) aspirates, tubercular etiology could neither be ruled out nor confirmed . Out of 50 AFB-positive confirmed cases of tubercular lymphadenitis, 46 were ELISA-positive . Out of 46 AFB-negative but cytomorphologically confirmed aspirates, antigen could be demonstrated in only 42 aspirates . Four samples from patients with nontubercular etiology were also found to be ELISA-positive . Antigen was picked up in a total of 90.3% of aspirates with suspicion of tuberculosis and 79.5% of scanty aspirates . The assay was found to be 91.6% sensitive and 85.7% specific . The assay was found to be simple and rapid, and hence, could be performed in areas where health facilities are rudimentary. Kekkaku, 2002 Dec, 77(12), 805 - 13 {Treatment for multidrug-resistant tuberculosis in Japan}; Nakajima Y; INTRODUCTION: Multidrug-resistant (MDR) tuberculosis is now refractory against standard chemotherapy for tuberculosis . The curability of medical treatments for it has been up to 50-75% . In Japan several hundreds new MDR tuberculosis cases are supposed to occur every year . This review is the outline of Japanese preliminary guideline of treatment for MDR tuberculosis . DRUG SUSCEPTIBILITY TEST: One of the most important points to manage MDR tuberculosis is the drug usages according to drug susceptibility . Recently some susceptibility tests with liquid media were introduced in our country, but Japanese new standard test of Ogawa method (using absolute concentration with proportion method) is still important from point of true evaluation of susceptibility . MEDICAL CHEMOTHERAPY: In MDR tuberculosis one-half of two-third cases are cured by suitable resume of anti-tuberculosis chemotherapy . If patients would prove to be suffered from MDR tuberculosis, chemotherapy resume must be changed from standard resume to special one, that are made from effective and stronger four or five (at least three) anti-tuberculosis drugs including new quinolons . Those drugs should be changed at the same time, not one by one . Although CPM and Tb1 cannot be available in Japan, but sometimes we have to try administrations of those drugs, beta-lactam antibiotics, interferon . The duration of treatment will be 18-24 months usually . If decreasing of tuberculosis bacilli in sputa is failed under new effective resume through four months treatment, surgical treatment may be indicated . SURGICAL TREATMENT: (1) In Fukujuji Hospital, Japan Anti-Tuberculosis Association, surgical treatments for seventy four cases of MDR tuberculosis were undergone from 1983 to 2001 March . 85 surgical interventions for them were performed in 71 pulmonary resections (pneumonectomy in 20, lobectomy in 44, segmentectomy in 7) for 64 cases, 8 thoracoplasties alone for 8 cases, 5 cavernostomies for 5 cases, 1 phrenic nerve avulsion for 1 . The result of pulmonary resections was as follows; early negative conversion rate of tuberculosis expectorations was 97.2%, reexpectoration rate of sputa tuberculosis bacilli was 13.8%, final success rate of pulmonary resections was 91.7% . The factors significantly correlated to reexpectoration of tuberculosis bacilli were preoperative positive bacilli in sputa, few sensitive drugs, other cavitary lesions remained, postoperative prolonged bronchopleural fistula . The result of thoracoplasty alone revealed 75% success rate . In postoperative complications of 85 interventions, there was no operative death, prolonged bronchopleural fistula in 17.6%, respiratory failure in 8.7%, pyothorax in 5.9% . (2) Recently results of surgical treatment for MDR tuberculosis were reported in several literatures . Those success rates were almost same 85-95% as our result . They seemed to be very excellent for refractory cases against vigorous medical treatments . So any surgical treatment for MDR tuberculosis should be indicated more constructively in its earlier course . (3) Indication of surgical treatment is as follows; Main target lesions that should be removed are cavitary ones in pulmonary or pleural foci . And any capsulated localized tuberculosis foci more than 2 cm in diameter is better to be resected because of the possibility of later cavitation . Surgically it is the best that all tuberculosis foci are within a resected lobe, effective drugs remained as many as possible and no cardiopulmonary risks . But even if patient's state are over those criteria, resections of more extended pulmonary foci including in opposite sides can be tried within tolerable cardiopulmonary function . OTHER COMMENTS: Treatment for HIV-positive MDR tuberculosis and protection for nosocomial transmission of MDR tuberculosis are discussed briefly in this article . Preventive therapy for newly infected persons with MDR tuberculosis is controversial . At this time just in MDR tuberculosis cases no preventive therapy, careful following up, and drastic treatment with remained effective drugs after developping of disease will be recommended. Emerg Infect Dis, 2003 Feb, 9(2), 251 - 4 Photorhabdus species: bioluminescent bacteria as emerging human pathogens? Gerrard JG, McNevin S, Alfredson D, Forgan-Smith R, Fraser N. We report two Australian patients with soft tissue infections due to Photorhabdus species . Recognized as important insect pathogens, Photorhabdus spp . are bioluminescent gram-negative bacilli . Bacteria belonging to the genus are emerging as a cause of both localized soft tissue and disseminated infections in humans in the United States and Australia . The source of infection in humans remains unknown. Rev Prat, 2002 Dec 1, 52(19), 2121 - 6 {Thoracic tuberculosis}; Dautzenberg B; The diagnosis and treatment of thoracic tuberculosis follow common principles whatever the localisation . Tuberculosis is diagnosed on clinical signs: night sweats, fever, cough, weight loss, persisting after non-specific treatment, for more than 3 weeks . The demonstration of bacilli in sputum is the keystone of diagnosis, but in extrapulmonary localisations definitive proof is often drawn from a pleural, pericardial or even lymph node biopsy . After diagnosis, or when diagnosis is highly suspected, antituberculous treatment is started . Steroid could be useful in exsudative forms . The overall cure rate is 95% but side effects, poor compliance or bacteriological resistance can yield complex problems and lead to failures. Rev Prat, 2002 Dec 1, 52(19), 2115 - 20 {Biological diagnosis of tuberculosis}; Carbonnelle B et al.; Today, the diagnosis tests for tuberculosis are based on: the observation of acid-fast-bacilli after Ziehl-Neelsen staining or fluorescent microscopy, the growth of a culture, the study of drug sensibility, the observation of granulomatous tissue lesions and caseous necrosis . Use of radioactive liquid culture media (Bactec) or not, has shortened the time required for obtaining the result, but it remains too long and, so far, polymerase chain reaction has not answered the challenge . However molecular techniques have been applied with success to the identification of mycobacterial strains (DNA fingerprinting) and to rapid detection of antimicrobial resistance caused by mutation of the target genes . Progress of the molecular tests could lead to desoxyribonucleic microarrays, which would be able to revolutionize the microbiological diagnostic tests. Pneumologia, 2002 Jul-Sep, 51(3), 206 - 13 {Clinical and epidemiological changes in tuberculosis in children in the last 5 decades(1950-2000) }; Calciu M; This study analyses over a 48 years period (1953-2000) the incidence of various clinical forms of TB in children aged 0-8, admitted in several ftizio-pediatric institutions . Follow-up included: primary complex, pleuro-pulmonary involvement, bronchial adenogenic involvement, extra-respiratory forms and major sequelae of primary tuberculosis . The results show a marked decrease of incidence of all TB forms in children and disappearance of chronic extensive primary tuberculosis and major sequelae of primary tuberculosis . The incidence tappered in steps: a sudden decrease in 1964-65, another in 1974, followed by a gradual decline . On contrary, the incidence of multiple sequela calcifications seems to be increasing after 1980 . These clinical mutations, especially the one in 1974, may be attributed to strictly observed treatment, to reintroduction of national campaign of BCG vaccination and to the decrease of TB incidence in adults (diminished bacilli offer). Am J Respir Crit Care Med, 2003 Mar 1, 167(5), 723 - 5 Yield of sputum induction in the diagnosis of pleural tuberculosis; Conde MB et al.; We prospectively evaluated the diagnostic yield of acid-fast bacilli smear and culture for Mycobacterium tuberculosis using sputum induction (SI) in the workup of patients with suspected pleural tuberculosis (TB) who were unable to produce sputum spontaneously . Of the 113 patients studied, a final diagnosis of pleural TB was made in 84 patients (71 HIV seronegative) and a final diagnosis of another disease in 29 patients . Histopathologic examination of the pleural biopsy tissue had the highest diagnostic yield (78%; 66/84) . The bacteriologic yield was 62% (52/84) for the pleural tissue, 12% (10/84) for pleural fluid, and 52% (44/84) for sputum cultures obtained by SI . The yield of SI culture for M . tuberculosis was 55% (35/64) in patients with a normal radiograph (except for the pleural effusion) and 45% (9/20) in those with evidence of parenchymal disease suggestive of pulmonary TB (p = 0.6) . The yield of sputum cultures obtained by SI is high in patients suspected of having pleural TB even in those cases with no pulmonary parenchymal abnormalities on the chest radiograph. Intensive Care Med, 2003 Feb, 29(2), 179 - 88 Epub 2003 Jan 14. Outcome of postoperative pneumonia in the Eole study; Dupont H et al.; OBJECTIVES: Prognosis factors of ventilator-associated pneumonia (VAP) have been largely investigated, while the data concerning postoperative pneumonia (POP) are scarce . The aim of this multicenter, prospective study was to evaluate the predictive factors of mortality due to POP and the impact of initial antibiotic therapy on outcome . METHODS: Two hundred centers were included . Diagnosis of POP was assessed on clinical and laboratory criteria, chest X-ray changes and microbiological criteria, when possible . Outcomes of the patients were noted . An independent committee made a retrospective assessment of appropriateness of antimicrobial therapy . RESULTS: The overall mortality among the 556 cases of POP was 23% (126 patients) . Five parameters were independently associated with mortality: American Society of Anesthesiology (ASA) grade 3 or more ( p<0.001), age 64 years or more ( p<0.01), time to onset of pneumonia more than 3 days ( p<0.01), mottling ( p<0.05) and hypotension ( p<0.05) . Among the 322 microbiologically confirmed cases of pneumonia, 92 received inappropriate antibiotic (AB) therapy (29%) . No difference in mortality was observed between the patients receiving inappropriate and appropriate AB therapy (22.8 vs 16.9%) . In this subgroup, three parameters remained independently associated with mortality: ASA grade 3 or higher ( p<0.001), time to onset of pneumonia more than 3 days ( p<0.05) and hypotension ( p<0.05) . Inappropriate initial AB did not modify the model ( p=0.22) . CONCLUSIONS: Five independent predictive factors for mortality of POP were identified . Despite a trend toward decreased mortality with appropriate initial antimicrobial therapy, no difference was observed between the groups . Polymicrobial pneumonia or non-fermenting Gram-negative bacilli appeared to be a risk factor for inappropriate AB. Thyroid, 2002 Dec, 12(12), 1137 - 40 Primary tuberculosis of the thyroid gland: report of three cases; Pazaitou K et al.; We report on three cases with rapidly increasing thyroid masses who were referred with the provisional diagnosis of thyroid carcinoma . In the two cases, the diagnosis of tuberculosis was established after thyroidectomy, but in the third case diagnosis was made pre-operatively with acid fast bacilli (AFB) staining and culture from fine needle aspiration (FNA) material . Although rare, tuberculosis of the thyroid gland should be included in the differential diagnosis of thyroid masses . FNA, AFB staining and culture of the aspirate are important diagnostic tools in these cases. JAMA, 2003 Feb 19, 289(7), 885 - 8 Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use; Neuhauser MM et al.; CONTEXT: Previous surveillance studies have documented increasing rates of antimicrobial resistance in US intensive care units (ICUs) in the early 1990s . OBJECTIVES: To assess national rates of antimicrobial resistance among gram-negative aerobic isolates recovered from ICU patients and to compare these rates to antimicrobial use . DESIGN AND SETTING: Participating institutions, representing a total of 43 US states plus the District of Columbia, provided antibiotic susceptibility results for 35 790 nonduplicate gram-negative aerobic isolates recovered from ICU patients between 1994 and 2000 . MAIN OUTCOME MEASURES: Each institution tested approximately 100 consecutive gram-negative aerobic isolates recovered from ICU patients . Organisms were identified to the species level . Susceptibility tests were performed, and national fluoroquinolone consumption data were obtained . RESULTS: The activity of most antimicrobial agents against gram-negative aerobic isolates showed an absolute decrease of 6% or less over the study period . The overall susceptibility to ciprofloxacin decreased steadily from 86% in 1994 to 76% in 2000 and was significantly associated with increased national use of fluoroquinolones . CONCLUSIONS: This study documents the increasing incidence of ciprofloxacin resistance among gram-negative bacilli that has occurred coincident with increased use of fluoroquinolones . More judicious use of fluoroquinolones will be necessary to limit this downward trend. Int J Tuberc Lung Dis, 2003 Feb, 7(2), 159 - 64 Evaluation of undergraduate training on tuberculosis at Istanbul Medical School; Kilicaslan Z et al.; SETTING: Undergraduate training on tuberculosis at Istanbul Medical School . OBJECTIVE: To assess whether tuberculosis-related questions asked in chest medicine examinations comply with the World Health Organization's (WHO) learning objectives for tuberculosis training, and to investigate students' skills in interpreting radiology and smears with respect to tuberculosis . DESIGN: Tuberculosis questions set for 4th year medical students (n = 838) were compared with WHO objectives (n = 23): 122 students were each asked to interpret 10 chest X-rays which had been read by three experts as 'typical tuberculosis lesions', 'normal' or 'non-tuberculosis lesions'; 114 students were also each given five smears which had been interpreted by an expert as 'negative' or 'positive' with respect to acid-fast-bacilli (AFB), and were asked to interpret them . RESULTS: Questions covered only nine of the WHO objectives . Among 117 types of questions, 91 (77.8%) were about clinical-radiological findings, treatment and drugs; 334 (65.1%) of 513 X-rays with typical tuberculosis lesions, 77 (21.1%) of 364 normal X-rays and 87 (25.4%) of 343 X-rays with non-tuberculosis lesions were identified as tuberculosis (kappa 0.45) . Of 369 AFB-positive smears, 149 (40.4%) were evaluated as false negative, and of 185 AFB-negative smears, 48 (25.9%) were evaluated as false positive (kappa 0.49) . CONCLUSION: Examination questions set on tuberculosis at Istanbul Medical School do not adequately reflect WHO learning objectives . Students' skills in interpreting radiology and smears suggest that their practical training on tuberculosis is insufficient. Int J Tuberc Lung Dis, 2003 Feb, 7(2), 117 - 23 Causes of lower respiratory infection in HIV-infected Ugandan adults who are sputum AFB smear-negative; Worodria W et al.; SETTING: Mulago national referral and teaching hospital . OBJECTIVE: To assess the etiology of lower respiratory infections in HIV-infected Ugandan adults who are sputum acid-fast bacilli (AFB) smear-negative . DESIGN: A descriptive cross-sectional study . Participants included consecutive adult patients admitted to medical wards with respiratory symptoms of at least 3 weeks and infiltrates on chest radiograph . Those who were sputum AFB smear-negative and HIV-positive underwent bronchoscopy and bronchoalveolar lavage (BAL) . BAL fluid was obtained and stained for AFB and Pneumocystis carinii, and cultured for bacteria and fungi . RESULTS: Of 198 patients screened, 48 were sputum smear-positive for AFB . Sixty-seven were excluded for various reasons, leaving 83 patients who met the inclusion criteria and underwent bronchoscopy: 32 (38.6%) patients had P . carinii infection, 20 (24%) had pulmonary tuberculosis, nine (11%) had pulmonary Kaposi's sarcoma and pyogenic bacteria were identified in seven (8%) . No aetiological diagnosis was found in 24 (30%) patients . CONCLUSION: P . carinii and Mycobacterium tuberculosis were the commonest causes of disease among sputum AFB smear-negative, HIV-positive adults presenting to Mulago Hospital . Pulmonary Kaposi's sarcoma and pyogenic bacteria occurred with less frequency. Scand J Infect Dis, 2002, 34(12), 931 - 4 Multiple tuberculous brain abscesses; Wang KC et al.; Multiple tuberculous brain abscesses are rare . This report presents a female patient with a rapidly deteriorating clinical course . Computed tomographic scanning revealed multiple brain abscesses . Aspiration of one of the lesions yielded pus and positive acid-fast stained bacilli . The pathogenesis of multiple tuberculous brain abscesses is discussed. Pediatr Infect Dis J, 2003 Feb, 22(2), 109 - 14 Cefepime use in a pediatric intensive care unit reduces colonization with resistant bacilli; Toltzis P et al.; BACKGROUND: Cefepime has activity against many hospital-acquired Gram-negative pathogens resistant to earlier beta-lactam antibiotics . This study was designed to test whether preferential use of cefepime in a pediatric intensive care unit could reduce enteric colonization with antibiotic-resistant Gram-negative rods . METHODS: After a 6-month period of uncontrolled antibiotic use, cefepime was preferentially used during 2 years as treatment for nosocomial or serious community-acquired infection . Rectal swab specimens were obtained daily on every patient regardless of antibiotic exposure during the 6 months of uncontrolled antibiotic use and during the first and last 6 months of the 2 years of cefepime preference . The study outcome was rectal colonization with a facultative Gram-negative rod resistant to at least one of four antibiotics: cefepime; ceftazidime; gentamicin; or piperacillin-tazobactam . RESULTS: The incidence of colonization by a resistant organism decreased only slightly during the first 6 months of cefepime use . By contrast, the number of antibiotic-resistant bacilli isolated from rectal swab specimens diminished from 27.6/100 patients during the baseline period to 12.9/100 patients by the last 6 months of the 2 years of cefepime preference (P < 0.01) . The proportion of patients harboring at least one resistant organism decreased from 11.6% to 7.4% during the same time period (P < 0.01) . A decrease in colonization with resistant organisms occurred for all the tested resistance phenotypes, including cefepime . CONCLUSION: Cefepime may possess a low potential for promoting bacillary resistance in critically ill patients, suggesting that its preferential use might be a key element in limiting the presence of antibiotic resistance in the intensive care unit. Vet Immunol Immunopathol, 2003 Feb 10, 91(3-4), 169 - 82 Immunopathological studies on feline cutaneous and (muco)cutaneous mycobacteriosis; Kipar A et al.; Eight cases of feline (muco)cutaneous mycobacteriosis were studied to identify the causative agent and examine for phenotype and functional characteristics (expression of interleukin (IL)-1beta, IL-6, IL-12, tumour necrosis factor-alpha and inducible nitric oxide synthase) of the inflammatory cells . Polymerase chain reaction and sequencing identified the causative agents as Mycobacterium tuberculosis or M . avium complex in each four cases . Lesions were characterised by pyogranulomatous infiltration, with variability in the presence and size of necrotic areas, the presence of multinucleated giant cells and the degree of lymphocyte infiltration . Macrophages were positive for myeloid/histiocyte antigen (calprotectin), suggesting they represented freshly recruited monocytes; further differentiation to epithelioid cells and multinucleated giant cells was associated with loss of the myeloid/histiocyte antigen . Lymphocytes were found disseminated in the infiltrate (predominantly T cells) and as B cell-dominated accumulations mainly in the periphery of the lesions . Acid-fast bacilli were numerous . In M . tuberculosis complex infection, extracellular bacilli were most prominent, whereas in M . avium complex infection, bacilli were mainly located intracellularly . All cytokines examined as well as inducible nitric oxide synthase (iNOS) were variably expressed by macrophages, epithelioid cells and multinucleated giant cells . Expression was most intense in degenerating macrophages loaded with intracellular bacilli, but was also seen cell-free within necrotic areas . The intense induction of cytokine and iNOS expression especially in infected macrophages suggests a relatively low virulence for these infectious agents in cats . Furthermore, the confinement of the bacilli to lesions indicates a successful response to infection . Acta Cytol, 2003 Jan-Feb, 47(1), 51 - 5 Tuberculosis of the intercostal lymph nodes; Prasoon D; OBJECTIVE: To describe tuberculosis of the intercostal lymph nodes and discuss its clinical and cytologic profile and pathogenesis . STUDY DESIGN: Fifteen cases from March 1994 to March 2000 were retrieved from our cytology records . Only clinically and therapeutically proven cases were included in the study . RESULTS: The ages of the patients ranged from 4 to 63 years . The male:female ratio was 2:1 . The duration of disease at presentation ranged from one week to nine months . The lumps presented either in the parasternal region or between the midclavicular and posterior axillary lines . One case presented with an infrascapular lump . Most of the lumps were ill defined and cystic . Chest radiographs in all cases showed a soft tissue swelling without bony involvement . The aspirates were of two types, blood-mixed particles and necrotic material . Four cytologic pictures were seen: (1) epithelioid cell granulomas alone or (2) with necrosis or (3) with both necrosis and acid-fast bacilli (AFB), or (4) necrosis with AFB . AFB were detected in 53.3% of cases . CONCLUSION: If necrotic material is aspirated or if granulomatous inflammation is encountered in soft tissue swellings of the chest wall, particularly in the parasternal and axillary regions, the possibility of intercostal tuberculous lymphadenitis should be considered. Eur J Clin Microbiol Infect Dis, 2003 Jan, 22(1), 49 - 50 Epub 2003 Jan 18. A case of tuberculous sinusitis without concomitant pulmonary disease; Beltran S et al.; This case report highlights the difficulty of diagnosing tuberculous sinusitis in the absence of pulmonary foci . Although extrapulmonary localisations of tuberculosis are rare in immunocompetent patients, it is important to consider this diagnosis, since therapeutic delay usually results in an unfavourable outcome . Acid-fast bacilli are sometimes difficult to detect in pathological specimens . Consequently, the diagnosis is usually based on the following criteria: (i) the absence of clinical response to usual antibiotics, (ii) the presence of caseous granulomatous inflammatory lesion on histopathology, and (iii) identification of Mycobacterium tuberculosis by the polymerase chain reaction assay confirmed by bacteriological culture . The diagnosis of tuberculosis is finally confirmed by the efficacy of antituberculous treatment . The differential diagnosis is Wegener's disease. Eur J Biochem, 2003 Feb, 270(4), 625 - 34 Cytotoxic activity of nucleoside diphosphate kinase secreted from Mycobacterium tuberculosis; Chopra P et al.; Pathogenicity of Mycobacterium tuberculosis is closely related to its ability to survive and replicate in the hostile environment of macrophages . For some pathogenic bacteria, secretion of ATP-utilizing enzymes into the extracellular environment aids in pathogen survival via P2Z receptor-mediated, ATP-induced death of infected macrophages . A component of these enzymes is nucleoside diphosphate kinase (Ndk) . The ndk gene was cloned from M . tuberculosis H37Rv and expressed in Escherichia coli . Ndk was secreted into the culture medium by M . tuberculosis, as determined by enzymatic activity and Western blotting . Purified Ndk enhanced ATP-induced macrophage cell death, as assayed by the release of {14C}adenine . A catalytic mutant of Ndk failed to enhance ATP-induced macrophage cell death, and periodate-oxidized ATP (oATP), an irreversible inhibitor of P2Z receptor, blocked ATP/Ndk-induced cell death . Purified Ndk was also found to be autophosphorylated with broad specificity for all nucleotides . Conversion of His117-->Gln, which is part of the nucleotide-binding site, abolished autophosphorylation . Purified Ndk also showed GTPase activity . Collectively, these results indicate that secreted Ndk of M . tuberculosis acts as a cytotoxic factor for macrophages, which may help in dissemination of the bacilli and evasion of the immune system. Hunan Yi Ke Da Xue Xue Bao, 2002 Feb 28, 27(1), 88 - 90 {Determination of lipopolysaccharide by capillary zone electrophoresis}; Jing ZZ et al.; OBJECTIVE: To detect lipopolysaccharides (LPS) in frangibility bacilli, control the procedure of LPS preparation, examine the ally of the product by high performance capillary zone electrophoresis (CZE), and obtain rapidly high alloy of LPS for scientific research . METHODS: Theoptyline was added to the sample as an internal standard . The LPS was separated and detected by CZE in sodium tetraborate-borate buffer . The concentration of the buffer was 30 mmol.L-1 (pH 8.0); the diameter of the capillary column was 75 microns, and the length was 57 cm; the CZE operative voltage was 25 kV, the electric current was 112 microA, and the detecting wavelength was 230 nm . RESULTS: CZE was first internally used to separate and detecte LPS in bacillus . The LPS had a good linearity in the range of 2-30 mg.L-1 (r = 0.996) . The average recovery rate was 99%-101%, the in-day and day-to-day coefficients of variation (CV) were less than 5%, and the minimum detectable quantity was 1.0 mg.L-1 . CONCLUSION: Compared with the limulus test (LT) and gel electrophoresis, this method can resist heat source interference and is more simple, rapid and accurate . Moreover, it can control the preparative process of LPS immediately, and may be an advanced method to determine LPS. J Mol Evol, 2003 Feb, 56(2), 175 - 80 The p32K structural protein of the atadenovirus might have bacterial relatives; Elo P et al.; The primary structure of a novel adenoviral protein referred to as p32K and found exclusively in members of the proposed new genus Atadenovirus was analyzed . The p32K gene sequence was determined from two bovine and one snake adenovirus types . Altogether five different p32K sequences were examined, two of them were obtained from the Gene Bank . The C-terminal part of the protein is conserved and shares similarity with certain bacterial small acid soluble proteins (SASPs) . The sequence similarity seems coupled with functional relatedness, i.e . both protein groups are found in structures where the genome of the "dormant" organism is packaged in tight nucleoprotein complexes . In these complexes the DNA is protected against harmful environmental effects until the new reproductive cycle is started with specific protease cleavage of the packaging proteins . Although there is no experimental clue about the role of the p32K proteins, we hypothesize phylogenetic relationship between the two protein groups based on the sequence similarity and the supposed functional similarity . The alignments of these protein groups shows that the conserved part of the p32Ks probably is the result of the duplication of a shorter sequence similar to the SASPs of the Bacilli. Clin Nephrol, 2003 Jan, 59(1), 47 - 55 A preliminary survey of bacterial contamination of the dialysate circuit in continuous veno-venous hemodialysis; Kanagasundaram NS et al.; AIMS: The problem of dialysate bacterial contamination has not been defined in continuous renal replacement therapy . We assessed the bacterial integrity of source bicarbonate dialysate (study 1) and the continuous veno-venous HD (CVVHD) bicarbonate dialysate circuit (study 2) . METHODS: Study 1: 50 ml dialysate were collected from 41 bags randomly selected from 150 consecutively made dialysate bags, immediately after manufacture or after 24, 48 or 72 h . Study 2: 10 ml dialysate were drawn from 4 sample points ranged along the dialysate circuit in 18 therapies (mean duration 119.5 +/- 72.0 h) . All points were sampled at therapy start then daily, bar the proximal point which was sampled after each dialysate bag change . All dialysate samples underwent Gram stain and aerobic/anaerobic culture . Samples over 10 ml were cultured after centrifugation (15 min, 4,000 rpm) . A disseminated contamination (DC) involved > or = 1 sample point at a time and/or was sustained over time . RESULTS: Study 1: One bag was culture-positive (staphylococcal/diphtheroid growths; 48-h sample) . Study 2: Six DCs developed in 6 therapies (1 at therapy end, 5 sustained to therapy end (duration 57.25 +/- 45.95 h), 5 with Gram-negative bacilli, all involving reported growths of > or = 1,000 cfu) . Dialyzer-inclusive dialysate circuit changes were more frequent in non-DC therapies (change rate: DC, 0.08 +/- 0.12/day, non-DC, 0.34 +/- 0.23, p = 0.02, permutation tests with general scores) but did not entirely prevent DC or alter it once underway . CONCLUSIONS: Sustained bacterial contamination of bicarbonate-based CVVHD is common and could relate to the completeness of dialysate circuit change . The importance of technique and regular quality control is highlighted. Trop Doct, 2003 Jan, 33(1), 7 - 11 The diagnosis of extrapulmonary tuberculosis in Malawi; Harries AD et al.; There is little information on a country-wide basis in sub-Saharan Africa about how the diagnosis of extra-pulmonary tuberculosis (EPTB) is made . A country-wide cross-sectional study was carried out in 40 non-private hospitals in Malawi which register and treat (TB) patients in order to assess diagnostic practices in adults registered with EPTB . All patients aged 15 years and above in hospital on treatment for EPTB were reviewed usingTB registers, case note files and clinical assessment . There were 244 patients, 132 men and 112 women whose mean age was 36 years . In 138 (57%) patients, all appropriate procedures and investigations, commensurate with hospital resources, had been carried out . Of 171 EPTB patients with cough for 3 weeks or longer, 138 (81%) submitted sputum specimens for smear microscopy of acid-fast bacilli (AFB) . A confirmed diagnosis ofTB was made in 15 (6%) patients based on finding AFB or caseating granulomas in specimens . In 157 (64%) patients, the diagnosis of EPTB was considered to be correct . In 46 (19%) patients the diagnosis was considered to be TB, although different from the type of EPTB with which the patient was registered . In 39 (16%) patients an alternative non-TB diagnosis was made and in two (1%) patients it was not possible to make a decision . Diagnostic practices need to be improved, and ways of doing this are discussed. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi, 1999, 17(2), 113 - 4 {Preparation of DNA probe for Cryptosporidium parvum}; Guo B et al.; AIM: To prepare a probe with high specificity and sensitivity for the detection of Cryptosporidium parvum . METHODS: Using PCR method, a fragment from the DNA of C . parvum was amplified . The PCR product, 452 bp DNA, was labeled with hapten digoxigenin . RESULTS: Examination of sensitivity showed that the DNA probe could detect as low as 2 pg DNA from C . parvum . The dot-blot hybridizition assay showed that the probe hybridized with the DNA of C . parvum, but not hybridized with DNA of E . histolytica, G . lamblia, E . coli and D . bacilli . CONCLUSION: The probe was highly specific and sensitive for the detection of C . parvum. Clin Exp Immunol, 2003 Feb, 131(2), 292 - 8 Influence of Mycobacterium tuberculosis on differential activation of helper T-cells; Talreja J et al.; Host defence against tuberculosis infection involves T-lymphocyte mediated cellular immune responses . In this study we assessed T-cell activation by studying the early signal transduction events and production of cytokines by human CD4+ T-cells . The study constituted of five groups of subjects: (a) untreated acid fast bacilli (AFB)+ve TB patients who have not started anti-tuberculosis therapy (ATT) {New}; (b) patients who have taken ATT for two months {2T}; (c) patients who have taken ATT for six months {6T}; (d) mantoux positive healthy controls {T+ve}; (e) mantoux negative healthy controls {T-ve} . We found that mantoux positive healthy controls produced significantly higher levels of IP3, intracellular Ca2+ and presented increased PKC activity when CD4+ T-cells were stimulated with M . tuberculosis H37Rv cell lysate as compared to mantoux negative controls . Furthermore, decreased expression of CD54 (ICAM-1) and reduced {Ca2+}i were seen in TB patients as compared to T+ve healthy controls . TB patients showed significantly lower levels of IL-2 and IFNgamma and higher levels of IL-4 as compared to normal healthy controls, suggesting a diminished Th1 response . Thus, the reciprocal changes in cytokines, reduced {Ca2+}i levels, and CD54 expression in patients imply phenotype shifting of Th precursors to Th2 type in TB patients. J Commun Dis, 2001 Dec, 33(4), 241 - 4 Detection of tubercle bacilli in sputum: application of sodium hypochlorite concentration method; Saxena S et al.; Tuberculosis has emerged as the leading cause of death due to single infectious agent . Sputum microscopy forms mainstay of diagnosis as it is most reliable, specific and objective method available especially in developing countries . However, this method is hampered by lack of sensitivity . Liquefaction and concentration of sputum before Ziehl Neelsen staining improves yield and also makes examination of smears rapid and convenient . A total of 304 sputum samples were studied by direct staining and after sodium hypochlorite treatment and centrifugation . Direct smears stained with Auramine-Phenol were also examined . Use of sodium hypochlorite method increased the number of positive samples from 52 to 96 . No false positives were detected by either method . The method is simple as the only extra reagent required is sodium hypochlorite that is easily available . Additional advantage is that sodium hypochlorite, being a potent disinfectant, reduces the risk of laboratory acquired infections. Izv Akad Nauk Ser Biol, 2002 Nov-Dec, (6), 763 - 8 {Influence of different ecological groups of earthworms on the intensity of nitrogen fixation}; Tereshchenko NN et al.; The results of studying nitrogen fixation in organic substrates processed by different ecological groups of earthworms suggest that the earthworms Aporrectoidea caliginosa actively stimulate nonsymbiotic nitrogen fixation . In this respect, they exceed the manure worms Eizenia foetida tens of times due to the formation in the organic substrate of conditions favorable for the nitrogen fixing bacteria, and namely: low content of nitrogen easily accessible for microorganisms, changes in the structure of the microbial community of the substrate in favor of non-spore forms of bacteria, and suppression of the growth of saprophyte bacilli, the main competitors of nitrogen fixing bacteria for carbon nourishment sources. Enferm Infecc Microbiol Clin, 2003 Jan, 21(1), 42 - 55 {beta-Lactam antibiotics}; Marin M et al.; Betalactams, which act by inhibiting the last phase of bacterial cell wall synthesis, constitute the largest family of antimicrobial agents and the most extensively used in current clinical practice . These drug have a slow bactericidal action that is relatively independent of plasma concentrations, little toxicity and a broad therapeutic margin . Their spectrum has increased over the years with the incorporation of new molecules having greater activity against gram-negative bacilli . Nevertheless, the progressive emergence of acquired resistance has limited the empirical use of betalactams and their efficacy in certain situations . Despite this problem, penicillin is still the treatment of choice for a large number of classic infections, cephalosporins are widely used in surgical prophylaxis and severe community-acquired infections, carbapenems are the choice for mixed nosocomial and multiresistant bacterial infections and betalactamase inhibitors permit the effective use of amino- and ureido-penicillins in highly significant infections. J Feline Med Surg, 2003 Feb, 5(1), 37 - 41 Opportunistic mycobacterial granuloma in a cat associated with a member of the Mycobacterium terrae complex; Henderson SM et al.; An 18-month-old domestic short-haired neutered male cat presented with a nodular dermal thickening on a digit . Biopsy demonstrated pyogranulomatous inflammation with moderately frequent acid-fast bacilli . A member of theMycobacterium terrae complex was isolated . There was no evidence of systemic involvement . Treatment was initiated with enrofloxacin, rifampicin and clarithromycin . After 2 months there was no longer any clinically apparent dermal thickening . Treatment was continued for a further 3 months using enrofloxacin and rifampicin. Mil Med, 2003 Jan, 168(1), 24 - 7 Resistance patterns of Mycobacterium tuberculosis complex isolates in the Turkish Army from 1998 to 2000; Saracli MA et al.; The aim of this retrospective study was to investigate susceptibility rates of Mycobacterium tuberculosis complex (MTBC) isolates against streptomycin, rifampicin, isoniazid, and ethambutol between January 1998 and December 2000 in the Turkish Army . Specimens collected from patients were cultured both conventionally and radiometrically . Differentiation of MTBC bacteria from Mycobacteria other than tuberculosis bacilli was made by the BACTEC p-nitro-alpha-acetyl-amino-beta-hydroxypropiophenone test . Susceptibility testing of MTBC isolates was performed using the BACTEC radiometric susceptibility assay for mycobacteria . Most of the specimens originated from respiratory system . A total of 98 isolates in 1998, 123 isolates in 1999, and 84 isolates in 2000 were obtained and identified as MTBC using the radiometric BACTEC TB460 system . Initial resistance was most frequent to isoniazid followed by ethambutol, streptomycin , and rifampicin in this study period . The differences between resistance rates were not statistically significant on an annual basis . None of these isolates was resistant to all four antimycobacterial agents . Although resistance rates of our isolates were not as high as previously reported by some authors from Turkey and there was no significant difference between the annual susceptibility rates, routine screening of antituberculosis drug susceptibility should be continued to control the resistance development and its spread. Int J Tuberc Lung Dis, 2002 Dec, 6(12), 1098 - 101 Study of drug resistance in previously treated tuberculosis patients in Gujarat, India; Shah AR et al.; SETTING: Department of Tuberculosis and Chest Diseases and State Tuberculosis Diagnosis and Training Centre (STDTC), a DOTS centre in Ahmedabad, Gujarat State, India . The study was carried out by retrospectively reviewing patient data between January 2000 and August 2001 . OBJECTIVE: To evaluate the pattern of drug resistance among previously treated tuberculosis patients who remained symptomatic or smear-positive despite receiving anti-tuberculosis drugs under DOTS for a minimum of 5 months . DESIGN: A total of 1472 pulmonary tuberculosis patients who had taken anti-tuberculosis treatment were evaluated retrospectively with respect to their drug resistance pattern by sputum culture for acid-fast bacilli (AFB) and sensitivity testing with isoniazid, rifampicin, streptomycin and ethambutol (E) . RESULT: Of the 1472 patients evaluated, 804 (54.6%) were treatment failure cases and 668 (45.4%) were relapse cases; 822 patients (373 failure and 449 relapse) were culture-positive . Of these 822 patients, 482 (58.64%, 261 failure and 221 relapse) were resistant to one or more drugs . Resistance to one drug was observed in 86 patients (10.46%), to two drugs in 149 (18.13%), to three drugs in 122 (14.84%) and to four drugs in 125 (15.21%) . Single drug resistance was most commonly seen with isoniazid (62 patients, 7.5%), followed by streptomycin (12 patients, 1.4%), rifampicin (eight patients, 0.97%) and ethambutol (four patients, 0.4%) . Resistance to isoniazid plus rifampicin alone was seen in 76 patients (9.2%) . CONCLUSION: Drug resistance is a major problem in the treatment of pulmonary tuberculosis . Detection of drug resistance patterns and treatment with second-line anti-tuberculosis drugs in appropriate regimens are necessary in the treatment of failure and relapse cases in order to reduce the emergence of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2002 Dec, 6(12), 1058 - 66 Treatment results of DOTS in 1797 Sudanese tuberculosis patients with or without HIV co-infection; El-Sony AI et al.; SETTING: Consecutive new tuberculosis (TB) patients, from eight states in Sudan, who had never been previously treated for as much as 1 month between 1998 and 2000 . OBJECTIVE: To determine the impact of human immunodeficiency virus (HIV) co-infection on tuberculosis treatment outcome . DESIGN: All patients presenting with symptoms suggestive of tuberculosis underwent sputum microscopy for acid-fast bacilli (AFB) . Treatment is free of charge, and directly observed for all smear-positive patients . Treatment outcomes were those defined by the World Health Organization . All patients were tested anonymously for human immunodeficiency virus (HIV) using the Bionor test . RESULTS: Of 10 494 patients suspected of TB and referred for sputum microscopy, 1797 were TB cases; 983 had smear-positive pulmonary tuberculosis, 521 smear-negative pulmonary tuberculosis, and 293 extra-pulmonary tuberculosis . Smear-positive cases showed a cure rate of 77.2% and a failure rate of 1% . Smear-negative and extra-pulmonary patients had a completion rate of 79.4% . Cure rates for the smear-positive cases were 68.3% for HIV-positive and 77.6% for HIV-negative patients (P = 0.164) . Case fatality was significantly higher among HIV-positive (12%) than among HIV-negative cases (1.8%) (OR 7.7, 95% CI 3.51-16.8) . CONCLUSION: To date, a relatively low proportion of tuberculosis patients in Sudan also have HIV infection . These patients are substantially more likely to die while on treatment for their tuberculosis, a fact that underlines their need for more comprehensive care if their lives are to be prolonged . In addition, every effort is required to diminish the transmission of HIV infection to prevent the tragedy this infection represents to the community. Crit Care Med, 2003 Jan, 31(1 Suppl), S25 - 8 Restrictive antibiotic policies are appropriate in intensive care units; Paterson DL; Antibiotic use will always be an important part of medical practice in the intensive care unit . Antibiotic resistance increases the chance that empirical therapy will be inadequate to cover the organisms implicated in any particular infection . Therefore, strategies that can allow for optimal empirical antibiotic choice, while at the same time minimizing emergence of antibiotic resistance, are particularly important . In many situations, such strategies require some external stewardship of antibiotic use to be maximally effective . Antibiotic stewardship programs may take the form of management teams comprising infectious disease physicians and pharmacists . These clinicians work in concert with critical care specialists in choosing optimal empirical regimens and in streamlining therapy once culture results are available . Alternatively, computer-based clinical support systems have been developed that can guide physicians to utilize optimal antibiotic choices . External stewardship of antibiotic use may be particularly necessary in circumstances of increased antibiotic resistance, especially exhibited by Gram-negative bacilli . A number of examples exist in which antibiotic control programs can work when traditional infection control programs have failed . Mutation of organisms to produce antibiotic resistance is undoubtedly going to outstrip availability of new antibiotics in the near future . Antibiotic stewardship in concert with improved diagnostic methods may be our only hope in preventing endemic panresistant organisms. Auris Nasus Larynx, 2003 Feb, 30 Suppl, S131 - 4 A case report of difficult diagnosis in the patient with advanced laryngeal tuberculosis; Kenmochi M et al.; We report a patient with severe laryngeal tuberculosis (LTB) involving thyroid cartilage and combined with whole-bone metastasis . A 57-year-old male had presented only with hoarseness . Radiological findings were indicative of suspected metastasis from a malignant tumor . However, tuberculosis was considered by histopathological findings, and so sputum samples were tested for acid-fast bacilli and purified protein derivatives of tuberculin in order to detect the presence of LTB . A polymerase chain reaction confirmed the diagnosis . Anti-tuberculous medications were effective in resolving the hoarseness, and the removal of the mass in the right wing of thyroid cartilage was confirmed by computed tomography (CT). Chin J Traumatol, 2003 Feb 1, 6(1), 28 - 31 The risk factors of nosocomial infection in severe craniocerebral trauma; Yang ZM et al.; OBJECTIVE: To explore the risk factors of nosocomial infection in severe craniocerebral trauma and the way of prevention . METHODS: The clinical data of 387 patients with severe craniocerebral trauma were reviewed . RESULTS: The total nosocomial infection rate of this study was 22.99% . Pulmonary nosocomial infection presented most frequently . The G-bacilli were the most common infectious bacteria . The mortality rate of the infection group was 38.20% . CONCLUSIONS: Complications of nosocomial infection affect the prognosis of craniocerebral trauma patients . Nosocomial infection is related to the age of the patients, craniocerebral trauma severity, unreasonable utilization of antibiotics and invasive operations, such as tracheal cannula, mechanical ventilation, urethral catheterization and deep venous catheterization . Patients with severe craniocerebral trauma should be carefully treated and nursed to avoid nosocomial infection . In order to reduce the rate of nosocomial infection, intensive measurement should be adopted. J Pharm Pharmacol, 2002 Dec, 54(12), 1693 - 6 Continuous infusion versus intermittent administration of cefepime in patients with Gram-negative bacilli bacteraemia; Jaruratanasirikul S et al.; The objective of this study was to compare the pharmacokinetics of cefepime administered by continuous infusion and intermittent injection regimens . A prospective, randomized, cross-over study of ten patients with Gram-negative bacilli bacteraemia was conducted . All patients were randomized to receive cefepime either as a 4-g continuous infusion over 24 h for 48 h or a 2-g bolus administered intermittently intravenously every 12 h for 48 h . After 48 h the patients received the alternative dose regimen . Cefepime pharmacokinetic studies were carried out during hours 36-48 after the start of both regimens . All of the pathogens isolated from the blood in 7 patients had a minimum inhibitory concentration (MIC) < 1 microg mL(-1) . In both regimens, the serum cefepime concentrations at all time points were higher than the MIC for the pathogens isolated from this study . For the continuous infusion arm, the highest steady-state concentration was 49.80+/-18.40 microg mL(-1) and the lowest steady-state concentration was 41.42+/-16.48 microg mL(-1) . The steady-state concentrations were greater than 4 times the MIC of 8 microg mL(-1) . For the intermittent injection regimen, the mean trough concentration was 4.74+/-3.99 microg mL(-1) . The mean serum cefepime concentration was above 8 microg mL(-1) for 81.66% of the dosing interval . Therefore, we conclude that either continuous infusion or intermittent injection can be used as an effective mode of cefepime administration to achieve bactericidal activity. Infect Immun, 2003 Feb, 71(2), 864 - 71 Immunopathogenesis of pulmonary granulomas in the guinea pig after infection with Mycobacterium tuberculosis; Turner OC et al.; Pulmonary tuberculosis in guinea pigs is similar to the disease in humans and is accordingly widely used as a model to test tuberculosis vaccines . The primary site of expression of acquired immunity and the hallmark of tuberculosis is the granuloma . Granuloma morphology is well described, but there is limited information regarding T-cell subset influx . We monitored the course of pulmonary tuberculosis in guinea pigs and observed four distinct immunohistopathological stages . In all stages there were similar numbers and arrangement of CD4 and CD8 T cells . There were only small numbers of apoptotic lymphocytes, scattered around and within the necrotic core, and acid-fast bacilli were visible both within macrophages and free within airway debris . A key finding of the study was the observation that the development of the necrotic core was an early event and almost certainly preceded the emergence of the acquired immune response . This in turn suggests that innate mechanisms are the basis of the early lesions and that subsequent acquired responses are unable to moderate them . This hypothesis differs from the current dogma that excessive activity of T cells mediates delayed-type hypersensitivity and that cellular cytolysis is the root cause of the necrosis. Int Immunopharmacol, 2003 Jan, 3(1), 115 - 8 Freund adjuvant induces TLR2 but not TLR4 expression in the liver of mice; Lim SK; Freund adjuvants are used extensively to establish experimental animal models of autoimmune diseases and to produce antibodies . However, studies on their mechanisms of action have been largely neglected, particularly their effects on liver, the primary target organ for host-microbe interaction . Here we show that treatment with either complete (CFA) or incomplete (IFA) Freund adjuvant induced a 5-10-fold increase in toll-like receptor (TLR) 2 mRNA but not TLR4 mRNA in livers of mice . Since CFA is essentially made of killed Mycobacterium tuberculosis bacilli (Mtb) dissolved in IFA, it is the solvent in CFA that induced an increase in TLR2 expression . As TLR2 is the receptor activated by killed Mtb, this solvent-mediated increase in TLR2 expression will result in enhanced recognition of killed Mtb by hepatocytes during CFA administration . We propose that the potency of Freund adjuvant in eliciting an immune response lies in their ability to induce expression of the appropriate TLR, TLR2, for the active ingredient, killed Mtb, in CFA . Neurosurgery, 2003 Feb, 52(2), 331 - 8; discussion 338-9 Surgical management and outcome of tuberculous atlantoaxial dislocation: a 15-year experience; Sinha S et al.; OBJECTIVE: Tuberculous atlantoaxial dislocation is a rare disease entity . However, tuberculosis continues to be endemic in developing countries . Its earliest clinical presentation may be nonspecific, and delay in diagnosis may lead to irreversible neurological deficit . The management of tuberculous atlantoaxial dislocation includes ventral cervicomedullary decompression, occipitocervical arthrodesis, and administration of antituberculous medications . METHODS: Eighteen patients with tuberculous atlantoaxial dislocation who presented with neck pain and/or occipital headache, restriction of neck movement, difficulty swallowing, and signs of myelopathy were studied . Four patients had evidence of associated pulmonary tuberculosis . Plain x-rays of the cervical spine, computed tomographic scans, and magnetic resonance images were obtained in all patients for diagnosis and to assess the degree of dislocation and cervicomedullary compression . Simultaneous anterior neural decompression, via a transcervical retropharyngeal approach, and posterior arthrodesis were performed on all patients while they remained under anesthesia . Antituberculous chemotherapy was continued for 18 months . RESULTS: Histopathological analysis of excised tissue was consistent with tuberculosis in all patients . However, Ziehl-Neelsen staining for acid-fast bacilli was positive in two cases, and culture for Mycobacterium tuberculosis was negative in all patients . Patients with severe myelopathy experienced marked improvement . One patient died of fulminant resistant tuberculous meningitis . CONCLUSION: The transcervical retropharyngeal approach to the craniovertebral junction provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity . It also prevents the development of persistent fistulae . Posterior stabilization should be performed directly after anterior neural decompression, while the patient remains under anesthesia, to prevent neurological deterioration before subsequent posterior fixation . This technique also is helpful for early mobilization of patients . The aim of surgical treatment should be to obtain biopsy tissue and to perform radical excision of epidural granulation tissue/abscess and infected bone using microsurgical technique . Antituberculous medication must be continued for 18 months with four drug regimens, and continuous monitoring of drug toxicity should be performed throughout the course of treatment. Rom J Gastroenterol, 2002 Dec, 11(4), 325 - 30 Whipple's disease . Case report; Andreica V et al.; The paper reports the clinical case of a 58 -year-old male patient admitted for diarrhea (6-7 stools/day, diffuse abdominal pain, borborygma, weight loss (20 kgs in two years), asthenia and fatigue . Physical examination evidenced a poor nutritional state (body mass index 19 kg/m2) . The abdomen was slightly distended . Biological tests evidenced moderate/severe anemia, hypoproteinemia and hypoalbuminemia . Endoscopic examination evidenced oedematous duodenal mucosa with white-yellowish deposits . Histology (HE stain) revealed the presence of foamy cells and the PAS-staining of the duodenal mucosa evidenced PAS-positive macrophages and numerous intracellular bacilli . Penicillin therapy 2 x 1 million U/day for 14 days, followed by tetracycline 4 x 250 mg/day improved the clinical picture, the patient had only one stool per day and gained weight . After 7 months of treatment the general condition was good and the patient had gained 17 kgs, the duodenal mucosa was normal . HE staining did not evidence foamy cells and no PAS-positive macrophages could be found. Paediatr Respir Rev, 2001 Jun, 2(2), 120 - 6 Diagnostic techniques in paediatric tuberculosis; de Charnace G et al.; Accurate diagnosis of tuberculosis (TB) in children is crucial to provide effective treatment and to identify the undiagnosed adult who probably infected the child . The diagnosis of tuberculosis in children is often based only on epidemiologic, clinical, and radiographic findings . Fibre-optic bronchoscopy may also be helpful but the recovery of tuberculous bacilli, which establishes the diagnosis, is difficult in children . Rapid diagnostic tests such as direct amplification and serological tests have been developed to improve early diagnosis . Their sensitivity is higher than that of conventional mycobacterial culture in most paediatric studies. Intensive Care Med, 2003 Jan, 29(1), 23 - 9 Epub 2002 Dec 04. Nosocomial pneumonia; Johanson WG et al.; Nosocomial pneumonia, or terminal pneumonia as it was formerly called, results from the repetitive microaspiration of contaminated oropharyngeal secretions into the lungs in the presence of impaired host defenses . This pathophysiologic sequence was suggested by the observations of Osler but clarified by the seminal work of Rouby and colleagues . The enormous impact of antimicrobial agents on the organisms responsible for nosocomial pneumonias was first identified by Kneeland and Price who found that organisms of the normal pharyngeal flora virtually disappeared in terminal pneumonias following administration of these drugs, being replaced by gram-negative bacilli . The remarkable susceptibility of seriously ill patients to becoming colonized by exogenous organisms, even in the absence of antimicrobial therapy, was shown by Johanson et al . These factors, antibiotics and the change in bacterial binding receptors in the airways associated with illness, lead to infections caused by exogenous organisms that are frequently resistant to antimicrobial agents . Clinical findings that usually identify patients with respiratory infections are unreliable for the diagnosis of nosocomial pneumonias as shown by Andrews et al . Invasive techniques, especially the protected specimen brush (PSB) technique, avoid contamination of the specimen by proximal secretions and accurately reflect the bacterial burden of the lung, as first shown by Chastre et al . Quantitation of such specimens serves as an excellent proxy for direct cultures of the lung and are the current gold standard for diagnosis. Rev Med Suisse Romande, 2002 Nov, 122(11), 531 - 3 {Traps of tuberculosis among the aged: an astonishing cyst of left foot}; Thievent B et al.; We report the case of a 75 years old man who insidiously developed a unusual presentation of tuberculosis . The story began with a tuberculous arthritis of the foot, later associated with pulmonary, endobronchial, mediastinal and cervical lymphadenitis tuberculosis . Because the microscopic examination was negative for acid-fast bacilli (AFB) in all involved sites, the diagnosis of sarcoidosis was suggested . We discuss the diagnosis difficulties of tuberculosis in the elderly, the extrapulmonary manifestations of tuberculosis and some aspects of its differential diagnosis with sarcoidosis. Afr J Med Med Sci, 2002 Mar, 31(1), 25 - 31 Pattern of active pulmonary tuberculosis in human immunodeficiency virus seropositive adult patients in University College Hospital, Ibadan, Nigeria; Awoyemi OB et al.; Fifty-eight confirmed HIV-seropositive adult patients were studied . All subjects were interviewed and examined . Subjects with positive respiratory symptoms and signs had their sputum examined and cultured for Mycobacterium tuberculosis (M . tuberculosis) . Their chest radiograph, full blood count (FBC) and erythrocyte sedimentation rate (ESR) were also estimated . Subjects with Pulmonary tuberculosis were treated using directly observed therapy short course (DOTS) regimen . Sixty-three percent of subjects were positive for Mycobacterium tuberculosis on direct smear and/or culture . Sputum acid fast bacilli (AFB) positive subjects who completed the intensive phase of antituberculous drugs were sputum converted at 2 months . The chest x-ray finding at diagnosis showed 2 subjects (11%) with normal chest x-ray; localised lesion in 7 (37%) subjects; diffuse lesion in 7 (37%); pulmonary cavities in 3 (16%); miliary pattern in 2 (11%); pleural effusion in 2 (11%); hilar adenopathy in 2 (11%) . Repeat chest-x-ray at 3 months showed complete clearance of pulmonary infiltrates in 29% whilst 71% had appreciable improvement in radiologic features . The study showed that although chest x-ray may be "normal" in sputum AFB positive HIV infected individuals, radiologic picture tends to be more diffuse and extensive . This study was therefore undertaken to determine the pattern of PTB in HIV seropositive adult patients in U.C.H., Ibadan. J Formos Med Assoc, 2002 Nov, 101(11), 741 - 8 Use of prophylactic antibiotics in surgery at a medical center in southern Taiwan; Chen YS et al.; BACKGROUND AND PURPOSE: Use of prophylactic antibiotics to prevent postoperative infection (POI) is a common practice in surgery . This study investigated the amount and cost of surgical prophylaxis in a representative general hospital in Taiwan in order to determine an appropriate course of action to control antibiotic use and decrease the burden of resistance . METHODS: The use of antibiotic prophylaxis for a wide variety of surgical procedures over a 6-month period was retrospectively evaluated in 3,104 patients at a medical center in southern Taiwan . RESULTS: Timing of perioperative parenteral antibiotics was inappropriate in 738 (23.8%) patients . The average duration of antibiotic use was 6.4 days (2.4 days intravenous + 4.0 days oral) . Only 4.9% of patients did not receive prophylactic antibiotics and only 9.2% received a single dose . Prophylaxis exceeded 1 day in 80% of patients and 3 days in 68.2% . The most common regimen was cefazolin plus gentamicin, used in 2,338 (75.3%) procedures . There were 146 POIs in 119 (3.8%) patients . The most common POI was at the surgical site . Aerobic gram-negative bacilli were most common among the 81 pathogens isolated (54.3%), followed by gram-positive cocci (34.6%), anaerobes (8.6%) and yeasts (2.4%) . The total cost for prophylactic antibiotics was New Taiwan (NT)$5,860,242 (approximately US$ 169,862) . Had a single dose of cefazolin been used for all patients, the cost would have been reduced by 92.1% . Had four doses of cefazolin been used, the cost would have been reduced by 68.5% . CONCLUSIONS: This study documented the excessive use and often inappropriate timing of administration of antibiotics for surgical prophylaxis in a representative medical center in Taiwan . Strategies are needed to improve the appropriate use of surgical antibiotic prophylaxis in Taiwan, not only to reduce costs but, more importantly, to delay the emergence of resistant microorganisms. J Assoc Physicians India, 2002 Sep, 50, 1110 - 4 Utility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients; Menon LR et al.; AIM: To evaluate the utility of bronchoalveolar lavage (BAL) in immunocompromised patients . MATERIAL AND METHODS: We studied BAL cytology and microbiological culture in 16 kidney transplant recipients (Group A), 14 dialysis patients (Group B) and eight HIV positive patients (Group C) suspected of having pulmonary infections . A group of 21 individuals without pulmonary diseases were studied as controls . RESULTS: A comparison of the cytological profile in controls and study groups showed that percentages of lymphocytes and neutrophils were significantly increased in all three patient groups as compared to controls, BAL bacterial cultures were positive in 4, 3 and 4 cases of Group A, B and C, respectively . Direct examination of BAL cytosmears helped in detecting cytomegalovirus inclusions, acid fast bacilli and Pneumocystis carinii in 3, 2 and 5 cases of Group A, B and C, respectively though microbial cultures were negative . The sensitivity of BAL cytology was found to be 76.3%, whereas that of microbial culture was only 31.5% . The diagnostic yield of BAL was 68.75%, 71.42% and 100% in the Groups A, B and C, respectively, while it was 76% when all three groups were considered together . BAL cytology yielded the diagnosis in 47.36% of cases, a combination of BAL cytology and culture in 23.68% and culture alone in 5.3% of cases . CONCLUSIONS: BAL is useful relatively non-invasive investigative tool in the rapid diagnosis of infections in immunocompromised patients . BAL cytology was found to be more useful than microbial cultures. Hunan Yi Ke Da Xue Xue Bao, 2000 Dec 28, 25(6), 573 - 5 {Comparison of infectious brain edema models induced by different kinds of pertussis bacilli in rats}; Yin F et al.; OBJECTIVE: To understand the difference of infectious brain edema models induced by varied kinds of pertussis bacilli in rats and to look for a new infectious brain edema model . METHODS: Sprague-Dawley rats were randomly divided into 3 groups: normal saline group(NS); rude pertussis bacilli(PBR); purified pertussis bacilli(PBP) . After infectious brain edema model was induced by rude pertussis bacilli or purified pertussis bacilli, the water content(WC), Evan's blue content(EB), Na+ and K+ content in brain tissues were measured . RESULTS: The WC, EB and Na+ contents in brain tissues in PBR and PBP groups were significantly increased than those in NS group; K+ content was significantly decreased in PBR and PBP groups than that in NS group(P < 0.01) . Evan's blue discoloration was demonstrated in all rats of PBR group, but 6 rats of PBP group showed bluish discoloration . EB content in brain tissues was significantly increased in PBR group than that in PBP group . CONCLUSIONS: The infectious brain edema model can be induced by rude pertussis bacilli or purified pertussis bacilli in rats, the former gives priority to mixed brain edema, and the latter mainly avails cytotoxin brain edema. Hunan Yi Ke Da Xue Xue Bao, 2000 Dec 28, 25(6), 519 - 21 {Effect of baicalin and dexamethasone on cytokines in brain tissue of infectious brain edema}; Yu Y et al.; OBJECTIVE: To explore the effect of baicalin(BC) and dexamethasone(DXM) on interleukin-1 beta (IL-1 beta) and tumor necrosis factor alpha(TNF-alpha) in brain tissues of infectious brain edema . METHODS: The infectious brain edema model induced by pertussis bacilli(PB) was used . Brain water content(WC), content of Na+ and the levels of IL-1 beta, TNF-alpha were determined, and the morphological changes were observed under the light microscope . RESULTS: The results showed that the levels of WC, Na+, IL-1 beta and TNF-alpha in group PB were higher than those in group of normal saline(NS) (P < 0.01) . And they were lower in groups BC and DXM than those in group PB(P < 0.05) . In groups BC and DXM, there were no significant difference in the contents of water, Na+, IL-1 beta and TNF-alpha(P > 0.05) . The water contents were positive linar correlated with IL-1 beta or TNF-alpha(P > 0.05) . The water contents were positive linear correlated with IL-1 beta or TNF-alpha contents(r = 0.9381, 0.8349, P < 0.01) . The structure of brain tissues in group NS was normal . In group PB, there were severe edema in brain tissues . In groups BC and DXM, the edema of brain tissues was reduced . CONCLUSIONS: The results suggest that the protective effect of BC and DXM against infectious brain edema were similar, the mechanism may be associated with the reduction of TNF-alpha and IL-1 beta. J Vet Sci, 2002 Sep, 3(3), 163 - 6 Mycobacterium bovis infection in a farmed elk in Korea; Kim JH et al.; A case of tuberculosis is reported in an eight-year-old, male, elk (Cervus elaphus nelsoni) . The elk showed severe coughing, respiratory distress, abdominal breathing, anorexia, and severe progressive emaciation in the elk farm . At necropsy, the elk appeared in poor body condition . Mild enlargement of retropharyngeal and submandibular lymph node was observed in the head . Diffuse fibrinous pleuritis and purple red lobar pneumonia were found in the thorax . Well demarcated numerous dark yellow discrete or confluent nodules from 0.3 to 2 cm in diameter were scattered in the whole lung . Bronchial and mediastinal lymph nodes were also enlarged . Histopathologically, lungs had typical classical tuberculous granulomas, multiple abscesses, and numerous macrophages and Langhans giant cells infiltration in alveolar lumen . In the lymph nodes, there were small clusters of necrosis and infiltration of numerous macrophages, epithelioid cells, and Langhans giant cells . With the acid-fast staining, numerous mycobacteria were revealed in the lung and lymph nodes . According to this study, there are differences of the histopathologic lesions and the numbers of acid-fast bacilli in the lesions between this elk and cattle . Mycobacterium bovis was confirmed as a causative agent in this elk using bacterial isolation, biochemical characteristics, and PCR technique . The isolate was negative for niacin test, nitrate reductase, and pyrazinamidase . This is a first report for bovine tuberculosis of farmed elk in Asia.<