Clin Infect Dis, 2001 Aug 1, 33(3), 330 - 7 Epub 2001 Jun 21. Mycobacterium haemophilum in immunocompromised patients; Shah MK et al.; Mycobacterium haemophilum, a recently described pathogen, can cause an array of symptoms in immunocompromised patients . To date, 90 patients with this infection have been described worldwide . We report our institution's experience with 23 patients who were treated from 1990 through 2000 . Fourteen patients had undergone bone marrow transplantation, 5 were infected with human immunodeficiency virus, 3 had hematologic malignancies, and 1 had no known underlying immunosuppression . Clinical syndromes on presentation included skin lesions alone in 13 patients, arthritis or osteomyelitis in 4 patients, and lung disease in 6 patients . Although patients with skin or joint involvement had favorable outcomes, 5 of 7 patients with lung infection died . Prolonged courses of multidrug therapy are required for treatment . A diagnosis of M . haemophilum infection must be considered for any immunocompromised patient for whom acid-fast bacilli are identified in a cutaneous, synovial fluid or respiratory sample or for whom granulomas are identified in any pathological specimen. J Cutan Pathol, 2001 Aug, 28(7), 368 - 70 Subcutaneous nodules in Whipple's disease; Tarroch X et al.; BACKGROUND: Cutaneous findings other than hyperpigmentation are rare in Whipple's disease . CASE REPORT: We present the case of a 59-year-old man previously diagnosed with Whipple's disease by duodenal biopsy, who developed red-brown, painful, subcutaneous nodules on the buttocks, thighs, arms and legs . Biopsy of these nodules showed a septal panniculitis and foamy macrophages containing PAS-positive, diastase resistant intracytoplasmic material, characteristic of Whipple's disease and similar to that observed in the duodenal biopsy . Ultrastructurally, this material in the histiocytes corresponded to degenerated bacilli . CONCLUSIONS: This is the fourth documented case of subcutaneous involvement by Whipple's disease . One should consider the possibility of Whipple's disease in any patient who presents with symptoms compatible with that condition who demonstrates septal panniculitis with a large amount of foamy histiocytes. Br J Oral Maxillofac Surg, 2001 Aug, 39(4), 320 - 3 Tuberculous parotitis: report of 3 cases; Suleiman AM; Tuberculous parotitis, particularly the diffuse form, is rare . I describe here three patients with diffuse tuberculous parotitis, two of whom presented with unilateral parotid swelling while the third had swellings of both glands . All had discharging sinuses . In two of the patients, the parotitis was associated with active pulmonary tuberculosis . In the patient with bilateral parotitis, the disease seemed to be confined to the glands . The diagnosis of tuberculosis was confirmed by the finding of tubercle bacilli in the lesion or the sputum . They all responded well to standard antituberculous drugs . Eur J Immunol, 2001 Jun, 31(6), 1935 - 43 Differential effects of TNF and LTalpha in the host defense against M . bovis BCG; Bopst M et al.; Signaling via TNF receptor type 1 (TNFR1) was shown to be crucial in host defense against the intracellular pathogens L . monocytogenes, M . tuberculosis and M . bovis . To investigate the function of TNF and LTalpha in host defense against M . bovis, mice double deficient for TNF and LTalpha (TNF / LTalpha (- / -)), TNF / LTalpha (- / -) mice complemented with a murine LTalpha transgene (TNF(- / -)) and LTalpha (- / -) mice were infected with BCG and the ensuing pathology was investigated . Control mice showed a normal host defense with early clearance of bacteria . The granulomatous reaction in the liver was accompanied by recruitment of activated macrophages characterized by their acid phosphatase positivity and differentiation into epithelioid cells as well as a coordinated expression of proinflammatory transcripts . In contrast, TNF / LTalpha (- / -) mice showed no comparable recruitment of activated macrophages in the liver . Furthermore, these mice showed extensive necrotic pulmonary lesions with massive growth of acid fast bacilli . Reintroduction of LTalpha as a transgene into TNF / LTalpha (- / -) mice prolonged survival but did not restore resistance to BCG . This, at least partially protective role of LTalpha was further supported by data demonstrating that LTalpha -deficient mice as well were susceptible to BCG infection . In contrast to the deleterious effect of TNF / LTalpha deficiency in BCG infection, BCG-infected TNF / LTalpha (- / -) mice were tolerant to LPS-induced shock . These results demonstrate that TNF as well as LTalpha are involved in murine host defense against BCG and that absence of TNF / LTalpha protects BCG-infected mice from LPS mediated shock. J Formos Med Assoc, 2001 May, 100(5), 336 - 8 Coexistence of tuberculous constrictive pericarditis and right atrial tuberculoma: a case report; Liu PY et al.; Tuberculous constrictive pericarditis is a rare condition with a high mortality rate . The coexistence of constrictive pericarditis and intracardiac tuberculoma has not previously been reported . We report the case of a 65-year-old man presenting with left-side pleural effusion and signs of systemic venous congestion for 2 months . Echocardiography and computerized tomography showed a thickened pericardium and a mass in the right atrium . Pericardiectomy and excision of the right atrial mass were performed . Pathologic examination of the pericardium and the right atrial mass both revealed chronic granulomatous inflammation with acid-fast bacilli and confirmed the diagnosis of tuberculous constrictive pericarditis and right atrial tuberculoma . This case reminds us of the possibility of this type of rare combination of tuberculous constrictive pericarditis and intracardiac right atrial tuberculoma, and the need for complete imaging studies when such cases are encountered. Nihon Kokyuki Gakkai Zasshi, 2001 Mar, 39(3), 205 - 9 {Follicular bronchiolitis associated with pulmonary tuberculosis--report of a case}; Ikedou Y et al.; The patient, a 39-year-old man, presented in May 1997 with an untreated persistent cough with excessive sputum of 5 years' duration . He was admitted to hospital because of the severity of the symptoms and the presence of acid-fast bacilli in his sputum . These bacilli were identified as Mycobacterium tuberculosis by the polymerase chain reaction method . After treatment with antituberculous drugs was initiated, his symptoms and the patchy infiltrative shadows on his chest radiographs gradually resolved . However, the patient continued to expectorate a purulent sputum, showed diffuse micronodular shadows on chest radiographs, and had hypoxemia as well as mixed ventilatory and small airway disturbances on pulmonary function tests . We performed a video-assisted thoracoscopic biopsy of the lung, which revealed follicular bronchiolitis. Nippon Ronen Igakkai Zasshi, 2001 May, 38(3), 312 - 6 {Clinical analysis of community-acquired pneumonia and pulmonary tuberculosis in the elderly and advances in treatment}; Kobashi Y et al.; We treated 510 elderly case (over 65 years old) among 1,017 patients with community-acquired pneumonia and 60 similar cases among 112 patients with pulmonary tuberculosis in Kawasaki Medical School Kawasaki Hospital during approximately the past 15 years . These were compared with non-elderly cases (below 65 years old) . In the elderly cases with community-acquired pneumonia, atypical clinical symptoms or physical signs were frequent and the mortality rate was high because of severe underlying diseases, and poor general and nutritional conditions . Regarding a prospective study of 84 elderly cases with community-acquired pneumonia during the past two years, S . pneumoniae, Respiratory virus, Gram-negative bacilli, H . influenzae, M . Tuberculosis were frequently isolated . In addition, mixed viral and bacterial infections, which were frequently noted during the winter, were significantly related to the increased frequency of community-acquired pneumonia . In treating elderly cases with community-acquired pneumonia, immunization therapy (e.g., influenza vaccine), second cephalosporin and/or macrolide antimicrobial agents for outpatients with mild pneumonia, and carbapenem and/or macrolide antimicrobial agents for hospitalized patients with moderate or severe pneumonia were most effective . The number of elderly cases with pulmonary tuberculosis has recently increased and the recognition of 10 cases was delayed because of a low percentage of positive smears, but no resistance to antituberculosis drugs have been observed . Regarding the treatment of pulmonary tuberculosis, fluoroquinolone and rifamycin derivative antibiotics have been developed as antituberculosis drugs with strong antituberculous activity . However, due to the high percentage of adverse effects in elderly patients, careful treatment with desensitization therapy for antituberculosis drugs is considered important. J Gynecol Obstet Biol Reprod (Paris), 2001 Jun, 30(4), 331 - 7 {Mammary tuberculosis: a series of 14 cases}; Morsad F et al.; OBJECTIVES: We examined cases of mammary tuberculosis in order to determine the different modes of presentation and analyze diagnostic difficulties . METHODS: Retrospective analysis of 14 cases of mammary tuberculosis treated at the Ibn Rochd University Hospital in Casablanca over a 16 year period . RESULTS: Patient age ranged from 16 to 65 years . Contact with a contaminated person was recognized in 2 cases . The predominant clinical presentation was a tumor formation (12 cases) which sometimes simulated cancer . Axillary nodes were observed in 10 cases with 1 case of fistulization . Mammography suggested cancer in 3 cases . The diagnosis of mammary tuberculosis was based on pathology findings in 14 cases (2 biopsies, 12 peroperative specimens) and isolation of bacilli from pus in one case . Medical treatment was given . Surgery was associated as needed (abscess drainage, residual lesions) . Except for one death due to tuberculous meningoencephalitis, clinical course was favorable with ad integrun breast recovery . DISCUSSION: Mammary tuberculosis is uncommon and often produces a pseudoneoplastic presentation . Pathology confirmation is required for diagnosis. Transpl Infect Dis, 1999 Jun, 1(2), 98 - 104 Tuberculosis in renal transplant recipients; Lattes R et al.; Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement . We report the impact of TB in kidney transplantation . Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections . Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed . Patients with a history of TB or graft loss in the first month were excluded . TB was diagnosed in 14 of 384 (3.64%) . Mean age at transplantation was 35 years . Twelve of these received the graft from a living donor . All had triple immunosuppression with cyclosporine . Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease . In 13 cases an invasive diagnostic procedure was performed . Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2 . Annual incidence varied from 0% to 3.1% . At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus) . Median time of onset was 13 months . Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft . TB was treated with 4 drugs including rifampin in 10 patients . Cyclosporine was discontinued in one, lowered in one and increased in 8 . During treatment 5 patients had rejection episodes . At 1 year, graft survival was 72.7% and patient survival 90.9% . TB was more prevalent when recipient and donor were both PPD positive . In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft . Optimal prophylaxis guidelines have yet to be completely defined. FEMS Microbiol Lett, 2001 Jun 25, 200(2), 215 - 9 Plate-based dormancy culture system for Mycobacterium smegmatis and isolation of metronidazole-resistant mutants; Lim A et al.; Mycobacterium smegmatis is an obligate aerobe . However, growth analyses in oxygen-limited liquid cultures have shown that the bacillus is able to survive anoxia with a half-life of 4 days by shifting down to a drug-resistant, dormant state . Metronidazole is the first lead against dormant bacilli and shows selective toxicity for this physiological state . Here, we report a plate-based dormancy culture system employing anoxic jars for M . smegmatis . Its usefulness for the genetic analysis of dormancy was demonstrated by isolating the first metronidazole-resistant mutants . Highly resistant mutants formed slightly yellow (as opposed to creamy) colonies . Furthermore, high-level metronidazole resistance correlated with an increased half-life of 12 days under anoxic conditions . This suggests a link between metronidazole susceptibility and anaerobic survival. Respir Med, 2001 Jun, 95(6), 444 - 7 Does immunotherapy with heat-killed Mycobacterium vaccae offer hope for the treatment of multi-drug-resistant pulmonary tuberculosis? Stanford JL, Stanford CA, Grange JM, Lan NN, Etemadi A. The ability of immunotherapy with heat-killed Mycobacterium vaccae (NCTC 11659), as an addition to the available chemotherapy, to improve the outcome in patients with multi-drug-resistant tubercle bacilli (MDRTB) who had not been cured by chemotherapy alone was evaluated in tuberculosis centres in Estonia, Iran, Kuwait, New Zealand, Romania, Vietnam and the U.K . A total of 337 patients in the above countries received intradermal injections of M . vaccae in addition to chemotherapy . Patients were grouped according to the length of their histories of disease: less than or greater than 2 years duration . Initially, single doses of M . vaccae were given but subsequently up to 12 doses at 2-month intervals were given . Chemotherapy varied from isoniazid alone to drugs selected according to susceptibility tests . Most patients had failed to respond to repeated courses of chemotherapy and the majority, were expected to die from their disease . Results were assessed by sputum smear and culture and by clinical observations . Cured patients were followed for 18-24 months to exclude relapse . Eighteen of 22 (82%) patients with disease for less than 2 years were bacteriologically cured by one or two doses of M . vaccae . Among 315 chronic patients, 24 (7.6%) were cured after one dose, 37.9% after seven doses and 41.6% after 12 doses . Sixty-six chronic patients were lost to follow-up, or died, during the multi-dose regimens . Nine of 33 patients (27%) with advanced disease unaffected by several courses of chemotherapy and discharged on isoniazid alone in Vietnam were cured by 3-12 injections of M . vaccae . The data provide preliminary evidence that the addition of immunotherapy with M . vaccae to chemotherapy improves the rate of cure of MDRTB, most effectively in patients with short histories of disease, but multiple dosing can have beneficial effects in chronic patients in whom chemotherapy has failed . A randomized clinical trial of this immunotherapy in MDRTB patients is therefore required. J Ind Microbiol Biotechnol, 2001 Mar, 26(3), 107 - 14 Inhibition of bacilli in industrial starches by nisin; Pirttijarvi TS et al.; The properties of Bacillus coagulans and of other bacilli that contaminate paper and paperboard manufacturing processes were investigated under simulated industrial conditions . Nisin (0.05 to 0.125 microg ml(-1) blocked growth of indigenous bacilli that contaminate sizing starches . B . coagulans starch isolates, B . licheniformis, B . amyloliquefaciens, and B . stearothermophilus grew at > or = 50 degrees C in industrial starch and produced alpha-glucosidase and cyclodextrins . The industrial isolates and reference strains of B . amyloliquefaciens, B . cereus, B . coagulans, B . flexus, B . licheniformis, B . pumilus, B . sporothermodurans, B . stearothermophilus and Alicyclobacillus acidoterrestris were inhibited by < or = 0.125 microg of nisin on agar . B . coagulans and B . stearothermophilus were similarly inhibited by < or = 0.025 microg of nisin ml(-1) and by 3 microg of the biocide DBNPA ml(-1) in industrial starch . B . licheniformis and B . amyloliquefaciens strains were less sensitive . About 40% of nisin added to starch was retained after cooking . Fifty percent of the nisin remained active after 11 h of storage at 60 degrees C . The results show that nisin has potential as a preservative for modified industrial starches. Eur J Surg, 2001 May, 167(5), 334 - 8 Diagnosis and treatment of isolated tuberculous mediastinal lymphadenopathy in adults; Ayed AK et al.; OBJECTIVE: To evaluate the diagnostic yield of bronchoscopy and mediastinoscopy in adults with isolated mediastinal tuberculous lymphadenitis and to assess the effect of antituberculous treatment . DESIGN: Prospective longitudinal cohort study of 34 patients with mediastinal tuberculous lymphadenitis followed for 6 to 19 months after completion of treatment . SETTING: Tertiary care hospital, Kuwait . PATIENTS: 34 consecutive patients who presented with isolated mediastinal lymphadenopathy from 1996 to 1998 . INTERVENTIONS: Bronchoscopy and cervical mediastinoscopy for all patients . MAIN OUTCOME MEASURES: Diagnostic yield of bronchoscopy and mediastinoscopy, and the outcome of treatment in patients with tuberculous lymphadenopathy . RESULTS: The mean age was 35 years (range 15-58) . The most common symptoms were cough, fever, and weight loss . The chest radiographs and computed tomograms showed abnormal mediastinal shadows with no evidence of parenchymal disease . All patients had right sided paratracheal lymphadenopathy . Tuberculin skin test gave a weal of >15 mm in 17 patients (50%) . Sputum smears and cultures failed to grow acid-fast bacilli in any patient . Seven patients had an endobronchial abnormality and samples taken at bronchoscopy gave a definite diagnosis in 3 (9%) . Paratracheal lymph node biopsy and culture by mediastinoscopy diagnosed tuberculosis in all cases . All patients were treated by a six month course of rifampicin and isoniazid supplemented initially by pyrazinamide for two months . Twenty-eight patients had a good response and the remaining patients were treated for a further 3 months . CONCLUSIONS: Bronchoscopy has a low diagnostic yield in mediastinal tuberculous lymphadenopathy in the absence of a parenchymal lesion . Mediastinoscopy is a safe but invasive procedure and provides a tissue diagnosis in most cases . Six months treatment with rifampicin and isoniazid supplemented initially by pyrazinamide is adequate treatment for most adults with tuberculous mediastinal lymphadenopathy. Dtsch Tierarztl Wochenschr, 2001 May, 108(5), 216 - 22 Ulcerative and papillomatous digital dermatitis of the pastern region in dairy cattle: clinical and histopathological studies; el-Ghoul W et al.; The study was carried out on a single herd of 500 Holstein breed dairy cattle . Only 50 dairy cows (10%) were found to be suffering from focal ulcerative and papillomatous digital dermatitis of the pastern region . The cows were subjected to clinical and histopathological examinations . Early ulcerative stage was seen in 30 cows and late papillomatous stage was observed in 20 cows . The topical application of oxytetracycline solution or benzathine penicillin powder appeared to be effective for the treatment of the ulcerative lesions . The histopathological findings showed signs of epidermopoiesis and papilloma formation . The dermal reaction revealed signs of fibroplasia and perivascular aggregation of inflammatory cells . Silver stained sections indicated the presence of longer filamentous spiral spirochetes, cocci and large-sized anaerobic bacilli invading the stratum spinosum . In conclusion it can be said that bovine digital dermatitis was observed in ulcerative and papillomatous form at the pastern region bordering the dewclaws . Spirochetes are frequently associated with and may be responsible for pathological changes in the lesion. Int J Tuberc Lung Dis, 2001 Jun, 5(6), 579 - 82 Quantitative bacillary response to treatment in Mycobacterium tuberculosis infected and M . africanum infected adults with pulmonary tuberculosis; Joloba ML et al.; Data regarding possible differences in microbiological response to therapy of disease caused by Mycobacterium tuberculosis and M . africanum are limited . Presenting clinical characteristics and sputum bacillary load during standard short-course chemotherapy in patients with newly-diagnosed pulmonary tuberculosis due to M . tuberculosis (n = 7) and M . africanum (n = 6) were compared . Changes in sputum bacillary load were measured using quantitative acid-fast bacilli smears, colony forming unit assay, and time until positive culture in the BACTEC radiometric system . Presentation and response to short course chemotherapy were comparable between patients infected with M . tuberculosis and those infected with M . africanum. Int J Tuberc Lung Dis, 2001 Jun, 5(6), 559 - 63 Efficacy and safety of sparfloxacin in combination with kanamycin and ethionamide in multidrug-resistant pulmonary tuberculosis patients: preliminary results; Singla R et al.; SETTING: Department of tuberculosis and chest diseases of a tertiary referral tuberculosis institute in New Delhi, India . OBJECTIVE: To study the efficacy and safety of sparfloxacin, in combination with kanamycin (for the initial 3-4 months) and ethionamide, in multidrug-resistant (MDR) pulmonary tuberculosis patients . DESIGN: Prospective, uncontrolled study of nine patients with pulmonary tuberculosis who had received adequate anti-tuberculosis treatment with first-line drugs, including supervised category II treatment regimen as per World Health Organization guidelines for 5 months, and were still sputum smear acid-fast bacilli positive . It was planned to give them kanamycin (initial 3-4 months), ethionamide and sparfloxacin for 2 years . RESULTS: All nine patients achieved sputum conversion within 6 months . Seven patients converted within 3.5 months, two of these within 1 month . All patients reported improvement in clinical symptoms, and chest X-ray improved in seven patients . Four patients developed mild to moderate phototoxicity . Eight patients have completed treatment for an average of 19 months (range 15-24 months), and are still under follow-up . One patient defaulted after 7 months of treatment . CONCLUSIONS: In MDR-TB patients, sparfloxacin, along with other anti-tuberculosis drugs, appears to be effective and safe . Mild to moderate phototoxicity is common . However, the long-term results, including relapses, are still awaited. J Neurosurg, 2001 Jun, 94(6), 988 - 91 An unusual presentation of neurotuberculosis: subdural empyema . Case report; Cayli SR et al.; Tuberculosis continues to be a major public health concern, especially in developing countries . Many types of neurotuberculosis have been described, but there is only one previously reported case of subdural empyema caused by tuberculous bacilli . A 1-year-old boy who had been treated for pulmonary tuberculosis was referred to the authors' institution with a diagnosis of right frontoparietal extraaxial abscess formation . Computerized tomography and magnetic resonance imaging revealed an extraaxial abscess with no evidence of calvarial infection . A craniotomy was performed to drain the pus, which was located subdurally . A polymerase chain reaction test yielded positive results, and histopathological examination revealed caseation . Antituberculous treatment was started after a diagnosis of subdural empyema with related neurotuberculosis had been made . At the end of a 12-month course of medical therapy, the patient was well with no evidence of tuberculosis. Int J Syst Evol Microbiol, 2001 May, 51(Pt 3), 1151 - 60 Legionella drozanskii sp . nov., Legionella rowbothamii sp . nov . and Legionella fallonii sp . nov.: three unusual new Legionella species; Adeleke AA et al.; Seven strains of Legionella-like amoebal pathogens (LLAPs) were characterized on the basis of their cultural and staining characteristics, biochemical reactions, serology, cellular fatty acids (CFAs), isoprenoid quinone composition, total DNA relatedness, analysis of 16S rRNA and macrophage infectivity potentiator (mip) gene sequence analyses . All seven strains exhibited limited growth on buffered charcoal yeast extract alpha (BCYE) agar, required cysteine for growth and contained branched-chain CFAs and quinones typical of Legionella species . The bacilli were Gram-negative and catalase-positive . There were varying degrees of serological cross-reactions between these LLAP strains and other previously described Legionella species . Results from the various tests revealed that four LLAP strains represent three unusual new species of Legionella: Legionella drozanskii sp . nov., type strain LLAP-1T; Legionella rowbothamii sp . nov., type strain LLAP-6T; and Legionella fallonii sp . nov., type strain LLAP-10T . Three other LLAP strains, designated LLAP-7FL, LLAP-7NF and LLAP-9, were shown to be members of the species Legionella lytica . The deductions made from the phenetic characteristics of these bacteria were consistent with the phylogenetic relationships inferred from 16S rRNA and mip gene sequence analyses . This study is the first to speciate LLAP strains on the basis of data including quantitative DNA hybridization. Int J Syst Evol Microbiol, 2001 May, 51(Pt 3), 1079 - 86 Sporosarcina aquimarina sp . nov., a bacterium isolated from seawater in Korea, and transfer of Bacillus globisporus (Larkin and Stokes 1967), Bacillus psychrophilus (Nakamura 1984) and Bacillus pasteurii (Chester 1898) to the genus Sporosarcina as Sporosarcina globispora comb . nov., Sporosarcina psychrophila comb . nov . and Sporosarcina pasteurii comb . nov., and emended description of th; Yoon JH et al.; A light-orange-coloured, facultatively anaerobic, rod-shaped bacterium (strain SW28T), which was isolated from seawater in Korea, was taxonomically studied by a polyphasic approach . This organism formed round terminal endospores in swollen sporangia . The peptidoglycan type is A4alpha, based on L-Lys-L-Ala-D-Asp . The predominant menaquinone is MK-7 and the major fatty acid is ante-C15:0 . The G+C content of the DNA is 40 mol% . Phylogenetic analysis based on 16S rDNA sequences showed that strain SW28T falls within the radiation of a cluster comprising the rRNA group 2 bacilli and non-Bacillus-type organisms . Strain SW28T showed the highest degree of relatedness to the type strain of Sporosarcina ureae, sharing 96.8% 16S rDNA similarity . Levels of DNA-DNA relatedness between strain SW28T and S . ureae DSM 2281T and the type strains of some Bacillus species forming a coherent phylogenetic cluster are less than 12.5% . On the basis of phenotypic and chemotaxonomic characteristics, 16S rDNA sequence analysis and DNA-DNA relatedness data, it is proposed that strain SW28T should be placed in the genus Sporosarcina as a new species, Sporosarcina aquimarina sp . nov . The type strain is SW28T (= KCCM 41039T = JCM 10887T) . From the results of the taxonomic re-evaluation, it is also proposed that Bacillus globisporus, Bacillus psychrophilus and Bacillus pasteurii be transferred to the genus Sporosarcina as Sporosarcina globispora, Sporosarcina psychrophila and Sporosarcina pasteurii, respectively. Indian J Pediatr, 2001 Apr, 68 Suppl 2, S11 - 9 Clinical approach to a patient with cough; Chugh K; A number of disorders of the respiratory tract and some even outside the respiratory tract can cause cough . A systematic approach towards a patient of chronic cough consisting of detailed history, physical examination of upper as well as lower respiratory tract, complete blood counts, tuberculin test, chest X-ray, and peak flow rate testing will give the diagnosis in majority of children . Pulmonary tuberculosis and asthma are the two commonest conditions diagnosed . If the initial work up is inconclusive, further laboratory testing and imaging studies should be considered . Thus, radiolabelled milk scan, barium swallow and 24-hour pH monitoring would diagnose gastroesophageal reflux . Spirometry, methacholine/exercise challenge test or a therapeutic trial may be required for confirming bronchial asthma . Flexible bronchoscopy is useful for evaluation for suspected aspiration syndromes and any anatomical or dynamic problem of the airway (e.g . tracheomalacia) . Spiral and high resolution computed tomography (HRCT) along with magnetic resonance imaging are the modern day imaging techniques used for studying mediastinal masses, airway obstruction and even lung parenchyma (HRCT) . Sputum examination for type of cells and bacteria can be useful, especially if pseudomonas or acid-fast bacilli are identified . Pseudomonas suggests cystic fibrosis (an uncommon disease in India) which can be confirmed by sweat chloride test and gene mutation studies. J Nephrol, 2001 Mar-Apr, 14(2), 132 - 5 Non tuberculous mycobacterium peritonitis in continuous ambulatory peritoneal dialysis; Youmbissi JT et al.; A forty-five-year old Saudi lady who had been on Continuous Ambulatory Peritoneal Dialysis (CAPD) for three years, was admitted with a clinical picture of night fever, sweating, weight loss and turbid peritoneal fluid (PF) . The PF had a high cell count, predominantly neutrophils . This condition failed to respond to a standard vancomycin-gentamycin treatment, and acid fast bacilli (AFBs) were stained from the PF . The patient was commenced on antituberculous treatment and the Tenckhoff catheter was removed . She was shifted to haemodialysis and recovered fully . Later, the AFBs were identified as a strain of mycobacterium fortuitum. J Leukoc Biol, 2001 Jun, 69(6), 1036 - 44 Different Toll-like receptor agonists induce distinct macrophage responses; Jones BW et al.; We previously reported that gram-negative bacterial lipopolysaccharide (LPS) activates cells via Toll-like receptor (TLR) 4, whereas the mycobacterial cell wall glycolipid lipoarabinomannan (LAM) activates cells via TLR2 . We also identified a secreted TLR2 agonist activity in short-term culture filtrates of Mycobacterium tuberculosis bacilli, termed soluble tuberculosis factor (STF) . Here we show that STF contains mannosylated phosphatidylinositol (PIM) and that purified PIM possesses TLR2 agonist activity . Stimulation of RAW 264.7 macrophages by LPS, LAM, STF, and PIM rapidly activated nuclear factor (NF)-kappaB, activator protein-1 (AP-1), and mitogen-activated protein (MAP) kinases . These TLR agonists induced similar levels of NF-kappaB and AP-1 DNA-binding activity, as well as trans-activation function . Unexpectedly, these TLR agonists induced tumor necrosis factor alpha secretion, whereas only LPS was capable of inducing interleukin-1beta and nitric oxide secretion . Thus, different TLR proteins are still capable of activating distinct cellular responses, in spite of their shared capacities to activate NF-kappaB, AP-1, and MAP kinases. Chest, 2001 Jun, 119(6), 1737 - 41 Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid; Nagesh BS et al.; OBJECTIVES: Tuberculosis, a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic . The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections . The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosis in pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation and acid-fast bacilli (AFB) screening . METHODS: The sensitivity and specificity of PCR in detection of mycobacterial DNA in 20 samples of tuberculous pleural effusion were evaluated using 40 samples of nontubercular pleural effusion as controls . The results were correlated with the ADA in all 60 pleural fluids . In addition, AFB detection by Ziehl-Neelsen staining on cytospin smears of all pleural fluids was also compared . RESULTS: Of the 20 samples of tuberculous pleural effusion, mycobacterium could be detected by AFB staining in 4 samples . Fourteen samples were PCR positive . None of the samples from the control group were AFB or PCR positive . The sensitivity of PCR, therefore, was 70.0% with specificity of 100% (positive predictive value, 100%; negative predictive value, 86.95%) . The sensitivity of AFB screening was at best 20% . The mean of ADA values in tubercular pleural effusions was 63.21 U/L (SD, 33.01), and the mean in the control samples was 51.1 U/L (SD, 29.71) . Taking a cut-off value of 50 U/L, both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were only 55% . CONCLUSION: PCR represents a rapid and sensitive method for the detection of mycobacterial DNA in tuberculous pleural effusions . AFB screening has low sensitivity, and ADA estimation has both low sensitivity and specificity . Therefore, when the clinical suspicion is high and smear result is negative, but the signs and symptoms of M tuberculosis are apparent, PCR is the method of choice for identifying the infection. Hong Kong Med J, 2001 Mar, 7(1), 89 - 92 Meningoencephalitis caused by Bacillus cereus in a neonate; Chu WP et al.; We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation . Grade IV hyaline membrane disease subsequently developed, for which a surfactant was given . On day 8, there were frequent apnoeic attacks, and on day 30, marked irritability developed, as did intermittent stiffening of all four limbs . The anterior fontanelle was bulging and tense, and the cerebrospinal fluid was found to be turbid . Gram staining of the cerebrospinal fluid and blood revealed Gram-positive bacilli . Subsequent culturing yielded Bacillus cereus, which was sensitive to amikacin and vancomycin . Severe cerebral oedema developed, however, and computed tomography of the brain showed bright cortical sulci, suggestive of meningitis . The baby died on day 37, and post-mortem histological examination of the brain showed extensive liquefactive necrosis with abundant neutrophilic infiltration . Since infection with Bacillus cereus is rapidly fatal, early recognition of infection by this organism is important. Kurume Med J, 2001, 48(1), 15 - 9 The significance of bronchoscopy for the diagnosis of Mycobacterium avium complex (MAC) pulmonary disease; Ikedo Y; To investigate the usefulness of bronchoscopy for the diagnosis of Mycobacterium avium complex (MAC) pulmonary disease, we retrospectively reviewed the clinical charts, and radiographic and bacteriologic findings of all patients who were admitted to our hospital between 1994 and 2000, and who fulfilled the 1997 American Thoracic Society (ATS) criteria for MAC pulmonary infection . A total of 132 patients were diagnosed as affected by MAC pulmonary disease during that period . Of these, bronchoscopic examination was performed in those patients who showed negative sputum smear for mycobacteria on three consecutive days (n = 43) or who could not expectorate sputum (n = 2) . Of 42 patients, sputum culture was positive for MAC in 34 patients (81.0%) . Bronchial washing sample was smear-positive for MAC in 17 of 39 patients (43.6%), and culture-positive for MAC in 33 of the 39 patients (84.6%) . Transbronchial lung biopsy (TBLB) specimens revealed specific findings (epithelioid cell granuloma and/or acid-fast bacilli) in 14 of 38 patients (36.9%) . Bronchial washing of all patients who showed specific histology in TBLB grew MAC in culture . Based on the bronchoscopic examination, we could diagnose MAC pulmonary disease in 36 patients . In addition, smear and polymerase chain reaction (PCR) results of bronchial washing made possible an early diagnosis of MAC pulmonary disease in 15 patients . We examined the relation of CT findings to bronchial washing results . Isolation of MAC in bronchial washing is significantly related to small nodular opacity around the ectatic bronchi on the CT scan (p = 0.016) . In our retrospective study, in sputum smear-negative patients with MAC pulmonary disease, MAC isolation by culture of bronchial washing was no more frequent than that with sputum culture . However, bronchial washing is useful to differentiate infection from casual isolation of MAC . In addition, we could make early diagnosis of MAC pulmonary disease based on smear and PCR results of bronchial washing . To make a diagnosis of MAC, bronchial washing is superior to TBLB, and should be done in the bronchus which drains the area revealing small nodular opacity around ectatic bronchi. Kekkaku, 2001 Apr, 76(4), 379 - 83 {A case of drug-resistant pulmonary tuberculosis treated successfully following disappearance of rifampicin resistance after 17 years' chemotherapy}; Shigeto E et al.; A female who first acquired pulmonary tuberculosis in 1962 when she was 25 years old, admitted to the National Hiroshima Hospital in 1982 . Her sputum has been smear positive for acid-fast bacilli for 3 years before admission in spite of continuous antituberculous chemotherapy, and were resistant to isoniazid (INH) and rifampicin (RFP) . She was treated with a regimen containing ethambutol (EB), prothionamide (TH) and enviomycin (EVM) but continued to be culture positive . Though she was treated with various regimens which include one to three sensitive drugs, her sputum continued to be positive for M . tuberculosis in the following 14 years . During the course, resistance to EB, TH, cycloserine (CS) and streptomycin (SM) emerged . Resistance to RFP temporarily retracted in 1988, but her sputum was bacilli negative only for 2 months after the addition of RFP to previous regimen, and followed by resurgence of RFP resistance . In 1992, data of drug sensitivity tests showed sensitivity to TH, CS and RFP in turn, which were not used for 3 to 5 years . In 1993, she was treated with RFP, TH and EVM successfully and continued to be bacteriologically negative for 7 years so far . Drug resistance to M . tuberculosis is induced by inappropriate chemotherapy as seen in this case . Regimens with less than three drugs without RFP and INH was not only insufficient to get cure but, what was worse, also induced additional resistance to used drugs . The reason of successful chemotherapy in this case was spontaneous disappearance of drug resistance to RFP and TH . This case suggests that the disappearance of drug resistance is possible, when drugs are not used for more than a few years, hence the successful treatment could be expected . However it must be emphasized that the drug resistance is produced by incorrect treatment as seen in this case, and its prevention is of the prime importance. Eur J Gastroenterol Hepatol, 2001 May, 13(5), 581 - 5 Tuberculous peritonitis--reports of 26 cases, detailing diagnostic and therapeutic problems; Demir K et al.; OBJECTIVE: To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic findings, and to assess the efficacy of triple antituberculous therapy without rifampicin for 6 months in patients with tuberculous peritonitis . METHODS: Twenty-six tuberculous peritonitis patients (11 male, 15 female) with a mean age of 34.8 +/- 3.4 years (range 14-77) were assessed with regard to diagnostic and therapeutic features . RESULTS: The most common symptoms and signs were abdominal pain (92.3%) and ascites (96.2%), respectively . Tuberculin skin test (TST) was positive in all patients . An abnormal chest radiography suggestive of previous tuberculosis was present in five patients (19.2%), and two patients (7.7%) had extra-peritoneal (cerebral, pericardial) active tuberculous involvement . In 24 of the 25 patients who underwent laparoscopy with directed biopsy, whitish nodules suggested tuberculous peritonitis; 76% of the biopsy specimens revealed caseating, 20% non-caseating granulomatous inflammation, and 4% non-specific findings . The ascitic fluid of one patient (3.8%) was positive for acid-resistant bacilli, and culture was positive in two patients (7.7%) . Twenty-four of the patients were treated for 6 months with isoniazid, streptomycin (total dose 40 g) and pyrazinamide (for the first 2 months and then substituted with ethambutol) . Eighteen patients also received methyl prednisolone, initially 20 mg/day, for 1 month . The follow-up period was 19 +/- 1.7 months after the end of therapy (range 6-36) . Ascites and abdominal pain abated earlier in patients on steroid therapy . All but two of the 24 patients responded to treatment . CONCLUSION: Non-invasive tests such as acid-fast stain and culture of the ascitic fluid are usually insufficient, hence invasive laparoscopy and peritoneal biopsy are necessary for the diagnosis of tuberculous peritonitis if non-invasive tests such as ascites adenosine deaminase activity measurement are not easily available . Triple therapy without rifampicin for 6 months is sufficient to treat tuberculous peritonitis. Biochem Biophys Res Commun, 2001 Jun 8, 284(2), 542 - 7 Resuscitation of dormant Mycobacterium tuberculosis by phospholipids or specific peptides; Zhang Y et al.; The presence of dormant tubercle bacilli presents a major problem for tuberculosis treatment . The culture supernatant of Mycobacterium tuberculosis was previously shown to resuscitate dormant bacilli in vitro . Here we report identification of active components as phospholipids and a tuberculosis protein Rv1174c . Remarkably, dormant bacilli from a one year old culture which failed to form any colonies could be resuscitated with peptides derived from Rv1174c and formed 10(5-7) colonies/ml . This finding represents the first unambiguous demonstration of resuscitation of dormant tubercle bacilli in vitro and may have implication for the study of mycobacterial dormancy and the design of novel strategies for improved treatment of tuberculosis . J Formos Med Assoc, 2001 Mar, 100(3), 213 - 6 Video-assisted thoracoscopic surgery for the diagnosis of patients with hilar and mediastinal lymphadenopathy; Chen JS et al.; In areas where tuberculosis (TB) is rare, cases of hilar and mediastinal lymphadenopathy are often attributed to the diagnosis of sarcoidosis or a malignant process . However, these manifestations have been only sparsely reported in countries with high rates of TB . The role of simultaneous lung biopsy in the differential diagnosis of these patients using a thoracoscopic approach is also undetermined . In this prospective study, 15 adult patients with hilar and mediastinal lymphadenopathy were evaluated using video-assisted thoracoscopy during the period from May 1995 through September 1999 . Biopsy of the hilar and mediastinal lymph nodes was undertaken in all 15 patients, and a wedge biopsy of the lungs was performed whenever frozen section of the nodes disclosed granulomatous inflammation . The final diagnoses included sarcoidosis (10 patients), TB (2), metastatic small cell carcinoma (2), and reactive lymphoid hyperplasia (1) . No morbidity or mortality was associated with the operation . In patients with sarcoidosis and TB, most of the lymph node biopsy specimens disclosed extensive hyaline fibrosis . Lung biopsy specimens presented small non-necrotizing granulomas with multinucleated giant cells even in the absence of demonstrable parenchymal lesions . In the two patients with TB, identification of acid-fast bacilli and growth of Mycobacterium tuberculosis occurred only in lung specimens and not in specimens from lymph nodes . Video-assisted thoracoscopic surgery is a safe, simple, and effective procedure for the diagnosis of patients with hilar and mediastinal lymphadenopathy . Our results suggest that for a better differentiation between TB and sarcoidosis, an additional lung biopsy could be undertaken to provide specimens for microscopic examination and culture. Acta Cytol, 2001 May-Jun, 45(3), 425 - 9 Pelvic abscess from enterobius vermicularis . Report of a case with cytologic detection of eggs and worms; Das DK et al.; BACKGROUND: Enterobius vermicularis is known to produce perianal and ischioanal abscesses and invade the peritoneal cavity via the female reproductive system, causing pelvic peritonitis . However, there are only rare case reports on the cytodiagnosis of these parasitic lesions . CASE: A 28-year-old woman was admitted with a tender left iliac fossa mass and greenish vaginal discharge . Ultrasonogram and computed tomography scan confirmed the presence of a mass lesion suggestive of a tuboovarian abscess . Cytologic examination of the pus obtained during left salpingo-oophorectomy revealed the presence of ova of E vermicularis and fragments of the adult worm in an inflammatory exudate consisting predominantly of neutrophils, eosinophils and occasional epithelioid cell granulomas . Paraffin sections of the tuboovarian mass showed necrotizing epithelioid cell granulomas, but neither ova nor any worm section was identified . Although the possibility of tuberculosis was considered histologically, Ziehl-Neelsen (Z-N) stain for acid-fast bacilli was negative . Z-N staining of the smear and mycobacterial culture of the pus also did not yield positive results . CONCLUSION: E vermicularis may cause tuboovarian abscess with necrotizing epithelioid granulomas mimicking tuberculosis . Cytologic examination of the pus is helpful in the diagnosis. Acta Cytol, 2001 May-Jun, 45(3), 333 - 40 Polymerase chain reaction vs . conventional diagnosis in fine needle aspirates of tuberculous lymph nodes; Goel MM et al.; OBJECTIVE: To compare four conventional methods of diagnosing tuberculous lymphadenophathy (TL)--namely fine needle aspiration cytology (FNAC), Zeihl-Neelsen staining of smears for acid-fast bacilli (AFB), culture for Mycobacterium tuberculosis (MTB) and lymph node biopsies--with the polymerase chain reaction (PCR) in order to assess the practicability and advantage of its use in routine diagnosis in a developing country . STUDY DESIGN: Fine needle aspirates from 142 consecutive patients presenting with lymphadenopathy (mainly cervical) without any known systemic involvement underwent cytomorphologic diagnosis, AFB smears, culture for MTB, confirmatory biopsy and PCR for MTB . The aspirates from cases other than TL served as controls for PCR . RESULTS: Correct diagnosis of tuberculosis could be made in 94.87% of cases by a combination of the four methods . PCR was done in 52 cases, 39 confirmed TL and 13 controls . Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of PCR were 94.44%, 38.23%, 44.73% and 92.85%, respectively, when culture alone was considered the gold standard . However, specificity (38.23-92.30%) and PPV (44.73-97.36%) of PCR increased remarkably when response to treatment was taken as the final arbiter . CONCLUSION: The four conventional tests were found to be the methods of choice for the diagnosis of TL in developing countries . PCR should be reserved for problem cases. Mikrobiol Z, 2001 Jan-Feb, 63(1), 72 - 9 {Bacteria of Bacillus species--prospective source for biologically active substances}; Smirnov VV et al.; The present data from literature on bio-active substances produced by aerobic sporulating bacteria of Bacillus genus are presented . Problems of antibiotics synthesis by bacilli are considered . The antibiotics under consideration are both well-known and new ones--biosurfactants characterized by the surface-active properties . Enzymic activity of Bacillus genus bacteria has been characterized . Special attention was given to the analysis of enzymes, which could play a positive part in the digestion processes . Data are presented which evidence that the bacilli produce the substances, which affect essentially the immune reactivity of the macroorganism. An R Acad Nac Med (Madr), 2000, 117(4), 791 - 806; discussion 807-12 {Spanish disinfectants for the 21st century}; Herruzo Cabrera R; There are two chemical disinfectants patents from Spain that permit to obtain advantageous products on other disinfectants: Nduopropenide (two iodures of quaternary ammonium) and "Peroxidine" (hydrogen peroxide that active to lactic acid and a surfactant mixture) . The first product is used as an antiseptic or disinfectant, but the second, only act as disinfectant . DISINFECTION: It is studied (by germ-carrier methods), the microbicide effect on different microorganisms (Gram positive cocci, Gram negative bacilli, fungus, Mycobacteria and B subtilis spores), comparing these two products with different disinfectants as 2% glutaraldehyde, 1/8 phenate-glutaraldehyde, peracetic acid compounds, 11% oxygen peroxide and 2% sodium hypoclorite . It is obtained that 1/4 Peroxidine in 5 minutes or 1/6 Peroxidine in 10 minutes, are the most effective disinfectant on all microorganisms used (includes the most resistant) since it produces destruction of 4 log-10 of spores and 5 log-10 of Mycobacteria . Moreover, it can destroy, completely, the inoculum of commercial spores, routinely used for sterilization process evaluation, in 20 minutes, when 2% glutaraldehyd needs 3-10 hours . ANTISEPSIE: It is studied the "hygienization" and surgical handwashing with Nduopropenide solution, in comparison with classical washing methods (neutral soap in routinely handwashing and 5% chlorhexidine or 10% iodine-povidone in surgical washing): 1) Nduopropenide and alcohol solution is more effective that routinely handwashing . 2) This product is more effective and persistent, after surgical washing that chlorhexidine or iodine-povidone . Moreover, it does not must be applied with brush . 3) The mixture Nduopropenide and chlorhexidine makes a synergy, then it can be used in hand or skin washing, on heath personnel or patient people, being advantageous on the other products. Phys Ther, 2001 Jun, 81(6), 1253 - 9 Physical therapist management of tuberculous arthritis of the elbow; Dahl CS; BACKGROUND AND PURPOSE: Tuberculous arthritis is not commonly seen by physical therapists in the United States . The purpose of this case report is to describe a case of tuberculous arthritis of the elbow . CASE DESCRIPTION: The patient was a 36-year-old man referred for physical therapy evaluation and intervention for chronic elbow pain . After an evaluation and a trial of physical therapy, the patient was referred back to a primary care provider for additional tests to rule out systemic pathology . An open debridement of synovium and biopsy of the capitellum and radial head was positive for acid-fast bacilli, which was later identified as Mycobacterium tuberculosis . OUTCOMES: The patient was placed on a 4-drug antituberculosis regimen that resolved all patient complaints and restored full elbow function . DISCUSSION: Tuberculous arthritis has characteristic findings during examination and in diagnostic tests . Although tuberculous arthritis is uncommon, it should be considered when patients have chronic or vague musculoskeletal complaints. Saudi Med J, 2001 May, 22(5), 423 - 7 Fever and granulocytopenia in children with acute lymphoblastic leukemia under induction therapy; Meir HM et al.; OBJECTIVE: Infection is one of the most serious complications of cancer therapy . The rationale of using broad spectrum antibiotics prophylactically has led to a great change in the causative organisms . The aim of the present study is to review retrospectively the type and sequence of infectious complications among Saudi children with acute lymphoblastic leukemia . METHODS: A total of 233 febrile episodes were observed in 137 children with acute lymphoblastic leukemia under induction therapy using modified BFM protocol were studied . RESULTS: Profound neutropenia (Absolute Neutrophil count < 100/mm3) was encountered in 72 episodes (31%) . Clinical signs and symptoms suggestive of infection were evident in 39% of the neutropenic episodes . The respiratory system was the most frequently affected site encountered in 17% of the episodes . Microbiologically documented infection was recorded in 59% (n=137) of the fever and granulocytopenia episodes . In 96 episodes (41%), there was neither clinical nor microbiological evidence of infection fever of unknown origin . Out of the 932 cultures, positive isolates were detected in 346 cultures (37%) . Gram positive cocci were the most frequently organisms (54%) followed by gram negative bacilli (39%) . In the current study, 7 patients (3%) died because of direct or indirect consequences of infection . CONCLUSION: The current study stresses the importance of frequent reviewing of the type, frequency, severity and outcome of infection complications over years to detect changing epidemiological patterns. Microb Pathog, 2001 May, 30(5), 271 - 8 Differential expression of sigE by Mycobacterium tuberculosis during intracellular growth; Jensen-Cain DM et al.; The Mycobacterium tuberculosis sigE gene encodes a sigma factor that is a member of the extracytoplasmic function subfamily of sigma factors . Using RT-PCR we demonstrated that sigE is expressed in M . tuberculosis bacilli during growth in human macrophages beginning after 30 min but before 6 h after infection through at least 5 days after infection, but that sigE is not expressed by M . tuberculosis bacteria during growth in Middlebrook 7H9 broth medium . However, sigE expression can be induced by treatment of broth cultures with hydrogen peroxide . Further, sigE is not expressed by M . tuberculosis bacilli during attachment or growth in type II pneumocytes . Using a green fluorescent protein (GFP) reporter gene fused to the sigE promoter, we observed induction of GFP expression following macrophage infection . Western blotting confirmed that sigE protein expression correlated with mRNA expression in induced systems . Analysis of the region of the M . tuberculosis genome encoding sigE suggested it is part of an operon consisting of sigE-orf1-htrA-orf2 . The data presented in this report showed that sigE is differentially expressed by M . tuberculosis bacilli in macrophages and might play a role in the pathogenesis of this organism . AIDS Treat News, 1999 Feb 19, (No 313), 5 - 6 Tuberculosis control: many cases found transmitted despite negative result on standard test; James JS; AIDS: The acid-fast bacilli (AFB) sputum smear is the standard tuberculosis test, but it fails to detect many people who are infectious . One-sixth of the patients diagnosed since 1991 in San Francisco acquired the infection from people whom the AFB smear did not detect as infectious . The research was supported by the U.S . National Institutes of Health and the McLaughlin Foundation of Canada . Although sputum smears identify the most infectious patients, patients with negative smears should not be considered non-infectious . Worldwide diagnosis of tuberculosis could be improved if a more sensitive and affordable test were developed . AIDS Clin Care, 1995 Dec, 7(12), 97 - 102 Bartonella-associated infections in HIV-infected patients; Koehler JE; AIDS: Two species of the gram-negative bacilli Bartonella, B . henselae and B . quintana, cause disease in HIV-infected patients . If untreated, infection can be fatal . Manifestations include bacillary angiomatosis (BA), bacillary peliosis hepatis (BP), bacteremia, or a combination of these . BA and BP present as lesions, but bacteremia may be subacute and persist for months without diagnosis . Additionally, patients may acquire cat scratch disease (CSD), but this is more common in immunocompetent patients . BA lesions are usually vascular, friable, and bleed profusely when traumatized . They may be confused with Kaposi's sarcoma (KS), pyogenic granuloma, lymphoma and various subcutaneous tumors and infections . Lesions may affect almost any organ, and appear as angiomatous papules, dry scaling lesions, subcutaneous nodules, cellulitic plaques or deep, highly vascularized, soft tissue masses . Patients may have osseus BA lesions (frequently affecting the long bones); hepatic and/or splenic lesions; bacteremia; or endocarditis . To diagnose infection, lesions should be biopsied and examined . Hematoxylin and eosin staining reveal histopathologic changes; darkly staining organisms are evident after Warthin-Starry silver staining; and electron microscopy allows visualization of the bacillus . An indirect immunofluorescence antibody test (IFA) detects bartonella-specific IgG antibodies . Treatment with erythromycin for at least three months is recommended, or with doxycycline if erythromycin is not well-tolerated . Severely ill patients should receive IV doxycycline with either gentamicin or rifampin for at least four months . To prevent infection, HIV-infected people should avoid traumatic cat contact and exposure to the body louse . J Immunol, 2001 Jun 1, 166(11), 6728 - 34 TNF-alpha controls intracellular mycobacterial growth by both inducible nitric oxide synthase-dependent and inducible nitric oxide synthase-independent pathways; Bekker LG et al.; The role of TNF-alpha in the control of mycobacterial growth in murine macrophages was studied in vitro . Infection of macrophages from TNF-alpha gene disrupted (TNF-knockout (KO)) mice with recombinant Mycobacterium bovis bacillus Calmette Guerin (BCG) expressing the vector only (BCG-vector) resulted in logarithmic growth of the intracellular bacilli . Infection with BCG-secreting murine TNF-alpha (BCG-TNF) led to bacillary killing . Killing of BCG-TNF was associated with rapid accumulation of inducible NO synthase (iNOS) protein and the production of nitrite . The uncontrolled growth of BCG-vector was associated with low iNOS expression but no nitrite production . Thus, iNOS expression appears to be TNF-alpha independent but iNOS generation of NO requires TNF-alpha . In cultures of TNF-KO macrophages infected with BCG-TNF, inhibition of iNOS by aminoguanidine (AMG) abolished the killing of the bacilli . However, the growth of the organisms was still inhibited, suggesting an iNOS-independent TNF-alpha-mediated growth inhibition . To confirm this, macrophages from iNOS-KO mice were infected with either BCG-vector or BCG-TNF . As expected, no nitrite was detected in the culture medium . TNF-alpha was detected only when the cells were infected with BCG-TNF . In the iNOS-KO macrophages, the growth of BCG was inhibited only in the BCG-TNF infection . These results suggest that in the absence of iNOS activity, TNF-alpha stimulates macrophages to control the growth of intracellular BCG . Thus, there appears to be both a TNF-alpha-dependent-iNOS-dependent killing pathway as well as a TNF-alpha-dependent-iNOS-independent growth inhibitory pathway for the control of intracellular mycobacteria in murine macrophages. Aust Endod J, 2000 Dec, 26(3), 115 - 8 Bacterial contamination of cracks in symptomatic vital teeth; Kahler B et al.; As part of an ongoing study on the initiation of cracks in teeth, 20 teeth exhibiting symptoms consistent with the presence of dentinal cracks were examined . The presence of a cracked cusp was confirmed by the selective application of pressure either with a mirror handle or Fracfinder (Svenoka, Dental Instruments, Vasby, Sweden) . Cracked cusps were fractured from the teeth after the removal of all existing restorations and were immediately placed into ten percent formalin . Subsequently, specimens were dehydrated, sputter-coated and examined under the scanning electron microscope (SEM) . All the cracked cusps exhibited complete fracture of the dentine to the level of the dentino-enamel junction . No partial fractures were seen . Numerous bacteria of many morphological forms were present on the dentinal surfaces, of all fractured cusps, in all teeth . Cocci, bacilli and filamentous forms were consistently found . Many bacteria were in the process of division . While bacterial contamination of dentinal cracks has been described in histological studies, the nature and distribution of these bacterial and fungal forms has not been shown previously in any detail . Prior SEM studies investigating the nature and mechanisms of fracture have not revealed bacterial contamination of the fractured surface . This paper draws attention to the fact that all symptomatic cracks in teeth appear to 1 . extend right through the dentine to the dentino-enamel junction, and 2 . appear to be extensively contaminated by bacteria. J Hosp Infect, 2001 May, 48(1), 76 - 9 Pseudo-outbreak of Mycobacterium gordonae associated with water from refrigerated fountains; Lalande V et al.; Between March 1997 and December 1997, acid-fast bacilli (AFB) were detected on sputum and/or gastric aspirates smears from five patients hospitalized in the chest medicine department . These specimens grew M . gordonae . Based on AFB-positive smear and clinical presentation, four out of five patients received antituberculous treatment until species identification was known . Epidemiological investigation revealed a heavy contamination of water collected from refrigerated fountains located on the same floor as the patient cases . Strains isolated from four patients and the refrigerated fountain exhibited the same pulsed gel electrophoresis pattern (using DraI and XbaI enzymes) suggesting that positive smears were related to drinking water from the refrigerated fountain . This cluster of pseudo-infections underlines the necessity for a proper maintenance of water supply equipment in order to avoid inappropriate decisions deleterious for patients . Rev Pneumol Clin, 2001 Apr, 57(2), 139 - 44 {Nosocomial pulmonary tuberculosis}; Bouvet E; The impact of nosocomial tuberculosis remains poorly known . There is a real risk that is relatively higher when the probability of community acquisition declines . Diagnosis is difficult due to the natural history of tuberculosis infection so that most cases of nosocomial contamination result in infection without disease expression . The nosocomial origin is rarely recognized . Though diagnosis is difficult, prevention is well described: early diagnosis of tuberculosis disease and treatment as well as respiratory isolation in case of suspected tuberculous bacilli . Particular care is required in units managing immunodepressed patients where the risk of contamination and development of overt tuberculosis is greater. Antimicrob Agents Chemother, 2001 Jun, 45(6), 1607 - 14 Effect of drug concentration on emergence of macrolide resistance in Mycobacterium avium; Nash KA; The emergence of antibiotic resistance in mycobacteria involves the selection of mutant variants within a susceptible bacterial population . However, it is unclear whether antimycobacterial drugs act just as selective agents or can influence the rate of appearance of resistant mutants . The present study was initiated to address this issue by monitoring the effects of antimicrobial agents on the appearance and growth of clarithromycin (CLR)-resistant (CLR(r)) bacilli in broth cultures of Mycobacterium avium . Preexposure of M . avium to CLR had a significant dose effect on the emergence of resistance, with concentrations of 4 to 8 microg/ml resulting in a maximal (approximately 10(4)-fold) increase in the number of CLR(r) bacilli after a 4-day incubation . In addition, a dose effect was found with azithromycin . The use of combinations of CLR with either ethambutol (EMB) or rifabutin (RFB) resulted in fewer resistant bacilli compared to the use of CLR alone . The lowest active concentration of EMB (4 microg/ml) was equivalent to the EMB MIC (4 to 8 microg/ml) for the parental CLR(s) strain and the emergent CLR(r) variants, and thus, the antiresistance effect was probably the result of the bacteriostatic effect of EMB on CLR(r) bacilli . However, RFB was an order of magnitude more active (0.05 microg/ml) at reducing resistance than suggested by the MIC of this agent (0.5 to 1 microg/ml) . These results indicate that the emergence of resistance was not simply the selection of a preexisting subpopulation of resistant bacilli . Further analysis suggested that early events in the emergence of resistance involved organisms (progenitors) that acquired a resistance phenotype . In addition, the progenitors appeared to be in a transient state, able to develop into a stable resistant lineage in the presence of CLR, or able to revert to the wild type in nonselective conditions. Chest, 2001 May, 119(5), 1434 - 8 Microbiology of pediatric primary pulmonary tuberculosis; Merino JM et al.; OBJECTIVE: To determine the sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis . PATIENTS AND METHODS: Between January 1988 and December 1996, 104 consecutive patients aged 0 to 18 years received a diagnosis of primary pulmonary tuberculosis at our institution . Demographic, clinical, laboratory, and bacteriologic data were collected . Clinical specimens were studied for acid-fast bacilli detection by Ziehl-Neelsen stain and cultured for Mycobacterium recovery by Lowenstein-Jensen culture medium . Statistical analysis was performed utilizing chi(2), t tests, and multivariate logistic regression analysis . RESULTS: Bacteriologic results were available for 57 patients (54.8%) . A positive smear or culture result for Mycobacterium tuberculosis was obtained in 9 of 54 patients (16.6%) and 25 of 50 patients (50%), respectively . Confirmation of M tuberculosis disease was achieved in 28 patients (49.1%) . Ziehl-Neelsen stain and Lowenstein-Jensen culture recovery rates were 10.3% (14 of 135) and 52% (48 of 92) of specimens studied, respectively . Sputum, pleural fluid, and biopsy material cultures yielded M tuberculosis in 55%, 75%, and 63% of patients, respectively . Mean +/- SD age (13.7 +/- 4.5 years vs 9.6 +/- 4.5 years) and number of samples submitted for culture (1.93 +/- 0.94 vs 1.31 +/- 0.97) were significantly higher in the confirmed tuberculosis disease group (p < 0.05) . The presence of a pleural effusion was also more commonly found in the confirmed tuberculosis disease group (p < 0.05) . CONCLUSION: The sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis disease was 49.1% . Age is the main factor associated with the positivity of culture results. J Appl Microbiol, 2001 May, 90(5), 761 - 70 Effect of sporulation and recovery medium on the heat resistance and amount of injury of spores from spoilage bacilli; Cazemier AE et al.; AIMS: To assess the influence of sporulation media on heat resistance, and the use of stress recovery media to measure preservation injury of spores of five representative spoilage bacilli . METHODS AND RESULTS: Bacillus spores prepared on nutrient agar supplemented with Ca2+, Mg2+, Mn2+, Fe2+ and K+ were more heat-resistant than spores obtained from nutrient agar with Mn2+ . This increased heat resistance correlated with a decrease in the protoplast water content as determined by buoyant density sedimentation . The degree of preservation injury severity could be assessed on media containing NaCl at moderate pH and organic acids at acid pH . Ca-DPA, K+ or proline were added to the recovery media to demonstrate that heat probably caused injury to both spore germination and the outgrowth system . SIGNIFICANCE AND IMPACT OF THE STUDY: The metal content of sporulation media can strongly effect the validity of preservation resistance studies . The distinctive recovery media developed here can be relevant for assessing and comparing new preservation technologies. Bull Soc Pathol Exot, 2001 Mar, 94(1), 9 - 10 {Value and limits of microscopy of exudates in Mycobacterium ulcerans cutaneous infection in Côte d'Ivoire}; N'Guessan K et al.; The objective of this study was to estimate the interest and the limits of skin exudate microscopy for patients with chronic ulceration with clinically suspected Buruli's ulcer and living in an endemic area in Cote d'Ivoire . Two stained smears, one with Ziehl-Neelsen and the other Dugomier staining, were produced from 140 samples obtained after a swab of skin lesions . The positive smear rate for the acid fast bacilli (AFB) was respectively 16.4% and 12.9% for Dugomier and Ziehl-Neelsen staining . The ulceration with less than one year of evolution have high AFB rates of 15.8% for Ziehl-Neelsen staining and 21.1% for Dugomier's . Microscopic examination of skin exudate in face of ulceration, clinically suspected to be a Buruli's ulcer is not the best tool for biological diagnosis, due to poor technical sensibility . Nevertheless, it remains a good first means of investigation in an endemoepidemic area. Am J Clin Pathol, 2001 May, 115(5), 755 - 62 Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (hot tub lung); Khoor A et al.; The clinicopathologic spectrum of infections due to nontuberculous mycobacteria (NTM) includes cavitary disease, opportunistic infection, and nodular disease associated with bronchiectasis . We report a less well-described manifestation of NTM infection: 10 immunocompetent patients without preexisting bronchiectasis had radiographic evidence of diffuse infiltrative lung disease . The most common symptoms were dyspnea, cough, hypoxia, and fever . All 10 patients had used a hot tub . Histologic examination revealed exuberant nonnecrotizing, frequently bronchiolocentric, granulomatous inflammation in all cases . In 1 case, necrotizing granulomas were also noted . The inflammation often was associated with patchy chronic interstitial pneumonia and organization . Cultures revealed NTM in all cases (Mycobacterium avium complex in all but 1 case), but staining for acid-fast bacilli was positive in only 1 case . Four patients received corticosteroids alone for presumed hypersensitivity pneumonia, 4 were treated with antimycobacterial therapy, and 2 received both . All patients demonstrated significant improvement at the time of follow-up . These findings suggest that disease due to NTM may manifest as diffuse infiltrates in immunocompetent adults and that hot tub use may be an important risk factor for this disease pattern. J Am Mosq Control Assoc, 2001 Mar, 17(1), 33 - 41 Recovery of commercially produced Bacillus thuringiensis var . israelensis and Bacillus sphaericus from tires and prevalence of bacilli in artificial and natural containers; Siegel JP et al.; We conducted surveys to identify the species of spore-forming bacteria present in natural and artificial containers . Most of our samples came from Illinois . Identification was based on the cellular fatty acid composition of the bacterial cell wall . In addition, we utilized a custom database for commercially produced strains of Bacillus thuringiensis var . israelensis (Bti) and B . sphaericus, to differentiate between larvicidal isolates with commercial or native origin . Native Bti was present at low levels in almost all habitats but was not recovered from bromeliads and metal containers . In temporary woodland pools, 27.9% of the colonies recovered were native Bti . We did not recover larvicidal B . sphaericus in untreated habitats . VectoBac and VectoLex were applied to tires containing water and the tires were sampled 3 months and 9 months after treatment . Isolates of Bti and B . sphaericus with commercial origin were recovered as long as 9 months after application . We noticed numerous cadavers of Aedes triseriatus in several tires 9 months after treatment with VectoBac . We could not determine if this mortality resulted from recycling of Bti in these tires or whether insecticidal crystal proteins from the original treatment were resuspended . Bacillus thuringiensis var . israelensis isolates with commercial ancestry were recovered from untreated tires 9 months after application . Isolates of larvicidal B . sphaericus that differed from the bacteria in VectoLex were also recovered from untreated tires. Rhinology, 2001 Mar, 39(1), 47 - 8 Primary nasal tuberculosis; Hup AK et al.; We present a case of a patient with primary nasal tuberculosis . Although this is a rare finding, it should be considered when a patient presents with a nasal obstruction . Smears for acid fast bacilli and cultures tend to be negative in nasal tuberculosis . Diagnosis is often based on histo- pathologic findings . Nasal TB is known to respond well to the regular treatment for (pulmonary) tuberculosis. Eur J Gastroenterol Hepatol, 2001 Apr, 13(4), 437 - 40 Tuberculous liver abscess: a case report and review of literature; Rahmatulla RH et al.; Tuberculous liver abscess is rare worldwide . We report a 45-year-old man who presented with abdominal pain, fever and weight loss . Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver . Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli . The abscess was drained under ultrasound guidance . Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity . He was concomitantly started on systemic antituberculous therapy . A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management . A greater awareness of this clinical entity is required for successful treatment. Diagn Cytopathol, 2001 May, 24(5), 333 - 5 Fine-needle aspiration cytology of postvaccinial disseminated bacillus Calmette-Guerin infection; Al-Bhlal LA; Nine patients with primary immunodeficiency who received bacillus Calmette-Guerin (BCG) vaccine at birth developed disseminated BCG lesions and presented clinically with generalized skin rash and skin nodules . Fine-needle aspiration biopsy of the skin nodules and/or enlarged lymph nodes was performed in all patients . The most common cytologic pattern encountered was cellular smears showing a large number of histiocytes with abundant streaked cytoplasm in a background of neutrophils and debris . No granulomas were noted . Ziehl-Neelsen (ZN) stain for acid-fast bacilli showed a large number of these bacilli within the cytoplasm of the histiocytes, and extracellularly . This pattern was seen in 6 patients . The cytologic smears from 3 patients showed epithelioid granulomas in a background of neutrophils and debris . ZN stain for acid-fast bacilli showed fewer numbers of these bacilli compared to the first cytologic pattern . In conclusion, the most common cytologic pattern of postvaccinial disseminated BCG lesions in immunocompromised patients is a large number of histiocytes with abundant streaked cytoplasm in a background of neutrophils and debris . No epithelioid granulomas are seen in this pattern . A less frequent pattern is also encountered which shows epithelioid granuloma in a neutrophilic background . In both cytologic patterns, ZN stain for acid-fast bacilli is positive . However, in the first and most common pattern, the number of acid-fast bacilli is much larger than that seen in the second pattern . The different cytologic patterns might be related to the status of immunity of patients at the time of biopsy . Enferm Infecc Microbiol Clin, 2001 Feb, 19(2), 61 - 5 {C reactive protein as marker of infection among patients with severe closed trauma}; Flores JM et al.; BACKGROUND: Injury and infection are characterized by the activation of the acute phase proteins response . C-reactive protein (CRP), an acute phase protein, has been mentioned as an useful indicator of infection and sepsis in critically ill patients . OBJECTIVE: To study the evolution of serum CRP in patients with severe blunt trauma and to ascertain its ability as a biological marker of infection during the first seven days after injury . METHODS: We prospectively studied 54 patients with blunt trauma (injury severity score>=16) age>14 years and length of the Intensive Care Unit (ICU) estay>= 7 days, over a 4-month period . Culture-proven infections were collected and serum CRP was determinated every day, during the first week after ICU admission . RESULTS: Twenty-eight patients (51.8%) developed an infection during the first week, and the median day of diagnosis of infection was day 6 . Pneumonia was the most common infection (50%) and Gram-negative bacilli (63.3%) were the most common microorganisms recovered . Serum CRP levels were significantly higher in the infected patients group after day 4, showing a median value higher than 170 mg/l . Based on the receiver operating characteristic (ROC) curve analysis, a cutoff value of 109.5 mg/l for CRP gives a sensitivity of 78.6% and a specifity of 73.1% in predicting the presence of infection . CONCLUSIONS: The course of serum CRP levels is different in the group of patients with severe blunt trauma and infection, compared with the non-infected group during the first week after injury and it could be an useful supplementary marker for infection after postinjury day 4 . A value of 110 mg/l or higher for CRP should suggest an underlying infectious complication. Int J Lepr Other Mycobact Dis, 2000 Dec, 68(4), 426 - 33 Immuno-histopathology in the diagnosis of early leprosy; Weng XM et al.; The present study of 45 early leprosy cases in an endemic area in China indicates: a) Sensitivity of acid-fast bacilli (AFB) detection can be significantly improved by examining approximately 30 serial sections . AFB and/or phenolic glycolipid-I (PGL-I) were mostly detected in the infiltrates in the subepidermal zone, intraneurium, perineurium and around blood vessels . b) PGL-I antigen was positive in 10 clinically suspected, single lesion leprosy cases and AFB positive in 7 patients, AFB and/or PGL-I in nerve in 6 patients . c) Nonspecific chronic inflammation in indeterminate leprosy presented as selective perineural and/or intraneural infiltration with lymphocytes predominating . In the infiltrating mass, fragments of neural tissue were demonstrated with anti-S-100 protein staining . d) Except for 3 cases with unknown numbers of lesions, the present positive immunohistopathological findings are in direct correlation with the number of lesions at first diagnosis, namely: 41.6% (10/24) for single lesion, 66.6% (6/9) for 2 lesions, and 88.8% (8/9) for patients with > or = 3 lesions . e) Typical epithelioid or macrophage granuloma formations were not seen in early leprosy with a single lesion . In testing the immunological inclination of these patients with CD68 or tumor necrosis factor-alpha (TNF-alpha) a positive test is likely to be of prognostic value since TNF-alpha is involved in granuloma formation and nerve damage. J Clin Microbiol, 2001 May, 39(5), 1813 - 8 Mutations in the rpoB gene of rifampin-resistant Mycobacterium tuberculosis isolates in Spain and their rapid detection by PCR-enzyme-linked immunosorbent assay; Garcia L et al.; Genetic alterations in the rpoB gene were characterized in 50 rifampin-resistant (Rif(r)) clinical isolates of Mycobacterium tuberculosis complex from Spain . A rapid PCR-enzyme-linked immunosorbent assay (ELISA) technique for the identification of rpoB mutations was evaluated with isolates of the M . tuberculosis complex and clinical specimens from tuberculosis patients that were positive for acid-fast bacilli (AFB) . Sequence analysis demonstrated 11 different rpoB mutations among the Rif(r) isolates in the study . The most frequent mutations were those associated with codon 531 (24 of 50; 48%) and codon 526 (11 of 50; 22%) . Although the PCR-ELISA does not permit characterization of the specific Rif(r) allele within each strain, 10 of the 11 Rif(r) genotypes were correctly identified by this method . We used the PCR-ELISA to predict the rifampin susceptibility of M . tuberculosis complex organisms from 30 AFB-positive sputum specimens . For 28 samples, of which 9 contained Rif(r) organisms and 19 contained susceptible strains, results were concordant with those based on culture-based drug susceptibility testing and sequencing . Results from the remaining two samples could not be interpreted because of low bacillary load (microscopy score of 1+ for 1 to 9 microorganisms/100 fields) . Our results suggest that the PCR-ELISA is an easy technique to implement and could be used as a rapid procedure for detecting rifampin resistance to complement conventional culture-based methods. Nihon Kokyuki Gakkai Zasshi, 2001 Feb, 39(2), 151 - 5 {A case of pulmonary Mycobacterium avium infection with a rapid-growing solitary node}; Yamazaki Y et al.; A 72-year-old man was admitted to our hospital because of an abnormal shadow on his chest radiograph . Computed tomography revealed a 3 cm solitary nodular opacity in the right S1 . Bronchofiberscopy could neither give any specific histological findings nor bacteriological findings . This nodular shadow increased in size to 1.5 times that in the first chest radiograph . In addition, since there was no abnormal finding in the chest radiograph one year before, we performed partial pulmonary resection by video-assisted thoracoscopic surgery, taking into consideration the possibility that the solitary node was malignant . The pathological findings of the resected specimen were an epitheloid cell granuloma with Langhans giant cell and caseous necrosis . We could not detect any acid-fast bacilli or malignant cells . After surgery, M . avium was detected in a 6-week culture of the resected specimen . We treated the patient with RFP, EB and CAM for 6 months . Outpatient follow-up revealed no relapse. Nihon Kokyuki Gakkai Zasshi, 2001 Feb, 39(2), 145 - 50 {Bronchiolo-alveolar cell carcinoma arising after active pulmonary tuberculosis' report of two cases}; Mizutani H et al.; We report on two patients diagnosed as having active pulmonary tuberculosis who later developed lung cancer . In both cases, the lung cancer was detected during the treatment of pulmonary tuberculosis . Both patients were initially considered to be experiencing exacerbation of pulmonary tuberculosis . Case 1 was seen in a 74-year-old man . His chest roentgenogram revealed microscopic cavitary lesions with infiltration into both lung fields . His sputum tested positive for acid-fast bacilli . Although he was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA), his general condition deteriorated, and the infiltrative shadows in the lung fields had expanded on subsequent chest radiography . Transbronchial lung biopsy (TBLB) yielded findings compatible with a diagnosis of bronchiolo-alveolar cell carcinoma . Case 2 occurred in a 52-year-old man . His chest radiograph revealed cavitary lesions with infiltration into both lung fields . His sputum also tested positive for acidfast bacilli . Despite medication with INH, RFP, EB and PZA, the infiltrative shadow in his chest radiograph increased in size . Bronchiolo-alveolar cell carcinoma was confirmed after examination of the sputum cytology . Case 1 was diagnosed as lung cancer 10 months after being admission to the hospital, and Case 2, seven months after hospitalization . Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a high frequency of coexistence of the two diseases . However, the coexistence of active tuberculosis with bronchiolo-alveolar cell carcinoma, as in our cases, is rare. Chemotherapy, 2001 May-Jun, 47(3), 153 - 6 Pharmacokinetics of high-dose meropenem in adult cystic fibrosis patients; Bui KQ et al.; Because patients with cystic fibrosis (CF) have pulmonary exacerbations secondary to multi-antibiotic-resistant Gram-negative bacilli, antibiotics, like meropenem, are often utilized . We studied the pharmacokinetics of meropenem (2 g i.v . administered every 8 h in clinically stable CF patients to determine if the recommended maximum doses could sustain adequate concentrations during the dosing interval . These pharmacokinetic data were similar to those obtained in non-CF populations . Using this regimen, concentrations of meropenem exceed the susceptibility breakpoint (4 microg/ml) for 50% of the dosing interval, and therefore provide optimization of the pharmacodynamic profile of the compound . Clin Exp Immunol, 2001 Mar, 123(3), 428 - 34 Effect of oestrogen on Mycobacterium avium complex pulmonary infection in mice; Tsuyuguchi K et al.; The purpose of the present study was to elucidate the role of oestrogen in the pathogenesis of Mycobacterium avium complex (MAC) pulmonary disease, which occurs most frequently in postmenopausal women . The study was carried out in a murine infectious model using ovariectomized DBA/2 female mice . Infection with MAC was established by intratracheal administration of bacilli . In some experiments, ovariectomized mice were treated with exogenous 17 beta-estradiol (E2) . The number of bacilli in the lungs of infected mice which received ovariectomy was significantly larger than that in the lungs of sham-operated control mice, and treatment of ovariectomized mice with exogenous E2 restored the burden of bacilli to the same level as that in the sham-operated control mice . We next examined the effect of E2 in vitro using bone marrow-derived macrophages obtained from DBA/2 female mice . The macrophages showed bacteriostatic activity against MAC after treatment with interferon-gamma (IFN-gamma) and this activity was further enhanced by the exogenous addition of E2 to the culture medium . In parallel with these findings, E2 augmented the production of reactive nitrogen intermediates (RNI) by macrophages pretreated with IFN-gamma and stimulated with MAC, as shown by evaluating nitrite production and inducible nitric oxide synthase mRNA expression . These findings taken together suggest that absence of endogenous oestrogen appears to be responsible for the development of MAC pulmonary disease in this mouse model and that the enhancement by E2 of anti-MAC activity of murine macrophages induced through increased RNI production may play some role in resistance to MAC infection. Infect Immun, 2001 May, 69(5), 3175 - 80 Extensive Mycobacterium bovis BCG infection of liver parenchymal cells in immunocompromised mice; Mills JW et al.; A histologic study was performed on the livers of wild-type (WT), severe combined immunodeficient (SCID), hydrocortisone acetate (HC)-treated WT, and HC-treated SCID mice infected intravenously with 10(5) CFU of Mycobacterium bovis BCG . It was found that infection progressed faster in SCID mice than in WT mice and that HC treatment caused exacerbation of infection in both types of mice . In all cases infection in the liver was confined to granulomas that were populated predominantly by macrophages . Higher levels of infection in HC-treated SCID mice, but not HC-treated WT mice, were associated with extensive infection and destruction of parenchymal cells at the margins of granulomas . The results indicate that in the absence of T-cell-mediated immunity and of HC-sensitive T-cell-independent defense mechanisms, macrophages are incapable of restricting BCG growth and of confining infection to their cytoplasm . Consequently, BCG bacilli are released into the extracellular environment, where they are ingested by neighboring parenchymal cells. Southeast Asian J Trop Med Public Health, 2000 Sep, 31(3), 473 - 7 Comparative yield of different respiratory samples for diagnosis of Pneumocystis carinii infections in HIV-seropositive and seronegative individuals in India; Mirdha BR et al.; Respiratory specimens were prospectively examined for Pneumocystis carinii from 53 patients . The majority of specimens were comprised of expectorated sputum, induced sputum, broncho-alveolar lavage (BAL), and tracheal aspirates . In only four patients Pneumocystis carinii (P . carinii) was detected . All the samples were produced by broncho-alveolar lavage . Candida spp and Aspergillus spp were also identified in a small number of patients . Acid-fast-bacilli were not detected in any of the cases under study . There were no sex-related differences in distribution . The present prospective study was undertaken in order to determine P . carinii infections in human immunodeficiency virus (HIV) seropositive and seronegative individuals . Expectorated sputum samples were probably the major limiting factor in low positivity for detection of P . carinii and study of BAL specimens would be more useful for better results. Med Dosw Mikrobiol, 2000, 52(4), 353 - 60 {Production of reactive nitrogen and oxygen intermediates in human granulocytes and monocytes during internalization of live BCG bacilli}; Paziak-Domanska B et al.; The production of nitric oxide (NO) and reactive oxygen intermediates in granulocytes and macrophages from healthy volunteers, infected in vitro with live Bacille Calmette-Guerin (BCG) mycobacteria, was estimated . Significant differences in the biochemical reactions induced by BCG bacilli in granulocytes and monocytes are described . The activity of phagocytes was also investigated in the cultures with cytokines: IFN-gamma, TNF-alpha, GM-CSF, IL-4. Mem Inst Oswaldo Cruz, 2001 Feb, 96(2), 277 - 80 Survival of tubercle bacilli in heat-fixed and stained sputum smears; Cardoso CL et al.; We used a slide culture technique to detect tubercle bacilli surviving in sputum smears (n=46) after conventional heat fixation and Ziehl-Neelsen staining . In all heat-fixed sputum smears, tubercle bacilli survived after time 0 (n=22), 24 h (n=7), 48 h (n=7), 72 h (n=4), and seven days (n=6) . None of the stained sputum smears showed growth on slide cultures . Viable tubercle bacilli remaining in heat-fixed sputum smears for at least seven days may present an infection risk to laboratory staff . Thus, sputum smears should be stained immediately by the Ziehl-Neelsen method or stored in a safe container to avoid transmission of tuberculosis. Clin Microbiol Infect, 2000 Dec, 6(12), 644 - 8 Extra-laryngeal head and neck tuberculosis; Sierra C et al.; OBJECTIVE: Extra-laryngeal head and neck tuberculosis is exceptional . Therefore, a retrospective multicenter study in patients with head and neck tuberculosis, excluding solitary lymphadenitis and laryngeal locations was carried out . METHODS: We reviewed the patients with these features and tuberculosis confirmation by culture and/or histologic granuloma with presence of acid-fast bacilli (AFB) . RESULTS: We found 16 patients with the following locations: eight in oral cavity and/or pharynx, four in ear, two in salivary glands, one in nose and one in frontal sinuses . The average duration of symptoms was 11.5 months . Purified protein derivative (PPD) was positive (> 10 mm) in all but one patient in whom it was performed (six of seven) . Except tuberculous otitis, which occured without reactive lymphadenitis, this was present in 50% of the rest (six of the 12) . In all cases a biopsy was required for diagnosis . Only in four patients, all with pharyngeal locations, was coincident pulmonary tuberculosis confirmed . One patient with tuberculous otitis developed meningitis and died; three additional patients (two with otitis) were cured but with sequelae; the evolution of the remaining patients was satisfactory with medical therapy . CONCLUSIONS: Extra-laryngeal head and neck tuberculosis has a slow course . The diagnosis is difficult due to the common absence of lung involvement and the usual requirements for biopsy procedures . The outcome is usually favorable with antituberculous drugs alone although in tuberculous otitis there are possibilities of complications. J Cutan Med Surg, 2001 Jan-Feb, 5(1), 28 - 32 A case of cutaneous Mycobacterium chelonae abscessus infection in a renal transplant patient; Endzweig CH et al.; BACKGROUND: Mycobacterium chelonae is an atypical "fast-growing Mycobacteria" that is a rare cause of human infection . There have been several reports of cutaneous infection among immunosuppressed patients, as well as in immunocompetent individuals following trauma . Most cases to date seem to have occurred among renal transplant recipients, raising the possibility that there is something inherent to the renal transplant patient that increases their susceptibility more than other immunocompromised patients . OBJECTIVE: The differential diagnosis of subcutaneous nodules distributed in a sporotrichoid pattern is extensive, particularly in an immunocompromised host . Although several cases of cutaneous M . chelonae abscessus infection have been reported among both immunosuppressed and immunocompetent patients, the clinical presentation has varied, and few cases have reported the appearance of lesions in a sporotrichoid pattern . We present a case of a renal transplant patient with a reported history of trauma to the lower extremities, who presents with subcutaneous nodules distributed in a sporotrichoid pattern . The patient is found to have M . chelonae abscessus infection, fails several treatment regimens, and presents with a recurrence . The literature of M . chelonae infection is reviewed, and the various treatment options are discussed . METHODS: An initial skin biopsy was stained with Hematoxylin and Eosin and revealed deep dermal abscesses with acid-fast bacilli in clusters . The culture became positive for Mycobacterium chelonae abscesses in four days and was found to be sensitive to multiple antibiotics . The patient underwent surgical excision of 14 nodules, which revealed findings consistent with the skin biopsy, and was subsequently treated with the appropriate antibiotics . RESULTS: Despite treatment with a full course of an organism-sensitive antibiotic regimen, the patient returned with persistent and recurrent nodules six weeks later . The patient was then treated as an inpatient with a seven-week course of intravenous antibiotics and was discharged home on a combined intravenous and oral regimen . CONCLUSION: Although M . chelonae abscessus is an extremely rare cause of infection among humans, there seems to be a predominance of cases reported among renal transplant patients . The explanation for this is not entirely clear; however, the organism must be considered as a cause of infection in any renal transplant recipient who presents with subcutaneous nodules . Eradication of the organism presents a tremendous challenge to the clinician, and, as presented here, even with appropriate antibiotics, there is a high rate of recurrence. Coron Artery Dis, 2001 Mar, 12(2), 115 - 25 On the wide spectrum of abnormalities in the coronary arteries of Whipple's disease; James TN; BACKGROUND: There is growing interest in the role of microbes in the pathogenesis of coronary atherosclerosis but most of the evidence has been seroepidemiologic . It would be useful to know more about the cytology and histology of coronary lesions containing clearly depicted microbes . OBJECTIVE: To define carefully the assorted abnormalities apparent in the coronary arteries of individuals dying with Whipple's disease . METHODS: Myocardial tissue from 12 cases of Whipple's disease was studied by light microscopy . Slides were stained routinely (in sequence) with either the periodic-acid-Schiff (PAS) or Goldner-trichrome method and some with Gomori methenimine silver . Cardiac slides with PAS-positive bacilli were compared to lesions in jejunal lamina propria . RESULTS: There were abundant sites of coronary arterial damage associated with presence of Whipple bacilli, more in the tunica media than in intima and adventitia . Bacilli in the arterial lesions were identical to those in lamina propria . Medial lesions were often associated with a fibroproliferative 'atheroma' . Both intracellular and extracellular bacilli were found . Most lesions were devoid of inflammation, but some sites exhibited either florid arteritis or dense scarring . Arteries that were scarred or inflamed exhibited only a few bacilli . There was an apparent affinity of bacilli for the nuclei in medial smooth muscle cells and in nearby ventricular myocytes . Apoptosis (TUNEL-positive) was present in medial smooth muscle cells, endothelial cells, and ventricular myocytes . CONCLUSIONS: There is a wide spectrum of coronary abnormalities in Whipple's disease . It would be useful to know how often the Whipple bacillus is a part of the total pathogen burden in coronary disease. Int J Dermatol, 2001 Jan, 40(1), 26 - 32 Childhood cutaneous tuberculosis: a study over 25 years from northern India; Kumar B et al.; AIMS: We undertook this study to analyse the pattern of childhood cutaneous tuberculosis prevailing in northern India over the past 25 years and to highlight differences from and similarities to adult tuberculosis . MATERIALS AND METHODS: Clinical records of children with cutaneous tuberculosis who attended the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 1975 to December 1999 were analysed . RESULTS: Four hundred and two patients with cutaneous tuberculosis were examined during the 25-year period of observation . These patients formed 0.1% of the total dermatology outpatients . Seventy-five (18.7%) of these 402 cases were children (</= 16 years) . There were 32 (42.7%) boys and 43 (57.3%) girls with a boy : girl ratio of 0.74 : 1 . The majority of the children, 41 (54.7%) were in the 10-14 years age group . There was no significant boy or girl preponderance in any group other than in scrofuloderma (SFD), where girls significantly outnumbered boys at all ages . Of the various patterns of cutaneous tuberculosis seen, 40 (53.3%) had SFD, 30 (40.0%) had lupus vulgaris (LV), 3 (4.0%) had tuberculosis verrucosa cutis (TVC), 1 (1.3%) child each had tuberculids and tubercular gumma . No child had a tubercular chancre or acute miliary cutaneous tuberculosis . The neck was the commonest site afflicted with SFD and the face was the commonest site affected with LV . No child had generalized lymphadenopathy . Eighteen (60.0%) of the 30 children with LV had regional lymphadenopathy of which 15 (83.3%) had localized disease and 3 (16.7%) had disseminated disease . Of the 16 children with systemic organ involvement, 12 (75.0%) had regional lymphadenopathy . Of the 62 children in whom the data regarding vaccination status was available, 31 (50.0%) had been vaccinated and 31 (50.0%) had not . Among the vaccinated group no child had disseminated disease . Three (9.7%) children in the nonvaccinated group had disseminated disease . Information regarding Mantoux reactivity was available in 71 (94.7%) children, 61 (86.0%) with localized disease and 10 (14.1%) with disseminated disease . Of the 61 children with localized disease, 56 (91.8%) were Mantoux positive and of the 10 children with disseminated disease, only 5 (50.0%) were Mantoux positive (> 10 mm) . Histopathologic reports were available for evaluation in all 75 children . Out of 30 cases of LV, 24 (80%) showed classical tuberculous histology . In contrast, out of 40 cases with SFD, only 19 (47.5%) showed classical histology . Classical tuberculous histology was noted in all 3 (100%) cases of TVC and 1 (100%) case each with tuberculids and gumma . Tubercle bacilli could be demonstrated in 4/30 (13.3%) cases with LV and 9/40 (22.5%) cases with SFD . Systemic involvement was seen in 16 (21.3%) children, of whom 3 (18.8%) had LV and 13 (81.3%) SFD . The lungs were the most common organs involved in 8 (50.0%) children followed by bone(s) in 4 (25.0%), abdomen in 2 (12.5%), and both lung and bone in 1 (6.3%) child . In contrast to adults, girls outnumbered boys in the childhood series; SFD was a common form of presentation in contrast to LV and TVC, tuberculous gumma and tuberculids were noted less often . In both children and adults, Mantoux reactivity did not correlate with the extent of the disease; patients with disseminated disease were found to be less often vaccinated with BCG and regional lymphadenopathy was noted more often in patients with disseminated disease . CONCLUSIONS: In the whole spectrum of cutaneous tuberculosis, there is a proportion of patients with dissemination (systemic involvement) who are of great epidemiological significance as they require a change in the standard therapeutic regimens recommended for cutaneous tuberculosis. Ann Dermatol Venereol, 2001 Feb, 128(2), 139 - 40 {Mycobacterium malmoense cutaneous infection in an immunocompetent patient}; Schmoor P et al.; BACKGROUND: Mycobacterium malmoense is a mycobacterium rarely described as a human pathogen . We report the first case of cutaneous infection in an immunocompetent patient.CASE REPORT: A 75-year-old woman presented with a cutaneous nodula on the back of her left hand . Histology of the node biopsy showed non caseating granuloma with giant and epithelioid cells . Acid-fast bacilli were isolated at direct smear and after culture . Mycobacterium malmoense was identified . The lesion has healed after surgery.DISCUSSION: Mycobacterium malmoense is an environmental mycobacterium isolated from soil and water . Typically, most patients with Mycobacterium malmoense infections are old people with previously lung disease . A few cervical lymphadenitis in children and rare cases of tenosynovitis of the hand have been reported . Disseminated infections with cutaneous lesions have been exceptionally described in immunocompromised patients . Mycobacterium malmoense is slow growing and its identification is hard, sometimes requiring molecular analysis . Probably it's the reason why we present the first description of a cutaneous infection in an immunocompetent patient . This case indicates that Mycobacterium malmoense is also a cutaneous pathogen. J Bacteriol, 2001 Apr, 183(8), 2672 - 6 Proteins of Mycobacterium bovis BCG induced in the Wayne dormancy model; Boon C et al.; Oxygen starvation triggers the shiftdown of the obligate aerobe Mycobacterium bovis BCG to a state of dormancy . Two-dimensional electrophoresis showed a drastic up-regulation of the alpha-crystallin homolog, the putative response regulator Rv3133c, and the two conserved hypothetical proteins Rv2623 and Rv2626c in dormant bacilli. Eur J Pediatr, 2001 Feb, 160(2), 88 - 90 Connatal tuberculosis in an extremely low birth weight infant: case report and management of exposure to tuberculosis in a neonatal intensive care unit; Saitoh M et al.; A case of connatal tuberculosis in an extremely low birth weight infant is reported . The patient was a female with a birth weight of 973 g born in the 27th week of pregnancy . She developed respiratory distress and signs of infection immediately after birth, which did not respond to mechanical ventilation, antibiotics, and corticosteroid therapy . Connatal tuberculosis was confirmed at 48 days of age by isolation of Mycobacterium tuberculosis from the infant's tracheal aspirate and the mother's menstrual discharge . The infant died of respiratory failure at 90 days of age . Mantoux tuberculin skin tests (TST) were performed on 99 infants, 144 medical staff members, and two family members . TST conversion occurred in three medical staff members, and preventive therapy with isoniazid was initiated . Eight exposed infants had normal chest X-rays and negative gastric aspirates for acid-fast bacilli and all received preventive isoniazid therapy . No case of tuberculosis developed during the 2-year follow-up period . CONCLUSION: Connatal tuberculosis should be considered in neonatal respiratory infection resistant to antibiotics . Prevention of transmission of tuberculosis on the neonatal intensive care unit by chemoprophylaxis is important. CRNA, 2000 Feb, 11(1), 15 - 9 Tuberculosis: the latest; Van Wormer LM; Tuberculosis (TB) is a complex disease with a long history of human infection . This article provides an overview of TB and discusses ramifications for anesthesia practitioners . Specific individuals and groups are at an increased risk of developing TB . The acid-fast bacilli that causes TB is transmitted via the airborne route . The anesthesia provider must adapt his/her approach to the patient with TB so that protection is afforded that practitioner, colleagues, and the patient . Future patients are also shielded from potential exposure to acid-fast bacilli . To minimize the risk of transmission of acid-fast organisms, the anesthesia practitioner must consider TB as a possible diagnosis when performing a preanesthetic evaluation . Standard precautions for bloodborne pathogens must be followed . In addition, appropriate respiratory precautions must be taken . Proper cleansing, decontaminating, sterilizing, or disposal of equipment must occur . Screening of anesthesia providers for the possibility of infection with TB is to be conducted at intervals recommended by the Occupational Safety and Health Administration . Each anesthetist has a responsibility to practice safely . In today's anesthesia practice, safety includes vigilance against TB. Int J Tuberc Lung Dis, 2001 Jan, 5(1), 80 - 6 Utility of blood cultures and incidence of mycobacteremia in patients with suspected tuberculosis in a South African infectious disease referral hospital; von Gottberg A et al.; SETTING: A 500-bed government referral institution for patients with tuberculosis and other infectious diseases in Gauteng, South Africa . OBJECTIVES: To assess the usefulness of BACTEC blood cultures over and above that of other microbiological methods for the diagnosis of tuberculosis in patients who are suspected of suffering from tuberculosis . DESIGN: Mycobacterial blood cultures were obtained from patients presenting with symptoms suspicious of tuberculosis and where there was no clinical evidence of other infectious etiologies, and from patients who had failed tuberculosis treatment . RESULTS: Sixteen (22%) of 71 patients included in the study were positive for Mycobacterium tuberculosis on blood culture, while seven (10%) were positive for M . avium complex (MAC) . Twelve (75%) of the patients with tuberculosis and positive blood cultures were however also positive for acid-fast bacilli on sputum smears and eight (50%) were initially diagnosed clinically and radiographically as localized pulmonary tuberculosis . Blood cultures positive for mycobacteria were only found among patients with human immunodeficiency virus infection (HIV) . CONCLUSIONS: Bacteremia with M . tuberculosis complex was detected in HIV-infected patients with suspected tuberculosis, even in patients presenting with localized pulmonary infection on initial clinical assessment . Among patients with suspected tuberculosis, blood cultures were useful in diagnosing unsuspected MAC disease, but did not add to the diagnostic yield of conventional tests for tuberculosis used routinely, namely sputum microscopy and culture, or occasional biopsy specimens. Zhonghua Jie He He Hu Xi Za Zhi, 1998 Mar, 21(3), 160 - 3 {A molecular and epidemiology study in patients with ventilator-associated pneumonia}; Geng L et al.; OBJECTIVE: To evaluate causative agents in patients with ventilator-associated (VA) pneumonia epidemiologically, then to provide useful suggestion for diagnosis and treatment of VA pneumonia . METHOD: Prospectively, a protected specimens brush was used to obtain the secretion of lower respiratory tract of 65 patients, who had been receiving mechanical ventilation or tracheostomy for more than 72 hours . At the same time, other samples were collected from the relevant places, including pharyngeal and gastric juice of patients as well as other persons, ward's air . The secretion obtained were cultured with a quantitative method . Then all bacteria isolated were studied with the analysis of pattern of plasmids and chromosomal restriction endonuclease . RESULT: It was showed that the route of infection of the Gram-negative bacilli in VA pneumonia (19 cases) was intrinsic, a retrograde colonization from patient's stomach, that was the pattern of clonization from stomach to pharynx, then into lower respiratory tract, and the Gram-positive staphylococcus spread mainly through the ward's air, then directly into lower respiratory tract, or extrinsic (20 cases) . CONCLUSION: The Gram-positive staphylococcus is also major disease-producing germs in VA pneumonia, and the infection routes of G+ and G- bacteria might be different. Ophthalmologe, 2001 Feb, 98(2), 207 - 11 {Posterior uveitis: sarcoidosis or tuberculosis}; Ness T et al.; PURPOSE: To demonstrate the difficulties of the differential diagnosis between tuberculosis and sarcoidosis as the cause of posterior uveitis . CASE REPORTS: A 56-year-old woman suffered from bilateral anterior uveitis, snow-ball like infiltrates in the vitreous, and peripheral retinochoroidal granulomas with marked exudation shown in fluorescein angiography . Angiotensin-converting enzyme, as a marker of sarcoidosis, was elevated; the tuberculin test, however, was negative . Chest X-ray revealed an infiltrate and numerous smaller granulomas . The presumptive diagnosis was sarcoidosis . Surprisingly, in the biopsy of the pulmonal lesion tubercle bacilli were detected by Ziehl-Neelsen staining . Thus, a diagnosis of pulmonal and also retinochoroidal tuberculosis was made . After tuberculostatic therapy the choroidal lesions healed off . In a second case, a 30-year-old man suffered from bilateral panuveitis with candle wax exudates near the retinal vessels . Chest X-ray revealed lymphomas in the hilus, and the lymph node biopsy showed granulomas with epitheloid cells, indicating sarcoidosis . Detection of mycobacterium tuberculosis by culture or histological criteria was negative . Only in the PCR was mycobacterium tuberculosis DNA detectable . Tuberculostatic therapy had no benefit . Under therapy with steroids, however, pulmonal and ophthalmologic findings rapidly disappeared . CONCLUSION: The difficult differential diagnosis between sarcoidosis and tuberculosis cannot always be made by laboratory tests or diagnostic imaging alone . Clinical manifestations, including response to therapy, are essential. J Infect Dis, 2001 Apr 15, 183(8), 1300 - 3 Epub 2001 Mar 08. A whole blood bactericidal assay for tuberculosis; Wallis RS et al.; The bactericidal activity of orally administered antituberculosis (anti-TB) drugs was determined in a whole blood culture model of intracellular infection in which microbial killing reflects the combined effects of drug and immune mechanisms . Rifampin (Rif) was the most active compound studied and reduced the number of viable bacilli by >4 logs . Isoniazid (INH), 2 quinolones, and pyrazinamide (PZA) showed intermediate levels of activity . Ethambutol exerted only a bacteristatic effect; amoxicillin/clavulanate was inactive . The combination of INH-Rif-PZA showed strong activity against 11 drug-sensitive isolates (mean, -3.8 log) but no activity against 12 multidrug-resistant (MDR) strains . The combination of levofloxacin-PZA-ethambutol had intermediate bactericidal activity against MDR isolates (mean, -1.2 log) but failed to equal that of INH-Rif-PZA against sensitive isolates (P<.001) . The whole blood BACTEC method (Becton Dickinson) may be useful for the early clinical evaluation of new anti-TB drugs and in the management of individual patients. Infection, 2001 Jan-Feb, 29(1), 4