Bacillus

Arch Pathol Lab Med, 1998 Apr, 122(4), 361 - 5
Primary T-cell lymphoma of the brain in a patient at advanced stage of acquired immunodeficiency syndrome; Aydin F et al.; OBJECTIVE: To present, to our knowledge, the first case of primary central nervous system T-cell lymphoma in the setting of acquired immunodeficiency syndrome . Design.Clinical, radiological, laboratory, and pathological data from a young patient at advanced stage of acquired immunodeficiency syndrome were studied . RESULTS: A 38-year-old white man with stage CIII human immunodeficiency virus infection presented with headaches . Cerebrospinal fluid culture was positive for mycobacterium . He had facial herpes simplex virus and disseminated cytomegalovirus infections . Magnetic resonance imaging of the brain showed multiple areas of patchy or ring-shaped contrast enhancement in the periventricular zone of the right frontoparietal region . Stereotactic brain biopsy showed perivascular CD3 (pan T-cell marker)-positive lymphocytic infiltrates with partial necrosis extending into the neuropil . Not a single cell was labeled with L26, a B-cell marker . Negative and positive controls were appropriate . Special stains for cytomegalovirus, herpes simplex virus, Epstein-Barr virus, acid-fast bacilli, and fungi were negative . Gene rearrangement studies showed rearranged Tgamma and Tbeta bands . Polymerase chain reaction with a primer specific for Epstein-Barr virus genome-encoding nuclear antigen 1 region was positive . Human T-cell leukemia/lymphoma virus I work-up was negative . The patient was treated for mycobacteria . Four months later, he presented with a paravertebral neck mass . Needle biopsy showed a T-cell lymphoma with morphology similar to that in the brain . CONCLUSIONS: To our knowledge, this case represents the first example of T-cell lymphoma of the brain in a patient with advanced stage of acquired immunodeficiency syndrome . Epstein-Barr virus may play a role in T-cell lymphomagenesis . The other unique finding is the complete absence of B cells in a central nervous system lesion . The underlying mechanism eradicating the B cells is unknown.

Kansenshogaku Zasshi, 1998 May, 72(5), 504 - 11
Evaluation of two commercial diagnostic kits for Mycobacterium tuberculosis completely based on bacterial DNA and rRNA amplification for direct detection of tubercle bacilli in sputum specimens; Sato K et al.; The Roche Amplicor Mycobacterium Tuberculosis Kit (Amplicor PCR) and Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) were compared for efficiency in the direct detection of tubercle bacilli in sputum specimens . In total, 72 sputum specimens obtained from patients with active tuberculosis were examined with the Amplicor PCR and MTD kits . Of the 72 test specimens, 45 and 41 samples were positive by the Amplicor PCR and MTD methods, respectively . These values were larger than those obtained by the culture method (Septi-Chek) and acid-fast bacilli-smear test, yielding 37 and 20 positive results, respectively, and the sensitivities were as follows: smear, 39.2%; culture, 72.5%; Amplicor PCR, 88.2%; MTD, 80.4% . Amplicor PCR was similarly or somewhat more sensitive in direct detection of M . tuberculosis in sputum samples from patients with clinically active tuberculosis than was MTD.

Am J Infect Control, 1998 Jun, 26(3), 270 - 6
Tuberculosis control in New York City hospitals; Stricof RL et al.; OBJECTIVES: To assess the implementation of tuberculosis (TB) control measures in New York City hospitals in 1992 and determine trends during the subsequent 2 years . METHODS: The 22 acute care facilities with the largest number of hospitalized TB patients in 1991 were selected for inclusion in the study . Medical and laboratory records of the 10 most recent acid fast bacilli (AFB) smear-positive patients in each of the selected facilities in 1992, 1993, and 1994 were reviewed by using a standardized questionnaire to determine risk factors for TB, previous history of TB, clinical signs and symptoms, AFB laboratory turnaround times, emergency department contact, timing of isolation, timing of treatment, case reporting, and status on discharge . The patients' rooms were evaluated for TB environmental control measures if the patient was still on respiratory isolation precautions . RESULTS: More than one third of patients were admitted with a previous history of TB, 31% were admitted with a cavitary lesion on chest x-ray examination, and 48% were known to have HIV infection . Eighty-five percent were admitted from the emergency department where they stayed for up to 116 hours (mean stay: 17 hours) . The proportion of patients placed in AFB isolation on admission to the floor increased from 75% in 1992 to 84% in 1994 . The proportion of patients given a minimum of four anti-TB drugs increased from 88% in 1992 to 94% in 1994 . Patients "on isolation" were sharing rooms with up to nine other patients in 1992, whereas no patients were sharing rooms in the 1994 survey . In 1992, 51% of the rooms were under negative air flow with respect to the corridor . During the 1994 survey, 80% of rooms were under negative air flow . Between 1992 and 1994, the proportion of AFB isolation rooms with dust/mist respirators increased from 28% to 76% (p < 0.00001) . Approximately 25% of discharged patients left against medical advice (no trend over time) . The proportion of medically discharged patients with three negative AFB smears before discharge increased from 26% to 48% (p = 0.03) and the proportion referred for directly observed therapy increased from 15% to 53% (p = 0.00001) . CONCLUSION: TB control efforts in New York City hospitals improved dramatically between 1992 and 1994 . The ultimate control of TB will continue to depend on the coordinated efforts within and between health care facilities, providers, and the community.

Rinsho Ketsueki, 1998 May, 39(5), 392 - 7
{Hemophagocytic syndrome due to miliary tuberculosis in the course of aplastic anemia}; Yashima A et al.; We report a 63 year-old female with aplastic anemia (AA) who was complicated with hemophagocytic syndrome induced by systemic miliary tuberculosis . Two years before admission to our hospital, she was diagnosed as AA and had been treated with granulocyte colony-stimulating factor, erythropoietin and methenolone acetate . In May, 1996, She was transferred to our hospital because of high fever and exacervation of pancytopenia . She showed severe pancytopenia, and an increase in macrophages showing remarkable erythrophagocytosis and decrease in hemopoietic cells in the bone marrow . In initial examination, high titer of IgM antibody to herpes simplex virus type I was identified and methylprednisolone pulse therapy was started under the diagnosis of virus associated hemophagocytic syndrome . Ten days later, however, she died for intestinal hemorrhage followed by multiorgan failure . In autopsy, multiple epitheloid cell granulomas with acid-fast bacilli were found in bone marrow, lungs, liver, spleen and kidneys.

Kekkaku, 1998 May, 73(5), 371 - 7
{The short-term effects of multidrug chemotherapy for pulmonary Mycobacterium avium-intracellulare complex (MAC) infection}; Kurashima A; In performing MAC chemotherapy, we are faced with the following two problems: first, unlike for Mycobacterium tuberculosis, we have neither any suitable bacteriocidal drugs nor bacteriocidal regimens for MAC treatment; secondly, in case of MAC, unlike in the case of Mycobacterium tuberculosis, in vitro sensitivity does not correlate with in vivo sensitivity . For these reasons, we find difficulty in planning a rational protocol for MAC treatment, and thus depend on previous experiences of other physicians in MAC chemotherapy . Here, we have tried to evaluate such previous experiences objectively, and studied retrospectively the effects of previous combination chemotherapy cases of pulmonary MAC infections at National Tokyo Hospital . We selected 170 cases which had received the same chemotherapy continuously over a period of six months . Concentration of bacilli cultured, 8 weeks in Ogawa solid egg containing medium was translated semi-quantitatively to colony forming units (CFU) according to the Japanese guideline for acid fast bacilli test . Having set a mean CFU of 3 times sputum culture before treatment as 100%, we calculated a six month sequential bacillary response to a regimen and plotted the bacillary response curves . The response curve of the total 170 MAC treatment cases exhibits a minimum point of 42.9% at 2 months, and subsequently rises to 71.1% after six months compared to the state before treatment . The response curves of various regimens of multidrug chemotherapy indicate that combinations of more than 3 drugs including aminoglycoside and clarithromycin are most effective . However, although some effectiveness is indicated, neither the present drugs nor regimens are capable to achieve a bacteriocidal effect in MAC treatment.

Kekkaku, 1998 May, 73(5), 355 - 9
{A preventable case who died of miliary tuberculosis after receiving contact examination}; Sasaki Y et al.; A 30-year-old-man was admitted to our hospital because of headache and fever . His consciousness on admission was clouding . Sputum examination was positive for acid fast bacilli which later identified as Mycobacterium tuberculosis . Chest-X-ray and computed tomogram on admission showed multiple cavitary lesions on bilateral upper lung fields and bilateral diffuse nodular shadow . He was diagnosed as miliary tuberculosis with tuberculous meningitis . His mother admitted because of pulmonary tuberculosis four months ago, and her sputum examination was smear positive for acid fast bacilli, Gaffky 4, and she complained of cough for 6 months before admission . Because of this situation, he rapidly underwent the contact examination with chest X-ray, but not examined by tuberculin skin test because he was 30-year-old . As then chest X-ray was normal, he was not indicated of chemoprophylaxis, and he died of miliary tuberculosis and tuberculous meningitis 4 months after the contact examination.

J Immunol, 1998 Jun 15, 160(12), 6101 - 11
Lack of both types 1 and 2 cytokines, tissue inflammatory responses, and immune protection during pulmonary infection by Mycobacterium bovis bacille Calmette-Guérin in IL-12-deficient mice; Wakeham J et al.; Understanding of key cytokines and the nature of protective immune responses in pulmonary mycobacterial diseases remains a task of paramount importance . In this study, both wild-type (wt) and IL-12-deficient (IL-12(-/-)) mice were infected by airways inoculation of live Mycobacterium bovis bacille Calmette-Guerin (BCG) . The type 1 cytokines IL-12, IFN-gamma, and TNF-alpha, but not the type 2 cytokines IL-4 and granulocyte macrophage (GM)-CSF, markedly increased in the lung and peripheral blood of wt mice postinfection, which resulted in the development of intense granulomatous responses and the effective control of mycobacterial infection in the lung . In contrast, IL-12(-/-) mice demonstrated a lack of both types 1 and 2 cytokines in the lung and blood and a severely impaired tissue immune-inflammatory response lacking not only macrophages and neutrophils but CD4 and CD8 T cells and NK cells in the lung throughout the entire course of study . Total lung mononuclear cells isolated from these mice, in contrast to wt mice, had an impaired recall immune response to Ag challenge in vitro . These impaired responses resulted in an uncontrolled local growth and systemic spread of bacilli . Our findings reveal that IL-12 plays an irreplaceable role in the initiation of Th1 responses, and the loss of its function cannot be compensated for by alternative mechanisms in the lung . This cytokine, together with IFN-gamma and TNF-alpha, and granulomatous inflammation are critically required for the effective control of pulmonary mycobacterial infection . Our results also indicate that the absence of type 1 cytokines does not necessarily favor a Th2 response.

Diagn Microbiol Infect Dis, 1998 Jul, 31(3), 473 - 7
The role of fourth-generation cephalosporins in the treatment of serious infectious diseases in hospitalized patients; Wilson WR; For many years, the third-generation cephalosporins have been utilized in the treatment of a broad range of infections . The reduction in the efficacy of these antimicrobials in hospitals seen in recent years is a result of the development of resistance to these compounds . This resistance, caused in part by the production of beta-lactamases which can spread from species to species, has intensified the search for alternative agents . Compared with third-generation cephalosporins, fourth-generation cephalosporins possess enhanced activity against Gram-positive organisms, excellent penetration into Gram-negative bacilli, and are more stable against the activity of some beta-lactamases . Accordingly, fourth-generation cephalosporins are attractive candidates to replace third-generation cephalosporins for the treatment of many nosocomial infections.

Nat Biotechnol, 1996 Mar, 14(3), 343 - 7
Efficient synthesis of mosquitocidal toxins in Asticcacaulis excentricus demonstrates potential of gram-negative bacteria in mosquito control; Liu JW et al.; The control of mosquitoes with chemical insecticides pollutes the environment and leads to resistance in mosquito populations . Bacterial control of mosquito larvae with Bacillus sphaericus and Bacillus thuringiensis subsp . israelensis, which produce protein toxins, has proved useful, safe, and nonpolluting . These bacteria do, however, suffer from disadvantages, including rapid setting, UV sensitivity, and lack of persistance of spores, proteolysis of toxins, narrow host range, and high production costs . Here we show that the Gram-negative bacterium Asticcacaulis excentricus is a promising host for delivering toxins to mosquito larvae . Plasmid-transformed A . excentricus cells expressing the binary toxin of B . sphaericus exhibited toxicity to Culex and Anopheles mosquito larvae similar to that of the high-toxicity strains of B . sphaericus which produce several toxins . A . excentricus has potential advantages as a larvicide compared with the bacilli, especially persistance in the larval feeding zone, resistance to UV light, lack of toxin-degrading proteases, and low production costs.

Am J Surg Pathol, 1998 Jun, 22(6), 736 - 41
Xanthomatous hypophysitis; Folkerth RD et al.; Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria) . These lesions are known to mimic pituitary neoplasms . We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma . Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus . Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another . By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk . The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography . In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation . At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases . Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes . Other fragments resembled granulation tissue, and some consisted of acellular debris . Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a . Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages . There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi . Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris . We propose the term "xanthomatous hypophysitis" for this lesion.

Lepr Rev, 1998 Mar, 69(1), 24 - 39
Impaired responses to Mycobacterium leprae antigens in rhesus monkeys experimentally inoculated with simian immunodeficiency virus and M . leprae; Gormus BJ et al.; Seven of eight rhesus monkeys (RM) coinfected with simian immunodeficiency virus (SIV) and Mycobacterium leprae harboured acid-fast bacilli (AFB) at sites of dermal inoculation and/or at disseminated sites at times of humane sacrifice (up to 270 days post-M . leprae inoculation) due to SIV-induced debilitation or, in one long term survivor's case, to date over 3 years post-M . leprae inoculation . Detectable AFB were cleared in biopsies of inoculation sites of RM inoculated with M . leprae alone after 63 days postinoculation; these sites have, so far, remained AFB-negative, thereafter . Compared to animals infected with M . leprae alone, RM coinfected with SIV plus M . leprae showed: 1, completely suppressed serum antibody responses to M . leprae-specific PGL-I antigen, but strong anti-SIV Gp120 antibody responses; 2, impaired sensitization of blood mononuclear cells (MNC) to in vitro recognition of M . leprae-specific antigens in blastogenic stimulation assays; 3, impaired in vitro responses of blood MNC to nonspecific (ConA) blastogenic stimuli; and 4, early post-M . leprae inoculation, there was a significant incremental diminution of percentages of blood CD4+CD29+ T-cells in addition to the existing SIV-induced diminished percentages of CD4+CD29+ T-cells . The results indicate that humoral and cellular immune responses to M . leprae antigens are compromised in M . leprae-inoculated RM previously infected with SIV . These results provide an immunologic basis for the demonstration of enhanced M . leprae persistence or leprosy susceptibility in SIV-M . leprae coinfected RM.

Ugeskr Laeger, 1998 May 18, 160(21), 3066 - 9
{Multiresistant tuberculosis in Denmark 1993-1996}; Viskum K et al.; Infections with multiresistant tubercle bacilli have also become a problem in the rich part of the world . The reasons are lack of compliance in patients with life style problems and ineffectiveness of the health system due to lack of fundings . During a four year period, 1993-1996 ten patients were seen in Denmark with tuberculosis due to multiresistant Mycobacterium tuberculosis . Nine were infected abroad, one developed MDR-TB during treatment in Denmark . It is possible to cure these patients, but it is expensive and takes a long time . In the future more cases created within Denmark are likely to be seen due to lack of funding for the tuberculosis programme and, depending on immigration, further cases created abroad are expected.

Kansenshogaku Zasshi, 1998 Apr, 72(4), 410 - 3
{A case of solitary pulmonary nodule caused by Mycobacterium avium}; Yokomura K et al.; A 56-year-old male without respiratory symptoms, past history nor familial history, was admitted to our hospital because of pulmonary solitary nodule on the chest radiograph . Computed tomograph showed a smooth surface nodule in the left lower lobe (segment 8) . Bronchofiberscopy could not give any specific histological findings nor bacteriological findings, therefore the patient underwent partial pulmonary resection by videoassisted thoracoscopic surgery . Pathology of the resected specimen revealed epithelioid cell granuloma with giant cells but not any acid-fast bacilli . He was treated with rifampicin and isoniazid for "tuberculoma" . After three weeks, thirty colonies grew on an Ogawa's egg medium, which were identified as Mycobacterium avium by PCR . There are few reports about the solitary pulmonary nodule due to M . avium-intracellurale complex infection, however, it is supposed that there are many "tuberculoma's" without bacteriological differentiation between tuberculosis and nontuberculous mycobacterial infection . It is difficult to diagnose a solitary pulmonary nodule caused by nontuberculous mycobacterial infection with bronchofiberscopy, and the location of the lesion is usually subpleural, therefore it is thought that videoassisted thoracoscopic surgery is valied for the diagnosis of solitary pulmonary nodule due to nontuberculous mycobacterium.

Hinyokika Kiyo, 1998 Apr, 44(4), 253 - 7
{Intravesical bacillus Calmette-Guerin instillation for patients over 80 years old}; Kanematsu A et al.; To study the efficacy and the safety of intravesical bacillus Calmette-Guerin (BCG) therapy for very elderly patients with superficial bladder cancer, we retrospectively compared patients over 80 years old who had received BCG therapy at our department between 1991 and 1996 (Group A; 10 patients 11 courses), with those below 80 years old (Group B, 17 patients 18 courses) . In these patients, skin test reactivity to purified protein derivative showed a significant negative correlation with age (p = 0.016) . No irreversible complications were observed in any patient . Persistence of acid-fast bacilli for more than one month after the termination of the course was observed in two patients in group A, and one in group B . A comparison of the cases undergoing eradicational BCG therapy in the two groups, grade 2 transitional cell carcinoma (TCC) was significantly more predominant than grade 3 TCC in group A (p = 0.004) . (None of the tumors in group A were of grade 3) The disease-free rate was significantly lower in group A (p < 0.05), but 5 of the 10 patients in this group were finally disease-free . From these results, we conclude that intravesical BCG instillation therapy can be performed in patients over 80 years old, although a relatively lower disease-free rate is expected and special attention should be taken with regard to persistent BCG infection . The lower disease-free rate could be attributable to either diminished cellular immunity or a difference in tumor grade, although a definite conclusion could not be obtained here.

Infect Control Hosp Epidemiol, 1998 May, 19(5), 345 - 7
Pseudo-outbreak of tuberculosis in an acute-care general hospital: epidemiology and clinical implications; Cronin W et al.; A 10-fold increase in patients with Mycobacterium tuberculosis-positive specimens in one hospital laboratory prompted an investigation . Clinical and epidemiological data, along with M tuberculosis DNA fingerprinting results, indicated that laboratory contamination led to nine false-positive M tuberculosis cultures . Pseudo-infection should be considered in patients with unusual tuberculosis presentations, negative acid-fast bacilli smears, and only one positive culture with a low colony count.

Int J Tuberc Lung Dis, 1998 May, 2(5), 397 - 404
Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda . Makerere University-Case Western Reserve University Research Collaboration; Johnson JL et al.; SETTING: TB Treatment Centre, Kampala, Uganda . OBJECTIVE: To evaluate the impact of human immunodeficiency virus (HIV) co-infection on the bacteriologic and radiographic presentation of pulmonary tuberculosis (TB) in Uganda, a nation with high rates of Mycobacterium tuberculosis and HIV infection . DESIGN: To compare baseline characteristics among HIV-infected and non-HIV-infected adults with initial newly-diagnosed episodes of culture-confirmed pulmonary TB screened for participation in a randomized prospective TB treatment trial . RESULTS: Negative and paucibacillary (very scanty or scanty) sputum acid fast bacilli (AFB) smears were more frequent in HIV-infected patients presenting with pulmonary TB (P = 0.007) . More HIV-infected individuals also had sputum cultures that required 7-8 weeks incubation until positivity than non-HIV-infected patients (P < 0.01) . Lower lung field and diffuse pulmonary infiltrates were more frequent among HIV-infected patients . Rates of atypical X-ray presentations and cavitary disease were comparable between HIV-seropositive and -seronegative patients; however, atypical disease was more frequent in HIV-infected patients with small tuberculin reactions or tuberculin anergy (PPD = 0 mm) . CONCLUSION: HIV co-infection was associated with a higher frequency of negative and paucibacillary sputum AFB smears . The differences in the diagnostic yields of microscopy and culture between HIV-infected and non-HIV-infected individuals were small and do not, in our opinion, significantly affect the utility of these important diagnostic tests in developing countries . Examining more than one sputum specimen and monitoring cultured specimens for a full 8 weeks may assist in optimizing the diagnostic yield . Upper lobe infiltrates and cavitary disease are still the most frequent radiographic presentations of pulmonary TB in HIV-infected and non-HIV-infected adults in countries with a high prevalence of TB.

Int J Tuberc Lung Dis, 1998 May, 2(5), 360 - 4
Two-year follow-up of directly-observed intermittent regimens for smear-positive pulmonary tuberculosis in China; Cao JP et al.; SETTING: The tuberculosis component of the Infectious and Endemic Disease Control Project in the People's Republic of China is the largest single tuberculosis control project in the world using directly-observed therapy and standardized intermittent regimens . OBJECTIVE: To determine the two-year relapse and mortality rates following completion of treatment . DESIGN: A prospective cohort study of 649 cases cured in this project . The 306 new and 343 retreatment cases were treated under field conditions with 2H3R3Z3S3/4H3R3 and 2H3R3Z3E3S3/6H3R3E3, respectively . Following treatment completion, two sputum samples were collected every six months for two years and examined for acid-fast bacilli . Causes of death were identified . RESULTS: The two-year relapse rates for new and retreatment cases were 3.3% and 5.6%, respectively . Retreatment cases with delayed sputum conversion had a greater risk for subsequent relapse . The two-year mortality rate for new and retreatment cases was 3.3% and 8.5%, respectively . The higher mortality rate in retreatment cases was not attributable to relapse of disease, but rather to non-infectious sequelae of tuberculosis . CONCLUSION: The use of directly-observed intermittent regimens is effective in permanently removing infectious tuberculosis cases from the community.

Kekkaku, 1998 Apr, 73(4), 315 - 20
{A case of pulmonary tuberculosis complicated with intracranial tuberculous abscess}; Inoue T et al.; A 75-year-old male was admitted to our hospital with complaints of fever and cough . Chest X-ray showed infiltrative shadows with cavity, and sputum smears were positive for acid-fast bacilli . About 2 months after the initiation of anti-tuberculous chemotherapy, suddenly generalized convulsion occurred . CT of the brain showed the solitary mass with the ring enhancement in the left subcortical area . About 4 weeks later, brain aspiration drainage was performed and pus was aspirated . He was diagnosed as intracranial tuberculous abscess . After the drainage, neurological symptoms disappeared completely and there were no recurrence of abscess . Attention should be called to the complication of intracranial tuberculosis, especially in cases worsened during anti-tuberculous chemotherapy.

Australas J Dermatol, 1998 May, 39(2), 92 - 5
Concurrent infection due to Shewanella putrefaciens and Mycobacterium marinum acquired at the beach; Papanaoum K et al.; Infection with marine bacteria is uncommon . A patient with systemic lupus erythematosus who developed concurrent infection with Shewanella putrefaciens and Mycobacterium marinum (M . marinum) is described . After bathing leg ulcers in sea water, severe cellulitis of the left leg with necrotic areas and extensive bullae developed . Infection due to S . putrefaciens was confirmed and a long course of hospitalization, oral ciprofloxacin and skin grafting was required . During hospitalization subcutaneous nodules developed on the other leg . Biopsy revealed acid-fast bacilli and culture grew M . marinum . These lesions responded to rifampicin and cotrimoxazole . Patients with leg ulcers, peripheral vascular disease, diabetes, or receiving immunosuppressive drugs may acquire unusual infections after salt water exposure.

Appl Environ Microbiol, 1998 Jun, 64(6), 2256 - 61
Mycobacterium avium bacilli grow saprozoically in coculture with Acanthamoeba polyphaga and survive within cyst walls; Steinert M et al.; Protozoans are gaining recognition as environmental hosts for a variety of waterborne pathogens . We compared the growth of Mycobacterium avium, a human pathogen associated with domestic water supplies, in coculture with the free-living amoeba Acanthamoeba polyphaga with the growth of M . avium when it was separated from amoebae by a 0.1-micron-pore-size polycarbonate membrane (in a parachamber) . Although viable mycobacteria were observed within amoebal vacuoles, there was no significant difference between bacterial growth in coculture and bacterial growth in the parachamber . This suggests that M . avium is able to grow saprozoically on products secreted by the amoebae . In contrast, Legionella pneumophila, a well-studied intracellular parasite of amoebae, multiplied only in coculture . A comparison of amoebae infected with L . pneumophila and amoebae infected with M . avium by electron microscopy demonstrated that there were striking differences in the locations of the bacteria within amoebal cysts . While L . pneumophila resided within the cysts, M . avium was found within the outer walls of the double-walled cysts of A . polyphaga . These locations may provide a reservoir for the bacteria when environmental conditions become unfavorable.

Can J Microbiol, 1998 Mar, 44(3), 259 - 69
Expression of a Bacillus thuringiensis delta-endotoxin gene by Bacillus pumilus; Selinger LB et al.; The delta-endotoxin genes from Bacillus thuringiensis were introduced into a rhizosphere-inhabiting Bacillus pumilus isolate to create a delta-endotoxin expression and delivery system for subterranean feeding insects such as the larvae of pale western cutworm (Agrotis orthogonia Morrison (Lepidoptera: Noctuidae)) . Preliminary experiments indicated that Bacillus thuringiensis subsp . kurstaki cultures were toxic to pale western cutworm larvae . Three different cry genes from Bacillus thuringiensis subsp . kurstaki were cloned into high and low copy number vectors and mated into Bacillus pumilus RB8 . When carried on high copy number vectors, cry genes appeared to inhibit sporulation and delta-endotoxin production in Bacillus pumilus RB8 cultures, since microscopic examination of these cultures revealed that < 0.1% of the cells of late stationary phase cultures had sporulated and produced parasporal inclusions . On low copy number vectors, the cry genes did not inhibit sporulation; however, production of delta-endotoxins was undetectable . Using a heat shock regime for enrichment of sporogenous crystalliferous variants, a Bacillus pumilus isolate, carrying cryIA(c) on a high copy number plasmid, was obtained in which high level delta-endotoxin production occurred concomitant with sporulation . Synthesis of functional delta-endotoxin by this strain was confirmed by Western blot analysis and bioassay with pale western cutworm larvae . These results show that rhizosphere-inhabiting bacilli are indeed a potential route for introduction of delta-endotoxins to the root environment for biocontrol purposes.

J Immunol, 1998 Jun 1, 160(11), 5448 - 54
Fas ligand-induced apoptosis of infected human macrophages reduces the viability of intracellular Mycobacterium tuberculosis; Oddo M et al.; Mycobacterium tuberculosis-specific cytolytic activity is mediated mostly by CD4+CTL in humans . CD4+CTL kill infected target cells by inducing Fas (APO-1/CD95)-mediated apoptosis . We have examined the effect of Fas ligand (FasL)-induced apoptosis of human macrophages infected in vitro with M . tuberculosis on the viability of the intracellular bacilli . Human macrophages expressed Fas and underwent apoptosis after incubation with soluble recombinant FasL . In macrophages infected either with an attenuated (H37Ra) or with a virulent (H37Rv) strain of M . tuberculosis, the apoptotic death of macrophages was associated with a substantial reduction in bacillary viability . TNF-induced apoptosis of infected macrophages was coupled with a similar reduction in mycobacterial viability, while the induction of nonapoptotic complement-induced cell death had no effect on bacterial viable counts . Infected macrophages also showed a reduced susceptibility to FasL-induced apoptosis correlating with a reduced level of Fas expression . These data suggest that apoptosis of infected macrophages induced through receptors of the TNF family could be an immune effector mechanism not only depriving mycobacteria from their growth environment but also reducing viable bacterial counts by an unknown mechanism . On the other hand, interference by M . tuberculosis with the FasL system might represent an escape mechanism of the bacteria attempting to evade the effect of apoptosis.

J Clin Microbiol, 1998 Apr, 36(4), 1046 - 9
Sensitivity of fluorochrome microscopy for detection of Mycobacterium tuberculosis versus nontuberculous mycobacteria; Wright PW et al.; The results for 6,532 consecutive mycobacterial respiratory specimens collected from 1,040 patients from 1993 to 1995 in a Texas hospital were studied to determine the sensitivity of fluorescence microscopy for detection of Mycobacterium tuberculosis and nontuberculous mycobacteria (NTM) . Smears were positive for acid-fast bacilli (AFB) in 63% (677 of 1,082) of specimens growing M . tuberculosis and 56% (638 of 1,148) of specimens growing the four most common species of NTM . Smear positivity by species was 58% (446 of 776) for M . avium complex, 51% (154 of 300) for rapidly growing mycobacteria (98% were M . abscessus), 78% (29 of 37) for M . kansasii, and 26% (9 of 35) for M . gordonae . Definite or probable disease by clinical criteria was present in 79% of patients with M . avium complex, 93% of patients with rapidly growing mycobacteria, 100% of patients with M . kansasii, and 0% of patients with M . gordonae . Patients with M . avium complex had a low incidence of AIDS (7%), and approximately 50% of non-AIDS patients had upper-lobe cavitary disease and 50% had nodular bronchiectasis . Only 23 of 6,532 (0.35%) of AFB smears were positive with a negative culture excluding patients on therapy for established mycobacterial disease . These studies suggest that NTM are as likely as M . tuberculosis to be detected by fluorescent microscopy in specimens from patients from areas endemic for NTM lung disease and at low risk for AIDS.

Indian J Lepr, 1998 Jan-Mar, 70(1), 97 - 102
Presence of M . leprae in the conjunctiva, vitreous body and retina of a patient having lepromatous leprosy; Orefice F et al.; Histopathological study of the ocular globe of a lepromatous leprosy patient revealed the presence of lepra bacilli in the conjunctiva, sclera, episclera, cornea, iris, ciliary body, vitreous body and retina.

Minerva Ginecol, 1998 Mar, 50(3), 93 - 6
{Postmenopausal endometrial tuberculosis . A clinical case}; Mantovani A et al.; Post-menopausal tuberculosis of the female genital tract is an uncommon condition that has received relatively little attention in the literature . The case described by the authors is about a sixty year old woman whose condition was brought to attention by leukorrhea and abnormal bleeding associated with a smear test suggesting CIN 1 . An endometrial aspiration biopsy revealed necrotic debris with focal granulomata and numerous acid-fast bacilli . Fungal stains were negative while mycobacterium tuberculosis was found . After three months of combination antimycobacterial treatment, she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by six months of post-operative drug therapy.

Trop Med Int Health, 1998 Mar, 3(3), 189 - 96
Mycobacterium ulcerans infection in a child from Angola: diagnosis by direct detection and culture; Bar W et al.; Buruli ulcer, caused by Mycobacterium ulcerans, is a chronic ulcerative skin disease, found predominantly in central and west Africa and Australia . A boy of 2.5 years of age from Angola was admitted to our hospital with severe kwashiokor and a large ulcer with undermined edges on the left side of the thorax . Further examination revealed anaemia, hypoproteinaemia, bacterial superinfection of the ulcer and intestinal parasites . Histological analysis showed acid-fast bacilli and histopathological changes typical of Buruli ulcer . M . ulcerans was detected by PCR and culture . The patient was treated by surgical excision of diseased skin, followed by split-skin grafting . He also received antibiotic therapy (ciprofloxacin, clarithromycin, rifabutin, and dapsone) . After six months, the child was discharged from hospital in good condition . This is the first published case of Buruli ulcer from Angola.

Zhonghua Yan Ke Za Zhi, 1996 Sep, 32(5), 376 - 8
{Anterior chamber associated immune deviation inhibiting experimental autoimmune uveoretinitis}; Zheng M et al.; OBJECTIVE: To study the inhibition of occurrence and development of experimental autoimmune uveoretinitis (EAU) by the induction of anterior chamber associated immune deviation (ACAID) . METHODS: All animals (guinea pigs), except controls, were pretreated with anterior chamber injection of allogeneic retinal extract to induce ACAID, and thereafter, they received intradermal footpad immunization of the same antigen in complete Freund's adjuvant (CFA) for induction of EAU, and dead pertussis bacilli were also subcutaneously injected as a second adjuvant . The pathological changes were investigated by light and electron microscopy . RESULTS: The incidence of EAU in experimental group was 25.0%, whereas 85.7% in the positive controls . CONCLUSION: ACAID does, to a great extent, inhibit the incidence and development of EAU.

Electrophoresis, 1998 Apr, 19(4), 573 - 6
Mycobacterial genome structure; Philipp WJ et al.; Genome maps have been constructed for the mycobacterial pathogens Mycobacterium leprae and Mycobacterium tuberculosis, as well as for the attenuated vaccine strain Mycobacterium bovis BCG Pasteur . While the chromosomes of M . tuberculosis and M . bovis BCG Pasteur show extensive conservation at the gross level, comparison with M . leprae revealed a high degree of diversification, with a mosaic-like pattern apparent . The ordered libraries of M . tuberculosis and M . leprae produced during the course of these studies played a central role in the genome sequencing projects of these two bacilli, showing the utility of this approach for systematic sequencing of bacterial genomes.

Jpn J Ophthalmol, 1998 Mar-Apr, 42(2), 115 - 8
Clinicopathologic study of satellite lesions in nontuberculous mycobacterial keratitis; Hu FR et al.; Multifocal stromal infiltrates or "satellite lesions" have been considered a characteristic feature of fungal keratitis . We examined two patients with nontuberculous mycobacterial keratitis who clinically presented with satellite lesions . The keratitis consisted of multifocal stromal infiltrates with indistinct white and fluffy margins . Both patients received topical fortified amikacin therapy with poor response . Lamellar keratectomy or penetrating keratoplasty was performed, respectively, in the two patients because of progressive stromal thinning and enlarging satellite lesions . Histopathologically, the main lesions consisted of dense infiltration of inflammatory cells with numerous acid-fast bacilli, while the satellite lesions were composed chiefly of inflammatory cells with fewer mycobacteria . Besides fungal keratitis, nontuberculous mycobacterial keratitis should also be considered when satellite lesions are present.

Am J Kidney Dis, 1998 Apr, 31(4), 701 - 5
Laryngeal tuberculosis in renal allograft patients; Tato AM et al.; Laryngeal tuberculosis, although the most common granulomatous disease of the larynx, is a rare form of extrapulmonary tuberculosis, never reported in immunosuppressed allograft recipients . We present two cases of laryngeal tuberculosis in renal transplant patients and a review of the literature . Two women, a 29-year-old and a 60-year-old, each more than 9 years after their cadaveric renal allograft, presented with a 2-week febrile illness with hoarseness and dysphagia, and both were found to have laryngeal tuberculosis by direct laryngoscopy . Although both radiographs were unremarkable, both patients had sputum positive for acid-fast bacilli that subsequently grew Mycobacterium tuberculosis . Clinical response promptly followed institution of isoniazid, rifampicin, and pyrazinamide in each case, although both required threefold increases in daily cyclosporin A dosage to maintain therapeutic levels.

Am J Clin Pathol, 1998 May, 109(5), 642 - 6
Polymerase chain reaction assay for the detection and identification of Mycobacterium leprae in patients in the United States; Scollard DM et al.; The differentiation of leprosy from other cutaneous granulomatous diseases is routinely based on characteristic histopathologic features and the demonstration of Mycobacterium leprae by acid-fast staining . Increased ascertainment of other mycobacterial infections in the skin has made this task more difficult, but the distinction remains fundamental for the selection of appropriate treatment . Experience with formalin-fixed, paraffin-embedded tissues, frozen tissues, and tissue lysates referred for detection of M . leprae DNA by a polymerase chain reaction (PCR) assay during the past 4 years was reviewed . This assay was done by using primers and probes previously developed in our laboratory to amplify a 360-base-pair fragment of the gene for an 18-kD protein of M . leprae . Among biopsy samples obtained from 37 patients, PCR results were positive for 10 of 20 samples diagnosed as leprosy by histopathologic criteria and in 0 of 17 not diagnosed as leprosy . The specificity of the assay was 100% in this clinical referral material; sensitivity ranged from 50% to 83% . The PCR assay also identified M . leprae in one third of samples in which acid-fast organisms were seen and the histopathologic features were consistent with but not definitive of leprosy . In a nonendemic population, the sensitivity and specificity of PCR assay recommend its use primarily to identify M . leprae when acid-fast organisms are discernible but atypical clinical or histopathologic features obscure the diagnosis . The assay is not highly informative when acid-fast bacilli are not detectable by light microscopy.

J Clin Microbiol, 1998 May, 36(5), 1352 - 6
Reverse transcription-PCR detection of Mycobacterium leprae in clinical specimens; Kurabachew M et al.; A reverse transcription (RT)-PCR assay targeting the 16S rRNA of Mycobacterium leprae was developed to detect the organism in clinical specimens . A 171-bp fragment was amplified when M . leprae RNA was used as a template but not when a panel of RNAs from 28 potentially cross-reacting mycobacterial species, seven genera related to Mycobacterium, and three organisms normally found among skin or nose flora were tested . As few as 10 organisms isolated from infected tissue could be detected, confirming the sensitivity of the assay . When the test was applied to clinical specimens, M . leprae was detected in 82% of skin biopsy specimens obtained from untreated leprosy patients, while skin biopsy specimens from healthy volunteers and patients with other dermatological disorders were negative . The sensitivity of the RT-PCR was higher than that of slit skin smear staining for acid-fast bacilli or acid-fast staining of fixed biopsy specimens since 53% of acid-fast bacillus-negative biopsy specimens were RT-PCR positive . Because 16S rRNA is rapidly degraded upon cell death, the assay may detect only viable organisms and may prove to be useful in assessing the efficacy of chemotherapy.

J Immunol, 1998 May 1, 160(9), 4490 - 9
Induction of in vitro human macrophage anti-Mycobacterium tuberculosis activity: requirement for IFN-gamma and primed lymphocytes; Bonecini-Almeida MG et al.; Mycobacterium tuberculosis (Mtb) is the world's leading infectious cause of mortality . Despite the overwhelming data supporting the critical role of cellular immunity, little is known of the early microbial and immune cell interactions and whether human macrophages can be activated to express anti-Mtb activity . We report the reconstitution of an in vitro system whereby human macrophages express anti-Mtb activity only in coculture with PBL and with IFN-gamma . Omission of IFN-gamma in the cocultures or Mtb lysate/IFN-gamma-primed lymphocytes was associated with high growth of Mtb, high IL-10 and IL-12 p40, nearly undetectable IL-12 p70 levels, and the highest percentages of CD4 and CD8 T cells . In contrast, IFN-gamma treatment of cocultures containing Mtb lysate/IFN-gamma-primed PBL reduced bacilli count by approximately 2.5 log, decreased the production of IL-10 by 5.7-fold, increased IL-12 p70 by approximately 50-fold, and reduced the percentages of CD4 and CD8 T cells . Activation of anti-Mtb activity was time and dose dependent . At 2000 U/ml of IFN-gamma, bactericidal activity was achieved (10-fold reduction from initial inoculum) . Anti-Mtb activity against several strains of M . tuberculosis (H37Ra and H37Rv, and C, a clinical isolate) was observed and was associated with expression of inducible nitric oxide synthase . These data suggest that induction of human macrophage anti-Mtb activity required dual signaling from PBL and IFN-gamma . Thus, the development of an in vitro human system may greatly facilitate studies to delineate immune cells, cytokines, and effector functions/genes critical in controlling Mtb . Defining the mechanisms may also provide novel treatment strategies for tuberculosis.

J Comp Pathol, 1998 Feb, 118(2), 109 - 21
Changes in lymphocyte subsets in the intestine and mesenteric lymph nodes in caprine paratuberculosis; Navarro JA et al.; Changes in the number and distribution of lymphocyte subsets were investigated in the intestinal mucosa and mesenteric lymph nodes of three goats with natural paratuberculosis, comparisons being made with a single uninfected control animal . Lesions in the naturally infected goats varied from small granulomata with scarce epithelioid or multinucleated giant cells, containing few or no bacilli, in the intestine (tuberculoid type) to an extensive, diffuse epithelioid cell infiltrate containing numerous bacilli in the gut and mesenteric lymph nodes (lepromatous type) . The number and distribution of lymphocyte subsets in the control were consistent with data reported from other non-infected goats . However, in the goats with paratuberculosis, significant changes were observed in the number and distribution of CD4+ and CD8+ T lymphocytes, the changes being related to the severity of the lesions . In the intestinal mucosa of the goat with tuberculoid lesions no significant changes were observed, but in the cortical area of mesenteric lymph nodes the number of CD4+ T lymphocytes decreased and the number of CD8+ T lymphocytes increased . In the two goats with lepromatous lesions, there was a decrease in the CD4+ T subpopulation and an increase of CD8+ T lymphocytes in the lamina propria of the intestine and particularly in the cortical area of the mesenteric lymph nodes, the CD4:CD8 ratio (< 1) being the opposite of that observed in healthy goats . Because of the small numbers of animals, further studies including additional animals are needed to confirm these preliminary results, which suggest that the progression of paratuberculous lesions may be due to an ineffective host immune response attributable to the CD8+ T lymphocyte subset that "downregulates" the activity of the CD4+ T lymphocytes required for macrophage activation.

J Vet Dent, 1997 Dec, 14(4), 127 - 30
Dental plaque flora of the dog with reference to fastidious and anaerobic bacteria associated with bites; Allaker RP et al.; Animal bite wounds are amongst the most common types of traumatic injuries in humans . The organisms isolated from these wounds generally reflect the oral flora of the biting animal, and may be fastidious in nature and difficult to identify . This study was undertaken to determine the prevalence of Eikenella corrodens, Actinobacillus actinomycetemcomitans, Porphyromonas and Prevotella spp . in supragingival dental plaque collected from the right maxillary canine and carnassial teeth and the right mandibular canine tooth of dogs . In part one of the study, 30 dogs were used . E . corrodens was found in 62% of these dogs and 44% of individual plaque samples . A . actinomycetemcomitans was not detected in any of the dogs sampled . In part two, 34 dogs were used to determine the prevalence of the black pigmented anaerobic bacilli (Porphyromonas and Prevotella spp.) . Porphyromonas gingivalis was present in 68% of these dogs and 47% of individual plaque samples . Prevotella intermedia was present in 44% of the dogs and 23% of individual plaque samples . The recently described Porphyromonas canoris, Porphyromonas salivosa, Porphyromonas cangingivalis, Porphyromonas cansulci, Porphyromonas crevioricanis and Prevotella denticola species were isolated from only 9%, 6%, 3%, 3%, 3% and 3% of dogs respectively . Porphyromonas gingivicanis was not isolated from any of the animals sampled . In conclusion, black-pigmented anaerobic bacilli were isolated from 91% of the animals sampled and therefore constitute a significant risk with respect to bite wound infections . It is also suggested that the prevalence of E . corrodens in wound infections has been underestimated in previous reports because of use of inappropriate techniques for detecting this organism.

J Immunol, 1998 Feb 1, 160(3), 1290 - 6
Cytokine activation leads to acidification and increases maturation of Mycobacterium avium-containing phagosomes in murine macrophages; Schaible UE et al.; Mycobacterium avium (MAC) organisms multiply in phagosomes that have restricted fusigenicity with lysosomes, do not acidify due to a paucity of vacuolar proton-ATPases, yet remain accessible to recycling endosomes . During the course of mycobacterial infections, IFN-gamma-mediated activation of host and bystander macrophages is a key mechanism in the regulation of bacterial growth . Here we demonstrate that in keeping with earlier studies, cytokine activation of host macrophages leads to a decrease in MAC viability, demonstrable by bacterial esterase staining with fluorescein diacetate as well as colony-forming unit counts from infected cells . Analysis of the pH of MAC phagosomes demonstrated that the vacuoles in activated macrophages equilibrate to pH 5.2, in contrast to pH 6.3 in resting phagocytes . Biochemical analysis of MAC phagosomes from both resting and activated macrophages confirmed that the lower intraphagosomal pH correlated with an increased accumulation of proton-ATPases . Furthermore, the lower pH is reflected in the transition of MAC phagosomes to a point no longer accessible to transferrin, a marker of the recycling endosomal system . These alterations parallel the coalescence of bacterial vacuoles from individual bacilli in single vacuoles to communal vacuoles with multiple bacilli . These data demonstrate that bacteriostatic and bactericidal activities of activated macrophages are concomitant with alterations in the physiology of the mycobacterial phagosome.

Clin Exp Immunol, 1998 Apr, 112(1), 52 - 62
Gammadelta+ and CD4+ alphabeta+ human T cell subset responses upon stimulation with various Mycobacterium tuberculosis soluble extracts; Batoni G et al.; By using a flow cytometric technique which allows direct identification of proliferating cells within mixed cell populations, we have previously described that soluble extracts obtained from Mycobacterium tuberculosis or M . avium represent strong stimuli for human gammadelta+ T cells . In the present study, we demonstrate that the protocol used for the preparation of M . tuberculosis soluble extracts may have an impact on their gammadelta+ T cell stimulatory capacity . In agreement with our previous data, soluble extracts prepared from bacteria killed at 85 degrees C and directly disrupted by prolonged sonication (TBe), elicited a strong proliferation of gammadelta+ T cells after 6-7 days of stimulation . In contrast, when soluble extracts were obtained from bacteria autoclaved (121 degrees C, 25 min) and then washed by centrifugation, a predominant proportion of CD4+ alphabeta+ T cells was achieved in the responding population . The stimulatory activity for gammadelta+ T cells was recovered in the supernatant of the autoclaved bacteria, indicating that autoclaving of M . tuberculosis bacilli releases an antigen(s) into the supernatant which stimulates human gammadelta+ T cells . While protease digestion of TBe only partially reduced its stimulatory capacity on gammadelta+ T cells, the stimulatory component(s) released into the supernatant after autoclavation of bacilli was found to be sensitive to protease digestion . Interestingly, in contrast to the preponderant proportion of gammadelta+ T cells induced in the responding population by unfractionated TBe, when the extract was fractionated by fast performance liquid chromatography (FPLC), most of the fractions exhibited a strong stimulatory capacity on CD4+ alphabeta+ T cells only . The gammadelta+ T cell stimulatory activity was confined to the low molecular weight range FPLC fractions . Such results may suggest a possible regulatory role of gammadelta+ T cells on CD4+ alphabeta+ T cells.

FEMS Immunol Med Microbiol, 1998 Mar, 20(3), 231 - 8
Mycobacterial crossreactivity of M . tuberculosis reactive T cell clones from naturally converted PPD positive healthy subjects; Oftung F et al.; Mycobacterium tuberculosis reactive CD4+, CD8- T cell clones were established from six naturally converted PPD positive healthy subjects by using whole bacilli as the primary stimulation antigen in vitro . Antigen specificity of the T cell clones was mapped by testing their proliferative response against a panel of pathogenic and environmental mycobacterial species . The crossreactivity patterns obtained showed that the T cell clones distributed along a spectrum from reactivity restricted to the M . tuberculosis complex to broadly crossreactive clones recognizing all mycobacterial species tested . Two of the T cell clones were able to discriminate between M . tuberculosis and M . bovis BCG, and importantly one of these clones was exclusively specific to M . tuberculosis . All of the CD4+ T cell clones tested, displayed MHC class II restricted cytotoxicity against macrophages pulsed with M . tuberculosis . In addition, some of these clones secreted GM-CSF upon antigen stimulation . The T cell clones described here represent relevant tools to identify and characterize target antigens of the immune response against M . tuberculosis with relevance to diagnosis and subunit vaccine design.

Int J Tuberc Lung Dis, 1998 Feb, 2(2), 164 - 7
Computed tomography findings of tuberculous pleurisy; Yilmaz MU et al.; SETTING: Review of the records of 491 patients with tuberculous pleurisy hospitalized between 1993 and 1995 in Izmir, Turkey . Those cases with typical histopathology or demonstrated acid-fast bacilli on pleural needle biopsies and/or positive pleural fluid/tissue cultures and available computed tomography (CT) scans are included . OBJECTIVE: To determine the CT features of tuberculosis of the pleural space . DESIGN: The CT scans of 66 patients with proven tuberculous pleurisy were interpreted retrospectively by three observers . RESULTS: Of 66 patients, 65 (98.5%) had pleural effusions; 38 (57.5%) had pleural lesions; six (9%) had involvement of interlobar fissure; and one patient (1.5%) had involvement only of the mediastinal pleura . All but one of the pleural lesions involved regular thickening of greater than 1 cm . Fibrotic parenchymal changes were seen in 11 of 66 patients (17%), cavitary changes were seen in eight (12%), and heterogeneous nodular shadows were seen in four (6%) . Two cases (3%) had parenchymal consolidation and one (1.5%) had a calcified subpleural nodule . In 39% (26/66) of cases, hilar and mediastinal lymphadenopathy was identified . CONCLUSION: Tuberculous pleurisy in our series was characterized on CT by the presence of pleural effusion, often with smooth pleural thickening; rarely was there involvement of the mediastinal pleura . Underlying lung parenchymal abnormalities were seen in 39% of cases . Although these findings are non-specific, they may help to distinguish tuberculous pleurisy from other causes of pleural effusion, such as malignancy.

Int J Tuberc Lung Dis, 1998 Feb, 2(2), 147 - 52
Adenosine deaminase activity and lysozyme levels in bronchoalveolar lavage fluid in patients with pulmonary tuberculosis; Orphanidou D et al.; SETTING: The estimations of adenosine deaminase (ADA) activity and lysozyme (LYS) levels in pleural fluid have been proved useful tools in the diagnosis of tuberculous pleural effusions . Little is known about their usefulness when estimated in bronchoalveolar lavage fluid (BALF) . OBJECTIVE: To evaluate whether both ADA activity and LYS levels in BALF could be employed in the diagnosis of pulmonary tuberculosis, and especially in active but acid fast bacilli (AFB) smear negative cases . DESIGN: ADA activity and LYS levels were determined in BALF and serum obtained on the same day in 28 patients with tuberculosis, 21 with interstitial lung diseases, 14 with lung cancer and 13 with infectious diseases . RESULTS: Patients with pulmonary tuberculosis had significantly higher ADA activity in BALF than patients with non-tuberculous lung diseases (P < 0.001) . High BALF ADA activity in pulmonary tuberculosis patients suggests increased local production . In contrast, in this group of patients BALF LYS levels were not significantly higher than in the other groups of patients, but were in the group with interstitial lung diseases . CONCLUSION: BALF ADA activity seems to be a useful tool in the differentiation of tuberculosis from other lung diseases . Its estimation can be restricted to the detection of cases with AFB negative smears.

Infect Control Hosp Epidemiol, 1998 Mar, 19(3), 186 - 8
Risk factors associated with the acquisition of amikacin-resistant gram-negative bacilli in central New Jersey hospitals; Jessop AB et al.; A case-control study was performed in central New Jersey hospitals to evaluate the potential patient factors associated with the acquisition of amikacin-resistant gram-negative bacilli (ARGNB) . Univariate analysis revealed an association between numerous patient factors, and multivariate analysis revealed four factors to be associated independently with ARGNB: the number of hospital admissions during the prior year, previous aminoglycoside exposure, intubation, and intensive-care-unit admission.

Zhonghua Yi Xue Za Zhi (Taipei), 1998 Mar, 61(3), 170 - 4
Genitourinary tuberculosis complicated with adrenal involvement and primary adrenocortical insufficiency: a case report; Lin SY et al.; Genitourinary tuberculosis (TB) rarely involves the adrenal gland . A 67-year-old man presented with progressively hyperpigmented skin and an enlarged mass over both testes . Early morning plasma cortisol concentration was low and adrenocorticotropic hormone (ACTH) concentration was high . A rapid ACTH stimulation test revealed the absence of plasma cortisol response and confirmed a diagnosis of primary adrenocortical insufficiency . An abdomen computed tomography (CT) scan disclosed enlargement of the right adrenal gland and punctuate calcification over the left one . This is compatible with tuberculous adrenalitis . Currettage biopsy of the prostate demonstrated chronic granulomatous inflammation with Langerhan's giant cells, but without TB bacilli . Anti-TB treatment, in addition to glucocorticoid and mineralocorticoid replacement, was administered . The testicular mass decreased progressively though the results of a subsequent ACTH stimulation test, six months later, disclosed no significant change . A follow-up CT scan, one and a half years later, showed a decrease in the size of the right adrenal mass.

Int J Artif Organs, 1998 Jan, 21(1), 23 - 5
Fatal hepatic failure caused by miliary tuberculosis in a hemodialysis patient: case report; Kushihata S et al.; A 57 year-old male dialysis patient died soon after the onset of high fever, hypoglycemia, and disturbance of consciousness . Autopsy revealed granulomatous lesions associated with caseous necrosis mainly found in the liver, despite the absence of pulmonary changes on chest radiographs performed during the patients illness . It appears that tubercle bacilli were hematogenously disseminated mainly to the liver causing miliary tuberculosis without producing typical diffuse lesions in the lungs . Since tuberculosis is a common complication in hemodialysis patients, the potential development of atypical miliary tuberculosis should always be borne in mind.

Antibiot Khimioter, 1998, 43(2), 20 - 3
{Effect of probiotics from bacilli on macrophage functional activity}; Sorokulova IB; The influence of new probiotics from bacilli i.e . biosporin and subalin on the functional activity of murine peritoneal macrophages was studied . After a single oral administration of the probiotics the maximum activation of the macrophages was observed in 4 hours . The activation level depended on both the dose and the probiotic . The highest value of the stimulation index was recorded with subalin . Analogous regularities were stated with parenteral administration of the probiotics . Some mechanisms of activation of peritoneal macrophages after oral administration of probiotics from live microbial cultures are discussed.

Kekkaku, 1998 Feb, 73(2), 65 - 70
{Biochemical and immunological properties of the fractions of tubercle bacilli}; Azuma I; In 1954, Dr . Yuichi Yamamura and his coassociates, National Sanatorium Toneyama Hospital, has reported the formation of experimental tuberculous cavity in rabbits . This work was a milestone of the researches in the field of cellular immunology . In 1960, I have started my scientific carrier in Kyushu University Medical School as the post-graduate student under the guidance of Prof . Yamamura . Since then, I have worked on the field of biochemical and immunological properties of tubercle bacilli . The arabinose mycolate, polysaccharides, cell-wall skeleton (CWS) and trehalose dimycolate (TDM) were purified from tubercle bacilli and their Chemical structures and biological activities were investigated in detail in our laboratory . In 1971, we have reported that adjuvant active principle of tubercle bacilli was a CWS fraction, and the details of chemical structure and adjuvantity of mycobacterial CWS were investigated in our research group . The application of BCG-CWS to cancer immunotherapy was also studied . In 1974, Prof . E . Lederer and his coworkers, University of Paris, have reported that N-acetyl muramyl-L-alanyl-D-isoglutamine (MDP) was the minimum adjuvant-active structure of bacterial cell wall . We have synthesized several hundreds of MDP derivatives and selected, MDP-Lys(L18), romurtide, as the candidate of cytokine inducer for the clinical application . Romurtide is applied in cancer patients for the recovery of the number and functions of monocytes, neutrophils and platelets . These results suggest that the tubercle bacilli, especially, CWS and related synthetic MDP derivatives, are effective for the potentiation of host resistance against infectious diseases and cancer.

J Leukoc Biol, 1998 Apr, 63(4), 440 - 50
Nonspecific and immune-specific up-regulation of cytokines in rabbit dermal tuberculous (BCG) lesions; Sugisaki K et al.; To our knowledge, this is the first sequential study of cytokines in tissue sections of developing and healing tuberculous (BCG) lesions . In situ hybridization, immunohistochemical, and RT-PCR techniques were used . Cytokine mRNAs showed a biphasic pattern . The percentage of mononuclear cells (MN) containing IL-1beta, TNF-alpha, MCP-1, and IL-8 mRNAs was highest in 1- to 3-day lesions, apparently because of the nonspecific inflammatory response caused by the tubercle bacilli in the BCG vaccine . At 5 days, this percentage was significantly reduced . With IFN-gamma, the peak and trough were delayed by 2 days . By 9 days, the percentage of MN containing the mRNAs of all five cytokines had again increased and the rabbits had become tuberculin-positive . In general, MCP-1 and TNF-alpha proteins and the vascular adhesion molecules, ICAM, VCAM, and perhaps ELAM, peaked at about 3 days . Many mononuclear cells surrounding the central areas of solid and liquefied caseous necrosis contained chemokine IL-8 mRNA . IL-8 is known to attract PMN, and PMN were present nearby . In contrast, MN containing chemokine MCP-1 mRNA were present more peripherally in areas rich in macrophages and lymphocytes . The early nonspecific cytokine response seems to be an adjuvant effect of the mycobacteria in BCG vaccine in that it causes a rapid entry of macrophages, lymphocytes, granulocytes, and probably dendritic cells into local sites of antigen deposition . This effect should be considered in developing improved vaccines for the prevention of tuberculosis, because BCG vaccines producing a strong early cytokine response should be more immunogenic than BCG vaccines with similar antigens producing a weak response.

FEMS Immunol Med Microbiol, 1998 Feb, 20(2), 129 - 38
Characterization of antigens recognized by new monoclonal antibodies raised against culture filtrate proteins of Mycobacterium bovis bacillus Calmette-Guérin; Freer G et al.; Effective protection against Mycobacterium tuberculosis may be achieved in experimental animals by immunization with proteins secreted by tuberculous bacilli in the extracellular milieu during growth . In this study, monoclonal antibodies were raised against Mycobacterium bovis bacillus Calmette-Guerin (BCG) culture filtrate proteins or live BCG, in an attempt to identify novel mycobacterial secretion antigens: the localization of the antigens recognized by the monoclonal antibodies within the mycobacterial cell was studied and interspecies reactivity was also investigated . The monoclonal antibodies obtained recognized proteins of molecular mass ranging from 5 to 82 kDa, with a prevailing frequency in the 30 kDa region . Three of the monoclonal antibodies recognized proteins present only in culture filtrates, one reacted with a cytoplasmic antigen, while the remaining antibodies recognized components which were mainly associated with the cell wall and the cytoplasmic membrane . The chemical nature and possible identity of the antigens was checked . Three monoclonal antibodies are likely to react with novel mycobacterial antigens of 5, 42 and 82 kDa, respectively.

J Trop Pediatr, 1998 Feb, 44(1), 40 - 2
Diagnosis of tuberculosis: PPD or BCG test; Sonmez E et al.; In recent years, several articles have been published about BCG tests in the diagnosis of tuberculosis, particularly in children . The test is reportedly more sensitive and more specific than tuberculin test (PPD) . We evaluated the results of simultaneous application of PPD and BCG test in order to assess its efficacy in adults and adolescents with tuberculosis (tbc) . We applied BCG test and PPD concurrently in 35 healthy controls and 41 tuberculosis cases presented to Research Hospital, Inonu University and Malatya Tuberculosis Dispensary with clinical and radiological findings . The subjects also had sputum examined for presence of acid-fast bacilli (AFB) by direct microscopy, culture on Lowenstein Jensen medium and by polymerase chain reaction (PCR) . We conclude that BCG test is more sensitive and more specific than PPD in diagnosis of tuberculosis in adults and adolescents.

FEMS Immunol Med Microbiol, 1997 Dec, 19(4), 297 - 305
Stazyme, a mycobacteriolytic preparation from a Staphylococcus strain, is able to break the permeability barrier in multiple drug resistant Mycobacterium avium; Rastogi N et al.; As a strategy to augment the potential of existing drugs against Mycobacterium avium we investigated a mycobacteriolytic preparation (stazyme) from the Staphylococcus strain Clavelis, which results in significant mycobacterial growth inhibition . A total of 10 specific protein bands were characterized in the stazyme preparation: three bands within a major 40-60 kDa fraction, five bands within the range of 30-90 kDa, and two bands of about 12 and 14 kDa respectively . Tested at concentrations of 50 and 200 microg ml(-1) of total protein, stazyme was highly bactericidal against M . smegmatis, and bacteriostatic against M . tuberculosis and M . avium . Stazyme was able to break the permeability barrier of M . avium isolates, significantly enhancing the activity of other antituberculous drugs (ethambutol, rifampicin, and amikacin), used at sub-MIC level . Stazyme essentially possessed a lytic activity as evidenced by its ability to lyse purified M . smegmatis cell walls . This lytic activity was also confirmed on intact M . smegmatis and M . avium bacilli by transmission electron microscopy . Precise identification of this mycobacteriolytic determinant(s) in stazyme may be helpful to define novel drug targets in mycobacteria.

Pathology, 1998 Feb, 30(1), 65 - 7
Actinomycosis of the cholecystic duct: case report and review; Ormsby AH et al.; Actinomycosis of the gall bladder, cholecystic duct or common bile duct is rare, with only 16 cases reported to our knowledge . We report a case of actinomycosis in the cholecystic duct remnant of an 80-year-old woman with a history of cholecystitis, choledocholithiasis and cholecystoduodenal fistula requiring cholecystectomy and fistula closure three years prior . Histologic sections of the cystic duct remnant showed several dense basophilic masses containing numerous, dark blue, Gram-positive branching bacilli compatible with actinomycotic granules . Fluorescent antibody staining was positive for Actinomyces naeslundii . Staining for acid-fast bacilli was negative . The pathogenesis, presentation, diagnosis and management of abdominal actinomycosis with specific reference to disease involving the gall bladder are discussed.

Curr Microbiol, 1998 Apr, 36(4), 220 - 5
SASP (small, acid-soluble spore proteins) and spore properties in Bacillus thuringiensis israelensis and Bacillus sphaericus; Cucchi A et al.; Entomopathogenic bacilli B . thuringiensis israelensis (Bti) and B . sphaericus (Bf) exhibit low survival on field application . It was previously shown that their spores are very sensitive to different stress effectors (heat, UV light) and especially to osmotic variations . Since SASP (Small, Acid-Soluble Spore Proteins), alpha/beta and gamma type, are involved in spore tolerance to heat, UV light, peroxide, and salt, they were analyzed in Bti and Bf . The molecular weight, migration pattern and amino acid composition of different SASP were determined and compared with other bacilli, in particular to B . subtilis . A relation between spore osmotolerance, SASP content, and amino acid composition was shown . In addition, the absence of gamma SASP in Bti and Bf is discussed.

Curr Biol, 1998 Jan 29, 8(3), R99 - R101
Microbial immunology: a new mechanism for immune subversion; Lachmann PJ; The number of mechanisms that have evolved in microbes to subvert the immune response seems limitless . Tubercle bacilli have found a novel way to coat themselves with the C3 complement protein and invade macrophages by interactions with complement receptors.

Antimicrob Agents Chemother, 1998 Feb, 42(2), 419 - 24
In vitro activities of Y-688, a new 7-substituted fluoroquinolone, against anaerobic bacteria; MacGowan AP et al.; The in vitro activities of Y-688, a new 7-substituted fluoroquinolone derivative, against 317 nonduplicate anaerobic isolates were determined . Eighty-five percent of the Bacteroides fragilis group (n = 89) were inhibited by < or = 2 mg of Y-688 per liter, while 78, 100, 89, and 98% of gram-negative bacilli (n = 135), gram-positive cocci (n = 59), and non-spore-forming (n = 58) and spore-forming (n = 51) gram-positive bacilli, respectively, were inhibited by < or = 1 mg of Y-688 per liter.

Electrophoresis, 1997 Dec, 18(14), 2558 - 65
The interaction between Mycobacterium and the macrophage analyzed by two-dimensional polyacrylamide gel electrophoresis; Sturgill-Koszycki S et al.; The intramacrophage pathogen Mycobacterium avium resides in a vacuole which displays unusual fusion characteristics, expressed as both a failure to mature into phagolysosomes and a continued access to the early recycling pathway . In contrast, compartments containing inert IgG-opsonized latex beads mature to phagolysosomes . Techniques were developed for the isolation of these particle-containing phagosomes from macrophages to facilitate analysis of phagosomal constituents by electrophoresis and autoradiography . Metabolic labeling of macrophages followed by phagosome isolation and two-dimensional polyacrylamide gel electrophoresis revealed only minor differences in the protein profiles between the M . avium and IgG-bead phagosomes despite the marked differences in the fusigenicity of the respective vacuoles . Pulse-chase labeling experiments revealed greater differences in the accessibility of Mycobacterium avium and IgG-bead phagosomes to newly synthesized proteins . These phagosome isolation techniques were extended to analyze the protein synthesis profile of intracellular M . avium for comparison with bacteria that were metabolically labeled in broth culture . Not surprisingly, the majority of polypeptides in the bacilli were common to both growth conditions . However, despite these similarities, intracellular M . avium express several unique proteins, most notably one abundant protein with a molecular weight of 51 kDa . In addition, the bacteria manifest a restricted set of proteins expressed while in stasis shortly after infection.

Clin Infect Dis, 1998 Mar, 26(3), 576 - 83
Randomized comparison of sulbactam/cefoperazone with imipenem as empirical monotherapy for febrile granulocytopenic patients; Winston DJ et al.; In a prospective, randomized, controlled trial, we compared sulbactam/cefoperazone with imipenem as empirical monotherapy for febrile, granulocytopenic patients; 101 patients received sulbactam/cefoperazone (2 g/4 g every 12 hours) and 102 patients received imipenem (500 mg every 6 hours) . Documented infections were present in 40% of patients treated with sulbactam/cefoperazone (40 of 101) and in 39% of patients receiving imipenem (40 of 102) . The number of pretherapy gram-positive pathogens (52 isolates) was twice the number of pretherapy gram-negative pathogens (26 isolates) . The overall favorable clinical response rates for sulbactam/cefoperazone (91 of 103 patients, or 88%) and imipenem (84 of 104 patients, or 81%) were similar . Both drugs were generally well tolerated . However, diarrhea occurred more often in patients treated with sulbactam/cefoperazone (31 of 101 patients, or 31%, vs . 15 of 102 patients, or 15%; P = .007), while seizures developed only in patients receiving imipenem (0 of 101 patients vs . 3 of 102 patients, or 3%) . Superinfections developed in 16% of patients in both study groups but were infrequently caused by beta-lactam-resistant gram-negative bacilli (two cases with sulbactam/cefoperazone therapy and six cases with imipenem) . These results support the efficacy and safety of either sulbactam/cefoperazone or imipenem as empirical monotherapy for febrile granulocytopenic patients.

J Zoo Wildl Med, 1997 Dec, 28(4), 494 - 7
Fatal Erysipelothrix rhusiopathiae septicemia in a captive Pacific white-sided dolphin (Lagenorhyncus obliquidens); Kinsel MJ et al.; One male of a group of seven Pacific white-sided dolphins (Lagenorhynchus obliquidens) died after a brief period of nonspecific clinical signs . Four beluga whales (Delphinapterus leucas) and four harbor seals (Phoca vitulina) were managed in the same water system . Gross examination of the dolphin revealed only moderately enlarged mesenteric lymph nodes . Histopathology revealed small to massive numbers of gram-positive bacilli, usually intravascular, in all tissues . Bacteria were both extracellular and present in macrophages, monocytes, and neutrophils . Aerobic bacterial culture of lung, liver, kidney, and spleen yielded pure cultures of Erysipelothrix rhusiopathiae . Based on clinical course, histopathology, and bacteriology, a diagnosis of acute erysipelas septicemia was made . None of the other cetaceans or pinnipeds exhibited clinical signs.

Neurologia, 1998 Jan, 13(1), 41 - 4
{Patient with Hansen disease and lepromatous reaction with predominant neural involvement}; Galvez J et al.; We describe a patient with a diagnosis of Hansen's disease borderline type, presenting as cutaneous lesions and silent multineuritis . Samples of nasal mucus, earlobe and cutaneous lesions were positive for acid-fast bacilli . He was given treatment with rifampin, dapsone and clofazimine . Five years later, he developed fever, poliarthritis, orchitis and hepatic involvement . Searching for acid-fast bacilli in many cutaneous and mucosal locations was fruitfulness . Because of clinical suspicion of erythema nodosum leprosum, he was treated with steroids with improvement of his clinical picture, but subsequently he developed multineuritis with many sensitive symptoms . A high number of bacilli was seen in nerve biopsy . We comment on atypical features of clinical evolution and erythema nodosum leprosum, and emphasize the significance of large number of bacilli into peripheral nerve in contrast with their absence at other levels.

Clin Diagn Lab Immunol, 1998 Mar, 5(2), 211 - 8
Involvement of antilipoarabinomannan antibodies in classical complement activation in tuberculosis; Hetland G et al.; We examined alternative and classical complement activation induced by whole bacilli of Mycobacterium bovis BCG and Mycobacterium tuberculosis products . After exposure to BCG, there were higher levels of the terminal complement complex in sera from Indian tuberculosis patients than in sera from healthy controls . The addition of BCG with or without EGTA to these sera indicated that approximately 70 to 85% of the total levels of the terminal complement complex was formed by classical activation . Sera from Indian tuberculosis patients contained more antibody to lipoarabinomannan (LAM) than sera from healthy Indians . Levels of anti-LAM immunoglobulin G2 (IgG2), but not anti-LAM IgM, correlated positively with classical activation induced by BCG in the sera . By flow cytometry, deposition of C3 and terminal complement complex on bacilli incubated with normal human serum was demonstrated . The anticomplement staining was significantly reduced in the presence of EGTA and EDTA . Flow cytometry also revealed the binding of complement to BCG incubated with rabbit anti-LAM and then with factor B-depleted serum . This indicates that classical activation plays a major role in complement activation induced by mycobacteria and that anti-LAM IgG on the bacilli can mediate this response . Classical complement activation may be important for the extent of phagocytosis of M . tuberculosis by mononuclear phagocytes, which may influence the course after infection.

Acta Microbiol Pol, 1997, 46(4), 377 - 85
Haemolytic activity of Mycobacterium spp; Brzychcy M et al.; Haemolytic activity of clinical isolates of Mycobacterium bacilli (98) was determined by the method of King et al., 1993 . During 3-h incubation, all M . tuberculosis (MTB) isolates (28) and one out of 38 M . avium-intracellulare (MAI) strains, produced a strong contact-dependent haemolysin (CDH) . Six MAI strains expressed a weak CDH . One MAI isolate produced a strong and five other MAI strains a weak contact-independent haemolysin (CIH) . Two M . bovis BCG strains and 7 M . vaccae strains did not demonstrate haemolytic activity . The persistence of chosen Mycobacterium strains differing by haemolytic activity, in the spleens of infected C57BL/6 mice was examined . Mycobacteria producing a strong CDH (MTB H37Rv, MTB 101/92, MAI 83/93) or CIH (MAI 475/93) survived in the spleens of nonimmunized or M . bovis BCG-immunized mice for longer time than MAI strains expressing weak haemolytic activity or M . bovis BCG vaccine strain.

Nihon Hansenbyo Gakkai Zasshi, 1997 Nov, 66(3), 223 - 6
A genomic study on the cultivable and nerve invading Mycobacterium HI-75 after the recovery 3 months of the inoculation to nude mice; Sakai T et al.; The sequence of the polymerase chain reaction (PCR) product of 16S ribosomal RNA (16S rRNA) of the leproma-derived and cultivable Mycobacterium HI-75 (M . HI-75) which was obtained from the infected regions of inoculated mice, was examined and compared with that of the cultured bacteria by the direct sequencing techniques . The sequence was completely consistent with the cultured bacilli in the comparable 837 bases of 16S rRNA . The mycobacterium examined in this study was originally isolated as M . leprae (ML) by Skinsnes, et al . in 1975 from leproma of a lepromatous type Hansen's disease patient and therefore named as Mycobacterium leprae HI-75 by them, and was maintained from 1984 using either Ogawa's or Sauton's media in the beginning and Ogawa's medium enriched with glucronic acid and N-acetyl-D-glucosamine recently . Sasaki and Hamit reported the nerve invasion and the growth of the inoculated bacilli either to the nude mice or the I131 treated immunocompromised Swiss mice . We previously reported that cultured HI-75 was most similar to M . scrofulaceum by the direct sequencing of the gene of 16S rRNA . The 16S rRNA obtained from the mouse tissue in the present study indicated that M . HI-75 would be a variant of M . scrofulaceum possessing an ability to invade into peripheral nerve . The results suggest that the HI-75 strain claims a nature as a pathogen to develop a leproma-like lesion.

Nihon Hansenbyo Gakkai Zasshi, 1997 Nov, 66(3), 215 - 21
{On the lesions caused by a leproma-derived and cultivated Mycobacterium HI-75 produced in ddY mice . With special reference to a factor influencing the lesions and the differences from those by BCG}; Furuno Y; Not only in the experimental leprosy, primary aim to make every experimental model crucial for the medical research has been the simulation of the aspect of disease encountered in human case by the simplest possible way . The present study was conducted to do so making some variations in addition to the experimental lepromata, produced in nude mice by Sasaki et al . and by Hamit, utilizing a leproma-derived and cultivated Mycobacterium HI-75 (HI-75) . In this study HI-75, Mycobacterium bovip BCG (BCG) and female SPF ddY(ddY) were utilized to make experimental models . In addition to these combinations, the effect of the immunization of beta-glucuronidase binding protein (BGBP) to the lesion was also examined . The BGBP extracted from pisum sativum and utilized in this study shows cross-immunoreactivity with those of HI-75 and M . leprae . As the results, the lesions caused by HI-75 and BCG were somewhat resembling though HI-75 caused a little more extensive lesions especially in lymphocytic and monocytic infiltration . Also HI-75 caused distinct nerve lesions(NL) in which the bacilli were often encountered in the endoneurium but not in those by BCG . Contrarily in mice immunized with BGBP, the lesions were only a little milder and the affected tissue was a little fibrosed . However, in NL the solid form HI-75 were more often observed in the endoneurium . The results indicated that the effect of BGBP immunization on the HI-75 induced lesion was not very clear by the present study alone, however, the proposed models itself should be and will become very useful, for experimental leprology with only slight modifications.

Eur J Clin Microbiol Infect Dis, 1998 Jan, 17(1), 53 - 5
Fatal Legionella longbeachae infection following heart transplantation; Korman TM et al.; A case of fatal Legionella longbeachae infection following heart transplantation is described . Gram stains of respiratory secretions on day 17 posttransplant revealed leucocytes and gram-negative bacilli, but there was no growth on routine bacterial culture . Legionella longbeachae serogroup 1 was isolated from respiratory specimens, blood, and postmortem lung tissue . Legionella longbeachae is a common cause of legionellosis in Australia, and infection has been associated with exposure to potting mixes . Specific culture for Legionella spp . should be performed for any patient who develops pneumonia following organ transplantation.

J Natl Med Assoc, 1998 Feb, 90(2), 73 - 6
Tuberculosis in African Americans: clinical characteristics and outcome; Funnye AS et al.; This study examined the clinical characteristics and outcome of pulmonary tuberculosis in African Americans hospitalized in a teaching hospital in south-central Los Angeles from May 1992 through April 1994 . The charts of 41 African Americans with culture-positive Mycobacterium tuberculosis were reviewed . Predisposing factors for pulmonary tuberculosis were identified in nearly half of cases . Cough and fever were the most common symptoms . Seventy-six percent had positive acid-fast bacilli (AFB) smears . Nine patients were human immunodeficiency virus (HIV)-positive, and 6 of 9 HIV-positive patients had positive AFB smears whereas 17 of 19 HIV-negative patients had positive AFB smears . Radiographic changes were not significantly different between HIV-positive and HIV-negative patients . Drug resistance was identified in nine of 31 patients (29%) . Eight of 41 patients (19.5%) died, with 2 being drug resistant . Human immunodeficiency virus infection was a major predisposing factor for tuberculosis, and no statistical differences were found in radiographic features or AFB smear positivity between HIV-positive and HIV-negative patients . Drug resistance and mortality were disproportionately high . These results indicate that HIV infection and drug resistance are major problems that predispose for tuberculosis infection and make its treatment difficult.

Gastroenterol Hepatol, 1997 Dec, 20(10), 490 - 3
{Isolated colonic tuberculosis}; Perez Fernandez T et al.; Two cases of colonic tuberculosis (TB) isolated in two elderly, not HIV seropositive women, presenting unspecific clinical manifestations (constitutional syndrome, fever, abdominal pain and diarrhea) and stenosis of the colon in diagnostic imaging techniques are presented . In the second case, endoscopy showed stenosis of the colonic lumen and inflammatory mucosa, the biopsy of which demonstrated granulation tissue with no signs of specificity (in the first case, technical problems did not allow the colonoscopy to reach the affected site) . In both cases, diagnosis was performed postoperatively by study of the surgical pieces . Biopsy showed granulomas with acid-alcohol resistant bacilli . Both patients responded favorably to tuberculostatic treatment.

Trends Microbiol, 1998 Feb, 6(2), 47 - 9; discussion 49-50
Mycobacterium tuberculosis and the complement system; Schlesinger LS; Accumulated evidence to date confirms the importance of the C3-CR pathway in the phagocytosis of pathogenic mycobacteria . Detailed receptor-ligand studies for phagocytosis are creating the framework to test the hypothesis that the entry pathway for these bacteria influences the immediate host cell response and their intracellular fate . These types of study are particularly important for improving our understanding of the outcome of primary infection in humans, where the number of bacilli is presumed to be very low.

Lepr Rev, 1997 Dec, 68(4), 301 - 15
Transmission and protection in leprosy: indications of the role of mucosal immunity; Ramaprasad P et al.; Recent advances in treatment have achieved a large drop in the prevalence of active leprosy cases, but the incidence is at best decreasing slowly . Most people within leprosy-endemic populations have been exposed to Mycobacterium leprae, but few develop disease and it seems likely that the majority of the population develops protective immunity . If the site of initial infection is in the nose, dissemination of bacilli around the body to skin and nerve implies that the initial infection is bacilliferous and it has been shown that nasal M . leprae are detectable by polymerase chain reaction (PCR) of nasal swabs . Since salivary anti-M . leprae IgA (sMLIgA) levels are correlated with protection, we have surveyed groups of leprosy patients, contacts and the general population for both their sMLIgA and nasal PCR positivity . A total of 304 subjects were enrolled in the study: PCR and mucosal challenge tests were performed in 204 of these individuals . sMLIgA was present in 66% of treated patients, 76% of leprosy workers and 72% of healthy contacts . However, only 33% of indigenous subjects were sMLIgA+, in contrast to the earlier studies showing 74% positivity . PCR for M . leprae was present in both household contacts (2%) and indigenous controls (5%) . In a subsequent follow-up study, nasal swabs were taken from 97 of those studied in the first series: three PCR+ individuals followed up after one year became negative, while of the remaining 94 PCR- individuals retested, 2 became positive . Of 112 subjects retested with the mucosal challenge test for sMLIgA: 22 converted from positive to negative and 12 from negative to positive . These results suggest that there is widespread subclinical transmission of M . leprae with transient infection of the nose resulting in the development of a mucosal immune response, despite the fact that few individuals will develop clinical disease . This may explain the current lack of effect of multidrug therapy (MDT) control programmes on incidence, although the reduction in general population immunity is consistent with some effect of MDT on transmission.

Clin Infect Dis, 1998 Feb, 26(2), 389 - 92
Bordetella holmesii-like organisms associated with septicemia, endocarditis, and respiratory failure; Tang YW et al.; We recovered an unusual bacterial strain from blood or sputum of three patients with septicemia, endocarditis, and/or respiratory failure . The three isolates were thin, curved, gram-negative, light brown, pigment-producing bacilli with variable catalase activity . They were asaccharolytic, oxidase-negative, nonmotile, and fastidious . Identification was not possible on the basis of these characteristics alone or in combination with cellular fatty acid profiles . Nucleic acid amplification and sequence analysis of the 16S rRNA gene revealed that all three isolates were identical and most closely related to the emerging pathogen Bordetella holmesii, diverging from the published sequence at three nucleotide positions (99.8% similarity) . Isolation of a B . holmesii-like pathogen from sputum suggests that, in addition to producing septicemia, the organism may inhabit the respiratory tract like other Bordetella species.

Br J Anaesth, 1998 Jan, 80(1), 41 - 5
Endogenous source of bacteria in tracheal tube and proximal ventilator breathing system in intensive care patients; Inglis TJ et al.; Although bacteria from both the ventilator breathing system and the gastrointestinal tract have been implicated in the pathogenesis of ventilator-associated pneumonia, an endogenous source of bacteria in the proximal respiratory breathing system has yet to be demonstrated conclusively . We investigated a potential route of bacterial colonization from the stomach contents to the efferent limb of the ventilator breathing system by bacterial culture of daily specimens from six sites in 20 surgical intensive care patients . Gram-negative bacilli were isolated in a progressively increasing proportion of samples at successive sampling points, consistent with an endogenous-to-external route of spread (patients, chi-square = 14.12, P < 0.02; samples, chi-square = 106.15, P < 0.001) . Identical strains of gram-negative bacilli, confirmed by REPS typing, were found at two or more sites in seven patients . In all seven, gram-negative bacilli were first isolated from a site in the patient . In none of the 20 patients was there evidence of a sequence of colonization from the ventilator tubing or Y-piece connector towards the patient . Probable colonization sequences plotted from the time of first isolation supported the proposed sequence in six patients, and in five began with the stomach contents . Isolation sequences contrary to the proposed direction of colonization involved four bacterial species and two patients, and did not extend beyond two sample sites . These findings imply that the retrograde route of bacterial colonization of the ventilated lung extends into the proximal respiratory breathing system and may help to identify additional targets for preventive intervention.

Chest, 1998 Feb, 113(2), 542 - 8
Pulmonary Mycobacterium avium complex disease without dissemination in HIV-infected patients; Hocqueloux L et al.; Pulmonary disease due to Mycobacterium avium complex (MAC) without evidence of dissemination is uncommon in HIV-infected patients . Five cases were observed over a 2-year period . All patients had AIDS and the median CD4 cell count at the time of presentation was 90 x 10(6)/L . Radiographic patterns included unilobar alveolar infiltrates or diffuse alveolar densities . All patients had a favorable clinical response to antimycobacterial chemotherapy with a median follow-up period of 10 months . MAC should be considered in HIV-infected patients with positive respiratory samples for acid-fast bacilli and pulmonary infiltrates . Patients with such findings in whom presumptive therapy for tuberculosis has failed should receive broad-spectrum antimycobacterial chemotherapy until final identification is available.

Immunology, 1997 Dec, 92(4), 429 - 36
Lipids from Mycobacterium leprae cell wall suppress T-cell activation in vivo and in vitro; Moura AC et al.; The influence of Mycobacterium leprae cell wall lipids on lymphocyte functions has been investigated in vivo (delayed-type hypersensitivity) and in vitro . The inflammatory response has been earlier evaluated by the mouse footpad oedema model and the delipidated mycobacteria evoked a mild but significant inflammatory response . Herein a higher level of hypersensitivity reaction was observed with delipidated bacilli than with the intact mycobacteria . The lipids obtained from the extract of M . leprae external cell wall were used to prepare liposomes, which have not been shown to be toxic to lymphocytes . The method of lipidic extraction and the sodium dodecyl sulphate-polyacrylamide gel electrophoresis of the lipid fraction did not reveal any trace of proteins . Thin-layer chromatography of this extract detected four different bands with an apolar character, suggestive of mycolic and fatty acids . These same M . leprae liposomes potently suppressed lymph node cells, as well CD4+ and CD8+ T-cell lines, and an antigen-specific T-cell clone (T 4-9) proliferation, even under potent stimulus . Cholesterol-choline liposomes, unrelated to M . leprae liposomes, used as a control in the biological assays showed no significant effect on lymphoblastic activity, which points to the specificity of M . leprae lipids . These data demonstrated that M . leprae cell wall lipids induce immune suppression in mice without causing any membrane alteration in T cells as assessed throughout kinetic studies in vitro . This fact is closely related to the down-regulating effect induced by M . leprae lipids which we have previously observed in macrophage functions in vivo and in vitro . Although this lipidic fraction showed a suppressive action on T lymphocytes in vitro (proliferation) and in vivo (delayed-type hypersensitivity), its possible significance in the establishment of a specific immune response to M . leprae must be further investigated.

J Gastroenterol, 1998 Feb, 33(1), 14 - 7
Evaluation of combined antibiotic-omeprazole therapies in Helicobacter pylori-infected Mongolian gerbils; Kusuhara H et al.; Mongolian gerbils are a laboratory host for gastric colonization with Helicobacter pylori, showing gastritis followed by typical gastric ulcer after infection with H . pylori . In such gerbils, we evaluated combined therapies of amoxicillin (AMPC) and clarithromycin (CAM) as antibiotics, and omeprazole (OPZ) as a H+/K+ adenosine triphosphatase (ATPase) inhibitor . The gerbils were orally inoculated with 2 x 10(8) bacilli of H . pylori ATCC 43504 . Four weeks after inoculation, the infected gerbils were orally treated singly with OPZ, AMPC, and CAM, and their insufficient efficacy on bacterial clearance was confirmed by a polymerase chain reaction technique, and by a culture method . In contrast, combined therapy of OPZ plus either AMPC or CAM showed significant bacterial clearance, demonstrating the efficacy of this combined therapy in the gerbil model . Mongolian gerbils are suggested to be useful for the pharmacological evaluation of anti-H . pylori compounds.

Rev Mal Respir, 1997 Dec, 14 Suppl 5, S124 - 9
{Prevention of tuberculosis}; Zellweger JP; Tuberculosis is transmitted by aerial route from an infected patient to a healthy subject and is facilitated when the receiver is immunologically sensitive . Even when the risk of transmission is low, measures should be taken to prevent emission of bacilli, their suspension in air and inhalation by sensitive subjects, especially immunodeficient subjects . Surveillance of hospital staff and preventive antituberculosis regimens are generally recommended, but often quite controversial.

Rev Mal Respir, 1997 Dec, 14 Suppl 5, S105 - 20
{Surgery of thoracic and pulmonary tuberculosis and the sequelae of its treatment in adults}; Riquet M et al.; Surgery for tuberculosis was the starting point for thoracic and cardiovascular surgery in the modern day, but its place was more and more restricted to the treatment of the disease . Excisions (lobectomies, pneumonectomies, segmentestomies) currently represent the majority of operations, after this come operations on the pleura (decortication) and rarely those on the thoracic wall (thoracoplasty, parietectomy) . The indications for excision are principally encountered with disease of the parenchyma itself: progressive disease under treatment or with resistant tubercle bacilli, sequelae of parenchymal complications (infections, aspergilloma or haemoptysis) and certain forms of atypical mycobacteria, and also a small but significant group in which excisions are aimed at diagnosis . Sometimes excisions are associated by necessity with decortication for pleural disease which may or may not have originally been intended for the underlying parenchyma or the lesions may be the sequelae of previous complications of treatment such as collapse therapy . Occasionally surgery is indicated in the treatment of lymph node masses in the mediastinum which have not responded to antituberculous therapy and during the treatment bronchial complications have evolved or there have been other sequelae . As for the indications for surgery of the thoracic wall such as thoracoplasty, they appear more than ever obsolete and even if they are still used in certain complications of surgery, they have apart from a few exceptions, lost their original therapeutic role in tuberculosis . However, currently there is a recrudescence of tuberculosis favoured by certain socio-economic situations and strengthened by the appearance of TB cultures which are more and more resistant . The surgery of tuberculosis in its oldest forms (thoracoplasty and removal of cavities) can no longer be said to be the surgery of the past . They proved in the old days that they could cure . Surgery has once more its place in the therapeutic arsenal of new forms of the disease and indirectly in limiting the risk of spread it has a role to play in prevention.

Rev Mal Respir, 1997 Dec, 14 Suppl 5, S49 - 59
{Tuberculous infection and pulmonary tuberculosis in adults}; Huchon G; A tuberculous infection is the result of inhalation of tubercle bacilli either in great numbers or in subjects with diminished immunity . Clinical tuberculosis will only occur in 10 per cent of subjects following a first infection (primary tuberculosis) or subsequently (secondary tuberculosis or by a reactivation of a tuberculous lesion) . All the intrathoracic structures may be involved in isolation or in the case of extra thoracic tuberculosis eventually disseminated . The clinical manifestations are most often non-specific . The persistence of respiratory symptoms are nevertheless suggestive, above all in a subject belonging to a group at elevated risk of tuberculosis . The radiological aspects may be very suggestive of tuberculosis . The diagnosis of an infection is based on a study of the skin responses to tuberculin and those on tuberculosis on the evidence of the tubercle bacillus.

Rev Mal Respir, 1997 Dec, 14 Suppl 5, S27 - 32
{The natural history of tuberculosis infection and skin tuberculin reaction}; Flament-Saillour M et al.; Though most often asymptomatic, tuberculous infection induces a delayed hypersensitivity reaction in the host by activating cellular immunity thus rendering the host refractory, "a priori", to a new infection; at least provided that the infecting dose is not massive or that the immune system of the host is not compromised . Less that ten per cent of immuno-competent individuals infected by Mycobacterium tuberculosis will develop tuberculous disease during their life . The intradermal reaction (IDR to tuberculin) in revealing delayed hypersensitivity to Mycobacterial antigens is in the absence of obvious signs, the only means of diagnosing a tuberculous infection in an individual . It is performed in France by an intradermal injection of 0.1 mls (10 U) of Merieux tuberculin . The response is read at 72 hours . In those who have not had BCG vaccination, an area of induration with a diameter of greater than or equal to 10 mm gives a positive result and is evidence of a tuberculous infection . The test is negative if the diameter is less than 5 mm and indeterminate between 5 and 9 mm . These indeterminate reactions may be the consequence of previous BCG vaccination or of a contact with atypical Mycobacteria in the environment . An IDR of greater than or equal to 10 mm less than ten years after BCG vaccination would not permit any discrimination between a reaction to the vaccine or an authentic tuberculous infection . On the other hand, an IDR of greater than 10 mm ten years after BCG vaccination is evidence of renewed contact with wild tubercle bacilli in 88 per cent of cases . In individuals whose immune defence is altered in particular in patients infected with HIV the threshold of positivity for IDR is lowered to 5 mm.

Rev Mal Respir, 1997 Dec, 14 Suppl 5, S19 - 26
{Pathophysiology and immunology of tuberculosis}; Marchal G; Only isolated bacilli are capable of reaching the pulmonary alveoli . Draining towards the lymphatic glanglia which corresponds to the infected pulmonary segment or transported by alveolar macrophages after being phagocytosed, these bacteria liberate molecules (antigens) presented to T lymphocytes . After clonal expansion, specific lymphocytes migrate out of the lymph nodes . From the initial area, other areas are infected and these specific lymphocytes lead to a local inflammatory reaction which is very rich in cells, in particular in activated monocytes and macrophages . The inflammatory granuloma or "tubercle" leads to control of the infection in the majority of cases . The inverse of this is that in five or ten per cent of cases a part of this granuloma is necrosed and caseus and leads to (or accompanies) an intense bacterial multiplication . At this stage with the formation of the cavity numerous bacilli may seed other regions of the lung or infect other people . The immune response in which T lymphocytes play a fundamental role thus permit at the same time the control of infection and the establishment of a lesion assuring the perpetuation of the species of Mycobacterium tuberculosis by contaminating new subjects . The respective roles of the different types of T lymphocyte and of liberated lymphokines remains to be determined . Also the principle antigens of the bacillus need to be characterised . The "dominant" antigens are probably liberated by bacteria during their growth phase.

Am J Clin Pathol, 1998 Mar, 109(3), 331 - 4
Histologic parameters predictive of mycobacterial infection; Tang YW et al.; Tissue specimens from a wide variety of anatomic locations are frequently examined for mycobacteria using a combination of cultures and special stains . Auramine-rhodamine (AR) staining is a sensitive method for detecting acid-fast bacilli (AFB) in tissue sections . We reviewed 85 AR-positive and 275 randomly selected AR-negative biopsy specimens collected during the past 2 years at the Mayo Clinic, Rochester, Minn . Pathologic diagnoses and culture results were also reviewed . Biopsy specimens containing necrotizing granulomas yielded the highest positivity rate for AFB (61 {47.7%}), followed by nonnecrotizing granulomas (14 {17.7%}) . Poorly formed granulomas (5 {16.1%}) and acute inflammation (5 {15.6%}) were less frequently positive . Cases with fibrotic or hyalinized granulomas, nonspecific chronic inflammation, nonspecific reactive or reparative changes, no significant histologic abnormality, or malignancy failed to disclose AFB . These specimens, which were consistently negative for AFB, were responsible for 25% of the samples submitted . Of the 360 tissue specimens submitted, 166 had a corresponding mycobacterial culture . Mycobacteria were cultured only from the biopsy specimens that contained necrotizing granulomas (38.2%), nonnecrotizing granulomas (32.4%), poorly formed granulomas (30.0%), or acute inflammation (15.8%) . Tissues with fibrotic or hyalinized granulomas, nonspecific chronic inflammation, nonspecific reactive or reparative changes, no significant histologic abnormality, or malignancy failed to yield positive cultures . These data suggest that biopsy specimens with these latter diagnoses are inappropriate specimens for mycobacterial culture or AR staining.

Eur Respir J, 1997 Dec, 10(12), 2722 - 4
Bronchoscopic diagnosis of sarcoidosis; Leonard C et al.; Transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA) of mediastinal lymph nodes and bronchoalveolar lavage (BAL) are routinely performed at fibreoptic bronchoscopy . Up to the present time, no data have been available on the efficacy of performing all three of these procedures simultaneously in the bronchoscopic work-up of sarcoidosis . A prospective study was undertaken to compare the diagnostic yield from TBLB, TBNA and BAL in patients presenting with clinical and radiological features typical of sarcoidosis . Thirteen consecutive patients with clinical and radiological features consistent with stage I and II sarcoidosis underwent bronchoscopy with TBLB, TBNA and BAL . Noncaseating granulomata (stain and culture negative for tuberculosis bacilli and fungi) were found in seven of the 13 patients by TBLB, and in six of the 13 patients by TBNA (of which four patients had negative TBLB) . Eight of the 13 patients had classical "sarcoid" BAL findings, i.e . >12% lymphocytes, and high CD4+:CD8+ lymphocyte ratio . Combining TBLB, TBNA and BAL gave a diagnostic sensitivity of 100% (12 out of 12 patients) for sarcoidosis . The remaining patient had nondiagnostic bronchoscopic studies and mediastinoscopy biopsy showed a non-Hodgkin's lymphoma . Our data suggest that performing simultaneous transbronchial lung biopsy, transbronchial needle aspiration and bronchoalveolar lavage produces optimal results in the diagnosis of sarcoidosis.

Pneumonol Alergol Pol, 1997, 65(9-10), 643 - 8
{Non-sporeforming anaerobic bacteria in bronchoalveolar lavage fluid of patients with pneumonia during the course of lung cancer}; Jassem E et al.; The aim of this study was to assess the occurrence of non-sporeforming anaerobes in bronchoalveolar lavage in patients with pneumonia coexisting with lung cancer . Material consisted of 40 patients with lung cancer . Bronchoalveolar lavage was performed before administration of antimicrobial treatment and obtained material was cultivated in anaerobic and aerobic conditions . Quantitative assessment of anaerobic bacteria and their susceptibility to common antimicrobial agents were also performed . Peptostreptococcus, Prevotella, Fusobacterium and Bacteroides were the most common anaerobes . Among aerobic bacteria, the most frequent were G-negative bacilli . G-negative anaerobes were susceptible to most tested agents, whereas G-positive rods were resistant to metronidazole and tinidazole . This study demonstrates presence of non-sporeforming anaerobic bacteria in lower respiratory tract infections accompanying lung cancer.

Int J Tuberc Lung Dis, 1997 Dec, 1(6), 509 - 17
A controlled clinical trial of oral short-course regimens in the treatment of sputum-positive pulmonary tuberculosis . Tuberculosis Research Centre; An outbreak involving extensive transmission of a virulent strain of Mycobacterium tuberculosis; Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USABACKGROUND AND METHODS: From 1994 to 1996, there was a large outbreak of tuberculosis in a small, rural community with a population at low risk for tuberculosis . Twenty-one patients with tuberculosis (15 with positive cultures) were identified; the DNA fingerprints of the 13 isolates available for testing were identical . To determine the extent of transmission, we investigated both the close and casual contacts of the patients . Using a mouse model, we also studied the virulence of the strain of Mycobacterium tuberculosis that caused the outbreak . RESULTS: The index patient, in whom tuberculosis was diagnosed in 1995; the source patient, in whom the disease was diagnosed in 1994; and a patient in whom the disease was diagnosed in 1996 infected the other 18 persons . In five, active disease developed after only brief, casual exposure . There was extensive transmission from the three patients to both close and casual contacts . Of the 429 contacts, 311 (72 percent) had positive skin tests, including 81 {corrected} with documented skin-test conversions . Mice infected with the virulent Erdman strain of M . tuberculosis had approximately 1000 bacilli per lung after 10 days and about 10,000 bacilli per lung after 20 days . In contrast, mice infected with the strain involved in the outbreak had about 10,000 bacilli per lung after 10 days and about 10 million bacilli per lung after 20 days . CONCLUSIONS: In this outbreak of tuberculosis, the growth characteristics of the strain involved greatly exceeded those of other clinical isolates of M . tuberculosis . The extensive transmission of tuberculosis may have been due to the increased virulence of the strain rather than to environmental factors or patient characteristics.

J Formos Med Assoc, 1998 Jan, 97(1), 66 - 8
Screening of human immunodeficiency virus infection in pulmonary tuberculosis patients in Taiwan; Chiang CY et al.; To disclose the impact of human immunodeficiency virus (HIV) infection on the tuberculosis epidemic in Taiwan, we prospectively screened for HIV infection in patients with active pulmonary tuberculosis . A total of 378 patients who were admitted to the Taiwan Provincial Chronic Disease Control Bureau from January through December 1996 were enrolled . HIV serologic testing was performed by enzyme-linked immunosorbent assay (ELISA) . A positive ELISA test was confirmed by Western blot analysis . One patient was infected with HIV . We conclude that the impact of HIV infection on the epidemic of tuberculosis in Taiwan is not significant at presentPIP: The impact of HIV infection on Taiwan's tuberculosis epidemic was investigated in a prospective study of all 378 pulmonary tuberculosis patients (mean age, 53.5 years) admitted to the Taiwan Provincial Chronic Disease Control Bureau in 1996 . Bacteriologic or pathologic evidence of pulmonary tuberculosis was obtained in 306 cases (81%); the remaining 72 patients had chest radiographs and clinical courses consistent with a tuberculosis diagnosis . In the former group, the sputum smear yielded acid-fast bacilli in 279 patients (73.8%) and sputum cultures grew Mycobacterium tuberculosis in 263 (69.6%) . Only 1 patient, an overseas Chinese man with a history of encounters with prostitutes, was HIV-positive . His symptoms included cough, weight loss, and malaise of 4 months' duration . His sputum culture was positive for M . tuberculosis and the chest radiograph revealed diffuse non-cavity infiltration lesions over the bilateral lung parenchyma and mediastinum lymphadenopathy . These findings suggest that the impact of HIV infection on Taiwan's tuberculosis epidemic is not significant at present, in part because HIV remains uncommon . However, continued monitoring of dual infection is essential to guide tuberculosis control efforts .

Indian J Lepr, 1997 Oct-Dec, 69(4), 353 - 9
Viability of M . leprae while undergoing laboratory procedures; Sreevatsa et al.; Studies were carried out to assess whether various methodological procedures adopted while conducting experiments, or, maintaining M . leprae under different conditions affected the number of organisms made available or their viability . Results of mouse foot-pad experiments showed that bacilli survived for one day at 37 degrees C, 7 days at 20 degrees to 30 degrees C and for 90 days in lyophilized conditions . Repeated daily exposure of the material preserved in refrigerator at +4 degrees C, to room temperatures showed that bacilli survived for only up to five days; whereas, with single exposure they survived up to 14 days . M . leprae were found to lose infectivity after 30 minutes of exposure to various disinfectants and ultra violet light . Centrifugation at high speed did not affect the viability of M . leprae.

J Bacteriol, 1998 Feb, 180(4), 801 - 8
Mycobacterial stationary phase induced by low oxygen tension: cell wall thickening and localization of the 16-kilodalton alpha-crystallin homolog; Cunningham AF et al.; Most cases of tuberculosis are due to reactivation of endogenous infection which may have lain quiescent or dormant for decades . How Mycobacterium tuberculosis survives for this length of time is unknown, but it is hypothesized that reduced oxygen tension may trigger the tubercle bacillus to enter a state of dormancy . Mycobacterium bovis BCG and M . tuberculosis H37Rv were cultured under aerobic, microaerobic, and anaerobic conditions . Their ultrastructural morphology was analyzed by transmission electron microscopy (TEM), and protein expression profiles were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) . TEM revealed that the microaerobically and anaerobically cultured bacilli but not the aerobically cultured bacilli developed a strikingly thickened cell wall outer layer . The thickening was not observed in aerobically cultured stationary-phase bacilli or in anaerobically cultured Mycobacterium smegmatis . A highly expressed protein was detected by SDS-PAGE in microaerobic and anaerobic cultures and was identified as the 16-kDa small heat shock protein or alpha-crystallin homolog . Immunolocalization by colloidal gold immunoelectron microscopy identified three patterns of protein distribution in M . bovis BCG cultured under low oxygen tension . The 16-kDa protein was strongly associated with the cell envelope, fibrous peptidoglycan-like structures, and intracellular and peripheral clusters . These results suggest that tubercle bacilli may adapt to low-oxygen conditions by developing a thickened cell wall and that the 16-kDa protein may play a role in stabilizing cell structures during long-term survival, thus helping the bacilli survive the low oxygen tension in granulomas . As such, the cell wall thickening and the 16-kDa protein may be markers for the dormant state of M . tuberculosis.

Clin Exp Immunol, 1998 Jan, 111(1), 56 - 63
Potential role of B7-1 and CD28 molecules in immunosuppression in leprosy; Agrewala JN et al.; In order to understand the mechanism of unresponsiveness towards Mycobacterium leprae antigens in leprosy, we evaluated the role of M . leprae sonicate antigens in regulating the expression of the costimulatory molecules B7-1, CD28, intercellular adhesion molecule-1 (ICAM-1), LFA-1alpha, LFA-1beta and Mac-1 on the lymphocytes of both leprosy patients and healthy subjects . It was observed that the expression of B7-1 and CD28 was significantly decreased but the levels of ICAM-1 and LFA-1alpha were increased in patients with untreated borderline leprosy (BL)/lepromatous leprosy (LL) disease . No remarkable change was noticed in the case of borderline tuberculoid (BT) leprosy or treated BL/LL patients . Further, a striking finding was that lymphocytes from healthy subjects cultured with a particularly high dose of M . leprae sonicate antigens down-regulated the expression of B7-1 and CD28 molecules, but up-regulated the display of ICAM-1 and LFA-1alpha . Furthermore, proliferation induced by M . leprae sonicate was inhibited only by anti-B7-1 antibody . Mycobacterium leprae antigen-induced suppression of the proliferation of lymphocytes of healthy volunteers and LL patients was reversed by culturing the lymphocytes with purified protein derivative (PPD) . It may be concluded from the findings in this study that down regulation of B7-1 and CD28 in BL/LL leprosy patients may be responsible for a defective T cell signalling by the B7-1/CD28 pathway caused by M . leprae antigens . This may lead to clonal inactivation of M . leprae-reactive T cells, consequently the bacilli grow without restriction in macrophages.

Neurologia, 1997 Nov, 12(9), 421 - 5
{Transitory cranial dyskinesias and tubercular meningitis . Report of three cases}; Serrano Duenas M; Three patients who suffered transitory (from 18 to 49 days) cranial dyskinesias during the course of tubercular meningitis are described . The diagnosis was confirmed by the presence of acid-alcohol resistant bacilli in spinal fluid . Cranial tomography or magnetic resonance images failed to demonstrate anatomical lesions . The blink reflex and brain stem auditory evoked potentials were abnormal, indicating dysfunction of motor nuclei of the cranial nerves, possibly secondary to changes in their regulation by basal ganglia . No recurrences have been observed during follow-up (from 3 to 7 years).

Br J Dermatol, 1997 Dec, 137(6), 1006 - 10
Leprosy type 1 reaction as the first manifestation of borderline lepromatous leprosy in a young native German; Biedermann T et al.; While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems . These reactions most often occur after initiation of therapy, but can also develop before treatment . Leprosy rarely presents with a reaction . We describe a German patient who presented in this unusual way in order to demonstrate the various tools used to confirm the diagnosis . A young German woman suddenly developed progressive functional loss of the left hand and within a few weeks an increasing number of erythematous macules and nodules appeared . Histological examination of a skin biopsy revealed tuberculoid granulomas, some located around small nerves; acid-fast bacilli were detected microscopically and DNA from Mycobacterium leprae was identified by polymerase chain reaction in the biopsy and a nasal swab; serological tests were positive . The disease was classified as borderline lepromatous leprosy . The acute neuritis followed by skin lesions represented a leprosy type 1 reaction in which the immune system reacts to bacilli previously unrecognized in nerve tissue, both in nerve and skin.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Oct, 35(10), 1136 - 40
{A case of pulmonary sarcoidosis mimicking relapse of pulmonary tuberculosis}; Arakaki N et al.; A 61-year-old woman was suspected of relapse of pulmonary tuberculosis . A chest X-ray film taken at a regular health check-up suggested relapse of pulmonary tuberculosis in a 61-year-old woman . Chest X-ray revealed irregular shadow with calcification in the upper lobe of the left lung and pulmonary tuberculosis was initially diagnosed a despite a negative reaction for acid-fast bacilli on examination of her sputum and bronchial lavage . Chest CT revealed thickened bronchi and blood vessels and nodules in the lung field . Transbronchial by biopsy failed to reveal caseating epithelioid cell granulomas transbronchial lung biopsy . Past history of facial palsy, uveitis, high plasma levels of angiotensin-converting enzyme (31.6IU/L), and abnormal HRCT levels . Bronchoalveolar lavage analysis revealed an increase in lymphocytes and a CD4/CD8 ratio of 8.67 . Sarcoidosis was diagnosed after a liver biopsy . This appears that HRCT findings are useful in the diagnosis of pulmonary sarcoidosis.

Kekkaku, 1997 Dec, 72(12), 649 - 57
{An observation on tuberculosis associated with HIV infection in Japan}; Mori T et al.; OBJECTIVE: To observe the reported cases of tuberculosis (TB) with HIV infection in Japan, in terms of their main clinical features and related factors . METHODS: A voluntary reporting network has been organized by the authors who are specialists of TB or respiratory medicine in tuberculosis institutions located roughly all over the country . The members have been encouraged to report not only their own cases but cases seen by their friends or in other institutions . RESULTS: By the end of 1996, a total of 71 cases have been reported of which 59 were TB and 12 NTM cases . Nationality of the cases were; Japan 48, Other Asian countries 16, Others 7 . All of the NTM cases were Japanese . 30% of the cases were aged less than 30 years, 24% were thirties, 24% forties, 17% fifties and 6% were those aged 60 years or older . The cases were clearly younger than the TB cases in the national TB registry, and older than HIV-infected persons as known from the HIV surveillance system . 97% of the TB cases were bacteriologically confirmed cases . Eight of NTM cases were positive for MAC, others for M.kansasii . 42% of the cases had extra-pulmonary disease, including disseminated infections seen among 19% . Of TB cases 25% were excreting bacilli resistant to any of the anti-TB drugs which was higher than in the case of general TB population (10-15%) . 11% of TB cases had past history of TB treatment . The cases had severe immunological impairment, 79% of the cases having CD4+ cell count less than 100 . The route of HIV infection were; 51% heterosexual, 13% homosexual, 13% through blood preparations, etc . DISCUSSION: Although there may be many cases not included in this observation, it is considered to well reflect the real situation of the problem of Japan . More attention should be paid to HIV infection of the patients in the clinical practice of TB in Japan.

Int J Lepr Other Mycobact Dis, 1997 Dec, 65(4), 461 - 4
Role of polymerase chain reaction in the diagnosis of early leprosy; Job CK et al.; For 39 patients suspected of early leprosy, skin biopsies of the lesions were done and bisected . One piece was used for histopathologic examination and the other for polymerase chain reaction (PCR) studies to detect Mycobacterium leprae . The diagnosis of early leprosy was made clinically in 14 patients and by histopathologic study in 26 patients . Acid-fast bacilli were seen in the histopathologic sections of only two patients, and M . leprae were detected using PCR techniques in 11 patients . In one patient the diagnosis of leprosy was made only because of the detection of M . leprae in the PCR study . Since even in endemic countries the profile of leprosy is changing, detection of leprosy lesions in their early stages has become increasingly important . Since the finding of M . leprae is crucial in the confirmatory diagnosis of early leprosy, it is suggested that PCR studies to detect M . leprae be done wherever possible in conjunction with histopathologic examination . It is also recommended that the feasibility and the cost-effectiveness of both of these methods to find M . leprae be evaluated.

Int J Lepr Other Mycobact Dis, 1997 Dec, 65(4), 443 - 9
Histopathologic evidence to show that indeterminate leprosy may be a primary lesion of the disease; Job CK et al.; Five biopsies of patients with indeterminate leprosy and five with skin lesions of nonspecific chronic inflammation were chosen . Histopathologic changes in the presence of acid-fast bacilli (AFB) in an average number of 145 serial sections from the entire paraffin block from each were evaluated . In all five indeterminate lesions AFB were found in the dermis, but intraneural AFB were present in only two cases . Mainly, lymphocytic infiltrate was present in two and early, poorly formed granulomas were seen in three . It is suggested that nonspecific chronic inflammation of the skin could precede indeterminate disease and that AFB, before they entered the dermal nerves, may be found in other dermal tissues . In most if not all early lesions of indeterminate leprosy Mycobacterium leprae would be found if an adequate number of sections stained for AFB were examined . The histopathologic and immunologic features of indeterminate disease were in favor of it being a primary lesion in leprosy.

Eur J Immunol, 1997 Dec, 27(12), 3182 - 90
High sensitivity of transgenic mice expressing soluble TNFR1 fusion protein to mycobacterial infections: synergistic action of TNF and IFN-gamma in the differentiation of protective granulomas; Garcia I et al.; To investigate the role of tumor necrosis factor (TNF) in protective immune responses to Mycobacterium tuberculosis and M . bovis Bacillus Calmette Guerin (BCG), we have used transgenic mice unable to use TNF because of the expression of high amounts of a soluble TNF receptor (R) type I (sTNFR1) fusion protein, and studied resistance of these mice to infection by lethality assays, evaluation of bacterial recovery and histologic examination . These mice showed a strongly increased sensitivity to M . tuberculosis and BCG infections, with bacterial overgrowth and marked inhibition of macrophage differentiation within granulomas; after M . tuberculosis infection, this resulted in extensive lesions of caseous necrosis in the lung . To explore the respective roles of TNF and interferon (IFN)-gamma in resistance to BCG and granuloma differentiation, controls and sTNFR1-transgenic mice were compared to IFN-gammaR mutant mice and mice double defective in TNF and IFN-gamma activity (obtained by crossing transgenic and mutant mice) . The three groups of deficient mice showed a strongly enhanced susceptibility to BCG infection, with the following decreasing order of sensitivity between groups: TNF + IFN-gamma --> TNF --> IFN-gamma-deficient mice . The hepatic granulomas of IFN-gammaR mutant mice were small and contained eosinophils but few differentiated macrophages; compared to those of sTNFR1-transgenic mice, acid-fast bacilli were less numerous within the macrophages . Granulomas of double-deficient mice were strikingly different by their very large size and cellular content, made up large numbers of polymorphonuclears, eosinophils, and cells undergoing apoptosis, but without detectable differentiated macrophages; acid-fast bacilli were spread in the lesions . These studies show the essential role of both TNF and IFN-gamma in the development, during mycobacterial infections, of protective granulomas containing highly differentiated macrophages capable of destroying ingested bacteria, and emphasize that these two cytokines act synergistically in granuloma formation.

Int J Tuberc Lung Dis, 1997 Aug, 1(4), 339 - 45
Evaluation of a standardized recording tool for sputum smear microscopy for acid-fast bacilli under routine conditions in low income countries; Rieder HL et al.; SETTING: Laboratories performing sputum smear microscopy for tuberculosis in Benin, Malawi, Nicaragua and Senegal . METHODS: Analysis of computerized laboratory registers to ascertain workload, yield from serial smear examination, and demographic characteristics of examinees . RESULTS: Data from more than 60,000 examinees in 42 laboratories showed that the average number of smears examined per day ranged from 4 to 19 (mean 6) per country . To find one case of tuberculosis, on average 21 smears of suspects were examined (range 8 to 50) . Of all cases with ultimately at least one positive result, 87% were already positive on the first examination . Demographic characteristics of cases differed considerably by country and gender . In 35 of 42 laboratories, males were more frequently found to be cases than females, and with increasing age an increasingly larger number of female than male suspects had to be examined to identify one case . CONCLUSIONS: This study demonstrates the usefulness of a standardized recording system for results of acid-fast microscopy in obtaining essential information for program management and on demographic characteristics of persons presenting for examination.

J Hepatol, 1997 Nov, 27(5), 830 - 4
Bacterial meningitis in cirrhosis: review of 16 cases; Pauwels A et al.; BACKGROUND: Although bacterial infections are frequent in patients with liver cirrhosis, only isolated cases of bacterial meningitis have been reported . METHODS: We have reviewed a series of 16 cases of bacterial meningitis in patients with cirrhosis, diagnosed in a single hospital over a 30-year period . RESULTS: Thirteen patients had alcoholic cirrhosis . On presentation, all patients had fever and most of them had an abnormal mental status (coma in 11 cases), but neck stiffness was not present or was delayed for more than 24 h in seven (43.7%) patients . The cerebrospinal fluid white cell count was always elevated, higher than 1000/microl in ten cases . The cerebrospinal fluid culture was positive in 14 (87.5%) patients . Gram-negative bacilli (mainly E . coli) and L . monocytogenes were the most frequent pathogens, accounting for nine cases . In contrast, S . pneumoniae and N . meningitidis were found in only four cases . Concurrent bacteremia was present in 12 (75%) cases . Ten patients (62.5%) died . Death was meningitis-related in seven patients and due to decompensated liver cirrhosis after clinical recovery from meningitis in the three other patients . Child-Pugh class C was associated with a higher mortality rate (80%, versus 33% for Child-Pugh class A-B), although the difference did not reach statistical significance . CONCLUSIONS: Bacterial meningitis should be suspected in every patient with cirrhosis presenting with a febrile coma . If lumbar puncture must be delayed, or if no causative agent can be identified on cerebrospinal Gram stain despite elevated cerebrospinal fluid white cell count, empirical antimicrobial therapy should be started straightaway with ampicillin plus a third-generation cephalosporin in sufficient doses.

Infect Immun, 1998 Feb, 66(2), 794 - 9
Growth of virulent and avirulent Mycobacterium tuberculosis strains in human macrophages; Zhang M et al.; Mycobacterium tuberculosis H37Rv causes progressive disease in animals, whereas the H37Ra strain does not . The relevance of this difference in virulence to human infection is uncertain because these strains have been shown to have similar growth rates in human macrophages . To evaluate the intracellular growth of M . tuberculosis strains in macrophages under conditions similar to those encountered in vivo, we infected human monocyte-derived macrophages with H37Ra, H37Rv, or one of four isolates from tuberculosis patients at a low bacillus-to-macrophage ratio . H37Rv and the patient isolates grew significantly faster than H37Ra, based on the numbers of CFU and acid-fast bacilli . These findings did not result from extracellular mycobacterial growth, differential macrophage viability, or bacillary clumping . In contrast to other published results, these findings indicate that the virulence characteristics of M . tuberculosis strains in animal models are relevant to human tuberculosis infection.

FEMS Microbiol Lett, 1998 Jan 1, 158(1), 139 - 45
Protein synthesis is shutdown in dormant Mycobacterium tuberculosis and is reversed by oxygen or heat shock; Hu YM et al.; Oxygen-limiting conditions are critical to the survival of the bacteria in tuberculosis . Mycobacterium tuberculosis can survive anaerobiosis in vitro for long periods of time only after a gradual transition to a microaerophilic stationary phase . The underlying mechanism behind stationary phase adaption needs to be elucidated . The protein profiles of Mycobacterium tuberculosis during long-term stationary phase growth and under strict anaerobic incubation were monitored by {35S}methionine labelling, SDS-PAGE and fluorography . These experiments have established that protein synthesis gradually decreased over 50 days in the long-term stationary phase cultures which were considered to be microaerophilic . There was an 80% linear decrease in the level of total protein synthesis during the first 40 days of microaerophilic growth and then the rate of protein synthesis faded quickly . For the first time we have shown that total protein synthesis shutdown occurred when bacilli were incubated under further anaerobic conditions . Viability, estimated by cfu counts, remained constant during stationary phase growth and under anaerobic incubation . Furthermore, when oxygen was introduced into the anaerobic culture, protein synthesis restarted . Also heat shock at 45 degrees C, 48 degrees C and 50 degrees C rapidly induced protein synthesis in stationary and anaerobic cultures . These data indicate that dormant bacteria shut down protein synthesis but remain responsive to specific stimuli which restore protein synthesis . In addition the dormant bacilli induced by anaerobiosis developed more heat resistance than nondormant organisms.

Clin Infect Dis, 1997 Dec, 25(6), 1465 - 7
Rifampin-monoresistant tuberculosis in New York City, 1993-1994; Munsiff SS et al.; All New York City patients whose cultures yielded Mycobacterium tuberculosis with isolated resistance to rifampin in 1993 and 1994 were included in this study . Of the 96 patients, 48 (50%) had primary resistance, 32 (33%) had acquired resistance, and 16 (17%) had unclassified resistance; 66% had histories of illicit drug use, and 79% were infected with human immunodeficiency virus (HIV) . The median time to emergence of resistance was 40 weeks among the 32 patients with acquired resistance . Each of the HIV-infected patients with acquired resistance (cases, n = 29) was matched to two HIV-infected patients who had disease due to fully susceptible M . tuberculosis (controls, n = 58) . In multivariate analysis, factors associated with the emergence of rifampin resistance were as follows: a sputum smear positive for acid-fast bacilli, advanced immunosuppression, and nonadherence to therapy.

Biochem Mol Biol Int, 1997 Nov, 43(4), 763 - 79
Adenosine deaminase activity in serum and pleural effusions of tuberculous and non-tuberculous patients; al-Shammary FJ; In a retrospective study Adenosine deaminase (ADA), was assayed in 86 serum samples and 12 pleural fluid samples of patients with pulmonary tuberculosis . Serum and pleural fluid ADA levels were also examined in a group of 38 non-tuberculous patients with pleural effusion . Highly significant increases in both serum and pleural fluid ADA levels were noted in tuberculous patients when compared to both control enzyme cut-off values and non-tuberculous pleural effusion patients . Negative Ziehl-Nielsen staining for acid fast bacilli and Purified Protein Derivative skin test results were obtained in 32.3% and 11.1% of the examined patients respectively . All these patients showed significantly elevated serum or pleural fluid ADA levels . It is hereby suggested that serum and pleural fluid ADA levels can in conjunction with other tests, serve as a marker in patients of pulmonary tuberculosis.

Pathologe, 1997 Nov, 18(6), 488 - 91
{Regeneration of bronchial mucosa after short-term repetition of biopsy versus bronchial carcinoma}; Wockel W et al.; We report on two patients, 74 and 73 years old, each of whom had had biopsy of the bronchial mucosa elsewhere . Histologically, normal mucosa and mild bronchitis was seen, respectively . In both patients a second biopsy specimen from the same site was taken, 4 and 7 days after the first biopsy . Now the diagnosis was carcinoma in situ (not excluding early squamous carcinoma) and squamous carcinoma, respectively . One of the patients came to our lung clinic for operation on the basis of the mentioned diagnosis . A third biopsy was performed for control purposes . It revealed just a perforation of a lymph node in the bronchial wall and some epithelioid granulomas without evidence of acid-fast bacilli . There was no evidence of malignancy in this specimen . Because of the discrepancy, the pathologist at the first institution was asked to send us the previous slides . On review of these slides, the described findings were seen, but they were interpreted as regenerative-atypical . In this way, an unnecessary surgical intervention was avoided . After a follow-up of 3 1/2 years the patient is healthy . In the other patient, because of the diagnosis of squamous carcinoma a lobectomy was undertaken by a surgeon elsewhere . The pathologist could not find any carcinoma in the surgical specimen . The biopsy material was reviewed in our department, the findings being interpreted as atypical, originating in reparative changes . Like the postoperative pathologist, we did not find any carcinoma in the surgical specimen . In both cases, therefore, regenerative-atypical changes after re-biopsy were first misinterpreted as a malignant process.

Acta Leprol, 1997, 10(4), 213 - 7
Microdensitometric scanning procedure for quantitative assessment of hybridization of rRNA targeting probes in leprosy; Sharma RK et al.; In order to develop an objective criteria of grading of positivity of hybridization signals of gene probes targeting rRNA, a microdensitometric scanning procedure was standardised . Ribosomal RNA was extracted from the bacilli harvested from biopsies of leprosy cases across the spectrum and blotted on nitro-cellulose membranes . M . leprae specific rRNA targeting oligonucleotide probes were end-labelled and hybridization was done by the technique standardised and published earlier . The autoradiographs were developed and microdensitometric scanning was done by altering different parameters . Positivity was graded in 5 grades and compared with visual positivity . Microdensitometric scanning procedure and 5 grade system appear to be useful and reproducible . Signals in paucibacillary specimens were in 2+ to 3+ grading range whereas those in multibacillary specimens varied in grades from 2+ to 5+ . This approach appears to have potential usefulness for assessing the bacillary load (possibly viable) in the clinical specimens from leprosy cases.

Acta Leprol, 1997, 10(4), 209 - 12
Viability determination of M.leprae: comparison of normal mouse foot pad and bacillary ATP bioluminescence assay; Gupta UD et al.; Correlation between viability assessment by mouse foot pad and ATP bioluminescence was studied in biopsy specimens from multibacillary leprosy cases . Biopsies were processed for inoculation into mouse foot pad and estimation of bacillary ATP levels by bioluminescent assay by earlier established procedures . ATP content as pg/million bacilli was estimated and correlation was assessed with growth in the mouse foot pad . It was observed that when the ATP content was > 36 pg/million bacterial cells, (> 1% probable viables) there was growth in the mouse foot pad from all the specimens . Similar results were observed when the ATP content was in the range of 3.6 to 35.99 pg/million cells (0.1 to 1% probable viables) . The positivity rates in the mouse foot pad decreased when the ATP content decreased further . No positive growth in the specimens below 0.04 pg/million bacilli (< 0.001% viable organisms) was observed . These findings show an overall correlation between viability assessed by mouse foot pad and ATP bioluminescence . These observations validate the concept of ATP content of viable unit of M.leprae being in the order of 10(-15) g/live cell which is in the same order of magnitude as a colony forming unit of cultivable mycobacteria.

Surg Clin North Am, 1997 Dec, 77(6), 1395 - 417
Antibiotics for the acute abdomen; Farber MS et al.; Antibiotics are only an adjunct to proper surgical therapy for the treatment of the acute abdomen associated with bacterial secondary peritonitis . Upon presentation, all patients require a preoperative dose of antibiotics for prophylaxis against infection of remaining sterile tissues . Patients found intraoperatively to have an established peritoneal infection benefit from an immediate postoperative course of therapeutic antibiotics . A regimen that adequately covers facultative and aerobic gram-negative bacilli and anaerobic organisms is essential . The duration of therapeutic antibiotics is probably best decided on an individual patient basis . The goal of antibiotics is to reduce the concentration of bacteria invading tissues . The pathogens of bacterial peritonitis are influenced by such factors as the patient's pre-existing chronic diseases, state of acute physiologic debilitation, immunocompetence, recent antibiotic use, recent hospitalization, and neutralization of gastric acidity . Intraoperative peritoneal cultures are most useful in patients suspected of having impaired local host defenses . In these patients, all identified organisms, such as Enterococcus or Candida, may be potential pathogens . The common practice of administering empiric and prolonged courses of broad-spectrum antibiotics in patients who manifest persistent signs of inflammation may be more harmful than beneficial . These patients warrant an exhaustive search for extra-abdominal and intraperitoneal sources of new infection . Otherwise, such use of antibiotics may continue to promote the selection of bacteria that are highly resistant to conventional antibiotics and permit the overgrowth of organisms commonly seen with tertiary peritonitis . The best chance of resolving bacterial peritonitis is through early, aggressive surgical management complemented by short courses of potent antibiotics and appropriate physiologic support . Through these efforts, the clinician tries to help the systemic inflammatory response to benefit the host and not become unregulated, result in MOFS, and produce a high mortality.

J Korean Med Sci, 1997 Dec, 12(6), 481 - 7
The role of nitric oxide in the immune response of tuberculosis; Kwon OJ; Nitric oxide (NO) formed by the action of inducible form of nitric oxide synthase (iNOS), reacts with oxygen radical forming reactive nitrogen intermediate (RNI) . NO and related RNI have been reported to possess antimycobacterial activity . Macrophages can inhibit the proliferation of Mycobacterium tuberculosis by producing NO . In murine models, the ability of macrophages to produce NO can determine the susceptibility of the host to M . tuberculosis and the virulence of M . tuberculosis . However, it is still not clear whether NO is involved in the defense mechanism against M . tuberculosis in humans . We have demonstrated that human peripheral blood mononuclear cells (PBMC) and airway epithelial cells can express iNOS mRNA expression and produce NO production in response to tubercle bacilli stimulation . Furthermore, H37Ra, avirulent strain of M . tuberculosis, induces a larger amount of NO in cultured PBMC than H37Rv, virulent strain, does . There was no difference in NO production between healthy volunteers and patients with tuberculosis . NO production in airway epithelial cells is closely related with IFN gamma concentration . The balance of stimulatory cytokines and inhibitory cytokines for NO production may play a critical role in the defense mechanism against M . tuberculosis considering that NO production is upregulated by IFN gamma, TNF alpha, and IL-1 beta and downregulated by IL-10 and TGF beta . The study of immune response to M . tuberculosis including NO production may give us a better understanding of the pathogenesis of tuberculosis.

Respirology, 1996 Dec, 1(4), 283 - 9
Results of surgical treatment of 107 patients with complications of pulmonary tuberculosis; Wu MH et al.; The objective of this study was to evaluate the results of surgical intervention performed on 107 patients with pulmonary tuberculosis complications . Between September 1988 and December 1995, 107 patients underwent a total of 126 operations for major complications of pulmonary tuberculosis . One hundred and twenty-six operations consisted of lobectomies only or plus other lung resections performed in 55 cases, pneumonectomies in 20 cases, segmentectomies in 18 cases, wedge resections in two cases, tracheobronchoplasties in four cases, decortications in two cases, cavernostomies with concomitant muscle transpositions in seven cases, thoracoplasties reserved for the previously failed operations or to be a supplement for pulmonary resections in 18 cases . The operative mortality rate was of 1.8%, and the major complication rate was of 16.8% . Twenty-eight (26.1%) patients with tuberculosis bacilli in sputum before operation have converted except one diabetic patient . In conclusion, surgery is indicated in pulmonary tuberculosis complications that are life-threatening or unresponsive to chemotherapy . Pulmonary resection is the procedure of choice for most cases that require surgery.

Int J Tuberc Lung Dis, 1997 Oct, 1(5), 417 - 21
Osteitis caused by bacille Calmette-Guérin vaccination: an emergent problem in Chile?
Castro-Rodriguez JA, Gonzalez R, Girardi G.
SETTING: Osteitis caused by bacille Calmette-Guerin (BCGOST) vaccination has not been described in Latin American countries . OBJECTIVE: To evaluate the incidence, clinical features and prognosis of patients with BCGOST in one of the most populated areas of Santiago, Chile . DESIGN: A retrospective analysis of medical records kept over twenty years (1976-1995) . RESULTS: In ten children (four in the last five years), diagnostic criteria of BCGOST were fulfilled . Six were boys, the mean age was 11 months (range 6.5-21), symptoms were present with a mean of 31 days (range 15-60) before diagnosis and the sites of predilection of osteitis were the lower extremity (8/10 cases) . Culture was positive in one case, and nine patients had typical histopathological lesions (two with acid-fast bacilli) . All had normal chest X-ray . Mantoux testing was performed in four cases (mean 21.5 mm, range 16-28) . None of the ten patients had a history of underlying immunodeficiency . In this area BCG coverage was 90.2 +/- 9.7% of all newborn infants, and the annual risk of tuberculosis infection was 24.6/100,000 population per year . CONCLUSION: Our study demonstrated an estimated incidence for BCGOST in this area of 3.2/100,000 vaccinated newborns . Based on the epidemiological situation of tuberculosis in Chile (29.5/100,000), universal BCG vaccination in newborns should be encouraged.

Int J Tuberc Lung Dis, 1997 Apr, 1(2), 122 - 7
Effect of human newborn BCG immunization on monocyte viability and function at 3 months of age; Sepulveda RL et al.; SETTING: Immune response induced by BCG vaccination seems to reflect the development of T-cell immunity and monocyte activation . Participants were recruited from a large prospective study in infants from a suburb in Santiago, Chile . OBJECTIVE: To determine whether newborn BCG immunization changes the innate ability of cultured monocyte-macrophages to ingest and kill virulent mycobacteria in the absence of lymphocytes . DESIGN: The study population consisted of 15 three-month-old, tuberculin-positive infants immunized with BCG (Japanese) at birth, 13 randomly-selected, age-matched tuberculin-nonreactive infants in whom BCG immunization was postponed until one year of age, and five BCG-immunized, tuberculin-reactive adults . Adherent cells were cultured for 48 h . Monocyte-macrophage viability and number and viability of intracellular Mycobacterium tuberculosis bacilli were assessed after an additional 2 h and 4 and 7 days of incubation . RESULTS: There was no difference in the mean number of adherent cells present after 48 h among the three study groups . Adherent cells from BCG-immunized infants and adults had a significantly higher viability after 7 days in culture than adherent cells from non-immunized infants . The percentage of cells ingesting M . tuberculosis and the number of bacilli per cell after 2 h and 4 days was significantly higher in immunized infants and adults than in non-immunized infants . However, there was no evidence for increased killing of mycobacteria by cells from immunized infants and adults . CONCLUSION: These results suggest that BCG vaccination increases monocyte viability and the uptake of M . tuberculosis without enhancing the ability to kill ingested M . tuberculosis in the absence of lymphocytes.

Int J Tuberc Lung Dis, 1997 Feb, 1(1), 25 - 30
Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative; Samb B et al.; SETTING: Two University hospitals in Eastern African capital cities where large prospective studies had been carried out on hospitalized patients to determine the cause of their respiratory diseases . OBJECTIVE: To identify features that differentiated between tuberculosis (TB) and non-tuberculous respiratory disease (non-TB) in hospitalized patients from Bujumbura, Burundi (n = 111) and Dar es Salaam, Tanzania (n = 71) whose sputum smears were negative on microscopic examination for acid-fast bacilli (AFB) . DESIGN: Review of clinical findings, radiologic abnormalities, and laboratory test results from 182 patients, first by univariate and then by multivariate (stepwise logistic regression) analysis to assess the contribution of each factor to the final diagnosis . RESULTS: Of the 182 patients with two or more negative AFB smears, 41 had TB and 141 had non-TB . Stepwise regression analysis revealed four easily ascertained symptoms were associated with TB: 1) cough > 21 days; 2) chest pain > 15 days; 3) absence of expectoration; and 4) absence of shortness of breath . Any two of the four diagnosed TB with 85% sensitivity and 67% specificity; any three of the four with 49% sensitivity and 86% specificity . Multivariate analysis showed that adding lymphadenopathy and hematocrit < 30% improved discrimination . CONCLUSION: This methodological approach provides a means for diagnosing TB among all AFB smear-negative hospitalized patients . In this setting, simple clinical symptoms alone are helpful . Similar studies are needed to develop a system for out-patient TB suspects.

J Thorac Imaging, 1998 Jan, 13(1), 58 - 64
Pulmonary tuberculosis: computed tomography and high-resolution computed tomography patterns in patients who are either HIV-negative or HIV-seropositive; Laissy JP et al.; To compare findings of active pulmonary tuberculosis on computed tomography (CT) and high-resolution computed tomography (HRCT) scans in patients without the human immunodeficiency virus (HIV) and patients with HIV, and to define the spectrum of pulmonary tuberculosis in patients with HIV according to the CD4 T cell status, 76 patients (47 patients without HIV and 29 patients with HIV) with newly diagnosed pulmonary tuberculosis were studied retrospectively . The diagnosis of active pulmonary tuberculosis was based on acid-fast bacilli (AFB) in sputum culture . All patients underwent CT within 1 month of diagnosis . Patients with HIV demonstrated significantly less cavitation and bronchial wall thickening (24% vs . 49% {p < 0.05}; and 14% vs . 45% {p < 0.01}, respectively) than the combined group of patients with HIV . Centrilobular nodules were significantly less common in patients without HIV (14% vs . 45%, p < 0.05) . Lymphadenopathy with low attenuation centers was significantly less frequent in the patients with HIV (3% vs . 15%, p < 0.05) . In patients with HIV, cavitation, lymphadenopathy, as well as the the number of nodules and the number of lobes involved correlated well with the CD4 levels . Two patients with less than 50 CD4 T cells/mm3 had normal chest CT results . Atypical chest CT patterns are frequently encountered in patients with HIV . Knowledge of these CT patterns may assist in the diagnosis and follow-up of patients with HIV with known or suspected pulmonary tuberculosis.

Pediatr Nephrol, 1997 Dec, 11(6), 695 - 8
Tuberculosis in childhood nephrotic syndrome in India; Gulati S et al.; We studied the prevalence, clinical features, and impact of tuberculosis (TB) on children with nephrotic syndrome (NS) . Of the 300 children with NS, 28 (9.3%) were diagnosed as having TB . This occurred following the initiation of immunosuppressive therapy in 27 children, and in 1 child it preceded the onset of NS . Pulmonary involvement was the commonest (22/28), followed by tubercular lymphadenitis (2/28), meningitis (2/28), and occult TB (2/28) . Of the various diagnostic criteria, history of previous cough, fever, or exposure to a case of TB (23/28) and chest skiagram (21/28) were the most useful . The occurrence of TB did not induce a relapse or affect the subsequent response to steroid therapy (as is often seen with other infections) or have a deleterious effect on renal function . Patients who received higher doses of steroids (frequent relapsers, steroid dependent, initial non-responders, and subsequent non-responders) had a significantly higher prevalence of TB (19/148) than those who received lower doses (infrequent relapsers 8/151) (P = 0.04) . We thus found TB to be an important complication of children with NS in our country . The conventional diagnostic tests, such as Mantoux and acid-fast bacilli isolation, are often unhelpful in these children, and a high index of suspicion is required, especially in children who require frequent courses of steroid therapy.

Arch Bronconeumol, 1997 Oct, 33(9), 475 - 7
{An unusual case of tuberculosis in an immunocompetent patient}; Roig Figueroa V et al.; Gastric tuberculosis is a rare entity that often coincides with pulmonary involvement at the time of diagnosis . Many cases reported in developed countries are in immunodepressed patients, particularly those with HIV infection . We report the case of a 43-year-old man who presented with weight loss of 14 kg, persistent vomiting and bilateral pulmonary nodes measuring 1.5 to 3 cm in diameter . An ulcerous, hypertrophic gastric lesion was observed by oral digestive endoscopy, such that the clinical, radiologic and endoscopic profile initially suggested gastric neoplasia with bilateral pulmonary metastasis . Examination of the gastric biopsy and of the bronchial aspirate revealed the presence of acid-alcohol resistant bacilli; a culture in Lowenstein-Jenssen medium was positive for Mycobacterium tuberculosis . The patient responded satisfactorily to short-term specific treatment with three drugs.

Infect Immun, 1998 Jan, 66(1), 289 - 96
MPB70 and MPB83 as indicators of protein localization in mycobacterial cells; Harboe M et al.; Culture fluids after growth of Mycobacterium bovis BCG on Sauton medium contain actively secreted proteins and proteins released by bacterial lysis . BCG culture fluids and sonicates of Mycobacterium tuberculosis and Mycobacterium paratuberculosis were tested after separation by gel filtration and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) . The localization of marker proteins was determined by enzyme-linked immunosorbent assay and Western blotting with selected monoclonal antibodies of known specificities . Soluble secreted proteins (MPB64 and proteins of the antigen 85 complex) and three heat shock proteins (DnaK, GroEL, and GroES) were recovered in a single peak after gel filtration, indicating their occurrence as a free monomer in the culture fluid and cytosol, respectively . Other constituents eluted in two distinct peaks during gel filtration . The first peak corresponded to the void volume, indicating complex formation between several proteins or attachment to lipids in the surface layer or the cytoplasmic membrane; the second peak corresponded to the expected monomer size indicated by SDS-PAGE under conditions that separate proteins from each other during sample preparation . The two-peak group contained constituents with known lipid contents, the 19- and 38-kDa lipoproteins and lipoarabinomannan . The 26-kDa form of MPB83 behaved similarly . After extraction with Triton X-114, these constituents entered into the detergent phase, confirming the lipoprotein nature of 26-kDa MPB83 . The MPB83 molecule was shown to be available on the surface of BCG Tokyo bacilli for reaction with monoclonal antibody MBS43 by flow cytometry.

Infect Immun, 1998 Jan, 66(1), 98 - 106
Processing of Mycobacterium tuberculosis bacilli by human monocytes for CD4+ alphabeta and gammadelta T cells: role of particulate antigen; Balaji KN et al.; Mycobacterium tuberculosis readily activates both CD4+ and Vdelta2+ gammadelta T cells . Despite similarity in function, these T-cell subsets differ in the antigens they recognize and the manners in which these antigens are presented by M . tuberculosis-infected monocytes . We investigated mechanisms of antigen processing of M . tuberculosis antigens to human CD4 and gammadelta T cells by monocytes . Initial uptake of M . tuberculosis bacilli and subsequent processing were required for efficient presentation not only to CD4 T cells but also to Vdelta2+ gammadelta T cells . For gammadelta T cells, recognition of M . tuberculosis-infected monocytes was dependent on Vdelta2+ T-cell-receptor expression . Recognition of M . tuberculosis antigens by CD4+ T cells was restricted by the class II major histocompatibility complex molecule HLA-DR . Processing of M . tuberculosis bacilli for Vdelta2+ gammadelta T cells was inhibitable by Brefeldin A, whereas processing of soluble mycobacterial antigens for gammadelta T cells was not sensitive to Brefeldin A . Processing of M . tuberculosis bacilli for CD4+ T cells was unaffected by Brefeldin A . Lysosomotropic agents such as chloroquine and ammonium chloride did not affect the processing of M . tuberculosis bacilli for CD4+ and gammadelta T cells . In contrast, both inhibitors blocked processing of soluble mycobacterial antigens for CD4+ T cells . Chloroquine and ammonium chloride insensitivity of processing of M . tuberculosis bacilli was not dependent on the viability of the bacteria, since processing of both formaldehyde-fixed dead bacteria and mycobacterial antigens covalently coupled to latex beads was chloroquine insensitive . Thus, the manner in which mycobacterial antigens were taken up by monocytes (particulate versus soluble) influenced the antigen processing pathway for CD4+ and gammadelta T cells.

Kekkaku, 1997 Nov, 72(11), 629 - 37
{BCG vaccines for the prevention of tuberculosis in the world}; Hashimoto T; The BCG vaccines will celebrate the 100th anniversary of their discovery in a decade at the beginning of the next century since Albert Calmette and Camille Guerin had presented it before the Academie des Sciences in 1908 . At present tuberculosis kills more people than any other infectious disease about 3 million people a year, including almost 300,000 children under 15, and is producing over 7,000 deaths and over 24,000 new cases every day . Therefore, WHO declared a global health emergency in 1993 . More worse, recently multi-drug resistant tubercle bacilli are emerging rapidly making TB patients incurable . Under these situations we need a potent anti-tuberculosis vaccine . So first of all, we must check the century-old BCG before proceeding further . At moment, the BCG vaccines are being used worldwide in the largest quantities in the world, but still most controversial vaccines anywhere . I would like to describe here their success and failure in the combat against the white plague . 1 . The Expanded Programme on Immunization (EPI) . In 1974, when the EPI was launched by WHO, less than 5% of the world children were immunized against six infectious diseases including tuberculosis . In 1995 statistics, BCG gave the highest vaccination coverage, 87% higher than any other 5 vaccines of EPI for children . The BCG in EPI must have saved a lot of infants as the vaccine, has been proved to be most effective against the blood-born tuberculosis of child type . 2 . The efficacy of BCG vaccination against tuberculosis . Results of each 10 of randomized controlled trials (RCT) and Case-control studies (CCS) showed the protective efficacy against tuberculosis as uncertain, unpredictable, as protective efficacy varied from 80% to 0% . More recently, a Meta-analysis of selected papers on BCG field trials which were so far collected . They recalculated vaccine protective effect separately for pulmonary TB and for meningeal/miliary TB in the trials . As the result, it was found that protective effect against pulmonary TB could not be calculated, but protective effect against meningeal and miliary TB was calculated as 86%, 75% respectively, in RCT and CCS, being higher than against pulmonary TB . 3 . The duration of BCG efficacy against tuberculosis was confirmed to continue for 15 years after vaccination . The incidence of every form of tuberculosis decreased steeply during the 15 years following vaccination . 4 . BCG revaccination . A WHO statement was issued in 1995 mentioning that there is no definitive evidence that repeated BCG vaccination confers additional protection against tuberculosis . Therefore WHO has not recommended to repeat BCG vaccination because of no scientific evidence to support this practice . Multiple BCG revaccinations are not indicated in any persons . 5 . Complications with BCG Second IUATLD study (1988) on complications induced by BCG was reviewed, especially following two points: 1-2) Regional suppurative lymphadenitis 3) Generalized lesions: fatal cases 1-2 Several African regions had experienced that the risk of outbreak of suppurative BCG lymphadenitis was low for vaccines with Glaxo and Japanese strains, but much higher for vaccines with Pasteur . This experience in nineteen eighties has led EPI to replace the Pasteur BCG vaccine with less reactogenic BCG, Japanese or Glaxo BCG to solve the outbreak of suppurative adenitis complication . 3 At moment, the only contra-indication of EPI BCG vaccination is symptomatic HIV infection (AIDS), but in the future asymptomatic HIV infection should be placed on alert, because fatal BCG generalized disseminations have already been experienced by HIV positive vaccinees although in a few cases in USA . 6 . BCG seed lots for use of vaccination in the world . Nearly 10 seed lots (BCG) are being used in the world at present . However, they are more or less different each other in various characteristics: morphological, biochemical, biophysical, immunological, vaccinological and so on . None of them is the same

Rinsho Kyobu Geka, 1994 Oct, 14(5), 413 - 6
{Cavernoplasty for atypical mycobacteriosis of the lung--case report of two M . avium complex}; Imura Y et al.; Two patients were diagnosed as suffering from localized atypical myocobacteriosis of the lung consisting of the infection in tuberculous open healing cavity of left upper lobe and giant bulla of right middle lobe . The type of bacteria classified according to Runyon's criteria was Group 3 (M . avium complex) . The bacilli had the resistance to most antituberculotics . One of them had the history of pulmonary tuberculosis complicated with giant cavity in left upper lobe and extensive hard pleural adhesion associated with restrictive ventilatory impairment . Another one had the history or right upper lobe lobectomy for tuberculosis complicated extensive pleural adhesion . A combination of thoracoplasty and cavernoplasty was applied to these two cases whose operation were once to the former and twice to the latter respectively, with satisfactory results . The patients show complete closure of the cavity and bulla and have no symptoms of recurrence after surgery . The application of thoracoplasty and cavernoplasty is useful and safe to the treatment of patients suffering from atypical mycobacteriosis of the lung in cases of prospected tough resection, with expecting one stage cure.

Biochem Pharmacol, 1997 Dec 1, 54(11), 1165 - 72
New horizons in the treatment of tuberculosis; Barry CE 3rd; The development of new chemotherapy for the treatment of tuberculosis has three major objectives: first, the development of faster-acting drugs to shorten the duration of treatment; second, the development of novel antimicrobials to counter the emergence of bacteria resistant to current therapies; and, third, the development of chemotherapeutics that specifically target dormant bacilli to treat the one-third of the world's population latently infected with tubercle bacilli . Strategies based upon optimizing the inhibition of known targets require an extensive knowledge of the detailed mechanism of action of current antimycobacterial agents . For many agents such as isoniazid, ethambutol, rifampin, and pyrazinamide such knowledge is now available . Strategies based upon the identification of novel targets will necessitate the identification of biochemical pathways specific to mycobacteria and related organisms . Many unique metabolic processes occur during the biosynthesis of mycobacterial cell wall components, and some attractive new targets have emerged . The development of targets specific to latency will require a detailed picture of the metabolism and biochemical pathways occurring in dormant bacilli . Recent evidence suggests that anaerobic metabolic pathways may operate in dormant bacilli, and the enzymes involved in such pathways may also provide significant new targets for intervention . The combination of the mycobacterial genome sequence that is anticipated to become available this year with an improved understanding of the unique metabolic processes that define mycobacteria as a genus offers the greatest hope for the elimination of one of mankind's oldest enemies.

Zhonghua Yi Xue Za Zhi (Taipei), 1997 Sep, 60(3), 168 - 72
Tuberculous arthritis of sacroiliac joint with abscess formation: a case report; Tseng CY et al.; Extrapulmonary tuberculosis at times appears to be an unusual presentation of the disease . Its incidence has not decreased, though a slow decline in pulmonary tuberculosis has been observed over the past decades around the world . The diagnosis of extrapulmonary tuberculosis is still rather difficult today . Tuberculosis of the bones and joints, which constitutes a smaller part of extrapulmonary tuberculosis, is relatively rare in documented cases and can yield variable clinical manifestations . This study describes a young male patient who developed a rare condition of tuberculous arthritis of the right sacroiliac joint, with an abscess formation over the anterior aspect of the right iliac fossa and iliopsoas muscle . The diagnosis was made by roentgenographic examinations and proved by microscopic confirmation of the presence tuberculous bacilli in drainage from the involved foci . Antituberculosis therapy was begun thereafter . Symptoms improved and the patient was regularly followed up at the Outpatient Department . It is suggested that in patients with prolonged fever and possible Mycobacterium tuberculosis infections, repeated roentgenographic and microbiological examinations are mandatory.

Int Immunol, 1997 Nov, 9(11), 1669 - 76
Specificity of CD8+ T cells from subunit-vaccinated and infected H-2b mice recognizing the 38 kDa antigen of Mycobacterium tuberculosis; Zhu X et al.; CD8+ T cells have been implicated in protective anti-tuberculous immune responses, but little is known about the identity of mycobacterial antigens recognized by CD8+ T cells . In this study we identified the Mycobacterium tuberculosis 38 kDa protein as a target for murine CD8+ cytotoxic T lymphocytes (CTL) which were induced by vaccination of C57BL/6 mice with DNA delivered with a plasmid, with transfected tumour cells or by infection with tubercle bacilli . Using overlapping synthetic peptides covering the whole protein sequence, peptides predicted to contain H-2Kb or H-2Db motifs, as well as naturally processed peptides, we were able to identify CTL epitopes . Differences were demonstrated in peptide specificity between CTL from immunized or M . tuberculosis-infected mice . The identified CTL epitopes could be important for future analysis of the involvement of CD8+ T cells in M . tuberculosis infections and for vaccine development.

Hum Pathol, 1997 Dec, 28(12), 1424 - 8
Invasion and destruction of mucosal plasma cells by Tropheryma whippelii; Eck M et al.; Whipple's disease is a poorly understood systemic disorder associated with the bacillus, Tropheryma whippelii . An early stage of Whipple's disease is studied by using electron microscopy (ELMI) and immunohistochemistry . The diagnosis was confirmed by polymerase chain reaction-amplification and sequencing of the 16S ribosomal-RNA of the bacterium . By using ELMI, Tropheryma whippelii was found in plasma cells and macrophages in the jejunal mucosa . The immunoglobulin (Ig)A-positive plasma cells were focally destructed and their number significantly reduced . However, the bacilli in the plasma cells were morphologically intact . In contrast, the macrophages showed no signs of cell destruction, but contained bacilli in various stages of disintegration . A cytopathic effect of Tropheryma whippelii to IgA plasma cells may be the reason for the commonly found plasma cell reduction in the small intestine mucosa and an important pathogenic mechanism contributing to the evasion of the bacilli from local immune response.

Vet Rec, 1997 Nov 15, 141(20), 516 - 8
Isolation of mycobacteria from lymph node lesions in deer; Quigley FC et al.; A total of 14,842 farmed deer were slaughtered and examined postmortem in Irish abattoirs between January 1993 and September 1996 . Lymph node lesions were detected in 119 deer and these were examined histopathologically and cultured . A total of 115 of the lesions were characterised as tuberculous and, on culture, Mycobacterium avium was isolated from 49 of them, M bovis from 41, unclassified mycobacteria from five, and 20 of the tuberculous lesions did not yield any isolate . Tubercles which yielded M avium on culture contained on average more acid-fast bacilli, more epithelioid macrophages and fewer Langhans giant cells than tubercles from which M bovis was isolated . Twelve lesions from feral deer culled from a national park were also examined and M bovis was isolated from nine.

Acta Neurochir Suppl, 1997, 70, 282 - 4
Effect of infection brain edema on NMDA receptor binding in rat brain in vivo; Cheng GS et al.; The purpose of this study was to determine the effect of infection brain edema (IBE) in the rat model induced by injecting pertussis bacilli (PB) into the left carotid artery . The specific binding of N-methyl-D-aspartate (NMDA) receptor with {3H} MK-801 was measured in the neuronal membrane of cerebral cortex . The Scatchard plots were performed . The Bmax values were 0.623 +/- 0.082 and 0.606 +/- 0.087 pmol/mg protein in the group that received normal saline (NS) and PB respectively (P < 0.05) . The Kd values were 43.1 +/- 4.2 and 30.5 +/- 3.0 nM in the groups NS and PB respectively . The results indicated that the affinity of NMDA receptor was significantly higher in the group PB than group NS, whereas the total number of NMDA receptors had not changed in the IBE model . The increase of affinity of NMDA receptor can be blockaded by MK-801 pretreatment in vivo.

Schweiz Arch Tierheilkd, 1997, 139(9), 397 - 402
{Occurrence of Mycobacterium genavense in birds}; Holsboer Buogo C et al.; A total of 253 birds were investigated to determine the presence of mycobacteria . Scrapings from various internal organs were stained according to Ziehl-Neelsen, and acid-fast bacilli were found in 26 birds (10.2%) . Cultivation of mycobacteria was attempted from 22 livers, 12 spleens, 14 kidneys, 12 lungs, and 9 intestines from these 26 birds . Each sample was first decontaminated using a modified sodium dodecyl sulfate method, and three media were inoculated (Bactec 12 B; Lowenstein-Jensen, Herrold) . Using a Polymerase-Chain-Reaction-Restriction-Enzyme-Analysis (PRA), M . genavense could be identified in 19 of 26 birds (73%) . M . avium could be isolated from three birds and M . fortuitum from one bird . In total, mycobacteriosis was the primary diagnosis made in 24 of 26 birds (92%) . A presumptive diagnosis of mycobacteriosis was already made macroscopically in 14 of these birds . In the remaining 10 cases, bacteriological and histological investigations with specific staining methods were necessary for diagnosis . Several different histological changes were found . We observed individual macrophages as well as epitheloid cell proliferation, with variable, relatively mild inflammatory and fibrous reactions . We could not find any correlation between infection with a mycobacterium species and a specific tissue reaction pattern . This report demonstrates that M . genavense is an important cause of avian mycobacteriosis especially in pet birds.

Rev Clin Esp, 1997 Jul, 197(7), 502 - 6
{Pericardial tuberculosis complicated with heart tamponade as presentation form of acquired immunodeficiency syndrome}; Dronda F et al.; BACKGROUND: Pericardial tuberculosis is an unusual presentation form of extrapulmonary tuberculosis, even in HIV-1 infected patients . When complicated with cardiac tamponade the prognosis worsens; therefore, early diagnosis and therapy are essential . METHODS: A cross-sectional and descriptive study was carried out of cases with documented diagnosis of tuberculous pericarditis in a cohort of prisoner patients with tuberculosis in the Comunidad Autonoma de Madrid, during a 4-year period (March 1991-March 1995) . The recovery and identification of Mycobacterium tuberculosis in our clinic were made on the basis of standard techniques and DNA probes . The clinical and microbiological features of patients with documented diagnosis of tuberculous pericarditis are reported and a bibliographic review on this topic is made (MEDLINE 1985-July 1996) . RESULTS: A total of 483 patients were diagnosed of tuberculosis, and 90% were HIV-1 positive . Only four patients, all coinfected with HIV-1, developed tuberculous pericarditis complicated with cardiac tamponade which required drainage and allowed the visualization of acid-fast bacilli and culture of M . tuberculosis in pericardial fluid (in three cases associated with recovery from other specimens) . All isolates were initially susceptible to first-line antituberculous drugs . No patient had previously had opportunist infections, although all of them had severe immunosuppression (< 0.200 x 10(9)/l CD4+ lymphocytes) . The clinical outcome was favorable with pericardial drainage and the drug regime prescribed; the survival times were 8, 12, 13 and 28 months . The latter patient, on account of inadequate therapy compliance developed multi-resistant tuberculosis . CONCLUSIONS: Tuberculous pericarditis in HIV-1 infected patients usually appears in situations of advanced immunosuppression and usually in the context of disseminated tuberculosis and as a first opportunist infection . Its presentation with cardiac tamponade is unusual and its high morbidity and mortality demand early diagnosis and therapy.

Enferm Infecc Microbiol Clin, 1997 Oct, 15 Suppl 3, 47 - 52
{Surveillance and control of infections in the intensive care unit: rates, resistance, and carrier state}; de la Cal MA et al.; The nosocomial infection detection systems in Intensive Care Units, present certain peculiarities . The traditional methods, the most important example of which is the National Nosocomial Infections System, have, among their most explicit main objectives, the comparison of the number of infections, and the infectious flora between Units, and within the same Unit, over a period of time . For this reason, they are experiencing a great development within the hospitality quality control programs . In the last decade, the control of the flora of the digestive apparatus, the oropharynx, and the rectum of ICU patients, has permitted the making of an etiopathogenic classification of the infections (primary endogenous, secondary endogenous, and exogenous), which has justified the use of preventive measures with topical and systemic antimicrobial agents, according to the cases, with a tremendous impact on the decrease in the number of pneumonia's associated with mechanical ventilation, and of early pneumonia's which traditionally are excluded from the traditional detectional systems, as well as the control of multiresistant gram-negative bacilli . For this reason, it is recommended that both methods be complementary to each other . Neither of the two detection systems has been evaluated in terms of efficiency.

J Formos Med Assoc, 1997 Nov, 96(11), 913 - 6
Osteomyelitis and tenosynovitis due to Mycobacterium marinum in a fish dealer; Shih JY et al.; Osteomyelitis caused by nontuberculous mycobacteria is rarely reported . We describe a case of tenosynovitis and osteomyelitis of the right middle finger and metacarpal bone caused by Mycobacterium marinum in a fish dealer . This 52-year-old woman suffered progressive pain, numbness, tenderness, and erythematous swelling of the right middle finger over a 2-month period . A radiograph of the right hand disclosed osteolytic lesions at the third metacarpal bone and the third proximal phalanx . She was treated successfully with repeated surgical debridement and antimicrobial agents, including clarithromycin, ethambutol, rifampin, and doxycycline for 1 month, followed by ethambutol and clarithromycin . Pathologic examination of the debrided tissue disclosed epithelioid granuloma, caseous necrosis, and numerous acid-fast bacilli, which were later identified as M . marinum using conventional biochemical tests and by the characteristic gas-liquid chromatogram of esterified cellular fatty acid . The wound healed completely after 7 months of treatment . The patient is still under treatment, and clarithromycin and ethambutol will be given for a total of 18 months.

Cytokines Mol Ther, 1995 Sep, 1(3), 185 - 96
Clinical and immune responses of tuberculosis patients treated with low-dose IL-2 and multidrug therapy; Johnson BJ et al.; The immune response to infection with M . tuberculosis depends on cytokine activation of effector cells . We therefore conducted a pilot study of recombinant human interleukin-2 (rhuIL-2) as an adjunct to multidrug therapy (MDT) to evaluate the safety of this approach and to determine whether IL-2 can enhance the cellular immune response in patients with pulmonary tuberculosis (TB) . Patients included in this study presented with a wide range of extent and duration of infection, and were grouped into three categories for data analysis: (1) patients with newly diagnosed, acute-stage TB who were just beginning MDT; (2) patients who had received a minimum of 45 days MDT before the start of the study and who had responded to treatment; and (3) patients with multidrug-resistant (MDR) TB who had been on MDT for at least seven months without apparent beneficial clinical response . Twenty patients received 30 days of twice-daily intradermal injections of 12.5 micrograms of IL-2 . Patients from all three groups showed improvement of clinical symptoms over the 30-day period of treatment with IL-2 and MDT . Results of direct smear for acid fast bacilli (AFB) demonstrated conversion to sputum-negative following IL-2 and MDT treatment in all newly diagnosed patients and in 5/7 MDR TB patients . (The size of the skin test response to purified protein derivative (PPD) of tuberculin increased during the 30-day IL-2 adjunctive therapy in newly diagnosed patients, but decreased or disappeared in the other two groups of treated patients.) Assays in vitro for phenotype distribution, natural killer (NK) cell activity, frequency of cells proliferating in response to exogenous IL-2, and antigen-induced blastogenesis demonstrated systemic responses to intradermally administered rhuIL-2 . Levels of interferon-gamma (IFN-gamma) in plasma, peripheral blood mononuclear cell (PBMC) IFN-gamma mRNA and IFN-gamma mRNA in biopsy of site of skin test response to purified protein derivative (PPD) were highest in those patients with the most acute symptoms at the beginning of the study, and decreased during rhuIL-2 and MDT . IL-2 immunotherapy did not modify levels of mRNA expression for other cytokines . Patients receiving IL-2 did not experience clinical deterioration or significant side effects . These results suggest that IL-2 administration in combination with conventional MDT is safe and may potentiate the antimicrobial cellular immune response to TB.

Zhonghua Hu Li Za Zhi, 1997 Jul, 32(7), 373 - 5
{The sterilization effect of formaldehyde fumigating on the catheter place vertically}; Feng YR et al.; The aim of this paper is to investigate the effect of formaldehyde fumigating on the sterilization of catheters with different diameters and placed in different positions . The lumen of cleaned catheters with different diameters was filled with a solution of live bacilli coil . The catheters were then dried by a drier and divided into 3 groups for formaldehyde fumigating sterilization . A segment of 5 cm of the middle section of the sterilized catheters was cut and incubated at 36 degrees C for 48 h with bouillon medium . For those segments with positive culture, bacteriologic identification was done . RESULTS: Group A, U = 6.85 and P < 0.01; Group B, chi 2 = 8 and P < 0.01; Group C, chi 2 = 13, P < 0.01 . CONCLUSIONS: in the same conditions, fumigating in vertical direction is better than fumigation in horizontal direction and save time; in the same conditions, the positive culture rate is inversely related to the diameter of the catheters; for catheter with a diameter greater than 0.75 cm, fumigating vertically for 2 h is enough to obtain satisfactory sterilization effects.

J Antimicrob Chemother, 1997 Oct, 40(4), 503 - 9
Bay 12-8039, a new 8-methoxy-quinolone: comparative in-vitro activity with nine other antimicrobials against anaerobic bacteria; MacGowan AP et al.; The in-vitro activity of a new 8-methoxy-quinolone, Bay 12-8039, was assessed against 218 anaerobic bacteria . Ninety-eight per cent of strains belonging to the Bacteroides fragilis group (n = 65) were inhibited by < or = 2 mg/L of Bay 12-8039 whereas 97%, 94%, 94% and 100%, respectively, of Gram-negative bacilli (n = 93), non-sporing Gram-positive bacilli (n = 36), endospore-forming Gram-positive bacilli (n = 34) and Gram-positive cocci (n = 45) were also inhibited by < or = 2 mg/L . Eighty-three per cent of all anaerobes tested were inhibited by < or = 1 mg/L Bay 12-8039 and 99.5% by < or = 4 mg/L . When compared with ciprofloxacin, clinafloxacin, ofloxacin and trovafloxacin, Bay 12-8039 was more active than ciprofloxacin and ofloxacin, equipotent to trovafloxacin but not as active as clinafloxacin.

Crit Care Med, 1997 Dec, 25(12), 2009 - 14
Early bloodstream infection after cardiopulmonary bypass: frequency rate, risk factors, and implications; Ryan T et al.; OBJECTIVE: To determine the incidence, predisposing factors, and outcome of early bloodstream infection after cardiopulmonary bypass . DESIGN: A case control study . SETTING: A 54-bed cardiac surgical intensive care in a tertiary referral center . PATIENTS: Patients from a 30-month period with preoperative hospital stay of <48 hrs and subsequent bloodstream infection within 96 hrs of cardiopulmonary bypass were included in a case group . The control group consisted of patients who had cardiac surgery on the same day as the case group . MEASUREMENTS AND MAIN RESULTS: Patient demographics, history of comorbidity, preoperative laboratory testing, details of surgery, transfusion requirement, inotropic infusions, hemodynamics, and arterial blood gases on admission to intensive care were compared in the two groups . Measures of outcome were duration of mechanical ventilation and intensive care stay, serum creatinine on the first postoperative day, highest creatinine and bilirubin concentrations, and hospital mortality . During the study period, 7,928 patients had cardiac surgery . Sixteen (0.2%) patients had early bloodstream infection; the control group consisted of 95 patients . Thirteen of the patients with bloodstream infection had Gram-negative bacilli on blood culture, two had Candida species, and two had Gram-positive bacteria . On multivariate logistic regression analysis, greater prevalence of preoperative pulmonary hypertension (odds ratio 9; 95% confidence interval 2 to 41.8; p = .004), diabetes (odds ratio 4.6; 95% confidence interval 1.4 to 15.8; p = .01), number of blood products transfused (odds ratio 1.09; 95% confidence interval 1.04 to 1.17; p = .005), and infusion of inotropes (odds ratio 4.7; 95% confidence interval 1.3 to 16.4; p = .02) or vasopressors (odds ratio 4.1; 95% confidence interval 1.3 to 15.6; p = .02) were associated with postoperative bloodstream infection . Early bloodstream infection was associated with significantly prolonged duration of mechanical ventilation (117.2 +/- 21.5 vs . 18 +/- 8.8 hrs; p = .0001), intensive care stay (213 +/- 27.5 vs . 53 +/- 11.3 hrs; p < .0001), greater creatinine concentrations on the first postoperative day (1.6 +/- 0.1 vs . 1.2 +/- 0.04 mg/dL; p = .0002), greater maximum creatinine concentration (2.4 +/- 0.2 vs . 1.3 +/- 0.1 mg/dL; p < .0001), and greater maximum bilirubin concentration (4.7 +/- 0.6 vs . 1.3 +/- 0.2 mg/dL; p < .0001) when compared with the control group . Five (32%) of 16 bacteremic patients died vs . none of the 95 control patients (p < .0001) . CONCLUSIONS: Early bloodstream infection after cardiac surgery is uncommon and involves predominantly Gram-negative bacteria . The risk factors associated with bloodstream infection were preoperative morbidity and more complex surgery . Bloodstream infection was associated with a significantly adverse impact on outcome after cardiac surgery.

Dermatology, 1997, 195 Suppl 2, 104 - 6
Bactericidal activities of povidone-iodine against Mycobacterium; Rikimaru T et al.; Three standard strains of Mycobacterium (M . tuberculosis H37Rv, M . avium ATCC15769 and M . kansasii ATCC12478) and 15 clinical isolates of Mycobacterium (7 M . tuberculosis, 2 M . avium, 3 M . kansasii, 1 M . intracellulare, 1 M . chelonae subsp . abscessus and 1 M . gordonae) were selected in order to study the bactericidal activities of povidone-iodine (PVP-I) drug substance and a commercially available PVP-I solution (Isodine solution) against Mycobacterium . After the bacilli had been exposed to the disinfectant solution at concentrations of 0.1 or 0.02% with 2% human serum for various incubation periods from 30 to 120 s, the PVP-I drug substance was inactivated by addition of 0.5% sodium thiosulfate . In the case of the commercially available PVP-I solution, a mixture of 10% Tween 80, 3% soybean lecithin and 0.5% sodium thiosulfate was used as inactivator . It was demonstrated that the 3 standard strains were completely inactivated within 30 s by 0.1% PVP-I drug substance and that the 15 clinical isolates were almost killed by 0.1% commercially available PVP-I solution within 60 s . As a result, the commercially available PVP-I product appeared to be a useful agent as disinfectant against all the tested species of Mycobacterium.

Int J Lepr Other Mycobact Dis, 1997 Sep, 65(3), 320 - 7
A follow-up study of multibacillary Hansen's disease patients treated with multidrug therapy (MDT) or MDT + immunotherapy (IMT); Rada E et al.; Multibacillary (MB) leprosy patients treated with multidrug therapy (MDT) or MDT + immunotherapy (IMT) with BCG + heat-killed Mycobacterium leprae were tested annually for their ability to proliferate in vitro to the mycobacterial antigens BCG, M . leprae soluble extract, and intact M . leprae . IgM antibody responses to phenolic glycolipid I (PGL-I) were measured, as well as serum nitrite levels in patients' sera, before, during and after treatment . Patients who received only MDT did not present cellular reactivity to intact M . leprae antigens, in contrast to the results obtained with BCG, which elicited reactivity at time zero, that increased after treatment . Regarding PGL-I antibody variations in relation to the initial value, we observed a statistically significant marked decrease at the end of 2 years which continued to fall in successive evaluations . MB patients showed high initial serum nitrite concentrations which dropped drastically with treatment . This decay was apparently associated with the bacillary load present in these patients . The group submitted to IMT + MDT showed high and long-lasting T-cell responses to mycobacterial antigens in a significant number of initially unresponsive MB patients . There was a marked increase to M . leprae soluble extract and BCG, as well as a more variable response to whole bacilli . The antibody levels in this group of patients are sustained for a somewhat longer period and decreased more slowly during the 5-year follow up.

Respirology, 1997 Sep, 2(3), 209 - 13
Tuberculosis and HIV infection: global perspectives; Murray JF; This paper reviews the epidemiological and clinical aspects of the interaction between Mycobacterium tuberculosis and HIV infection . The incidence of HIV-associated tuberculosis is increasing worldwide and is expected to increase further, especially in Africa and parts of Asia . HIV infection appears to increase the likelihood that tuberculous infection will occur after tubercle bacilli are inhaled into the lungs . Moreover, there is persuasive evidence that in the presence of HIV infection, new-onset tuberculous infection will progress rapidly to clinically significant disease and the probability that latent tuberculous infection will reactivate is enormously increased . The accelerating and amplifying influence of HIV infection is also contributing to the increasing incidence of disease caused by multidrug-resistant strains of M . tuberculosis . Neither clinical nor radiographic features reliably distinguish the majority of patients with HIV-associated tuberculosis from those who are non-HIV-infected . Some HIV-infected patients, however, have atypical manifestations and are difficult to diagnose . Chemotherapy for 6 months with conventional antituberculosis drugs cures most patients, but many died during or after treatment of other AIDS-related complications . HIV is contributing heavily to the worldwide increase in tuberculosis . There is also mounting evidence that tuberculosis accelerates the course of co-existing HIV disease.

J Clin Microbiol, 1997 Dec, 35(12), 3082 - 5
Diagnostic value of the strand displacement amplification method compared to those of Roche Amplicor PCR and culture for detecting mycobacteria in sputum samples; Ichiyama S et al.; We compared the ability of the semiautomated BDProbeTec-SDA system, which uses the strand displacement amplification (SDA) method, with that of the Roche Amplicor-PCR system and the Septi-Chek AFB culture system to directly detect Mycobacterium tuberculosis complex (MTB) and other mycobacteria in sputum samples . A total of 530 sputum samples from 299 patients were examined in this study . Of the 530 samples, 129 were culture positive for acid-fast bacilli with the Septi-Chek AFB system; 95 for MTB, 29 for M . avium-M . intracellulare complex (MAC), and 5 for other mycobacteria . The BDProbeTec-SDA system detected 90 of the 95 samples culture positive for MTB (sensitivity, 94.7%), and the Amplicor-PCR system detected 85 of the 95 samples culture positive for MTB (sensitivity, 89.5%) . The specificity of each system, based on the clinical diagnosis, was 99.8% for SDA and 100% for PCR, respectively . Among the 29 samples culture positive for MAC, the BDProbeTec-SDA system detected MAC in 24 samples (sensitivity, 82.8%), whereas the Amplicor-PCR system detected MAC in 23 samples (sensitivity, 79.3%) . The specificities of the systems were 98.3 and 100%, respectively . The high degrees of sensitivity and specificity of the BDProbeTec-SDA system suggest that it should be very useful in clinical laboratories for the rapid detection of mycobacteria in sputum samples.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Sep, 35(9), 1013 - 9
{A case of tuberculous abscess in the chest wall close to the thickening pleural lesion following tuberculous pleuritis}; Koreeda Y et al.; A 33-year-old woman with a history of right tuberculous pleuritis was successfully treated in December 1992 by administration of anti-tuberculous drugs, she demonstrated residual localized pleural thickening on chest computed tomography (CT) and gradually developed a subcutaneous mass in the right chest which became apparent in March 1993 . In September, chest CT revealed a periocostal abscess in the right anterior chest wall close to the localized pleural thickening . The patient was diagnosed with tuberculous abscess in the right chest wall on confirmation of acid-fast bacilli in a needle aspiration material of the abscess, and was referred to our hospital . Anti-tuberculous chemotherapy was continued but the chest abscess grew, so on January 28, 1994 she underwent a resection of the abscess, the third costal cartilage and bone, and the parietal pleural lesion connected to the abscess . Histopathological examination showed that the abscess and parietal pleural lesion were compatible with tuberculosis, i.e . both lesions consisted of caseous necrosis and epitheloid cell granuloma, but acid-fast bacilli were not demonstrated in both lesions . After one year of postoperative anti-tuberculous chemotherapy, she was followed without any therapy for 3 years and there has been no recurrence to date . When a localized thickening pleural lesion remains after tuberculous pleuritis, complication of tuberculous abscess in the chest wall should be considered.

Kansenshogaku Zasshi, 1997 Oct, 71(10), 1075 - 9
{A case of cat scratch disease identified by an elevated Bartonella henselae antibody level using enzyme immunoassay}; Kusaba N et al.; A 68-year-old male was admitted to our hospital because of fever and a 2-week history of inguinal adenomegaly . Since he owned a cat, cat scratch disease was suspected . But it was necessary to distinguish cat scratch disease from lymphoma type adult T-cell leukemia because he showed a high level of antibody against HTLV-1 . An excisional biopsy of the inguinal node was performed . Histopathologic examination revealed abscess-forming granulomatous lymphadenitis compatible with cat scratch disease . A Warthin-Starry silver stain showed pleomorphic bacilli in the lymph node . So we confirmed a serological response to Bartonella henselae, the causative agent of cat scratch disease, using enzyme immunoassay (EIA) . The IgG antibody level to B . henselae was positive at 42 EIA Unit before treatment . After treatment with intravenous cefepime and oral tosufloxacin, his physical symptoms improved and the antibody level decreased to less than 12 EIA Unit . EIA was very useful for diagnosis of this case . Serology to B . henselae may replace traditional diagnostic criteria for cat scratch disease.

Crit Care Nurs Q, 1997 Nov, 20(3), 21 - 35
Antimicrobial resistance: implications for the clinician; Freeman CD; Antimicrobial resistance has become an issue of global proportion, and this dilemma has greatly affected the intensive care unit (ICU) setting . Increased antimicrobial use and other selective pressures have created an environment in the ICU that is a testing ground for survival of microorganisms . By various mechanisms, gram-positive cocci and gram-negative bacilli are becoming more resistant to our current armamentarium of antimicrobials . Strategies to improve the current situation of reduced microbial susceptibility include the following: continued and specific surveillance in ICUs, antimicrobial protocols, continued isolation precautions and appropriate handwashing, increased education at all levels, increased use of immunotherapies, better use of our current antimicrobial agents, and increased research in finding new and innovative antimicrobial agents while curtailing the marketing ploys that promote excessive and inappropriate use of these valuable medications.

J Wildl Dis, 1997 Oct, 33(4), 749 - 58
Bovine tuberculosis in free-ranging white-tailed deer from Michigan; Schmitt SM et al.; A 4.5 yr-old male white-tailed deer (Odocoileus virginianus) killed by a hunter during the 1994 firearm hunting season in northeastern Michigan (USA) had lesions suggestive of tuberculosis and was positive on culture for Mycobacterium bovis the causative agent for bovine tuberculosis . Subsequently, a survey of 354 hunter-harvested white-tailed deer for tuberculosis was conducted in this area from 15 November 1995 through 5 January 1996 . Heads and/or lungs from deer were examined grossly and microscopically for lesions suggestive of bovine tuberculosis . Gross lesions suggestive of tuberculosis were seen in 15 deer . Tissues from 16 deer had acid-fast bacilli on histological examination and in 12 cases mycobacterial isolates from lymph nodes and/or lungs were identified as M . bovis . In addition, lymph nodes from 12 deer (11 females and 1 male) without gross or microscopic lesions were pooled into 1 sample from which M . bovis was cultured . Although more male (9) than female (3) deer had bovine tuberculosis infections, this difference was not statistically significant . Mycobacterium bovis culture positive deer ranged in age from 1.5 to 5.5 yr with a mean of 2.7 yr (median 2.5 yr) for males and 3.2 yr (median 3.5 yr) for females . This appears to be the first epidemic occurrence of M . bovis in free-ranging cervids in North America . A combination of environmental (high deer density and poor quality habit) and management-related factors (extensive supplemental feeding) may be responsible for this epizootic.

Zhonghua Jie He He Hu Xi Za Zhi, 1996 Jun, 19(3), 136 - 9
{Clinicopathological study of 34 autopsy cases of mycobacteriosis in patients with acquired immunodeficiency syndrome}; Liu D et al.; OBJECTIVE: Clinicopathological features of mycobacteriosis were studied by means of microscopical examination of 34 autopsy cases in patients with acquired immunodeficiency syndrome (AIDS) and the diagnostic methods were evaluated . METHODS: All cases were anatomized, sampled, fixed and embedded routinely and stained with hematoxylin-eosin . Acid fast stain was applied to identify the mycobacteria . The pathological sections and files were reviewed systemically and retrospectively . RESULTS: Thirty-four cases of mycobacteriosis, including Mycobacterium avium-intracellular complex (MAI) infection (20 cases) and Mycobacterium tuberculosis (10 cases) and mixed infection of both pathogens (4 cases) were found out of 151 autopsy AIDS patients . MAI infection involved mostly the lymph nodes (21 cases) and followed by spleen, liver and lung, etc . The infection were often disseminated and characterized by proliferation of histocytes with foamy or vacuolar cytoplasm containing acid fast bacilli and formation of granulomatous nodules . Tuberculosis often involved the lung (10 cases) and lymph node (8 cases), the typical manifestations of which were caseous necrosis and tuberculation . Other opportunistic infections and neoplasmas occurred with mycobacteriosis in 25 cases . CONCLUSIONS: Mycobacteriosis, especially the tuberculosis and MAI infection are common in patients with AIDS, which are often disseminated and involved the lung and lymph node . The diagnosis can be made according to the specific pathological appearances and positive acid fast stain.

Kekkaku, 1997 Oct, 72(10), 587 - 95
{Pyrazinamide-containing initial intensive short course chemotherapy of pulmonary tuberculosis}; Wada M; Six-month short course regimen had been accepted all over the world since early 1980s . In Japan this short course regimen had not been accepted as a standard regimen for treatment of pulmonary tuberculosis until April 1996 . The reason why this was not accepted is resumably due to hepatotoxicity of pyrazinamide . The situation around tuberculosis were changing in Japan especially in urban areas . Incidence of tuberculosis in younger generations is higher in urban areas than in rural areas . More effective and shorter course regimen were needed . Efficacy of pyrazinamide were briefly described first, then results of six-month regimen with pyrazinamide in Fukujuji Hospital since 1991 January were discussed . Pyrazinamide can kill tubercle bacilli in acidic environment . It works bacericidally during the early treatment phase . It can kill not only replicating bacilli but also semidormant ones . The results of many six-month regimens showed that only pyrazinamide containing regimens were acceptable for standard regimen in pulmonary tuberculosis with less than a few percent of relapse . Newly accepted standard chemotherapy included 2HRZ with or without S or E/4HRE, 6HRS or E/3HR, and 6HR . Among 429 tuberculosis patients treated at Fukujuji Hospital with pyrazinamide-containing regimens, the negative conversion rate after two months of chemotherapy was 95 percent and similar to those of Western, African and Asian tuberculosis trials . Six of 290 evaluable cases have relapsed . (relapse rate; 2%) Noticeably all relapsed cases were complicated with diabetes mellitus . The higher percent of patients, 8.2 had elevated serum transaminase levels 5 times of upper limit of normal level or more compared with that of patients without pyrazinamide, 6.6 percents, but this difference is not statistically significant . One patient whose pretreatment liver function was abnormal with unknown origin died from hetatoxicity of anti-tuberculous drugs . The risk factors of hepatotoxicity included HCV carrier, elderly more than 80 years old, but HB carrier, alcohol drinking and hepatic diseases were not risk factors . Less patients, 5.6% defaulted from regimen compared with that with 9-month regimen without pyrazinamide (8.6%), but this difference is not statistically significant . The efficacy of the regimen was 90.3% higher than that of 9-month regimen, 86.0% In summary, six-month regimen containing pyrazinamide is highly effective . The incidence and severity of hepatotoxicity must be further studied in Japan.

Curr Opin Hematol, 1994 Jan, 1(1), 85 - 91
Penetration, retention, intracellular localization, and antimicrobial activity of antibiotics within phagocytes; Silverstein SC et al.; The deficiency in cell-mediated immunity that is the hallmark of AIDS has led to a resurgence of infections with tubercle bacilli and other intracellular pathogens, and to renewed attention to the mechanisms by which antibiotics penetrate and are retained within phagocytic leukocytes . We review here recent studies of these mechanisms and the activity of different classes of antibiotics against microbial pathogens growing within or ingested by neutrophils and mononuclear phagocytes.

Diagn Microbiol Infect Dis, 1997 Oct, 29(2), 73 - 9
Comparison of quantitative polymerase chain reaction, acid fast bacilli smear, and culture results in patients receiving therapy for pulmonary tuberculosis; Afghani B et al.; Quantitative-competitive polymerase chain reaction (QPCR) was performed on serial sputum samples from 22 consecutive cases of acid fast bacilli (AFB) smear-positive pulmonary tuberculosis . Of 94 specimens, 55, 72, and 83% were positive by culture, AFB smear, and QPCR, respectively . Of 52 culture-positive specimens, 6% were negative by PCR, and 13% were negative by AFB smear . Of 42 culture-negative specimens, AFB smear and QPCR were positive in 55 and 61%, respectively . AFB smear and QPCR results were strongly correlated (r = 0.75, p < 0.001), but each correlated less strongly with culture (r = 0.54, p < 0.005 for smear and r = 0.52, p < 0.005 for QPCR) . When patients were classified by microbiologic response, responders tended to have less DNA in their sputum and shorter time to a negative PCR result compared to nonresponders . These data do not suggest a great advantage of QPCR over AFB smear for predicting culture results in patients with pulmonary tuberculosis.

J Hepatol, 1997 Oct, 27(4), 620 - 7
Direct detection of Mycobacterium tuberculosis using polymerase chain reaction assay among patients with hepatic granuloma; Alcantara-Payawal DE et al.; BACKGROUND: In liver tuberculosis, demonstration of acid bacilli by conventional methods remains futile . Since the definitive diagnosis of liver tuberculosis is based on the histologic evidence of granulomatous process with caseation necrosis, seen in only a third of cases, the diagnosis is made retrospectively by response to empirical anti-tuberculous drug therapy . AIMS: Our objective is to establish a polymerase chain reaction assay for detection of Mycobacterium tuberculosis affecting the liver using the paraffin-embedded liver biopsy specimens obtained from patients with hepatic granulomas . METHODS: As positive control, patients having either "definitive" (n=8) or "presumptive" (n=9) tuberculosis on the basis of clinical, microbiological, histologic data and their positive response to empirical treatment of anti-tuberculous drugs were used . Patients with hepatic granulomas secondary to schistosomiasis (n=6), sarcoidosis (n=2) and other liver diseases (n=10) were used as negative control . RESULTS: Of those patients who were diagnosed as having "definitive" and "presumptive" liver tuberculosis, positivity by one-step polymerase chain reaction was 100% and 44%, respectively . Using the nested polymerase chain reaction, positivity increased to 78% with "presumptive" liver tuberculosis . In contrast, the polymerase chain reaction assays were negative among all patients with hepatic granuloma due to non-tuberculous-in-origin and other liver diseases . CONCLUSIONS: The overall positivity of this polymerase chain reaction assay (88%) compares favorably with that of other conventional methods (12%) . Thus, this polymerase chain reaction assay may be a reliable diagnostic tool for liver tuberculosis in a patient population in which the prevalence of diseases associated with hepatic granuloma is common.

Int J Epidemiol, 1997 Oct, 26(5), 1115 - 20
Risk factors for the development of non-response to first-line treatment for tuberculosis in southern Vietnam; Keane VP et al.; BACKGROUND: Acquired resistance to standard chemotherapy for tuberculosis (TB) is an increasing problem worldwide . Vietnam has one of the highest incidences of TB and also has a large population of potential migrants to other countries . Since 1979 the International Organisation for Migration (IOM) has been running a supervised programme of TB treatment for intending migrants from Vietnam where few facilities for bacteriological culture and sensitivity testing exist . This study aimed to assess the most important factors for predicting non-response to first-line treatment as treatment starts and whether any further indicators occur during the course of treatment which may enable more accurate prediction of non-response . METHODS: In all, 130 subjects failing to respond to first-line therapy (cases) between 1990 and 1995 were compared with 673 subjects who responded to therapy (controls) on various demographic and clinical characteristics using logistic regression to create a prognostic index . Variables analysed included the patient history of past TB treatment, weight, age, sex and radiological and bacteriological findings . All subjects also tested negative for HIV status . RESULTS: The chief markers of successful response were x-ray signs and degree of sputum smear positivity . These markers provided a prognostic index with an optimal cutoff providing about 70% sensitivity and 80% specificity . Incorporating further measures obtained through the first 3 months of treatment improved the sensitivity to 80% . CONCLUSION: While this study enabled prediction of the majority of subjects failing to respond to first-line therapy, other factors need to be assessed before recommendations for altering treatment regimens can be made . The prognostic index could be useful in assessing subjects for closer supervisionPIP: Since 1979, the International Organization for Migration has provided tuberculosis screening and treatment for those who intend to migrate from Viet Nam--a country with one of the highest tuberculosis incidence rates . The factors associated with non-response to first-line tuberculosis treatment were investigated in a comparative study of 130 non-responders (cases) and 673 responders (controls) . Cases had worse radiologic signs and greater numbers of acid-fast bacilli on their sputum smears than controls . When these two factors were used as a diagnostic test to predict non-response, the model had a sensitivity of 70% and a specificity of 80% . Sensitivity increased to 80% when variables measured in the first 3 months of treatment were used . Failure to respond to treatment can be a result of infection with other mycobacteria, infection with a multi-drug resistant tuberculosis strain, or acquisition of resistance after the initiation of therapy . Further analysis of the same database is underway to determine the natural history and success of second-line treatment .

Neth J Med, 1997 Sep, 51(3), 119 - 22
Be aware of abdominal tuberculosis; Bouma BJ et al.; Abdominal tuberculosis is often diagnosed in a late stage because symptoms are aspecific . Two patients with intestinal tuberculosis and tuberculous peritonitis respectively, both from endemic countries presented with long-standing fever, abdominal pain and weight loss . Acid fast bacilli were present in aspirate and biopsy specimens obtained by colonoscopy and laparoscopy respectively; PCR was positive for M . tuberculosis complex and later M . tuberculosis was cultured . Both patients responded to antituberculous therapy . In one patient AIDS was diagnosed.

Philos Trans R Soc Lond B Biol Sci, 1997 Sep 29, 352(1359), 1303 - 10
Why intracellular parasitism need not be a degrading experience for Mycobacterium; Russell DG et al.; The success of mycobacteria as pathogens hinges on their ability to infect and persist within the macrophages of their host . However, activation of host macrophages by cytokines from a productive cellular immune response can stimulate the cells to kill their resident pathogens . This suggests that the interaction between host cell and microbe is in delicate balance, which can be tipped in favour of either organism . Biochemical analysis of mycobacterial vacuoles has shown them to be integral to the host cell's recycling endosomal system . As such they show limited acidification and hydrolytic activity despite possession of known lysosomal constituents such as cathepsins D, B and L, and LAMP 1 . Even in established infections, they remain dynamic compartments accessible to several plasmalemma-derived constituents . Once the macrophage has been activated by IFN-gamma and TNF-alpha the vacuoles coalesce and acidify . This marks a distinct alteration in vacuole physiology and leads to stasis and death of the mycobacteria . Mycobacteria have developed several strategies to avoid this outcome . Most notably, live bacilli-induce sustained release of IL-6 from infected macrophages . IL-6 blocks the ability of both polyclonal primary T cells and T-cell hybridomas to respond to appropriate stimuli . Such an activity could render the centres of infection foci, such as granulomas, anergic and thus avoid release of macrophage-activating cytokines . This paper discusses both the mechanisms by which mycobacteria try to ensure their success as intracellular pathogens and the relevance of these strategies to the overall understanding of mycobacterial diseases.

Infect Immun, 1997 Nov, 65(11), 4880 - 2
Differential immunogenicity of novel Mycobacterium tuberculosis antigens derived from live and dead bacilli; Amara RR et al.; Mouse serum raised against killed antigen preparations of Mycobacterium tuberculosis failed to recognize most of the recombinant antigens of M . tuberculosis that were originally identified by reactivity to tuberculosis (TB) patient sera . Similar results were obtained with serum from guinea pigs immunized with live and killed mycobacteria . Antibodies raised against seven random TB patient serum-reactive antigens detected each of these antigens in the sonicate preparation . The nucleotide sequences of the genes for these seven antigens revealed that all represented hitherto unreported genes of M . tuberculosis . Our results suggest differential presentation to the host immune system of the same antigens derived from live and killed mycobacteria.

Infect Immun, 1997 Nov, 65(11), 4850 - 7
Mycobacterial growth and sensitivity to H2O2 killing in human monocytes in vitro; Laochumroonvorapong P et al.; The intracellular growth and susceptibilities to killing by H2O2 in cultured human monocytes of a number of mycobacterial species including laboratory strains and clinical isolates of Mycobacterium tuberculosis, and Mycobacterium bovis bacillus Calmette-Guerin (BCG) and a clinical isolate of Mycobacterium avium-M . intracellulare were examined . The clinical isolate of M . avium-M . intracellulare did not replicate in freshly explanted monocytes (generation time of >400 h); BCG replicated with a generation time of 95 h, and M . tuberculosis strains CDC551, H37Rv, and H37Ra replicated with generation times of 24, 35, and 37 h, respectively, during the 4-day growth assay . When cultured in monocytes for 4 days, the mycobacteria were variably sensitive to H2O2-induced killing . A positive correlation between the generation time and percent killing of intracellular bacilli was observed . By comparison, mycobacterial strains were similarly sensitive to H2O2 treatment in cell-free culture media and in sonicated cell suspensions . Using a number of inhibitors of reactive oxygen intermediates we determined that other than catalase the inhibitors tested did not affect H2O2-induced killing of intracellular mycobacteria . Our studies suggest that the killing of mycobacteria growing in human monocytes in vitro by the addition of exogenous H2O2 is dependent on the susceptibility to a peroxide-induced killing pathway as well as on the intracellular growth rate of the mycobacteria.

Infect Immun, 1997 Nov, 65(11), 4548 - 57
Cloning, sequencing, and expression of the mig gene of Mycobacterium avium, which codes for a secreted macrophage-induced protein; Plum G et al.; Mycobacterium avium is an intracellular pathogen that has evolved to be a frequent cause of disseminated infection in immunocompromised patients . Although these bacilli are readily phagocytized, they are able to survive and even multiply within human macrophages . The process whereby mycobacteria circumvent the lytic functions of the macrophages is currently not well understood, but this is a key aspect in the pathogenicity of all pathogenic mycobacteria . Previously, we identified a gene in M . avium, designated mig (for macrophage-induced gene), the expression of which is induced when the bacilli grow in human macrophages (G . Plum and J . E . Clark-Curtiss, Infect . Immun . 62:476-483, 1994) . In the present study we show that (i) the nucleotide sequence of the mig gene has an open reading frame of 295 amino acids with a strong bias for mycobacterial codon usage, (ii) the mig gene also codes for a putative signal peptide of 19 amino acid residues, (iii) mig is induced by acidity to be expressed as an early-secreted 30-kDa protein, and (iv) the Mig protein exhibits an AMP-binding domain signature . However, beyond this motif which is common to enzymes that activate a large variety of substrates, no homologies to known sequences are found . We also show that (v) Mycobacterium smegmatis strains expressing the Mig protein have a limited advantage for survival in macrophages . These findings may be concordant with a role of the mig gene in the virulence of M . avium.

J Clin Microbiol, 1997 Nov, 35(11), 2915 - 7
Culture of the causative organism of donovanosis (Calymmatobacterium granulomatis) in HEp-2 cells; Carter J et al.; We report successful culture of Calymmatobacterium granulomatis by standard cell culture methods . Swabs were obtained from lesions in three patients with a clinical diagnosis of donovanosis . For two patients, there was histological confirmation of the disease (i.e., the presence of Donovan bodies in Giemsa-stained smears) . Specimens were inoculated onto cycloheximide-treated HEp-2 cell monolayers in RPMI 1640 medium (supplemented with fetal calf serum, NaHCO3, vancomycin hydrochloride, and benzylpenicillin) . At 48 h, organisms resembling Donovan bodies were identified in monolayer cultures from all three specimens . The organisms appeared as pleomorphic bacilli with characteristic bipolar staining and "safety pin" appearance . Using a PCR designed to differentiate C . granulomatis from the Klebsiella species (which have a high degree of molecular homology), we were able to demonstrate that the cultured organisms produced a PCR product identical to that obtained from the original swab specimens . It is now possible to test in vitro susceptibility of C . granulomatis to antibiotics and to provide a ready source of DNA and antigenic material to enable the development of serological tests and, possibly in the future, a vaccine.

J Clin Microbiol, 1997 Nov, 35(11), 2791 - 4
Inhibitory effects of polyoxyethylene stearate, PANTA, and neutral pH on growth of Mycobacterium genavense in BACTEC primary cultures; Realini L et al.; We report on the influences of polyoxyethylene stearate (POES), PANTA, and pH on primary cultures of Mycobacterium genavense in BACTEC vials . As a model for primary cultures from tissue, seven different strains first isolated from AIDS patients (five from Switzerland and two from the United States) were inoculated into nude mice in order to obtain large amounts of bacilli to test different conditions simultaneously . Our results demonstrate that the size of the inoculum (10{6} acid-fast bacilli/vial), an acid pH (pH 6.0), and the absence of additives (POES and PANTA) significantly (P < 0.001) increased the probability of a successful culture in 1 month, considering growth index (GI) of > or =100 or a GI of > or =999 as criterion of success . In logistic regression analysis, all factors maintained a significant (P < 0.001) independent effect, and no interactions were observed between them . The best conditions for the primary cultures of M . genavense were the use of Middlebrook 7H12 medium at pH 6.0 without any additives.

J Intern Med Suppl, 1997, 740, 79 - 88
Is there a rationale for the use of antimicrobial prophylaxis in neutropenic patients?
Donnelly JP.
Antimicrobial prophylaxis in neutropenic patients has been practised in one form or another for several decades but the goal is no longer clear . From being initially solely an attempt at decontamination, drugs such as co-trimoxazole and later the fluoroquinolones were preferred to non-absorbable regimens because they achieve reliable protection against bacteraemia due to Gram-negative bacilli . Nevertheless, fever still invariably occurs during neutropenia leading to the initiation of traditional empirical therapy . Not only is this approach illogical but it also ignores the flexibility afforded the oral and parenteral formulations of the fluoroquinolones . Instead, it might be as effective and less costly if these agents were given orally until the end of neutropenia unless there was evidence of malabsorption or poor oral intake, in which case treatment would be continued parenterally . Should patients develop fever, an attempt would be made to complement treatment with another anti-microbial agent for microbiologically or clinically defined infection . This would be carried out at diagnosis, before any changes in the prophylactic regimen could be made . Otherwise, treatment with the prophylactic regimen would continue without modification . There is a less compelling need for prophylaxis against candidosis, herpes simplex and cytomegalovirus disease as these would be better managed pre-emptively when there is evidence of yeast carriage or re-activation of viral infection . Similarly, prophylaxis of aspergillosis is a forlorn hope and again a pre-emptive approach might serve us better once there is a screening test available and a safe and effective drug.

J Vet Diagn Invest, 1997 Oct, 9(4), 368 - 74
Seminal vesiculitis and orchitis caused by Brucella abortus biovar 1 in young bison bulls from South Dakota; Rhyan JC et al.; Specimens of blood, lymph nodes, spleens, and genitalia were collected at slaughter from seven 3- and 4-year-old male bison that had recently become seropositive for brucellosis . The animals were from a captive herd of approximately 3,500 bison located in central South Dakota . Brucella abortus biovar 1 was isolated from 2 or more specimens from each of 6 bison . Severe necrotizing and pyogranulomatous orchitis was present in 1 testicle from 1 bull, and 4 animals had mild to marked seminal vesiculitis . Immunohistochemical staining labeled organisms in seminal vesicles and the testicle with orchitis . Ultrastructurally, intact bacilli were present in cytoplasmic vacuoles of some macrophages; other macrophages contained intracytoplasmic aggregates of calcified coccobacilli.

Cutis, 1997 Oct, 60(4), 201 - 2
Tuberculoma of the tongue presenting as macroglossia; Ramesh V; Lingual tuberculosis presenting as macroglossia in a 20-year-old woman has been reported . The histopathologic picture was similar to lupus vulgaris and the intradermal tuberculin test showed a strongly positive vesiculobullous reaction after forty-eight hours . No active internal focus of tubercular infection could be detected . The patient responded well to antituberculous chemotherapy . The relative lack of symptoms suggest that the enlargement had been a slow process resulting from the lodging of bacilli in the tongue.

Sarcoidosis Vasc Diffuse Lung Dis, 1997 Sep, 14(2), 165 - 8
Sarcoidosis involving the thyroid and pleura; Warshawsky ME et al.; We report the coincidence of uncommon manifestations of sarcoidosis, each confirmed by percutaneous needle biopsy, revealing noncaseating granulomas . A patients presented with a thyroid nodule which demonstrated noncaseating granulomas on biopsy . When pleural effusion subsequently developed, pleural biopsy demonstrated noncaseating granulomas with no acid fast bacilli on stain or culture, and a diagnosis of sarcoidosis was made . Thyroid and pleural involvement are each rare manifestations of sarcoidosis, and are usually associated with extensive systemic disease . The diagnosis of sarcoidosis requires the appropriate clinical presentation, compatible histologic findings, and evaluation for other causes of granuloma formation.

Klin Lab Diagn, 1997 Jul, (7), 38 - 40
{Comparative analysis of 2 sanitary-bacteriological methods of detecting bacteria of the Escherichia coli group in the environment}; Ivanov AA et al.; A total of 965 parallel tests for coli bacilli were carried out using the wash-out or print methods in the course of sanitary and epidemiologic inspection of different objects . The methods used in the study were equally sensitive and provided compatible results which were in good correlation . The print method with bacterial tests is more rapid (by 24 hours) and helps detect other bacteria which grow in Endo's medium; moreover, it is three times cheaper than the labor-consuming wash-out method.

Pediatr Dermatol, 1997 Sep-Oct, 14(5), 365 - 8
Disseminated bacillus Calmette-Guerin infection in an HIV-infected child: a case with cutaneous lesions; Raton JA et al.; A boy born to a mother with unknown HIV infection was immunized with BCG in his first month of life . Seven months later axillary adenopathy developed . At the age of 10 months, 2 months after HIV infection had been diagnosed, papular skin lesions appeared all over his body . Mycobacterium bovis, BCG strain, was cultured from a lymph node and blood . Ziehl-Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid-fast bacilli . The patient died 10 days later, before the infection was confirmed . This is the first reported case of disseminated BCG infection in an HIV-infected child presenting with cutaneous lesions.

J Biol Chem, 1997 Oct 17, 272(42), 26530 - 5
Binding of the catabolite repressor protein CcpA to its DNA target is regulated by phosphorylation of its corepressor HPr; Jones BE et al.; Catabolite repression of a number of catabolic operons in bacilli is mediated by the catabolite control protein CcpA, the phosphocarrier protein HPr from the phosphoenolpyruvate-dependent sugar transport system (PTS), and a cis-acting DNA sequence termed the catabolite-responsive element (cre) . We present evidence that CcpA interacts with HPr that is phosphorylated at Ser46 (Ser(P) HPr) and that these proteins form a specific ternary complex with cre DNA . Titration experiments following the circular dichroism signal of the cre DNA indicate that this complex consists of two molecules of Ser(P) HPr, a CcpA dimer, and the cre sequence . Limited proteolysis experiments indicate that the domain structure of CcpA is similar to other members of the LacI/GalR family of helix-turn-helix proteins, comprised of a helix-turn-helix DNA domain and a C-terminal effector domain . NMR titration of Ser(P) HPr demonstrates that the isolated C-terminal domain of CcpA forms a specific complex with Ser(P) HPr but not with unphosphorylated HPr . Based upon perturbations to the NMR spectrum, we propose that the binding site of the C-terminal domain of CcpA on Ser(P) HPr forms a contiguous surface that encompasses both Ser(P)46 and His15, the site of phosphorylation by enzyme I of the PTS . This allows CcpA to recognize the phosphorylation state of HPr, effectively linking the process of sugar import via the PTS to catabolite repression in bacilli.

Mem Inst Oswaldo Cruz, 1997 May-Jun, 92(3), 297 - 316
The changing face of the epidemiology of tuberculosis due to molecular strain typing--a review; Suffys PN et al.; About one third of the world population is infected with tubercle bacilli, causing eight million new cases of tuberculosis (TB) and three million deaths each year . After years of lack of interest in the disease, World Health Organization recently declared TB a global emergency and it is clear that there is need for more efficient national TB programs and newly defined research priorities . A more complete epidemiology of tuberculosis will lead to a better identification of index cases and to a more efficient treatment of the disease . Recently, new molecular tools became available for the identification of strains of Mycobacterium tuberculosis (M . tuberculosis), allowing a better recognition of transmission routes of defined strains . Both a standardized restriction-fragment-length-polymorphism-based methodology for epidemiological studies on a large scale and deoxyribonucleic acids (DNA) amplification-based methods that allow rapid detection of outbreaks with multidrug-resistant (MDR) strains, often characterized by high mortality rates, have been developed . This review comments on the existing methods of DNA-based recognition of M . tuberculosis strains and their peculiarities . It also summarizes literature data on the application of molecular fingerprinting for detection of outbreaks of M . tuberculosis, for identification of index cases, for study of interaction between TB and infection with the human immuno-deficiency virus, for analysis of the behavior of MDR strains, for a better understanding of risk factors for transmission of TB within communities and for population-based studies of TB transmission within and between countries.

Southeast Asian J Trop Med Public Health, 1997 Mar, 28(1), 235 - 6
Miliary tuberculosis with unusual matted giant mesenteric lymph nodes; Viriyavejakul P et al.; We report a case of miliary tuberculosis in a 10-month old female with unusual matted giant mesenteric lymph nodes . She presented with prolonged fever and poor feeding for two months . With the evidence of miliary pattern in chest X-ray and the positive acid-fast bacilli from the sputum, she was treated with antituberculous chemotherapy . She died from pneumomediastinum and pneumopericardium . Post-mortem findings disclosed miliary tuberculosis involving major organs . Acid-fast bacilli were numerous . Large matted mesenteric lymph nodes measuring 10 x 6 x 5 cm3 were noted . A strikingly large palpable matted mesenteric lymph nodes in suspected miliary tuberculosis should not be confused with tumors in the children.

FEMS Immunol Med Microbiol, 1997 Sep, 19(1), 89 - 94
Aminoglycoside resistance . Enzymatic mechanisms in clinical bacterial strains in Slovakia during the last decade; Kallova J et al.; We determined the importance and dissemination of enzymatic mechanisms of aminoglycoside resistance in 239 gentamicin-resistant strains of Gram-negative bacilli isolated in Slovakia during the past decade . Over the past 5 years, the resistance to tobramycin has risen by 1.1% to netilmicin by 27.4%, to amikacin by 78.3%, and resistance to isepamicin was high too (81.9%) . Sixteen different aminoglycoside-modifying enzymes were detected and their significance for resistance to aminoglycosides was confirmed . It is evident that within the past 5 years gentamicin-resistant bacterial have obtained genetic information on resistance to the other aminoglycosides tested and the percentage of strains with different enzyme combinations has risen . These observations confirm the continuously increasing complexity of antibiotic resistance in clinical bacterial isolates under study in Slovakia during the last decade.

J Clin Microbiol, 1997 Oct, 35(10), 2464 - 71
Determination of the etiology of presumptive feline leprosy by 16S rRNA gene analysis; Hughes MS et al.; PCR-amplified 16S rRNA gene sequences were obtained directly from tissue specimens from eight cats with presumptive feline leprosy . Acid-fast bacilli were observed in sections from all eight specimens, but culture for mycobacteria was successful for one specimen only . Analysis of the V2 variable region of each 16S rRNA PCR product identified a sequence with 100% nucleotide identity to the sequences of Mycobacterium lepraemurium, Mycobacterium avium, and Mycobacterium paratuberculosis in four of the specimens from cats with feline leprosy . Separate M . paratuberculosis- and M . avium-specific PCR amplifications of the four specimens were negative, thus substantiating the identification of M . lepraemurium in these specimens from cats with feline leprosy . Further sequence analysis of the V3 variable region of one of the four specimens provided conclusive evidence of the presence of M . lepraemurium . This is the first report of the definitive identification of M . lepraemurium in cats with feline leprosy by molecular biology-based analyses . M . avium, which is rarely reported in cats, and Mycobacterium chitae, a reported nonpathogenic, rapidly growing mycobacterial species found in the environment, were identified in the specimen from which acid-fast bacilli were cultured . Two of the specimens from cats were infected with a potentially novel species of mycobacteria which had a 16S rRNA gene sequence sharing the closest nucleotide sequence identity with that of Mycobacterium malmoense . Molecular biology-based analyses provided for the accurate and rapid diagnosis of mycobacterial infections in cats and circumvented the problems of culture and misdiagnosis of feline leprosy associated with traditional methods.

Zhonghua Yi Xue Za Zhi (Taipei), 1997 Jul, 60(1), 21 - 7
Drug resistance of Mycobacterium tuberculosis isolated from patients at a medical center in Taiwan; Su WJ et al.; BACKGROUND: The advent of bactericidal drugs has had a major impact on the treatment of pulmonary tuberculosis . However, the main reasons for continuing tuberculosis prevalence are the resistance of mycobacteria and patients' lack of endurance to undergo the long-term therapy . In Taiwan, the prevalence of tuberculosis among the population of over 20-year olds has fallen from about 5.15% in 1957, to 0.88% in 1982, but then increased to 1.29% in 1987 . Although it continued decreasing to 0.65% in 1994, tuberculosis remains a potential public health problem . METHODS: To determine the temporal status of drug resistance pattern among the Mycobacterium tuberculosis (M . tuberculosis) isolated at Veterans General Hospital (VGH)-Taipei, analysis was undertaken of the drug susceptibility data reported by the central Mycobacterial Laboratory, using conventional indirect methods, between 1990 to 1992 . RESULTS: The susceptibility pattern of 651 M . tuberculosis isolates obtained from patients admitted to VGH-Taipei during 1990 to 1992 were analyzed; 504/651 (77.4%) were sensitive to all drugs tested . Among veterans, 23.7% (95/401) had organisms resistant to one or more antituberculosis medications: 11.5% (46/401) to a single drug; 6.2% (25/401) to two drugs; 3.2% (13/401) to three drugs, and 2.7% (11/401) to four drugs . The overall resistance rates in isolates from 250 non-veterans (142 males and 108 females) were 22.5% (32/142) in male patients and 18.5% (20/108) in female patients . Among the 142 male patients, 6.3% were resistant to a single drug; 3.5% to two; 7.7% to three and 4.9% to four drugs . Among 108 female patients, 8.3% to a single drug; 1.9% to two drugs; 2.8% to three drugs, and 5.6% to four drugs . The proportion of drug-resistance was higher in the isolates from patients with a history of previous therapy (p < 0.05) . Overall, of the 401 veterans with positive cultures, 4.0% had isolates resistant to only isoniazid (INH), 14.7% had isolates resistant to at least INH, and 7.5% had isolates resistant to both INH and rifampin (RIF) . Of the 142 non-veteran males, 1.4% had isolates resistant to only INH, 16.9% had isolates resistant to at least INH, and 10.6% had isolates resistant to both INH and RIF . Of the 108 non-veteran females, 3.7% had isolates resistant to only INH, 12.0% had isolates resistant to at least INH, and 8.3% had isolates resistant to both INH and RIF . Among the 401 veterans, all the drug resistant isolates were found in patients older than 45 years, and of these, 66.3% (63/95) were over 65 years, whereas age was not a significant factor for predicting resistance rates among the non-veteran patients . CONCLUSIONS: There has been a marked increase in drug-resistant tuberculosis in old aged veterans . In contrast, age was not found to be a significant factor to predict resistance rates among the non-veterans . Previously treated patients are at increased risk for drug resistance . In view of these data, it is important to identify drug susceptibility patterns accurately from all tubercle bacilli isolated from patients as this has implications for control programs as well as for patient therapy . Surveillance of drug resistance is again being considered for patients admitted to this hospital, and all physicians are urged to remain alert to drug-resistance rates and patterns in the areas where they practice.

JAMA, 1997 Oct 1, 278(13), 1093 - 5
Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope . Identification by DNA fingerprinting; Michele TM et al.; CONTEXT: An ongoing restriction fragment length polymorphism (RFLP) study of Mycobacterium tuberculosis isolates from tuberculosis (TB) cases revealed an identical 10-banded IS6110 RFLP pattern unique to 2 patients diagnosed as having TB 6 months apart . Their only identifiable link was care at the same hospital . OBJECTIVE: To determine if nosocomial transmission had occurred . DESIGN: Traditional and molecular epidemiologic investigation . MEASUREMENTS: We reviewed medical charts and bronchoscopic records, examined hospital locations visited by both patients, evaluated hospital ventilation systems, and observed cleaning and disinfection of bronchoscopes . RESULTS: A patient with cough, hoarseness, and fever underwent bronchoscopy and was diagnosed as having TB . A second patient with a mediastinal mass underwent bronchoscopy 2 days later and was diagnosed as having small cell carcinoma . Following 6 months of chemotherapy and radiation therapy, the second patient developed fever and an infiltrate of the right upper lobe of the lung . Bronchoscopic washings revealed acid-fast bacilli and were culture positive for M tuberculosis . Both patients had undergone bronchoscopy with the same instrument in the same operating room with no intervening bronchoscopies . Bronchoscope cleaning and disinfection procedures were inconsistent with national guidelines . CONCLUSIONS: A contaminated bronchoscope was the most likely source of M tuberculosis transmission between these 2 patients . The RFLP analysis of M tuberculosis isolates was responsible for detecting this nosocomial source of transmission and led to the implementation of public health measures to prevent further spread of infection and disease . This study emphasizes the need for continued vigilance in endoscope cleaning techniques.

Radiology, 1997 Oct, 205(1), 185 - 90
Small lymph nodes of the abdomen, pelvis, and retroperitoneum: usefulness of sonographically guided biopsy; Fisher AJ et al.; PURPOSE: To evaluate the usefulness of sonographically guided percutaneous biopsy of small lymph nodes in the abdomen, retroperitoneum, and pelvis . MATERIALS AND METHODS: From May 1995 through January 1997, 35 sonographically guided lymph node biopsies were performed in 34 patients . All biopsies were performed with a 20- (n = 18) or 22-gauge (n = 10) self-aspirating needle alone or in combination (n = 7) . To determine the amount of compression achieved with the transducer, the skin-to-lesion distance on reference computed tomographic (CT) scans was compared with that on sonograms . A biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist . RESULTS: Of 35 sonographically guided biopsies, 30 (86%) were successful . Diagnoses included 26 (74%) cases of carcinoma, three (9%) cases of benign reactive lymphocytosis confirmed at open biopsy, and one (3%) case of a lymph node with a positive acid-fast bacilli stain . The average lymph node diameter was 2.1 cm (range, 0.9-4.3 cm) . With sonography, a mean of 2.5 needle passes (range, 1-5) were made per biopsy . Transducer compression reduced the skin-to-lesion distance from an average of 8.8 cm (at CT) to 4.5 cm . CONCLUSION: Sonographic guidance seems to provide a reasonable alternative to CT in biopsy of small abdominal, pelvic and retroperitoneal lymph nodes.

Clin Infect Dis, 1997 Sep, 25(3), 666 - 70
Factors influencing time to sputum conversion among patients with smear-positive pulmonary tuberculosis; Telzak EE et al.; For hospitalized patients with smear-positive pulmonary or laryngeal tuberculosis, the Centers for Disease Control and Prevention recommends that three consecutive sputum samples be negative for acid-fast bacilli (AFB) before respiratory isolation is discontinued . Limited data are available to predict the length of time to obtain three negative sputum smears and cultures and to determine factors associated with a prolonged interval before sputum smear and culture conversion, especially among patients infected with human immunodeficiency virus (HIV) . For 100 consecutive patients with smear-positive pulmonary tuberculosis, the mean and median numbers of days from the initiation of appropriate therapy to the first of three consecutive negative smears were calculated, and associated risk factors were determined . The mean number of days before the first of three consecutive negative sputum smears was 33 days; the median was 23 days . On stepwise multiple regression analysis, cavitary disease, numerous AFB on the initial smear, and no prior history of tuberculosis were the factors independently associated with an increased number of days for both smear and culture conversion . HIV does not prolong the period of infectiousness.

Am J Respir Crit Care Med, 1997 Sep, 156(3 Pt 1), 918 - 23
Early bactericidal activity of isoniazid in pulmonary tuberculosis . Optimization of methodology . The DATRI 008 Study Group; Hafner R et al.; Early bactericidal activity (EBA) of antituberculosis drugs is the rate of decrease in the concentration of tubercle bacilli sputum during the initial days of therapy . The study reported here was designed to optimize the methodology for obtaining precise EBA measurements . The study compared the results with two versus five treatment days; overnight sputum collections with early morning collections; and quantitative smears for acid-fast bacilli (AFB) with quantitative cultures . Isoniazid (INH) was used as a model drug . Among 28 smear-positive patients enrolled in the study in five cities in the United States, 16 were evaluable (INH-susceptible tuberculosis {TB} and adequate sputum collections) . The mean baseline bacterial load was 6.69 log10 cfu/ml (SE = 0.24) . Quantitative culture of 10- or 12-h sputum collections obtained on two baseline days and treatment Day 5 was the optimal method for EBA measurement . The mean 5-d EBA was 0.21 log10 cfu/ml/d (SE = 0.03; p < 0.001) and the EBA appeared to be constant during the first five treatment days . On the basis of these data, multiarm studies of investigational drugs will require 25 evaluable subjects per arm to detect (80% power and two-tailed alpha of 0.05) an EBA at least 50% as large as the EBA of INH . In countries with a low incidence of TB, the usefulness of this methodology for rapidly assessing new antituberculosis agents may be limited by the relatively large number of subjects required to compare EBA values across treatment arms.

Am J Respir Crit Care Med, 1997 Sep, 156(3 Pt 1), 901 - 5
The early bactericidal activity of ciprofloxacin in patients with pulmonary tuberculosis; Sirgel FA et al.; The early bactericidal activity (EBA) of ciprofloxacin (CIP) was measured in 80 patients with previously untreated, smear-positive pulmonary tuberculosis by counting viable bacilli in sputum collections during the first 2 d of treatment . Groups of about 10 patients were treated daily with graded doses of CIP or with 300 mg isoniazid or with no drug . The mean EBA, defined as the fall in log CFU/ ml sputum/d, increased from -0.011 in the no drug group to 0.046, 0.092, 0.121, and 0.205 in the groups receiving 250, 500, 1,000, or 1,500 mg CIP, respectively, a highly significant trend . These results demonstrate the antimycobacterial activity of CIP in high dosage, though the mean EBAs of 0.55 and 0.66 in two groups receiving isoniazid were much higher.

Cancer Detect Prev, 1997, 21(5), 476 - 82
Preventive effects of polysaccharides extracted from human tubercle bacilli (specific substance of Maruyama) on colonic carcinogenesis in rats; Iida K et al.; Polysaccharides extracted from human tubercle bacilli (specific substance of Maruyama {SSM}) have been clinically applied with satisfactory results . Thymidylate synthetase (TS) and thymidine kinase (TK) are key enzymes in de novo and salvage pathways for pyrimidine nucleotide synthesis . Well- and moderately well differentiated adenocarcinomas induced with 1,2-dimethylhydrazine (DMH) are widely distributed throughout the colorectal tract with high TK activity, and the poorly differentiated type is mainly restricted in the proximal colon and the cecum with high TS activity in rats . Subcutaneously injecting the rats with SSM reduced TS activity in colonic nontumorous regions, but in the tumorous regions it reduced TK activity compared with that of the DMH-treated rats without SSM treatment . SSM is suggested to reduce the colorectal carcinogenesis induced with DMH by inhibiting DNA synthesis in a de novo pathway, and to suppress the development of the tumors by decreasing DNA synthesis in the salvage pathway in rats.

Ugeskr Laeger, 1997 Sep 1, 159(36), 5384 - 6
{Mycobacterium marinum . A rare cause of infection of the skin and joints}; Byg KE et al.; Mycobacterium marinum is a rare cause of disseminated infection in man . The case report describes an 80-year-old woman, who had been treated with oral corticosteroids for bronchial asthma for 40 years, and in the same period had been swimming daily in swimming pools . At the first admission, the symptoms and clinical findings were interpreted as seronegative rheumatoid arthritis . After eight years of disease with recurrent infections of the skin, periarticular tissues and joints in the hands and one elbow, a biopsy specimen from an abscess showed granulomatous inflammation and acid fast bacilli . Culture for mycobacteria grew M . marinum . There was a severe, destructive monoarthritis in the right second metacarpophalangeal joint . The patient recovered completely on treatment with clarithromycin and doxycycline.

Hautarzt, 1997 May, 48(5), 297 - 302
{Current aspects of leprosy}; Sticht-Groh V et al.; About 95% of individuals who come in contact with M . leprae do not develop overt disease . The clinical form of the disease correlates with the T-cell mediated immune response of the host rather the direct damage caused by bacilli . We review the current aspects of epidemiology, transmission, bacteriology, clinical features, reactions, diagnosis, chemotherapy and treatment of reactions.

Int Arch Allergy Immunol, 1997 Sep, 114(1), 23 - 9
The effect of glucosaminylmuramyl dipeptide injection to mice on the course of tuberculous infection and in vitro superoxide anion production; Venkataprasad N et al.; Immunotherapy as an adjunct to chemotherapy is of interest for optimizing therapeutic regimens for tuberculosis . In this context, we investigated the influence and mode of action ofglucosaminylmuramyl dipeptide (GMDP) in mouse experimental models . Intermittent injections of GMDP to Mycobacterium tuberculosis-infected mice reduced the viable bacilli in the lungs, but increased the counts in the spleens at 16 weeks, but not at earlier harvests after infection . Injections of GMDP selectively ameliorated also in the lungs the spontaneous relapse of infection following chemotherapy . The mode of GMDP action was examined in respect of superoxide anion production . The O2 production by phorbol myristate-induced peritoneal macrophages in vitro was reduced by preinjection of mice with 100 microg of GMDP . Notably, this outcome contrasts and can also override the previously known enhancing effect of MDP on O2- production . The inhibitory activity of GMDP became even more pronounced when testing macrophages from Mycobacterium bovis BCG-infected mice . However, these results do not explain readily the grounds for the contrasting effects of GMDP on the growth patterns of tubercle bacilli in the lungs and spleens . Although the observed effects on bacillary counts have been modest, such action of GMDP could represent a beneficial adjunct to suitably formulated chemotherapeutic regimens.

Rev Saude Publica, 1996 Dec, 30(6), 536 - 41
{Histopathologic findings for the research of acid-fast bacilli in erythema nodosum}; Pires MC et al.; It was possible to prove, by means of retrospective histopathological studies of 51 glass slides of common erythema nodosum (EN) and 39 glass slides of erythema nodosum leprosum (ENL), that the histopathological features of the two groups differed in several ways . It was found that the most prominent divergent findings between these two diseases was the presence of a lepromatous granulomatous infiltrate in the ENL; the predominant location of the inflammatory infiltrate was derma-hypodermal in ENL and hypodermal in common EN; there was a preferential septa attack in common EN and lobular in ENL; foreign giant cells occurred only in common EN; the lymphocyte cell infiltration in common EN and of neutrophils in ENL and the presence of inflammatory infiltrate around nerves in ENL . Our study has proved that the search for M . leprae does not have to be made in all cases of EN as there are histological differences in the routine histopathological exam between common EN and ENL that can alert to the real need for this procedure . This search must be performed when during the routine histopathological exam of sections stained by hematoxilin-eosin the ENL histopathological characteristics delineated herein are observed.

J Am Vet Med Assoc, 1997 Sep 15, 211(6), 709 - 11
An abattoir monitoring system for diagnosis of tuberculosis in cattle in Baja California, Mexico; Hernandez de Anda J et al.; OBJECTIVE: To implement a disease monitoring system in federal, municipal, and private abattoirs in Baja California, Mexico and to estimate annual prevalence of tuberculosis (TB) in beef and dairy cattle slaughtered and inspected in 1995 and 1996 . DESIGN: Epidemiologic survey . ANIMALS: About 200,000 cattle (95% beef, 5% dairy) . PROCEDURES: Lymph node and tissue specimens with lesions suggestive of TB were fixed in neutral-buffered 10% formalin and embedded in paraffin . Sections were stained with H&E and Ziehl-Neelsen and examined for typical tuberculous lesions and acid-fast bacilli . Annual prevalence and 95% confidence intervals were estimated . RESULTS: Prevalence of TB in all slaughtered cattle was 0.12 and 0.46% in 1995 and 1996, respectively (beef cattle, 0.02 and 0.05%, respectively; dairy cattle, 2.0 and 8.3%, respectively) . Tuberculosis cases/1,000 slaughtered cattle were linearly associated with monthly volumes of tissue submissions . CLINICAL IMPLICATIONS: It is critical to quantify the monitoring activity at abattoirs to better estimate the prevalence of TB in slaughtered cattle . Annual prevalence of TB was significantly greater in dairy cattle than in beef cattle . Veterinarians and cattle producers in this region are encouraged to develop and work on herd plans aimed at controlling and eradicating TB.

Nihon Hansenbyo Gakkai Zasshi, 1997 Jul, 66(2), 97 - 102
{Pathological findings of the liver in Hansen's disease}; Matsumoto K et al.; In leprosy patients, granulomatous lesion are often observed, not only in skin and nerve, but also other visceral organs such as liver, kidney, spleen and cardiovascular system . But for the development of drug therapy, there are very few cases we can see the acid-fast bacilli in the lesion these days . We have reviewed the histopathological lesions in the liver of leprosy patients who had been treated for long term, based on autopsy findings of 31 cases, including 24 cases with lepromatous leprosy (LL) and 7 cases with tuberculoid leprosy (TL) . Except one case of LL with progressive stage, most of them diagnosed as retrogressive or quiescent stage . Morphologically, acid-fast bacilli and granuloma were seen in a few cases of Hansen's disease . In addition, no suggestive changes of drug and virus induced liver injury were recognized . However, sclerotic change of portal vein was remarkably encountered in the tuberculoid leprosy.

J Cataract Refract Surg, 1997 Jul-Aug, 23(6), 824 - 7
Consultation section . Refractive surgical problem; Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients; Department of Pathology, National Institute of Health, Bogota, ColombiaThe histopathology is described of 190 skin biopsies from 71 patients who presented during an epidemic of nodules and abscesses in the periumbilical region and buttocks, secondary to the application of xylocaine injections . Positive cultures for Mycobacterium abscessus were obtained from the specimens and from the xylocaine solution . The severe inflammatory lesions involved the dermis and the hypodermis and had three main histopathological patterns: (i) granulomatous nodular or diffuse inflammation with mixed granulomas in 57 (80%) of the cases; (ii) prevailing abscesses with mild granulomatous reaction in 28 (15%) of the biopsies; and (iii) deep dermal and subcutaneous granulomatous inflammation with no neutrophil component in three (4%) of cases . Bacilli were detected in 51 (27%) of the specimens, frequently forming small clumps at the centre of clear spaces or vacuoles and which were lipid-like structures in 156 (82%) of the abscesses or granulomas . This series represents one of the largest reported outbreaks caused by atypical mycobacteria and in which the source of infection was confirmed . The results emphasize the essential role of skin biopsies in determining the histopathological substrate, in helping to detect the atypical mycobacterial origin and in encouraging the practice of cultures for the identification of micro-organisms.

J Chromatogr A, 1997 Aug 1, 776(2), 205 - 19
Quantitative analysis of neutral and acidic sugars in whole bacterial cell hydrolysates using high-performance anion-exchange liquid chromatography-electrospray ionization tandem mass spectrometry; Wunschel D et al.; A procedure for analysis of a mixture of neutral and acidic sugars in bacterial whole cell hydrolysates using high-performance anion-exchange liquid chromatography-electrospray ionization tandem mass spectrometry (HPAEC-ESI-MS-MS) is described . Certain bacteria (including bacilli), grown under phosphate-limited conditions, switch from producing a teichoic acid (containing ribitol) to a teichuronic acid (characterized by glucuronic acid content) . Bacterial cells were hydrolyzed with sulfuric acid to release sugar monomers . The solution was neutralized by extraction with an organic base . Hydrophobic and cationic contaminants (including amino acids) were removed using C18 and SCX columns, respectively . HPAEC is well established as a high-resolution chromatographic technique, in conjunction with a pulsed amperometric detector . Alternatively, for more selective detection, sugars (as M-H- ions) were monitored using ESI-MS . In HPAEC, the mobile phase contains sodium hydroxide and sodium acetate, which are necessary for chromatographic separation of mixtures of neutral and acidic sugars . Elimination of this high ionic content prior to entry into the ESI ion source is vital to avoid compromising sensitivity . This was accomplished using an on-line suppressor and decreasing post-column flow-rates from 1 ml to 50 microliters/min . In the selected ion monitoring mode, background (from the complex sample matrix as well as the mobile phase) was eliminated, simplifying chromatograms . Sugar identification was achieved by MS-MS using collision-induced dissociation.

J Infect Dis, 1997 Sep, 176(3), 672 - 7
Deactivation of macrophages with interleukin-4 is the key to the isolation of Tropheryma whippelii; Schoedon G et al.; Whipple's disease is a systemic illness caused by a specific agent . Despite recognition of bacteria in lesions, efforts to isolate the causative agent remained futile . A novel strategy was devised to culture Whipple bacilli in deactivated mononuclear phagocytes . Infected tissue was inoculated into human phagocytes deactivated with interleukin (IL)-4, IL-10, and dexamethasone . Within 8-10 days, diastase-resistant periodic acid-Schiff-positive inclusions appeared, corresponding to intact and degenerating bacteria shown to be Tropheryma whippelii by electron microscopy and molecular analyses . T . whippelii was passaged several times in deactivated monocytes and a monoblastic cell line . Time-kinetics growth studies and comparative polymerase chain reaction analysis documented multiplication of T . whippelii in deactivated macrophages . Complementary studies showed that IL-4 rendered phagocytes permissive for T . whippelii, a strong indication that host factors contribute to the pathogenesis of Whipple's disease . The propagation of T . whippelii will permit microbiologic, immunologic, seroepidemiologic, and therapeutic studies of this pathogen.

Infect Immun, 1997 Sep, 65(9), 3896 - 905
Identification of phosphatidylinositol mannoside as a mycobacterial adhesin mediating both direct and opsonic binding to nonphagocytic mammalian cells; Hoppe HC et al.; The molecular basis for the binding of Mycobacterium tuberculosis to nonphagocytic cells, which are readily infected in vitro, and the in vivo significance of this interaction are incompletely understood . Of six cell types tested, we found that only two, Chinese hamster ovary (CHO) fibroblasts and primary porcine aortic endothelial cells, were able to bind M . tuberculosis H37Rv efficiently in vitro . Binding to both CHO and endothelial cells was markedly (three- to fivefold) enhanced by 10 to 20% human or bovine serum, suggesting that the bacteria were coated by a serum opsonin . Preincubation with individual candidate opsonins revealed that recombinant human mannose-binding protein (rMBP), fibronectin, and transferrin were each able to enhance binding threefold . Preincubation of bacteria in serum depleted of mannan-binding lectins or in genetic MBP-deficient serum resulted in enhancements that were only approximately 60 and 58%, respectively, of that produced by preincubation in control serum . In contrast, serum depleted of fibronectin or transferrin retained its opsonizing capacity, suggesting that the latter two are not significant opsonins in whole serum . Binding of M . tuberculosis and Mycobacterium smegmatis to both CHO and endothelial cells in the presence or absence of serum was blocked (60 to 70%) by a monoclonal antibody, MAb 1D1, selected for recognition of intact bacilli . The 1D1 antigen was purified from mycobacterial cell walls and chemically identified as a polar phosphatidylinositol mannoside (PIM) . Latex beads coated with purified 1D1 antigen bound to CHO cells, which was enhanced threefold by serum and abolished by periodate treatment, suggesting a requirement for the PIM mannoses in opsonic adhesion . This was likely mediated, at least in part, by serum MBP, as rMBP bound strongly to 1D1 antigen in both thin-layer chromatography overlay and plate binding assays, the latter in a mannan-inhibitable manner . This is the first demonstration that mycobacterial PIMs can function as adhesins for binding to nonphagocytic cells, both directly and after opsonization with serum proteins, including MBP.

J Clin Microbiol, 1997 Sep, 35(9), 2375 - 80
PCR-enzyme-linked immunosorbent assay and partial rRNA gene sequencing: a rational approach to identifying mycobacteria; Patel S et al.; A PCR-enzyme-linked immunosorbent assay (ELISA) for amplification and rapid identification of mycobacterial DNA coding for 16S rRNA was developed . The PCR selectively targeted and amplified part of the 16S rRNA gene from all mycobacteria while simultaneously labelling one strand of the amplified product with a 5' fluorescein-labelled primer . The identity of the labelled strand was subsequently determined by hybridization to a panel of mycobacterial species-specific capture probes, which were immobilized via their 5' biotin ends to a streptavidin-coated microtiter plate . Specific hybridization of a 5' fluorescein-labelled strand to a species probe was detected colorimetrically with an anti-fluorescein enzyme conjugate . The assay was able to identify 10 Mycobacterium spp . A probe able to hybridize to all Mycobacterium species (All1) was also included . By a heminested PCR, the assay was sensitive enough to detect as little as 10 fg of DNA, which is equivalent to approximately three bacilli . The assay was able to detect and identify mycobacteria directly from sputa . The specificities of the capture probes were assessed by analysis of 60 mycobacterial strains corresponding to 18 species . Probes Avi1, Int1, Kan1, Xen1, Che1, For1, Mal1, Ter1, and Gor1 were specific . The probe Tbc1 cross-hybridized with the Mycobacterium terrae amplicon . Analysis of 35 strains tested blind resulted in 34 strains being correctly identified . This method could be used for rapid identification of early cultures and may be suitable for the detection and concurrent identification of mycobacteria within clinical specimens.

J Clin Microbiol, 1997 Sep, 35(9), 2229 - 34
Rapid detection of mycobacteria in clinical specimens by using the automated BACTEC 9000 MB system and comparison with radiometric and solid-culture systems; Pfyffer GE et al.; Recovery rates of acid-fast bacilli (AFB) and the mean time to their detection from clinical specimens were determined by using the fluorescent BACTEC 9000 MB system . Data were compared to those assessed by the radiometric BACTEC 460 system and by cultivation on solid media . A total of 3,095 specimens were processed with N-acetyl-L-cysteine-NaOH by two laboratories . The contamination rates for the BACTEC 9000 MB system were 6.8% (center 1) and 9.8% (center 2) . A total of 451 mycobacterial isolates were detected (Mycobacterium tuberculosis complex, n = 296; nontuberculous mycobacteria {NTM}, n = 155) . These isolates originated from 94 (20.8%) smear-positive and 357 (79.2%) smear-negative specimens . The BACTEC 9000 MB system was significantly better than solid media (P < 0.05) in detecting AFB, but it was less efficient than the radiometric system (P < 0.01) . The BACTEC 9000 MB system plus solid media (combination A) recovered 393 (87.1%) of the isolates, while the BACTEC 460 system plus solid media (combination B) detected 430 (95.3%) of all AFB isolates . Between combination A and B there was no statistically significant difference for the detection of isolates from smear-positive specimens (P > 0.05), in contrast to the recovery of AFB from smear-negative specimens for M . tuberculosis complex, P < 0.05; for NTM, P < 0.01) . The mean time to detection of M . tuberculosis complex was 12.2 days for smear-positive specimens and 18.1 days for smear-negative specimens with the BACTEC 9000 MB system; 9.3 and 15.6 days, respectively, with the BACTEC 460 system; and 21.2 and 28.4 days, respectively, with solid media . For NTM, the average detection times were 15.1, 17.3, and 31.3 days by the three methods, respectively . In conclusion, the BACTEC 9000 MB system is a rapid, less labor-intensive detection system which allows for higher levels of recovery of AFB than solid media . There is no risk of cross contamination, which is known to be the case for the BACTEC 460 system, and data management is greatly facilitated . As a whole, however, the BACTEC 9000 MB system should only be used in conjunction with solid media.

Eur J Cardiothorac Surg, 1997 Aug, 12(2), 209 - 13
Pneumonectomy for tuberculosis; Ashour M; OBJECTIVE: Surgery for tuberculosis has been of major concern because of its associated morbidity and mortality, particularly with respect to pneumonectomy . METHODS: Over a period of 11 years, between January 1985 and December 1995, pneumonectomy was performed for 20 patients with documented history of mycobacterium tuberculosis (TB) . There were 12 male and eight female patients with an average age of 28.7 years . All patients had productive cough for an average duration of 12.8 years, while ten (50%) had an additional hemoptysis for an average duration of 3.9 years . Four patients (20%) were still with positive acid-fast bacilli due to drug resistance and four (20%) had aspergilloma complex . Preoperatively, all patients showed radiological evidence of unilateral destroyed lung with no perfusion . RESULTS: Among the 20 patients with post-tuberculosis lung destruction, 16 had left lung destruction and four had the right lung destroyed . In this series, there was no mortality and morbidity accounted for 15% (n = 3) . Two patients required re-exploration for bleeding, while one patient developed post-pneumonectomy empyema without bronchopleural fistula, for which drainage with rib resection was performed . All patients were found to be symptom free during the follow up period which averaged 93.7 +/- 23.9 months (range between 12 and 124 months) . CONCLUSIONS: In this series of 20 patients, pneumonectomy for TB and post-tuberculosis lung destruction was performed with no mortality and acceptable morbidity . Meticulous surgical technique is mandatory to avoid operative complications . Persistent positive sputum for acid-fast bacilli should not be considered as contraindication in symptomatic patients.

Infect Control Hosp Epidemiol, 1997 Aug, 18(8), 582 - 6
Effect of treatment on contagiousness of patients with active pulmonary tuberculosis; Menzies D; In view of the important consequences with regard to policies for respiratory isolation of hospitalized patients with active tuberculosis, the duration of contagiousness after initiation of effective therapy was reviewed . All relevant English-language literature was reviewed to identify in vitro, animal experimental, and epidemiological evidence regarding contagiousness of patients with active tuberculosis after initiation of therapy . Based on in vitro evidence of numbers of tubercle bacilli initially present and rapidity of reduction-with therapy, it can be predicted that patients whose respiratory secretions are initially smear-negative but culture-positive should no longer have viable bacilli detectable by culture within 2 weeks . Based on the same evidence, it can be predicted that, after 2 weeks of therapy, almost all smear-positive patients will remain culture-positive, and more than one half will remain smear-positive . There are few epidemiological studies of this issue, most of which have had major methodological weaknesses . None of the results from these studies can be considered relevant to the hospital environment, where the majority of workers are uninfected and patients are potentially immunocompromised . Animal and in vitro evidence suggest that patients with active tuberculosis remain contagious at least 2 weeks after the initiation of therapy . Patients with smear-positive disease are likely to be contagious much longer . There is no relevant and valid epidemiological evidence regarding this issue.

Eur Respir J, 1997 Aug, 10(8), 1874 - 6
Limits of commercial molecular tests for diagnosis of pulmonary tuberculosis; Lebrun L et al.; Several studies report high specificity, but variable sensitivity, of Amplified Mycobacterium tuberculosis Direct Test (AMTDT, Gen-Probe) based on ribosomal ribonucleic acid (rRNA) amplification and Amplicor Mycobacterium tuberculosis test (Amplicor, Roche) based on deoxyribonucleic acid (DNA) amplification for diagnosis of pulmonary tuberculosis . We have retrospectively evaluated these assays on selected acid-fast bacilli (AFB)-positive and -negative smear specimens and compared the results obtained from nucleic acid amplification with those of AFB staining of semi-quantitative cultures as determined by radiometric Bactec and Lowenstein-Jensen cultures . In comparison to cultures, Amplicor and AMTDT assays exhibited identical overall sensitivities of 80%, while the staining had a lower sensitivity of 62% . The sensitivities of Amplicor and AMTDT were 98% and 100%, respectively, for the AFB-positive specimens, and 50 and 46%, respectively for the AFB-negative specimens in comparison to cultures . The sensitivities of both assays appeared similar, and were directly related to the number of bacilli in the specimens studied . The low sensitivity (50%) for smear-negative specimens showed that current amplification assays may be unsuitable to replace cultures for diagnosis of tuberculosis . The decision to perform these molecular techniques should result from close co-operation between clinicians and microbiologists, taking into account the sensitivity results reported here, as well as the expense of the assays.

J Chemother, 1997 Aug, 9(4), 285 - 92
Etiology and therapy of community-acquired pneumonia; Ginesu F et al.; The Authors report the data of a retrospective study performed on 520 patients admitted to the Institute of Respiratory Diseases, University of Sassari, Italy, for community acquired pneumonia (CAP) from 1980 to 1995 . The aim of this study was to investigate: the frequency of risk factors and their impact on severity of pneumonia; the frequency of pathogens and their correlation with the severity of the illness; antibiotic treatments . One or more risk factors were found in 86% of patients, while 14% had none . In 286 patients (55%) no etiological diagnosis was possible, while in 234 patients (45%) the pathogen was identified . Of the latter, 73% suffered from pneumonia caused by Gram-negative bacilli, 24% by Gram-positive organisms, 0.8% by Mycoplasma pneumoniae and 1.7% by respiratory viruses and endemic fungi . The mortality rate found was 2.69% . In this study, pneumonia caused by Gram-negative bacilli showed a plurilobar and often bilateral involvement, frequent resistance to the most common antibiotics, which required longer hospitalization (> 30 days) . The high prevalence of pneumonia caused by Gram-negative bacilli can be explained by the presence in most of the patients, of serious and numerous risk factors.

Diagn Cytopathol, 1997 Aug, 17(2), 108 - 14
Utility of fine-needle aspiration in the diagnosis of granulomatous lesions of the breast; Martinez-Parra D et al.; Fourteen cases of granulomatous mastitis (GM) studied by fine-needle aspiration (FNA) are reviewed and nine cytologic features (necrosis, neutrophil granulocytes, foamy cells, plasma cells, granulomas, epitheloid cells, multinucleated giant cells of foreign body type and Langhans' type, duct cells, and the presence of acid-fast bacilli) are reappraised in a semiquantitative manner . The main objective of this study was to find out if one or more of these features would permit the various granulomatous entities identified in surgical pathology to be separated cytologically . The results suggest that FNA does not permit the various granulomatous lesions identified in surgical pathology to be differentiated, since in this series different entities share a common cytologic pattern . Only the presence of acid fast bacilli in smears would enable a tuberculous etiology to be diagnosed . The opinion is put forward that the term GM should be avoided in the cytologic report and substituted by the noncommitted term "granulomatous lesion of the breast.

J Clin Microbiol, 1997 Aug, 35(8), 2142 - 4
Pretreatment of clinical specimens with sodium dodecyl (lauryl) sulfate is not suitable for the mycobacteria growth indicator tube cultivation method; Pfyffer GE et al.; When using the Mycobacteria Growth Indicator Tube (MGIT), pretreatment of clinical specimens with N-acetyl-L-cysteine-NaOH is recommended by the manufacturer . Processing of clinical specimens (n = 1,000) with sodium dodecyl (lauryl) sulfate-NaOH resulted in both poor recovery and delayed mean time to detection of acid-fast bacilli . Values were comparable to those obtained on solid media.

AIDS, 1997 Jul 15, 11(9), 1151 - 8
Impact of HIV infection on the development, clinical presentation, and outcome of tuberculosis among children in Abidjan, Côte d'Ivoire; Mukadi YD et al.; OBJECTIVE: To assess the impact of HIV infection upon the development, clinical presentation, and outcome of tuberculosis (TB) among children . DESIGN: Case-control study and prospective cohort study . METHODS: From March 1994 to November 1995, children aged 0-9 years with newly diagnosed TB were enrolled at the two outpatient TB centers and the two principal university hospitals in Abidjan, Cote d'Ivoire . Children were examined, blood samples were collected for HIV serology and lymphocyte phenotyping, chest radiography was performed, and gastric aspirates and sputum samples were collected for acid-fast bacilli smear and culture . Children were then followed every 2 months during a standard 6-month course of anti-TB therapy . To examine risk factors for TB, age- and sex-matched healthy control children were enrolled from among the siblings of children referred for TB skin testing . RESULTS: Overall, 161 children with TB were enrolled, including 39 (24%) with culture-confirmed pulmonary TB, 80 (50%) with clinically diagnosed pulmonary TB, and 42 (26%) with extrapulmonary TB . Children with TB were significantly more likely than 161 control children to be HIV-seropositive (19 versus 0%), to have a past TB contact (55 versus 16%) and to live in very low socioeconomic status housing (24 versus 6%) . No significant differences between HIV-seropositive and seronegative children were found in the distribution of radiologic abnormalities for pulmonary TB or in the site of extrapulmonary TB . The mortality rate in HIV-seropositive children was significantly higher than in seronegative children (23 versus 4%; relative risk, 3.6; 95% confidence interval, 2.0-6.6), and all deaths in HIV-seropositive children with available lymphocyte subtyping results occurred in those with a CD4 percentage of < 10% . CONCLUSIONS: This study documents the importance of HIV infection as an independent risk factor for the development of TB in children, and demonstrates that HIV-related immunosuppression is a critical risk factor for mortality in this population.

J Immunol, 1997 Jul 15, 159(2), 635 - 43
Activation of human dendritic cells following infection with Mycobacterium tuberculosis; Henderson RA et al.; Dendritic cells (DC) play an essential role in the initiation of primary T cell responses to foreign Ag . It is likely that these potent APC are critical in the initiation of immune responses to pathogens, such as bacteria or parasites . However, little is known about the interaction of these important APC with pathogens . To address this issue, the interaction of the bacterium Mycobacterium tuberculosis with human DC was studied . DC generated from human peripheral blood by short term culture in medium containing recombinant human cytokines granulocyte-macrophage-CSF and IL-4 were capable of phagocytosing M . tuberculosis . Infection of DC with live M . tuberculosis bacilli resulted in increased APC surface expression of the costimulatory molecules CD54, CD40, and B7.1, as well as MHC class I molecules . In addition, infected DC secreted elevated levels of inflammatory cytokines, including TNF-alpha, IL-1, and IL-12 . M . tuberculosis-infected human monocytes also secreted inflammatory cytokines, but exhibited no enhancement of costimulatory or MHC class I molecule expression . These data indicate that infection with M . tuberculosis results in the direct activation and maturation of these DC . In vivo, such activation may facilitate migration to the lymph nodes, and enhance presentation of Ag to T cells, thereby facilitating the induction of the immune response against this pathogen.

Respir Med, 1997 Jul, 91(6), 377 - 9
A case of rapidly expanding tuberculous lung cavity after bronchoscopy; Tsang KW et al.; A non-smoking Asian woman with previously treated pulmonary tuberculosis presented with a recent onset unproductive cough and cavitating mass lesion on her chest X-ray which rapidly developed into a large tuberculous cavity after bronchoscopy . Acid-fast bacilli were isolated from the cavity and she responded very rapidly to standard anti-tuberculous chemotherapy . This unusual condition must be considered in patients who deteriorate after bronchoscopy.

Zentralbl Veterinarmed B, 1997 Jul, 44(5), 313 - 7
Natural cilia-associated respiratory bacillus infection in rabbits used for elaboration of hyperimmune serum against Mycoplasma sp; Oros J et al.; Cilia-associated respiratory (CAR) bacillus was identified in lung lesions of rabbits used for elaboration of hyperimmune serum against Mycoplasma mycoides ssp . capri (Mmc) . Numerous Warthin Starry (WS) positive filamentous bacteria aligned perpendicularly to the surface of bronchial epithelial lining were observed . Immunoperoxidase staining of these bacteria was detected using a serum anti-rabbit CAR bacillus . Ultrastructural morphology corresponds to that of CAR bacilli previously reported in rabbits . The desirability of monitoring laboratory rabbits for CAR bacillus infection as part of the health programme is reinforced, especially in rabbits used for raising sera against respiratory pathogens of animal species in which CAR bacillus infection has been described . This is the first report of natural CAR bacillus infection in rabbits in Europe.

Kekkaku, 1997 Jul, 72(7), 443 - 8
{A case of Mycobacterium intracellulare infection associated with sinobronchial syndrome}; Kobayashi A et al.; The patient was 71-year-old male with a history of sinobronchial syndrome since 8 years ago . He has been suffering from cough, sputum and upper abdominal discomfort since January 1994 . He was diagnosed as an early gastric cancer by endoscopy, and his chest X-ray film showed an infiltrative shadow in the right upper lung field . A smear of the sputum specimen was positive for acid fast bacilli, which were later identified as Mycobacterium intracellulare . In this case, before the Mycobacterium intracellulare infection, it was confirmed that his mucociliary transport was severely impaired by using aerosol inhalation cine-scintigraphy . This case suggests that an impairment of the local defence mechanisms may play an important role in the pathogenesis of Mycobacterium intracellulare infection.

Vet Pathol, 1997 Jul, 34(4), 263 - 70
Pathogenicity of cilia-associated respiratory (CAR) bacillus isolates for F344, LEW, and SD rats; Schoeb TR et al.; We conducted experiments to test whether rats of F344, LEW, and SD strains differ in susceptibility to mycoplasma-free isolates of cilia-associated respiratory (CAR) bacillus, whether Mycoplasma pulmonis can affect expression of CAR bacillus disease, and whether isolates of CAR bacillus differ in virulence for rats . In the first experiment, 24 rats of each strain were inoculated intranasally with 10(7) bacilli of CAR bacillus X1428D/AS, and 24 rats of each strain were inoculated with sterile medium (controls) . Eight weeks later, eight inoculated rats and eight control rats of each strain were euthanatized, eight inoculated and eight control rats were given 10(6.5) colony-forming units of M . pulmonis X1428D, and eight inoculated rats and eight control rats were sham inoculated . Four rats of each group were euthanatized 4 or 8 weeks after the second inoculation . Severity of lesions in nasal passages, middle ear, trachea, and lungs was assessed by scoring . Rats of all three strains given CAR bacillus had typical lesions of similar severity; M . pulmonis X1428D was avirulent and did not exacerbate CAR bacillus disease . In the second experiment, groups of eight rats of F344 and SD strains were given 10(5) or 10(7) CAR bacillus X1328E, X1428D/AS, or X2450D and euthanatized 8 or 16 weeks later . Isolates X1428D/AS and X2450D caused similar lesions in rats of both strains and at both doses, but CAR bacillus X1328E was avirulent . Rats of the tested strains are similarly susceptible to CAR bacillus disease, but CAR bacillus isolates differ in virulence.

Am J Med, 1997 Jul, 103(1), 51 - 9
Antimicrobial resistance with focus on beta-lactam resistance in gram-negative bacilli; Pitout JD et al.; beta-Lactam antibiotics are the most frequently prescribed antibiotics worldwide . Therefore, it is not surprising that resistance to this very important class of agents poses an increasingly complex and perplexing problem for physicians . Among the variety of mechanisms that can provide resistance to beta-lactam antibiotics in gram-negative bacilli, the production of beta-lactamase is by far the single most important factor . With the introduction of newer beta-lactam agents observed changes in beta-lactamases include the increased prevalence of older enzymes, the appearance of new enzymes, and alteration in the level of expression of the enzymes . These changes have been responsible for resistance to newer cephalosporins, monobactams, carbapenems, and beta-lactamase inhibitor/beta-lactam drug combinations . Resistance to beta-lactam antibiotics has also emerged through alterations in the targets of the drugs, the penicillin-binding proteins, and through alterations in outer membrane permeability of the organisms to the drugs . With some beta-lactam agents, multiple mechanisms must be acquired before clinically relevant levels of resistance are attained . This is especially true for carbapenems and fourth generation cephalosporins . Nevertheless, resistance to beta-lactam antibiotics is on the rise among clinical isolates of gram-negative bacilli, and only through more judicious use of these agents can their usefulness for treatment and prevention of infections be preserved.

Ann Intern Med, 1997 Jul 1, 127(1), 32 - 6
A nosocomial outbreak of multidrug-resistant tuberculosis; Kenyon TA et al.; BACKGROUND: An outbreak of seven cases (in six patients and one health care worker, all of whom had AIDS) of multidrug-resistant tuberculosis occurred in a hospital in Chicago . The hospital had a respirator-fit testing program but no acid-fast bacilli isolation rooms . OBJECTIVE: To identify risk factors for transmission of Mycobacterium tuberculosis . DESIGN: Retrospective cohort study . SETTING: Private hospital . PARTICIPANTS: Patients and health care workers exposed to M . tuberculosis . MEASUREMENTS: Analysis of M . tuberculosis isolates, tuberculin skin testing, assessment of exposure, and assessment of participant characteristics . RESULTS: All seven M . tuberculosis isolates had matching DNA fingerprints . Of patients exposed to M . tuberculosis, those who developed tuberculosis had lower CD4+ T-lymphocyte counts (P = 0.02) and were more likely to be ambulatory (P = 0.03) than those who did not . Of 74 exposed health care workers, the 11 (15%) who had conversion on tuberculin skin testing were no more likely than those who did not have conversion to report that they always wore a respirator with a high-efficiency particulate air filter . CONCLUSIONS: Transmission of M . tuberculosis occurred in a hospital that did not have recommended isolation rooms . A respirator-fit testing program did not protect health care workers in this setting.

J Neurosurg, 1997 Jul, 87(1), 106 - 8
Stenotrophomonas maltophilia meningitis . Report of two cases and review of the literature; Papadakis KA et al.; The authors report two cases of meningitis caused by Stenotrophomonas maltophilia in cancer patients following placement of an Ommaya reservoir for treatment of meningeal carcinomatosis . In addition, they review eight other cases of S . maltophilia that have been reported to date . Stenotrophomonas maltophilia meningitis is often associated with neurosurgical procedures; however, spontaneous infection may also occur, mainly in neonates . The disease's clinical presentation is similar to that of other forms of meningitis caused by Gram-negative bacilli . The overall mortality rate of this disease is 20% and is limited to neonates with spontaneous meningitis in whom effective antibiotic therapy is delayed . Meningitis caused by S . maltophilia in the modern era should be considered in immunocompromised hosts with significant central nervous system disease who have undergone neurosurgical procedures and who do not readily respond to broad-spectrum antimicrobial coverage.

Pediatrics, 1997 Jul, 100(1), 19 - 23
Mycobacterium tuberculosis transmission from a pediatrician to patients; Askew GL et al.; The following report describes the contact investigation of a pediatrician with tuberculosis (TB) . The pediatrician's disease was discovered in late February 1993 after tuberculin skin testing (TST) of his 15-month-old son was positive (13-mm induration) . Further investigation to identify the source of the child's infection revealed a positive (15-mm induration) TST in the pediatrician . The pediatrician had been symptomatic with a cough since September 1992 . The pediatrician had a chest radiograph that revealed numerous cavitary lesions and a sputum smear that was positive for acid-fast bacilli . An investigation was initiated to assess whether the transmission of Mycobacterium tuberculosis had occurred in the pediatrician's office to patients, families, or other visitors . The investigation was later extended to include the hospitals and the day care center where the pediatrician worked . METHODS: A letter was mailed to parents of children served by the practice, explaining the potential exposure to TB and requesting that all persons who visited the office after September 1, 1992 complete an interview and Mantoux TST . Mass interviewing, testing, and test interpretation within the practice took place seven times during March and April 1993 . RESULTS: At the completion of screening, 181 (87%) of 208 children who had close contact with the index case were reliably skin-tested and returned for interpretation . Three (1.7%) of the 181 children were TST-positive (>/=5 mm) . Thirty-seven (13%) of the 286 adults tested and returning for interpretations were TST-positive (>/=10 mm) . Thirty-two (86%) of the 37 adults who tested positive were foreign-born . CONCLUSION: This investigation highlighted the need for identifying childhood TB infection as a sentinel event for adult disease . It also demonstrated the difficulty associated with deciding the extent of contact investigation of a health care worker with TB . Finally, the investigation emphasized the importance of maintaining regularly scheduled and appropriate testing for TB infection in health care workers and the need for health care workers to be cognizant of their own risk and be able to identify, especially in themselves, signs and symptoms of potential TB disease.

J Immunol, 1997 Jun 15, 158(12), 5921 - 6
Functions and specificity of T cells following nucleic acid vaccination of mice against Mycobacterium tuberculosis infection; Zhu X et al.; The 38-kDa glycolipoprotein of Mycobacterium tuberculosis has been known to evoke prominent T cell and Ab responses in patients with active tuberculosis . In this study, we investigated its protective capacity using plasmid DNA immunization in a mouse experimental model . Prior knowledge of several antigenic determinants has been beneficial for analyzing the phenotype and specificity of T cells, which determine the efficacy of this vaccination procedure . C57BL/6 mice responded to the 38-kDa gene-pcDNA3 plasmid with strong CD4+ Th1 and CD8+ cytotoxic T cell responses of the IFN-gamma-producing Tc1 phenotype . After challenge with virulent tubercle bacilli, the bacterial load in the spleens and lungs of vaccinated mice was reduced to a level similar to that imparted by Mycobacterium bovis Bacille Calmette-Guerin vaccination . Notably, the specificity of CD4+ and CD8+ T cells from DNA-vaccinated and tubercle-infected mice was found to be strikingly different in respect of several peptide epitopes . The identified peptides recognized by T cells from protected mice are of further interest for the development of subunit-based vaccines against tuberculosis.

Br J Ophthalmol, 1997 Jun, 81(6), 490 - 2
Pathology of iris in leprosy; Daniel E et al.; AIM: The histopathological features of the iris in leprosy were studied by light microscopy . METHOD: Formalin fixed and paraffin embedded iris tissue excised during cataract surgery from 20 leprosy patients were sectioned and studied with haematoxylin and eosin stain and modified Fite Faraco's stain for acid fast bacilli (AFB) . RESULTS: Chronic inflammatory reactions were seen in the iris of 11 patients, seven of whom did not have any clinically demonstrable evidence of iridocyclitis . Smooth muscle disruption and destruction were seen in two specimens . AFB were found in the iris tissue of a polar lepromatous patient whose skin smears were negative for AFB and who had completed the WHO recommended antileprosy multidrug therapy (MDT) . CONCLUSION: Histopathology discloses far more silent chronic iridocyclitis in leprosy patients than are diagnosed clinically . AFB can persist in the iris tissue even after completion of MDT . Smooth muscle disruption and destruction, a cause of the miotic pupil in leprosy has been conclusively demonstrated histopathologically.

Thorac Cardiovasc Surg, 1997 Jun, 45(3), 140 - 2
Mediastinal tuberculous lymphadenitis diagnosed and treated by thoracoscopy; Suzuki T et al.; Mediastinal tuberculous lymphadenitis is a relatively rare disorder and it is sometimes hard to identify the acid-fast bacilli involved or its specific pathological findings . We employed thoracoscopy to obtain diagnostic material from a 25-year-old woman with a newly-appearing mediastinal mass despite antituberculous therapy for cervical tuberculous lymphadenitis . Thoracoscopy also proved effective in the curative surgical procedure, i.e . resection of the abscess wall as far as possible, debridement of the remaining wall, irrigation, and instillation of streptomycin into the abscess and thoracic cavity . Postoperatively the patient has followed a favorable course for one year.

Med Microbiol Immunol (Berl), 1997 Jun, 186(1), 45 - 51
Immunoprophylactic properties of 71-kDa cell wall-associated protein antigen of Mycobacterium tuberculosis H37Ra; Dhiman N et al.; Proteins associated with the cell wall peptidoglycan (CW-Pr) of Mycobacterium tuberculosis H37Ra were isolated to evaluate their immunoreactivity and immunoprophylactic properties against experimental tuberculosis . Chemical treatment of the cell wall with trifluoromethanesulfonic acid: anisole (2:1) resulted in the release of three proteins of 71, 60 and 45 kDa as resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . A comparative study of immune responses elicited to individual proteins in mice immunized with CW-Pr emulsified in incomplete Freund's adjuvant showed the 71-kDa protein to be the most immunoreactive antigen . This 71-kDa protein was found to cross-react with the 70-kDa heat shock protein from M . leprae and possessed ATPase activity . Mice immunized with the 71-kDa protein exhibited significantly higher immune responses, on the basis of T and B cell reactivity, as compared to a M . bovis Bacillus Calmette Guerin (BCG)-vaccinated group . The culture supernatants collected from 71-kDa stimulated lymphocytes stimulated exhibited increased interferon-gamma and interleukin-2 production . The protective efficacy of the 71-kDa protein in comparison to BCG was determined by challenging the mice with a virulent strain M . tuberculosis H37Rv . The 71-kDa protein was found to be more protective in animals challenged at 8 and 16 weeks post immunization, shown by increased survival rates and decreased viable bacilli counts in the target organs as compared to BCG-vaccinated animals.

Microbiologia, 1997 Jun, 13(2), 131 - 48
Two generations of spore research: from father to son; Halvorson HO; Harlyn O . Halvorson has played an active and defining role in the field of microbiology for more than 40 years . In this article, he reminisces on the major influence that his father, H . Orin Halvorson, had in the direction of his professional life . The two H.O . Halvorson's, often confused in the literature, became one of the only two father and son pairs to head the American Society for Microbiology in 1954 and 1977, respectively . Major scientists of the era, their research and their collaborations, are remembered in relation to their main works . Harlyn O . Halvorson's interest in bacterial and yeast spores, and especially spore germination in bacilli, is the highlight of this memoir . His scientific research thrusts, leadership at Marine Biological laboratories, Woods Hole, NACSEX (North American-Cuban Scientific Exchange) and elsewhere, his dedication to advanced students and numerous other endeavors, both scientific and political, are told here.

Int J Lepr Other Mycobact Dis, 1997 Jun, 65(2), 211 - 6
Comparison of bacillary indexes in slit-skin smears, skin and nerve biopsies; a study from Malawi; Ponnighaus JM et al.; Data analyzed in this paper were collected within the framework of the Lepra Evaluation Project, an epidemiological study of leprosy in Karonga District, northern Malawi . For 212 patients information on the number of skin lesions, slit-skin smear and skin biopsy results were available . Among 61 patients with a single lesion none were slit-skin-smear positive and two had bacilli detected in skin biopsies . In contrast, among 119 patients with four or more lesions 34 (28.6%) versus 59 (49.6%) had bacilli detectable in slit-skin smears or skin biopsies, respectively . In a further 47 patients skin biopsy results could be compared with split-nerve biopsy results . In 20 of 47 patients the bacterial indexes (BIs) were identical in skin and nerve biopsies, while in 26 of 47 patients the BIs were higher in nerve than in skin biopsies . This difference, which is consistent with several other studies in the literature, provides an insight into the pathogenesis of leprosy.

Kekkaku, 1997 Jun, 72(6), 411 - 4
{A case of pulmonary tuberculosis complicated with gingival lesions}; Kobayashi T et al.; A case of secondary gingival tuberculosis is presented . The case is 51 year-old male who had been suffering from undetected pulmonary tuberculosis visited a dentist because of chronic periodontal inflammation around the gingiva of the right upper and left lower molar teeth lasting for one year . The lesions remained unchanged and painful granulomatous swelling sustained in spite of the conservative treatment . The case was treated with the extraction of six teeth due to continued toothache . By pathohistological examination of gingiva and chest X-ray examination, the case was diagnosed as tuberculosis . Chest roentgenogram showed active pulmonary tuberculosis, and bacteriological examination of sputum showed tubercle bacilli . The administration of INH, RFP and EB was started, and the response to the treatment was good and the pain in the gingiva disappeared within three weeks . Secondary gingival tuberculosis is manifested as local granulomatous lesions with severe pain . The incidence of gingival tuberculosis is very rare, but we have to keep in mind that the oral tuberculosis secondary to pulmonary tuberculosis could occur.

Kekkaku, 1997 Jun, 72(6), 403 - 10
{Cytokine producing ability of peripheral blood mononuclear cells in the clinical course of pulmonary tuberculosis}; Nakaya M et al.; Interferon-gamma (IFN-gamma) and interleukin-10 (IL-10)-producing ability of peripheral blood plastic-dish adherent cells and non-adherent cells obtained from patients with active pulmonary tuberculosis (N = 17) and healthy controls (N = 14) upon stimulation with purified protein derivatives (PPD) were assessed . Adherent cells and non-adherent cells were obtained two times from each patient with active pulmonary tuberculosis without any underlying diseases, on admission before the initiation of administering anti-tuberculous drugs and 2 months later from the negative conversion of Mycobacterium tuberculosis in sputum culture . ELISA was performed to measure IFN-gamma and IL-10 levels in culture media of adherent cells and non-adherent cells stimulated with PPD . IFN-gamma levels produced by non-adherent cells on admission were significantly higher than that of healthy controls (p < 0.001) . Elevated IFN-gamma levels on admission was reduced after treatment for tuberculosis (p < 0.03), but still remained higher than that in healthy controls . IL-10 levels of non-adherent cells of patients were lower than those of healthy controls, although the difference was not significant . IL-10 levels produced by non-adherent cells on admission correlated with the time needed for negative conversion of bacilli in sputum culture (p < 0.05) . IL-10 level produced by adherent cells from nutritionally normal patients were significantly higher than that of healthy controls (p < 0.05), and elevated IL-10 level was significantly reduced after therapy (p < 0.05) . In the normonourished patients, the time needed for negative conversion of the bacilli in sputum culture of patients kept higher level of IL-10 of non-adherent cells (N = 5) was significantly longer than that of patients reduced IL-10 level after therapy . These results suggest that IL-10 produced by monocytes may diminish the TH1 responses of patients with pulmonary tuberculosis.

Kekkaku, 1997 Jun, 72(6), 395 - 401
{Actual status of the management of tuberculosis patients in a university hospital without isolation wards for infectious diseases}; Kako K et al.; We retrospectively evaluated clinical findings and the actual status of management of 69 tuberculosis patients admitted to the Fujita Health University Hospital, a hospital without isolation wards for infectious diseases, between 1991 and 1994 . The largest age group was 60s (27.5%) followed by 70s (24.6%), 80s (15.9%) and 50s (13.0%) . Eight patients (11.6%) were in the 20s . Forty-nine patients were smear-positive and 22 patients were smear-negative and culture-positive . Fourteen patients (20.3%) had a past history of pulmonary tuberculosis . Twelve patients (17.4%) also had diabetes mellitus, ten patients (14.5%) had cancer, ten patients (14.5%) gastric ulcer and five patients (7.2%) renal failure . Positive skin reaction to PPD was not found in eleven patients (15.9%) and seven of these patients were quite elderly (over 70 years old) . Twenty-five cases (36.2%) were classified as type II (cavitary) and 29 cases (42.0%) as type III (non-cavitary) according to the GAKKAI classification of findings on chest X-ray films for pulmonary tuberculosis . Twenty-four patients (34.8%) were not diagnosed as tuberculosis on admission by physicians in charge . Physicians in charge tended not to suspect smear-negative patients of tuberculosis . Most of the patients with cavities on their chest X-ray films were strongly suspected of tuberculosis on admission, but in some of them, tuberculosis was not considered at all . Smear-positive patients with strongly suspected tuberculosis were diagnosed with the disease within three hospital days, while it took about three weeks in patients who were not considered as tuberculosis on admission to be diagnosed as tuberculosis . In the case of smear-negative patients, it took about one month and two months respectively to diagnose the case as tuberculosis . About half (51.1%) of the smear-positive patients were admitted and treated in single-bed rooms while 44.7% were attended in multiple-bed rooms for 11 days before they were transfered to single-bed rooms . When acid-fast bacilli were detected, 57.4% of the smear-positive patients were transfered to hospitals with isolation wards for infectious diseases, while the remaining smear-positive patients were treated in single-bed rooms at the university hospital . About one-third (31.7%) of the smear-negative patients had already left the hospital when specimens were found to be culture positive for tubercle bacilli . In conclusion, it is utmost important for physicians to suspect tuberculosis for the early diagnosis of the disease.

J Dermatol, 1997 Jun, 24(6), 401 - 4
Concurrent cytomegalovirus, M . tuberculosis and M . avium-intracellulare cutaneous infection in an HIV patient; Nunez M et al.; We report a 25-year-old HIV-positive man with a past medical history of disseminated cytomegalovirus (CMV) infection, who developed cutaneous lesions during a disseminated mycobacterium infection . The histological changes of CMV and acid-fast bacilli were seen on histopathology of the lesions . Cultures were positive for M . tuberculosis and M . avium-intracellulare (MAI) . CMV is frequently isolated from HIV patients, but skin involvement is rare . The association of CMV and mycobacteria can occur in cutaneous lesions of AIDS patients, but concurrent cutaneous involvement of CMV, M . tuberculosis, and MAI is unusual . These findings emphasize the polymorphous presentation of infectious disorders in AIDS patients and the need for multiple biopsies and for special stains in such patients.

Immunol Lett, 1997 Jun 1, 57(1-3), 143 - 6
Regulation of macrophage gene expression following invasion by Mycobacterium tuberculosis; Ragno S et al.; INTRODUCTION: Mycobacteria are intracellular pathogens which survive and grow in host macrophages . M . tuberculosis bacilli enter the macrophage via binding to several distinct cell surface molecules . Following phagocytosis, sustained intracellular bacterial growth depends on the ability to avoid destruction by macrophage-mediated host defences such as lysosomal enzymes, reactive oxygen and the reactive nitrogen intermediates . We used differential display reverse transcription polymerase chain reaction (DD RT-PCR) to identify host genes which are regulated during infection and hence which might be involved in the host-parasite cross talk . RESULTS: Live M . tuberculosis (strain H37Rv) was used to infect Balb/c peritoneal murine macrophages . mRNA from infected and uninfected macrophages was isolated at different time intervals after phagocytosis and subjected to DD RT-PCR . Oligo dT12NV and random 10mer primers were used for PCR amplification of cDNA . Macrophage genes which appeared to be differently regulated during infection were subjected to further reamplification by PCR in order to clone and sequence them . The differential expression of the selected bands was further analysed by an RNA protection assay and a Northern blot . RESULTS: Several differentially regulated bands were identified . One band, of 158 bp, was down regulated after infection . Sequencing of this band revealed a high level of homology (95% identity) to mouse cytochrome c oxidase subunit VIIc . The downregulation was specific for live virulent Mtb, while live BCG, heat killed Mtb and latex beads-mediated phagocytosis did not affect the transcriptional level of this enzyme . CONCLUSIONS: The cytochrome oxidase enzyme complex of the inner mytochondrial membrane catalyzes the reaction between ferrocytochrome c and oxygen . The reaction is the terminal event in the electron transport scheme . Downregulation of cytochrome c oxidase subunit VIIc could interfere with: (1) the host apoptotic programme; or (2) the host respiratory burst.

Lepr Rev, 1997 Jun, 68(2), 167 - 72
Transepidermal elimination of lepromatous granuloma: a mechanism for mass transport of viable bacilli; Namisato M et al.; A 35-year-old male with lepromatous leprosy showed significant progression of the disease on initial examination . Along with typical lepromatous skin lesions, many scar-forming lesions were present, mainly on his extremities . Some lesions showed erosive surfaces . From clinicopathological findings, these lesions were suspected to be due to the partial excretion of intradermal lepromatous granulomata by 'transepidermal elimination' . Increased local volume, which might be due mainly to rapidly growing lepromatous infiltration before chemotherapy, is suspected of triggering this phenomenon . There is no doubt that many fresh Mycobacterium leprae were included in these excretions . After the initiation of chemotherapy, no new scar-forming lesions were observed.

Lepr Rev, 1997 Jun, 68(2), 131 - 8
Higher incidence of viable Mycobacterium leprae within the nerve as compared to skin among multibacillary leprosy patients released from multidrug therapy; Shetty VP et al.; As identified by a significant growth in the footpads of immunosuppressed mice, the incidence of viable bacteria in a group of 26 multibacillary (BL-LL) patients released from multidrug (MDT) treatment was found to be two times more in the nerves (46%) as compared to skin (23%) . Evidently there was a positive correlation between the overall bacterial load and the incidence of viable organisms . Bacterial growth was also observed in two out of five cases where neither the skin nor the nerve homogenate had shown any presence of acid-fast bacilli . Histopathology of biopsies, skin as well as nerve, including those having viable bacteria did not show any features of active disease.

World J Surg, 1997 Jun, 21(5), 520 - 3
Surgical treatment of bacillus Calmette Guérin lymphadenitis; Hengster P et al.; Although its protective effect is contested and the risk of contracting tuberculosis is rather low nowadays, BCG vaccination is frequently performed . Changes of strain repeatedly led to an increased complication rate . In Austria between 1990 and 1991, of 3386 newborn babies (Strain Pasteur) 116 developed lymphadenitis 3 to 28 weeks after vaccination . The affected children received four types of treatment: nothing specific, isoniazid, or surgery with and without isoniazid . Surgical treatment was found to be necessary in 96 cases . Bacilli were successfully grown in culture in 46% of cases up to week 20 after vaccination; but later than 20 weeks no culture became positive . All cultured bacteria were isoniazid-sensitive . From our data we drew the following conclusions: isoniazid therapy did not prove successful when inflamed lymph nodes exceeded a certain size . Suppurative lymphadenitis in lymph nodes exceeding 1.0 to 1.5 cm usually led to infiltration or even perforation of the skin . Surgery prevents these complications and significantly reduces healing time . Adjuvant isoniazid therapy cannot be recommended, except for generalized BCG tuberculosis.

Mol Cell Biochem, 1997 Jun, 171(1-2), 1 - 10
Quantitative assessment of tuftsin receptor expression and second messenger during in vitro differentiation of peripheral blood derived monocytes of leprosy patients; Khare S et al.; Tuftsin, a tetrapeptide (Thr-Lys-Pro-Arg) is known to potentiate the immunogenic activity of antigen-fed macrophages . The present study describes the mechanism of action of tuftsin in leprosy patients throughout the spectrum of the disease in vitro as a function of culture age in terms of (A) involvement of second messengers cAMP, cGMP and {Ca2+}i and (B) number of tuftsin binding sites/and their relative affinities on the monocytes/macrophages . There is apparently no direct involvement of either cAMP or cGMP while comparing the stimulated and unstimulated cultures during in vitro differentiation of monocytes (days 1, 3 and 7) or with the spectrum of the disease . Inhibition of superoxide anion release either by verapamil or with Quin 2 clearly demonstrated the involvement of {Ca2+}i as a second messenger during activation of monocytes/macrophages with tuftsin . Scatchard analysis of radiolabelled tuftsin binding data showed only one type of tuftsin receptor (low affinity) on BL/ LL monocytes/macrophages and normal and BT/TT cultures showed a gradual change in receptor number and affinities (low to high) with the maturation of monocytes to macrophages in contrast to BL/LL groups which displayed significantly less number of receptors . This study elicits a model which depicts that the biological responses/metabolic functions of early monocytes of normal and BT/TT gradually increase with the age of the culture till day 3 and tapers off thereafter in the older (day 7) cultures, whereas the monocytes/macrophages of BL/LL group are metabolically active only on day 1 . The present study thereby implies that the clearance of leprosy bacilli from lepromatous leprosy lesions as a consequence of local or systemic immunotherapy (in the present study, the macrophage modulation by tuftsin) depends on the influx of new competent macrophages, rather than the local activation of resident lepromatous macrophages.

Med Anthropol Q, 1997 Jun, 11(2), 183 - 201
Sociocultural aspects of tuberculosis control in Ethiopia; Vecchiato NL; This article examines ethnomedical knowledge and practices related to tuberculosis conceptualization and management in a rural southern Ethiopian community . An adult health-status survey, administered to 217 adults selected through quota sampling procedures, investigated prevailing nosological structures . Additionally, disease-enhancing behaviors were identified through qualitative-research methods . The findings show that while symptomatological concepts coincide with biomedicine, the local etiological model postulates empirically based causational factors unrelated to tubercle bacilli . Therapeutic preference hinges on the utilization of ethnobotanical remedies and their expected emetic effects . The relevance of tuberculosis-related ethnomedical knowledge and management practices is discussed in relation to primary health care and disease-control programs in Ethiopia . It is recommended that health-education interventions, illustrating the nature and transmission avenues of tuberculosis and the effects of biomedical therapies, precede and/or accompany vaccination campaigns or chemotherapy . Teaching materials should valorize existing ethnomedical notions that emphasize contagion as an avenue of disease transmission, and the importance of nutritional adequacy in fighting the disease.

Am J Med Sci, 1997 Jun, 313(6), 355 - 63
The value of in vitro drug activity and pharmacokinetics in predicting the effectiveness of antimycobacterial therapy: a critical review; Burman WJ; Marked increases in case rates of drug-resistant tuberculosis and nontuberculous mycobacterial infections have brought renewed urgency to the development of new treatment regimens for mycobacterial infections . Preclinical data, such as in vitro measures of drug activity and pharmacokinetics, are used in the design of new treatment regimens . This review surveys the extensive published clinical experience concerning the treatment of drug-susceptible tuberculosis to evaluate the use of these preclinical measures in predicting clinical outcomes of antimycobacterial therapy . In vitro measures of drug activity predict the potency of a drug to prevent the emergence of resistance to other antimycobacterial drugs but do not predict the sterilizing activity of a drug or the activity of drug combinations . In vitro measures of drug activity do not allow reliable predictions of the level at which an organism should be considered resistant . Assays of drug penetration in tissues and activity against intracellular bacilli add modestly to the predictive value of in vitro measures of drug activity but still do not predict sterilizing activity . In contrast, animal models of tuberculosis have predicted relative drug potency (including sterilizing activity), the efficacy of multidrug regimens, and the duration of therapy needed . Despite pharmacokinetic parameters that would suggest the need for multiple doses per day, all of the first-line antituberculous drugs are active when given as infrequently as twice weekly . It is difficult to predict the efficacy of therapy for an intracellular pathogen that has the capacity for dormancy . Better in vitro models are needed, particularly ones that predict sterilizing activity.

Biochim Biophys Acta, 1997 May 2, 1352(1), 56 - 62
Gene from tropical Bacillus sphaericus encoding a protease closely related to subtilisins from Antarctic bacilli; Wati MR et al.; We undertook to identify the protease(s) involved in the in vivo degradation of the 100 kDa mosquitocidal toxin (Mtx) from Bacillus sphaericus SSII-1 and isolated a B . sphaericus SSII-1 gene flanked upstream by a typical Shine-Dalgarno ribosome binding site and downstream by a strong rho-independent transcription terminator . The predicted ORF encodes a 432 amino acid protein with significant homology throughout its sequence to two subtilisin-like serine proteases from the Antarctic psychrophilic (cold-adapted) bacilli, TA39 and TA41 . The predicted N-terminal sequence suggests that the B . sphaericus protease is related to sfericase, a partially characterized serine protease from B . sphaericus . Only B . sphaericus strains which produce Mtx-degrading protease activity harbour the subtilisin-like protease gene, suggesting that this protease may be responsible for or contribute to the degradation of Mtx in B . sphaericus SSII-1 . A 36-kDa protease with Mtx-degrading activity and similar properties to sfericase was also purified from sporulated cultures of B . sphaericus SSII-1 . Further studies are needed to determine the relationship of this protease to sfericase and to the predicted product of the subtilisin-like serine protease gene.

Rev Soc Bras Med Trop, 1997 May-Jun, 30(3), 241 - 5
{Persistent neutrophilic meningitis in a patient with the acquired immunodeficiency syndrome}; Marinho SF et al.; Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment . The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months . Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids . For 3 months, the serologic evaluation, smears and cultures were negative . On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid . Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.

Perit Dial Int, 1997 May-Jun, 17(3), 269 - 72
The diagnostic value of Gram stain for initial identification of the etiologic agent of peritonitis in CAPD patients; Bezerra DA et al.; OBJECTIVE: To evaluate the effectiveness of the Gram stain in the initial diagnosis of the etiologic agent of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) . DESIGN: Retrospective study analyzing the sensitivity (S), specificity (SS), positive predictive value (+PV), and negative predictive value (-PV) of the Gram stain relating to the results of cultures in 149 episodes of peritonitis in CAPD . The data were analyzed in two studies . In the first, only the cases with detection of a single agent by Gram stain were taken (Study 1) . In the second, only the cases with two agents in Gram stain were evaluated (Study 2) . SETTING: Dialysis Unit and Laboratory of Microbiology of a tertiary medical center . PATIENTS: Sixty-three patients on regular CAPD who presented one or more episodes of peritonitis from May 1992 to May 1995 . RESULTS: The positivity of Gram stain was 93.2% and the sensitivity was 95.7% . The values of S, SS, +PV, and -PV were respectively: 94.9%, 53.5%, 68.3%, and 90.9% for gram-positive cocci and 83.3%, 98.8%, 95.2%, and 95.6% for gram-negative bacilli . The association of gram-positive cocci plus gram-negative bacilli were predictive of growth of both in 6.8%, growth of gram-positive cocci in 13.7%, and growth of gram-negative bacilli in 72.5% . CONCLUSIONS: The Gram stain is a method of great value in the initial diagnosis of the etiologic agent of peritonitis in CAPD, especially for gram-negative bacilli.

Antonie Van Leeuwenhoek, 1997 May, 71(4), 379 - 86
The potential of mining slag as a substrate for microbial growth and the microbiological analysis of slag and slag seepage; Male DW et al.; The potential of a Cu/Ni mining slag to act as a substrate for the growth of the bacteria Thiobacillus ferrooxidans, Thiobacillus thiooxidants, and Thiobacillus thioparus was examined . As well, slag and slag seepage samples were screened for the presence of the Thiobacillus species . For the 28 samples employed in the environmental recovery studies, T . ferrooxidans was recovered in 25 samples, T . thiooxidans in 19 samples, and T . thioparus in 27 samples . For R . ferrooxidans, the development of a colour change in the medium corresponded with the presence of motile bacilli as detected microscopically . For T . thiooxidans and T . thioparus, a decrease in culture pH of greater than 0.2 units usually corresponded with the presence of motile bacilli . The potential for growth on slag was determined by adding slag samples to media (devoid of an electron donor) appropriate for the growth of the three Thiobacillus species . All pulverized slag samples supported the growth of the three species.

J Neurol, 1997 May, 244(5), 318 - 23
Value of nerve biopsy in the diagnosis and follow-up of leprosy: the role of vascular lesions and usefulness of nerve studies in the detection of persistent bacilli; Chimelli L et al.; Nerve biopsy specimens from 53 patients with leprosy and neuropathy were taken from the sural, the dorsal branch of the ulnar, or the superficial radial nerves and processed for light and electron microscopy . There was inflammation in 40 cases (75%), 7 with a granulomatous reaction, various stages of fibrosis in 35 (66%), and endoneurial vascular neoformation in 7 . In two cases, small focal infarcts were associated with marked endoneurial inflammation compressing the vessels, in addition to endoneurial lymphocytic vasculitis . Most had an axonal neuropathy of varying degree, some with total fibre loss, others with predominant small myelinated and unmyelinated fibre loss . Signs of demyelination and remyelination were the main findings in 9 cases (17%) . Bacilli were present in endothelial, perineurial, Schwann cells and in macrophages . On two occasions, they lost their alcohol acid resistance, were suspected in semithin sections, and confirmed ultrastructurally . The biopsy was decisive for the diagnosis of leprosy in 15 cases (28%), most without skin lesions . We evaluated the effectiveness of the treatment in 20 (37.7%), 12 without and 8 with bacilli, despite negativity in the skin . The diagnosis of leprosy based on skin lesions was confirmed with the nerve biopsy in 9 cases, 6 had an inflammatory neuropathy suggestive of leprosy in the absence of bacilli, and 3 had nonspecific changes in the sural nerve since the neuropathy was in the upper limbs . We conclude that nerve biopsy is indicated for the diagnosis of leprosy in cases without clinically visible skin lesions and to evaluate the effectiveness of the treatment . In these cases the ultrastructural studies are important for recognition of the bacilli . Vascular lesions may play an important role in the progression of the nerve damage, including the occurrence of focal nerve infarcts which, to our knowledge, have not been previously reported in association with leprosy.

Am J Respir Crit Care Med, 1997 May, 155(5), 1804 - 14
Rapid diagnostic tests for tuberculosis: what is the appropriate use? American Thoracic Society Workshop; Unusual presentations of extrapulmonary tuberculosis in three hemodialysis patients; Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung Medical and Technological College, Taipei, Taiwan, Republic of ChinaWe report three patients who received maintenance hemodialysis and suffered from extrapulmonary tuberculosis with unusual presentations . The first patient presented with fever of unknown origin . All studies showed negative findings except high erythrocyte sedimentation rate and high value of C-reactive protein . He failed to response to broad-spectrum antibiotics but showed a complete response to antituberculosis therapy . The second patient presented with right supraclavicular lymphadenopathy and weakness . Lymph node biopsy revealed caseating granuloma with positive acid-fast bacilli . The third patient presented with tumor mass of left sternoclavicular joint for which malignancy was suspected initially . Ultimately, tuberculosis was documented by histopathologic studies showing caseating granuloma . All three patients had normal findings of chest x-ray and did not have previous history of tuberculosis and diabetes mellitus.

Chest, 1997 May, 111(5), 1174 - 9
The utility of a single sputum specimen in the diagnosis of tuberculosis . Comparison between HIV-infected and non-HIV-infected patients; Finch D et al.; STUDY OBJECTIVES: (1) To assess the utility of a single sputum specimen in the evaluation of HIV-infected patients who are suspected of having tuberculosis (TB) . (2) To identify radiographic findings that discriminate between HIV-infected patients with TB and those with pneumonia of other causes . DESIGN: Retrospective cohort analysis . PATIENTS: All patients evaluated at Harborview Medical Center, Seattle, between January 1986 and July 1994 in whom culture of respiratory secretions grew Mycobacterium tuberculosis or Mycobacterium avium-complex . Patients who were coinfected with HIV formed the primary study group . Their chest radiographs were then compared with those of a matched group of patients with pneumonia of other causes . MEASUREMENTS AND RESULTS: We identified 164 patients with TB, 20 of whom were HIV infected . The initial sputum specimen grew M tuberculosis in all HIV-infected patients and 99% of non-HIV-infected patients . Seventy percent of HIV-infected and 71% of non-HIV-infected patients had at least one positive smear . Most of these patients tested positive on their initial smear, and no significant difference was found between HIV-positive and HIV-negative patients (79% and 90%, respectively {p = 0.34}) . The addition of a second sputum smear identified all HIV-infected patients and all but one in non-HIV-infected patients who were ultimately determined to be smear positive . A total of 27 HIV-infected patients had a positive acid-fast bacilli sputum smear during the study period, 14 of which were attributable to TB (specificity = 52%) . The only radiographic findings that discriminated between HIV-infected patients with TB and those with pneumonia of other causes were the presence of cavitation or a miliary pattern (p = 0.014) . CONCLUSIONS: A single sputum specimen was sufficient to establish the diagnosis in all HIV-infected patients with pulmonary TB . A single negative sputum smear made the diagnosis of TB significantly less likely . However, a minimum of two smears were necessary to achieve an acceptable early diagnostic yield . The presenting chest radiograph failed to discriminate between HIV-infected patients with TB and pneumonia of other causes in most cases.

J Bacteriol, 1997 May, 179(9), 2845 - 51
Three Bacillus cereus bacteriophage endolysins are unrelated but reveal high homology to cell wall hydrolases from different bacilli; Loessner MJ et al.; The ply genes encoding the endolysin proteins from Bacillus cereus phages Bastille, TP21, and 12826 were identified, cloned, and sequenced . The endolysins could be overproduced in Escherichia coli (up to 20% of total cellular protein), and the recombinant proteins were purified by a two-step chromatographical procedure . All three enzymes induced rapid and specific lysis of viable cells of several Bacillus species, with highest activity on B . cereus and B . thuringiensis . Ply12 and Ply21 were experimentally shown to be N-acetylmuramoyl-L-alanine amidases (EC 3.5.1.28) . No apparent holin genes were found adjacent to the ply genes . However, Ply21 may be endowed with a signal peptide which could play a role in timing of cell lysis by the cytoplasmic phage endolysin . The individual lytic enzymes (PlyBa, 41.1 kDa; Ply21, 29.5 kDa, Ply12, 27.7 kDa) show remarkable heterogeneity, i.e., their amino acid sequences reveal only little homology . The N-terminal part of Ply21 was found to be almost identical to the catalytic domains of a Bacillus sp . cell wall hydrolase (CwlSP) and an autolysin of B . subtilis (CwlA) . The C terminus of PlyBa contains a 77-amino-acid sequence repeat which is also homologous to the binding domain of CwlSP . Ply12 shows homology to the major autolysins from B . subtilis and E . coli . Comparison with database sequences indicated a modular organization of the phage lysis proteins where the enzymatic activity is located in the N-terminal region and the C-termini are responsible for specific recognition and binding of Bacillus peptidoglycan . We speculate that the close relationship of the phage enzymes and cell wall autolysins is based upon horizontal gene transfer among different Bacillus phages and their hosts.

Infect Immun, 1997 May, 65(5), 1761 - 6
Effects of gamma interferon and nitric oxide on the interaction of Mycobacterium avium subsp . paratuberculosis with bovine monocytes; Zhao B et al.; In this study, we examined the effects of recombinant bovine gamma interferon (rIFN-gamma) and nitric oxide (NO) on the interaction of M . avium subsp . paratuberculosis with bovine monocytes . Monocytes pretreated with rIFN-gamma exhibited slightly increased phagocytosis of M . avium subsp . paratuberculosis and modest inhibition of the intracellular growth of this microorganism . The number of viable intracellular bacilli decreased earlier in rIFN-gamma-pretreated monocytes than in control monocytes . After infection with M . avium subsp . paratuberculosis, NO was not constitutively released, but NO release from infected monocytes was induced by treatment with rIFN-gamma or with rIFN-gamma and lipopolysaccharide (LPS) . Release of nitric oxide was inhibited by addition of N(G)-monomethyl-L-arginine; however, inhibition of nitric oxide did not alter the pattern of intracellular survival of M . avium subsp . paratuberculosis in rIFN-gamma-treated bovine monocytes . Although chemically generated nitric oxide killed M . avium subsp . paratuberculosis in a cell-free system in vitro, the amount of nitric oxide required was far greater than that released from infected monocytes stimulated with rIFN-gamma and LPS . Our data suggest that rIFN-gamma activates M . avium subsp . paratuberculosis-infected bovine monocytes to release nitric oxide but only modestly increases antimycobacterial activity of monocytes against this organism . This may be due, in part, to the fact that the amount of nitric oxide produced by rIFN-gamma-activated bovine monocytes is insufficient to kill intracellular M . avium subsp . paratuberculosis bacilli in vitro.

J Clin Microbiol, 1997 May, 35(5), 1239 - 43
Confirmation of the presence of Mycobacterium tuberculosis and other mycobacteria in mycobacterial growth indicator tubes (MGIT) by multiplex strand displacement amplification; Badak FZ et al.; Multiplex strand displacement amplification (mSDA) is capable of amplifying three distinct DNA sequences simultaneously . These include sequences present in most genera of mycobacteria, a sequence specific for Mycobacterium tuberculosis, and an internal control . mSDA was used to detect the presence of these target sequences in 154 (72 positive, 76 negative, and 6 failed) clinical specimens cultured in the mycobacterial growth indicator tube (MGIT) system . A wide variety of specimen types were processed and cultured . Once these cultures were deemed positive by MGIT fluorescence or were deemed negative after 8 weeks of incubation, MGIT culture aliquots were processed for mSDA analyses . A chemiluminescent microwell assay was used to detect the amplified products . The procedure was relatively simple and took less than 6 h to complete . The sensitivity of mSDA for detecting acid-fast bacilli was 96.4% compared to that of MGIT culture . Sensitivity and specificity were 97.2 and 96.1%, respectively, when all clinical criteria were considered . mSDA was shown to be a rapid and effective method for confirming the presence of M . tuberculosis and other mycobacteria in positive MGIT cultures.

Orv Hetil, 1997 Apr 27, 138(17), 1053 - 6
{Hematologic abnormalities in pulmonary tuberculosiss}; Bozoky G et al.; This study surveys the extent and severity of haematological abnormalities which occurred in 380 patients with pulmonary tuberculosis . Full blood count, bone marrow aspiration smears, and bone marrow trephine biopsy was analyzed by authors . Anaemia was present in 32 percent of patients . Leucocytosis with neutrophilia occurred in 18 percent . Leucopenia with neutropenia, and lymphopenia was observed in 16 percent in patients with very severe clinical tuberculosis . Elevated platelet count occurred in 8 percent with deep vein thrombosis in legs in 50 percent . Dysmyelopoietic syndrome was diagnosed in one case by bone marrow trephine biopsy . There was a close correlation between the haematological abnormalities and the severity of clinical findings of pulmonary tuberculosis . This survey has revealed that haematological abnormalities are relatively common in severe pulmonary tuberculosis . It seems that body weight loss, white blood cell count, haemoglobin level and erythrocyte sedimentation rate are useful indices of severity of the tuberculosis . The return of these indices to a normal level is a good indication of disease control in that they correlate with sputum conversion to acid-fast bacilli negative.

Eur J Cancer Prev, 1997 Apr, 6(2), 167 - 70
Non-neoplastic changes in gastric antrum: are they different in distally located intestinal and diffuse-type gastric adenocarcinoma?
Knawy BA, Morad NA, Jamal A, Hamdi J, Mirdad S.
A total of 126 cases of primary adenocarcinoma of distal (antrum and/or adjacent body) stomach were reviewed . These cases were collected from the histopathology laboratory of Asir Central Hospital, Southwestern Saudi Arabia over an 8 year period (1987-94) . Only gastrectomy specimens with non-neoplastic antral mucosa available for histological examination were included . Of 126 cases, 85 (67.5%) were of the intestinal type and 41 (32.5%) were of the diffuse type . Histological examination of the non-neoplastic antral mucosa showed: gastritis in 100% of these cases; Helicobacter pylori in 103/126 cases (81.8%); multifocal atrophic gastritis (MAG) in 53/126 cases (42.1%); intestinal metaplasia (IM) in 62/126 (49.2%); and type III intestinal metaplasia in 30/62 cases (47.7%) . None of these non-neoplastic changes of antral mucosa was significantly different when the prevalence of these changes in intestinal and diffuse type gastric adenocarcinoma were compared using the chi 2 test . The prevalence of these non-neoplastic lesions were calculated in a 126 dyspeptic age- and sex-matched control patients and were as follows: H . pylori 91%; gastritis 78%; MAG 7.4%; IM 19% and type III IM 1.6% . The prevalence of H . pylori bacilli and gastritis was not significantly different between the cancer patients and the controls . The prevalence of MAG, IM and type III IM was significantly higher among cancer patients compared with the control group.

Pathologica, 1997 Apr, 89(2), 155 - 8
Esophageal ulcers in AIDS; Calore EE et al.; Thirty five esophageal biopsies from AIDS patients with clinical symptoms of esophagitis sent to "Emilio Ribas Institute", Pathology Laboratory, in a 2 year period were revised for possible infectious agents . Microorganisms were seen in 17 cases (48.6%) . In 6 cases (17.1%), Acid-Fast bacilli were observed . One of these cases also had characteristic cytomegalic inclusions in endothelial cells . Inflammatory responses were composed of lymphocytes, some plasma cells and many histiocytes, with absence of giant cells in 4 cases of mycobacteriosis; in the other 2 cases, acid-fast bacilli were seen over the epithelium . Exclusive infection by cytomegalovirus was detected in 5 cases (14.3%), and candidiasis in 5 cases (14.3%) . In one case there was association of cytomegalovirus and candidiasis . Esophageal ulcers in AIDS patients caused by Mycobacterium sp, may be more common than previously reported, and certainly an overlooked diagnosis . Once esophageal biopsy is an easy diagnostic procedure, this method may be used in routine screening for tuberculosis in patients with AIDS.

Intern Med, 1997 Apr, 36(4), 298 - 300
Fatal pulmonary infection due to multidrug-resistant Mycobacterium kansasii which developed in an immunocompetent young man; Yamada H et al.; A 32-year-old immunocompetent man developed fever and malaise that persisted for three years . As he had no health insurance, he never received any medical treatment . On admission, chest X-ray revealed multiple cavitary lesions and his sputnum yielded acid-fast bacilli, that were identified as Mycobacterium kansasii with multidrug resistance . Although his general status improved transiently by antituberculous agents, he died of respiratory insufficiency after four months . The prognosis of Mycobacterium kansasii pulmonary disease is reported to be relatively good among non-tuberculous mycobacteriosis, however, physicians must pay careful attention to cases of delayed start of therapy or multidrug resistance, or both.

Immunology, 1997 Apr, 90(4), 607 - 17
Analysis of the local kinetics and localization of interleukin-1 alpha, tumour necrosis factor-alpha and transforming growth factor-beta, during the course of experimental pulmonary tuberculosis; Hernandez-Pando R et al.; A mouse model of pulmonary tuberculosis induced by the intratracheal instillation of live and virulent mycobacteria strain H37-Rv was used to examine the relationship of the histopathological findings with the local kinetics production and cellular distribution of tumour necrosis factor-alpha (TNF-alpha), interleukin-1 alpha (IL-1 alpha) and transforming growth factor-beta (TGF-beta) . The histopathological and immunological studies showed two phases of the disease: acute or early and chronic or advanced . The acute phase was characterized by inflammatory infiltrate in the alveolar-capillary interstitium, blood vessels and bronchial wall with formation of granulomas . During this acute phase, which lasted from 1 to 28 days, high percentages of TNF-alpha and IL-1 alpha immunostained activated macrophages were observed principally in the interstium-intralveolar inflammatory infiltrate and in granulomas . Electron microscopy studies of these cells, showed extensive rough endoplasmic reticulum, numerous lysosomes and occasional mycobacteria . Double labelling with colloid gold showed that TNF-alpha and IL-1 alpha were present in the same cells, but were confined to separate vacuoles near the Golgi area, and mixed in larger vacuoles near to cell membrane . The concentration of TNF-alpha and IL-1 alpha as well as their respective mRNAs were elevated in the early phase, particularly at day 3 when the bacillary count decreased . A second peak was seen at days 14 and 21-28 when granulomas appeared and evolved to full maturation . In contrast, TGF-beta production and numbers of immunoreactive cells were low in comparison with the advanced phase of the disease . The chronic phase was characterized by histopathological changes indicative of more severity (i.e . pneumonia, focal necrosis and extensive interstitial fibrosis) with a decrease in the TNF-alpha and IL-1 alpha production that coincided with the highest level of TGF-beta . The bacillary counts were highest as the macrophages became large, vacuolated foamy cells, and containing numerous bacilli with immunoreactivity to mycobacterial lipids and lipoarabinomannan (LAM) . These macrophages displayed poor and scarce TNF-alpha and IL-1 alpha immunostaining but still strong immunoreactivity to TGF-beta . These cytokine production kinetics and the spatial relationship between immunostained cells and lung lesions corroborate the important role of TNF-alpha and IL-1 alpha in the constitution of granulomas and immune protection during the early phase of the infection, and also suggest an important if not primary role for TGF-beta in the immunopathogenesis of the advanced forms of pulmonary tuberculosis.

Biochem Mol Med, 1997 Apr, 60(2), 182 - 6
Quantitative-competitive polymerase chain reaction for rapid susceptibility testing of Mycobacterium tuberculosis to isoniazid; Afghani B et al.; The objective of this study was to determine whether quantitative-competitive polymerase chain reaction (QC-PCR) can be used for rapid susceptibility testing of Mycobacterium tuberculosis (MTB) . QC-PCR was used to determine relative amounts of mycobacterial DNA inoculated at different isoniazid (INH) concentrations . A total of six different INH-sensitive (INH-S) and five INH-resistant (INH-R) strains were inoculated in the presence of 0.0, 0.2, 1.0, and 10.0 micrograms/ml of INH . DNA was quantified using QC-PCR at Week 0 and weekly thereafter for 3 weeks . For the QC-PCR, 10-fold dilutions of control (240 bp) DNA having the same primer set as the target DNA (123 bp) were used . The amount of target DNA was estimated by using known amounts of the internal standard . For INH-S isolates there was > or = 1 log difference in DNA concentration in the presence of each INH concentration compared to that of the control within 1 to 3 weeks . In contrast, for INH-R isolates there were no apparent differences in DNA concentration between the control suspensions and those containing 0.2 and 1.0 microgram/ml INH during the 3-week incubation period . The highest INH concentration (10 micrograms/ml), however, did abolish the DNA increase seen in the other MTB suspensions . This preliminary study suggests that by using concentrations of 0.2 or 1.0 microgram/ml of INH, QC-PCR may differentiate INH-R and INH-S MTB isolates within 1 week . This method may be of particular value when applied directly to clinical specimens with varying numbers of bacilli.

J Clin Microbiol, 1997 Apr, 35(4), 843 - 6
Molecular fingerprinting of Mycobacterium tuberculosis on a Caribbean island with IS6110 and DRr probes; Sola C et al.; Because of a substantial increase in human immunodeficiency virus (HIV) infection and HIV-linked tuberculosis in the Caribbean, a molecular fingerprinting study of clinical isolates of Mycobacterium tuberculosis isolated at the Pasteur Institute of Guadeloupe from 1994 to 1995 was undertaken with the insertion sequence IS6110 and the direct repeat DRr probes . We present the results for 72 isolates from 51 patients . A major cluster (cluster A) representing isolates from 12 patients (24%) was detected upon PvuII-IS6110 fingerprinting, which revealed a pattern of four bands among these isolates . Homogeneity was retained when the isolates were further analyzed with the DRr probe or further characterized by AluI and SmaI-DRr restriction fragment length polymorphism analysis . The isolates of cluster A, from 10 men and 2 women, was present in people of all ages and of different ethnic and geographical backgrounds, and infection with these isolates was independent of the HIV status of the patients (except for 2 HIV-positive patients from the same ward from whom the tubercle bacilli were isolated at the same time) . The percentage of reactivation versus active transmission events could not be precisely determined in this study . These results are discussed on the basis of the genetic advantage of predominant clusters and/or specific characteristics of the settings from which a similar cluster of isolates with four bands has so far been reported, which include South Africa, French Polynesia, and Guadeloupe.

Diagn Microbiol Infect Dis, 1997 Apr, 27(4), 113 - 6
Evaluation of the Roche AMPLICOR MTB assay for the detection of Mycobacterium tuberculosis in sputum specimens from prison inmates; Smith MB et al.; The reliability of the Roche Mycobacterium tuberculosis polymerase chain reaction (PCR) assay (AMPLICOR MTB) for the diagnosis of pulmonary tuberculosis was evaluated by testing expectorated sputum specimens from 187 inmates in Texas state prisons and comparing the results to culture and medical history . Of the 80 specimens that were culture positive for mycobacteria, 36 specimens from 16 patients grew M . tuberculosis . Forty-six specimens were smear positive for acid-fast bacilli (AFB), and of these, M . tuberculosis was isolated from 24 . On initial testing, 52 specimens were PCR positive . Thirty-one of these 52 were culture positive for M . tuberculosis, and 21 were culture negative, resulting in a PCR sensitivity and specificity of 86.1 and 96.1%, respectively . After resolving discrepancies by review of the medical history and repeat testing, PCR sensitivity, specificity, and positive and negative predictive values, respectively, were 92.8, 99.8, 98.1, and 99.2% . For AFB smear-positive specimens, the sensitivity, specificity, and positive and negative predictive values, were 95.8, 100, 100, and 93.3, respectively; whereas, for AFB smear-negative specimens, these values were 87.5, 99.7, 95.5, and 99.4%, respectively . These results confirm the reliability of the AMPLICOR MTB assay for direct detection of M . tuberculosis in AFB smear-positive sputum specimens and suggest a potential role in evaluating AFB smear-negative sputum specimens.

Clin Infect Dis, 1997 Apr, 24(4), 661 - 8
A prospective study of tuberculosis and human immunodeficiency virus infection: clinical manifestations and factors associated with survival; Alpert PL et al.; We prospectively studied the effect of human immunodeficiency virus (HIV) infection on the presentation and outcome of tuberculosis . A total of 216 patients with tuberculosis were identified; 162 (75%) of these patients were tested for antibodies to HIV; 92 (57%) were seropositive . The patients who were seropositive for HIV were more likely to be male and Hispanic and to have been homeless or incarcerated . Eighty-one percent of these patients had CD4 lymphocyte counts of < or =200/mm3 . The seropositive patients had extrapulmonary tuberculosis more often than did the seronegative patients (odds ratio {OR}, 2.3; 95% confidence interval {CI}, 1.2-4.8) . Smears for acid-fast bacilli were positive more often for non-HIV-infected patients with pulmonary tuberculosis (74.5%) than for HIV-infected patients (54.3%) {OR, 2.46; 95% CI, 1.01-6.02}-even those with focal or cavitary disease . A delay in initiating therapy was associated with in-hospital mortality: the median time from admission to the start of treatment was 4 days for patients who survived and 15 days for those who died (P = .02) . The median survival was 22.7 months for HIV-infected patients who did not die during the initial hospitalization . Factors independently associated with reduced rates of survival included the severity of immunodeficiency, nonuse of directly observed therapy, infection due to drug-resistant Mycobacterium tuberculosis, and a history of injection drug use.

Microb Pathog, 1997 Apr, 22(4), 193 - 8
Expression of the green fluorescent protein (GFP) in mycobacterium avium as a tool to study the interaction between Mycobacteria and host cells; Parker AE et al.; Mycobacterium avium is an intracellular pathogen able to invade and survive within macrophages and mucosal epithelial cells . The study of the interaction between M . avium and host cells is important to establish the mechanisms of pathogenesis of the infection . One of the limitations of microscopic study of intracellular M . avium is the difficulty of identifying isolated bacilli within cells . As a general strategy to visualize and analyse the influence of M . avium on intracellular trafficking, we cloned the gene encoding the green fluorescent protein (GFP) in M . avium . A vector was constructed by cloning the cDNA for the GFP of the bioluminescent jellyfish Aequorea victoria into an Escherichia coli/Mycobacteria shuttle vector (pMV261) . The recombinant plasmid (pWES-4) was transformed into both E . coli and M . avium strain 104 (serovar 1) . The transformants were screened for strong expression of the GFP . Transformed M . avium were clearly visible inside human macrophages and epithelial cells using fluorescence microscopy . These transformed M . avium should provide a useful tool for further study of intracellular behaviour.

Infect Immun, 1997 Apr, 65(4), 1189 - 95
Susceptibility of a panel of virulent strains of Mycobacterium tuberculosis to reactive nitrogen intermediates; Rhoades ER et al.; Murine bone marrow-derived macrophages were infected with a panel of virulent isolates of Mycobacterium tuberculosis including laboratory strains Erdman and H37Rv and various clinical isolates in order to determine the sensitivity of each of these strains to the antimycobacterial activities of macrophage-generated reactive nitrogen intermediates (RNI) . All of the M . tuberculosis strains grew in murine bone marrow-derived macrophages; however, gamma interferon-primed macrophages limited the initial growth of intracellular bacilli . Some of the mycobacterial strains, including Erdman, were killed over the first 4 days of infection, as evidenced by significant decreases in the number of viable intracellular bacilli determined by a CFU assay . Other mycobacterial strains were not killed during this same period, and some isolates, including CSU 24 and CSU 31, grew steadily in activated macrophages . The accumulation of nitrite on infected monolayers was measured, and it was found that inhibitory levels of RNI did not vary among infections with the different strains . Nitrite tolerance was determined in a cell-free system for each of the strains in order to compare susceptibilities of the strains to RNI . All of the strains tested were killed by levels of RNI generated by the acidification of 10 mM NaNO2 to pH 6.5 or 5.5, and the strains exhibited a range of tolerance to lower concentrations of RNI . No correlations were observed between such cell-free RNI tolerances and the capacity of bacilli to resist macrophage RNI-mediated killing . These results indicate that under stringent conditions, RNI can kill M . tuberculosis, but that under less harsh, more physiological conditions, the effects of RNI range from partial to negligible inhibition.

Infect Immun, 1997 Apr, 65(4), 1152 - 7
Effects of essential fatty acid deficiency on prostaglandin E2 production and cell-mediated immunity in a mouse model of leprosy; Adams LB et al.; Results from animal and in vitro studies suggest that essential fatty acid (EFA) deficiency enhances cell-mediated immunity by reducing production of prostaglandins with immunosuppressive actions . However, direct experimental evidence that EFA deficiency enhances T-lymphocyte function in vivo has not been obtained . In this study, athymic (nu/nu) mice were infected in the footpads with Mycobacterium leprae and fed a linoleic acid-free diet . These mice, and infected nu/nu mice on control diets, were given an adoptive transfer of M . leprae-primed, T-cell-enriched lymphocytes . After 2 weeks, M . leprae bacilli were harvested from the recipient mice and bacterial viability was determined by the BACTEC system . M . leprae recovered from recipient mice fed control diets displayed little reduction in metabolic activity . In contrast, M . leprae from recipient mice fed the EFA-deficient (EFAD) diet exhibited markedly reduced viability . In vitro, donor cells from M . leprae-primed mice secreted elevated levels of gamma interferon upon exposure to the bacilli . These cells also exhibited an enhanced proliferative response, which was reduced by exogenous prostaglandin E2 (PGE2) . In addition, M . leprae-infected granuloma macrophages (Mphi) from EFAD recipient nu/nu mice secreted significantly less PGE2 than granuloma Mphi from mice on control diets . These data suggest that enhanced levels of Mphi-generated PGE2, induced by M . leprae or its constituents, could act as an endogenous negative modulator of the immune response occurring in the microenvironment of the lepromatous granuloma.

Pediatr Infect Dis J, 1997 Apr, 16(4), 417 - 8
Disseminated histoplasmosis in a human immunodeficiency virus-infected African child; Pillay T et al.; PIP: Progressive disseminated histoplasmosis (PDH), a recognized defining illness of AIDS, is an opportunistic fungal infection caused by Histoplasma capsulatum . The authors report a case of PDH in a HIV-infected African child from a Histoplasma capsulatum non-endemic area . An 8-year-old girl from Kwazulu/Natal, South Africa, was admitted to King Edward VIII hospital with pyrexia and respiratory distress . Pale with generalized lymphadenopathy, she had been sick with general malaise and fever for 3 weeks . A punched-out painless ulcer was present on the child's lower left leg and she had ulcerative lesions on the tip of her tongue and the angle of her mouth . There was a tender hepatomegaly and clinical signs of pneumonia, while a chest roentgenogram showed right upper lobe consolidation with early cavitation . The purified protein derivative tuberculin skin test was negative and no acid-fast bacilli were detected on three sputum samples taken on different days . A Western blot test conducted for antibodies to HIV was positive . Additional laboratory tests were conducted . The patient was treated with parenteral acyclovir for herpesvirus infection, ceftriaxone for severe community-acquired pneumonia, and trimethoprim-sulfamethoxazole because Pneumocystis carinii infection was part of the clinical differential diagnosis . Bone marrow aspirate and trephine biopsy revealed yeast forms of H . capsulatum . The girl died on the second day of hospital admission, before antifungal therapy could be commenced .

Drugs Aging, 1997 Apr, 10(4), 259 - 77
Use of aminoglycosides in elderly patients . Pharmacokinetic and clinical considerations; Morike K et al.; Aminoglycosides still represent a mainstay in the treatment of serious infections caused by Gram-negative bacilli in elderly patients . The aging process is accompanied by various physiological changes (e.g . alterations in body composition, impairments in certain organ functions), which may affect drug disposition and, subsequently, drug action . For aminoglycosides that are eliminated by the renal route, kidney function is the key parameter that should be taken into account when dosage regimens are calculated . Because there is a progressive decline in renal function with aging, the glomerular filtration rate should be estimated for each patient . Any change in creatinine clearance (CLCR) should result in a proportional correction of the dosage regimen . Such individualised dosage of aminoglycosides is particularly important because of their narrow therapeutic indices . There are no conclusive data which indicate that age per se affects the elimination of aminoglycoside antibiotics . Overdosage may result from overestimation of renal function if crude serum creatinine (SCr) levels are used as a guide . Nomograms for the relationship between SCr and CLCR have been developed . However, nomograms should be used with caution because substantial interindividual variability in the plasma concentration-clearance relationship is still observed . Therefore, the choice of a maintenance dose based on an assessment of renal function, which change rapidly, should always be considered as preliminary, and verification by serum concentration measurements is necessary . As a result, the use of aminoglycoside serum concentration monitoring during therapy as the most important guide for dosage adjustment is particularly important in the elderly, and is indispensable in conjunction with frequent assessment of renal function . Although a matter of debate, the value of serum concentration monitoring has been demonstrated . With traditional multiple daily dosage, monitoring peak and trough concentrations has been recommended . For once daily dosage, however, no guidelines relating to therapeutic and/or toxic concentrations are available yet . In the meantime, we recommend monitoring at least trough concentrations . Once daily administration of aminoglycosides has emerged as a new mode of treatment . Compared with multiple daily administration, once daily dosage may have a number of advantages, and many clinical trials comparing the efficacy or safety of both modes have shown either superiority or equivalence of the new mode in most indications . At present, however, no data from studies of once daily administration in young compared with elderly adults are available.

AIDS, 1997 Apr, 11(5), 669 - 72
The risks and benefits of childhood bacille Calmette-Guérin immunization among adults with AIDS . International MAC study groups; Marsh BJ et al.; OBJECTIVE: To define the risks of disseminated bacille Calmette-Guerin (BCG) or disseminated Mycobacterium tuberculosis in adults with AIDS who were immunized with BCG in childhood . DESIGN: HIV-infected patients with CD4 < 200 x 10(6)/l were enrolled from five study sites (New Hampshire, Boston, Finland, Trinidad and Kenya) . Prior BCG immunization was determined and blood cultures for mycobacteria were obtained at study entry and at 6 months . Acid-fast bacilli were identified as Mycobacterium tuberculosis complex (MTBC) using DNA probes . MTBC isolates were then typed by both IS6110 restriction fragment length polymorphism and polymerase chain reaction/restriction enzyme analysis . SETTING: Most patients in New Hampshire and Finland were outpatients; most patients in Trinidad were inpatients with terminal illness; and most patients in Kenya were outpatients, although 44 were inpatients with terminal illness . PARTICIPANTS: A total of 566 patients were enrolled, including 155 with childhood BCG immunization; 318 patients had a single study visit and culture, and 248 patients had two study visits and cultures . MAIN OUTCOME MEASURES: Isolation and identification of mycobacteria from blood cultures . RESULTS: Blood cultures were positive for MTBC in 21 patients; none were positive for M . bovis BCG, and 21 were M . tuberculosis-positive . In Trinidad, seven (87%) out of eight isolates of M . tuberculosis were indistinguishable by IS6110 typing; BCG immunization was associated with a decreased risk of bacteremic infection with M . tuberculosis (P = 0.05) . CONCLUSIONS: The risk of disseminated BCG among adult AIDS patients with childhood BCG immunization is very low . Childhood BCG immunization is associated with protection against bacteremia with M . tuberculosis among adults with advanced AIDS in Trinidad.

Antimicrob Agents Chemother, 1997 Apr, 41(4), 721 - 7
Importance of beta-lactamase inhibitor pharmacokinetics in the pharmacodynamics of inhibitor-drug combinations: studies with piperacillin-tazobactam and piperacillin-sulbactam; Lister PD et al.; An in vitro pharmacokinetic model was used to study the pharmacodynamics of piperacillin-tazobactam and piperacillin-sulbactam against gram-negative bacilli producing plasmid-encoded beta-lactamases . Logarithmic-phase cultures were exposed to peak antibiotic concentrations observed in human serum after the administration of intravenous doses of 3 g of piperacillin and 0.375 g of tazobactam or 0.5 g of sulbactam . Piperacillin and inhibitor were either dosed simultaneously or piperacillin was dosed sequentially 0.5 h after dosing with the inhibitor . In studies with all four test strains, the pharmacodynamics observed after simultaneous dosing were similar to those observed with the sequential regimen . Since the ratio between piperacillin and tazobactam was in constant fluctuation after sequential dosing, these data suggest that the pharmacodynamics of the piperacillin-inhibitor combinations were not dependent upon maintenance of a critical ratio between the components . Furthermore, when regrowth was observed, the time at which bacterial counts began to increase was similar between the simultaneous and sequential dosing regimens . Since the pharmacokinetics of the inhibitors were the same for all regimens, these data suggest that the length of time that the antibacterial activity was maintained over the dosing interval with these combinations was dictated by the pharmacokinetics of the beta-lactamase inhibitor in the combination . The antibacterial activity of the combination appeared to be lost when the amount of inhibitor available fell below some critical concentration . This critical concentration varied depending upon the type and amount of enzyme produced, as well as the specific inhibitor used . These results indicate that the antibacterial activity of drug-inhibitor combinations, when dosed at their currently recommended ratios, is more dependent on the pharmacokinetics of the inhibitor than on those of the beta-lactam drug.

Med Clin (Barc), 1997 Mar 15, 108(10), 361 - 5
{A contagiousness study in 3071 familial contacts of tuberculosis patients}; Vidal R et al.; BACKGROUND: The study of contacts of patients with tuberculosis is an important preventive measure which helps to identify the risk factors for contagion, to detect new cases of the disease early and to break the epidemiological chain of transmission . MATERIAL AND METHOD: Three thousand and seventy-one contacts of 635 patients with tuberculosis were studied in our department over a period of 6 years . With the aid of uni- and multivariate analyses we established the importance of different factors in the appearance of tuberculous disease and infection in contacts . RESULTS: There were 1,341 tuberculin positive contacts (44%) . The proportion increased in relation to the degree of the relationship and the bacillary density of the index case . A hundred and seventy-six new cases of tuberculosis were diagnosed among the contacts (5.7%) . To study the risk factors for contagion, we analyzed the characteristics of 322 patients with positive sputum smears and their 1,623 contacts; 124 new cases were diagnosed among them (124/176; 70%) . The most important factors for contagion in the multivariate analysis were the closer relationship (odds ratio {OR} = 8.32; confidence interval {Cl} 95% = 3.9-17.6), greater TST reaction of contacts (OR = 4.43; Cl 95% = 2.5-7.7), presence of more than 10 bacilli per microscopic field in the sputum samples of the index case (OR = 1.97; Cl 95% = 1.1-3.3), male contacts (OR = 1.86; Cl 95% = 1.2-2.7) and those younger than 15 years (OR = 1.58; Cl 95% = 1.01-2.45) . Conversely, the sex of the index case and the history of previous tuberculosis in contacts did not influence the contagion . CONCLUSIONS: The study of contacts offers a high yield in the diagnosis of new tuberculosis cases, because the incidence of the disease is much higher than that of the general population . Moreover, it allows the detection of newly infected subjects in whom the application of chemoprophylaxis prevents the development of the disease, and thus the epidemiologic chain of transmission is broken.

Sante, 1997 Mar-Apr, 7(2), 89 - 94
{Primary chemoprevention of tuberculosis in HIV-infected patients in non-industrialized countries}; Anglaret X et al.; In randomized placebo-controlled trials in Haiti, Zambia and Uganda, prophylactic use of isoniazid (INH) for 6 to 12 months reduced the annual incidence of tuberculosis in HIV-infected patients by more than 50 per cent . For several years, WHO, IUTATLD and CDC have recommended that HIV-positive patients testing positive in a PPD test should be treated with INH as a form of anti-tuberculosis chemoprophylaxis (ATC) . Whilst these recommendations are easy to follow in industrialized countries, widespread use of ATC in developing countries remains problematic because: (i) It is unknown what proportion of patients are likely to be re-infected at the end of ATC in countries where TB is endemic; (ii) It is possible that resistant bacilli may be selected due to the incomplete exclusion from the ATC program of patients with active TB at enrollment; (iii) It is difficult to identify asymptomatic carriers of M . tuberculosis at enrollment; (iv) It is doubtful that all patients will comply with a treatment regime which lasts several months; (v) The cost of a widespread ATC program, whose full benefit remains to be evaluated, may be difficult to justify . This paper attempts to review these issues and demonstrates the need for more population-based clinical trials in the field.

Int J Lepr Other Mycobact Dis, 1997 Mar, 65(1), 90 - 4
Pathologic changes in a tibial nerve with surviving M . leprae in a healed tuberculoid leprosy patient; Job CK et al.; A tibial nerve from a disease-arrested borderline tuberculoid (BT) leprosy patient was dissected out and examined almost in its entirety using hematoxylin and eosin staining, a modified Fite's stain for acid-fast bacilli (AFB), solochrome cyanin stain for myelin, and van Gieson's stain for fibrous tissue . Fibrosis of the perineurium and epineurium and fibrous replacement of the nerve parenchyma, which was maximum at the ankle joint area, were seen . In focal areas inflammation was present, especially in the epineurium around blood and lymph vessels . Even 21 years after adequate antileprosy therapy, AFB were present in the endoneurium in all except 2 of the 10 segments of the nerve, evoking hardly an inflammatory reaction or other ill effects . It is pointed out that BT leprosy should also be considered a generalized disease, especially when there is peripheral nerve trunk involvement and, in such cases, a longer duration of currently available antileprosy therapy is advisable . Trauma to nerve trunk plays a major role in producing nerve destruction and paralysis.

East Afr Med J, 1997 Mar, 74(3), 154 - 7
HIV infection and antituberculosis drug resistance among pulmonary tuberculosis patients in Harar Tuberculosis Centre, Ethiopia; Mitike G et al.; A cross-sectional study was conducted to estimate HIV seroprevalence among infectious (smear positive) cases of pulmonary tuberculosis and to describe the relation between antituberculosis drug resistance and infection with human immunodeficiency virus . A total of 418 smear positive pulmonary tuberculosis patients who attended the out patient departments of Harar Tuberculosis Centre and two general hospitals were studied from October 1994 through January 1995 . The majority (94%) of these patients were from the tuberculosis centre . Sputum cultures were positive for 338/418 (80.9%) patients . HIV seroprevalence was 92/418 (22.0%) among smear positive and 69/338 (20.4%) among culture positive patients . HIV positive patients were more likely to be from urban than rural areas (p < 0.001) . Initial resistance was not affected by HIV seropositivity . Secondary drug resistance was significantly higher in HIV positive patients than HIV negatives (p < 0.05) . Although not significant, HIV positive patients were more defaulters than HIV negatives . Significantly higher numbers of HIV positive pulmonary tuberculosis patients were cases of relapse and treatment failure (p < 0.05) . Other studies are required in order to assess the impact of HIV infection on the spread of anti-tuberculosis resistance . Supervised and appropriate treatments with follow up are required in order to minimise the spread of drug resistant tubercle bacilli among HIV infected patients.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Mar, 35(3), 328 - 33
{Systemic sarcoidosis with involvement of the spermatic cord}; Nagayama M et al.; A 49-year-old man presented with an enlarging, painful, right inguinal mass and small red nodules around his nose and upper lip . He had undergone an operation for a right inguinal hernia in childhood . Because malignancy was suspected, the right spermatic cord, testis, and epididymis were resected . Histological examination of the lesion in the spermatic cord revealed non-caseating epithelioid-cell granuloma and no acid-fast bacilli, which was compatible with sarcoidosis . A chest X-ray film and computed tomograms showed enlarged hilar lymph nodes and reticular infiltrates . Histological examination of specimens obtained by transbronchial lung biopsy and by skin biopsy also showed non-caseating epithelioid-cell granulomas . After resection of the spermatic cord, the activity of angiotensin-converting enzume was 29.9 IU/L, which was above the reference range . Systemic sarcoidosis with involvement of the spermatic cord was diagnosed . Because he had no respiratory symptoms and his skin lesions resolved without treatment, he is currently under observation and is not receiving corticosteroid therapy.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Mar, 35(3), 267 - 72
{Tuberculosis in patients with human immunodeficiency virus infection}; Nagai H et al.; Six men (mean age: 36.3 +/- 29 years) infected with the human immunodeficiency virus (HIV), four Japanese and two from Myammar, were admitted to our hospital for treatment of tuberculosis . In five, HIV positivity on serologic testing was first found when tuberculosis was diagnosed . The mean CD4 cell count was 37.3 +/- 29.6/microliters . Results of tuberculin skin tests were negative in 5 patients . One patient had pulmonary tuberculosis and 5 had miliary tuberculosis . Hilar and mediastinal lymphadenopathy was found on chest X-ray films in 4 patients and superficial lymphadenopathy was found in all patients . All patients had positive mycobacterial cultures of sputum and 2 patients had positive tests for acid-fast bacilli on smears of lymph-node aspirates . In one patient with tuberculosis meningitis, a culture of cerebrospinal fluid for acid-fast bacilli was positive . Epithelioid cell granulomas were found in samples of lung, liver, and bone marrow from 4 patients . Mycobacterium tuberculosis was isolated from all patients, and was not resistant to isoniazid, rifampicin, ethambutol, or streptomycin . Therefore all patients responded well to treatment of tuberculosis.

J Am Mosq Control Assoc, 1997 Mar, 13(1), 18 - 23
Evaluation of Caribbean strains of Macrocyclops and Mesocyclops (Cyclopoida:Cyclopidae) as biological control tools for the dengue vector Aedes aegypti; Rawlins SC et al.; Fifteen Caribbean strains of copepods were assessed for their predation ability against mosquito larvae . Macrocyclops albidus from Nariva . Mesocyclops aspericornis from Oropouche, and Mesocyclops longisetus from E1 Socorro, Trinidad, were most effective against Aedes aegypti but not against Culex quinquefasciatus . Mesocyclops longisetus and Me . aspericornis prevented any mosquito survival over 25 wk of observation despite weekly challenges with Ae . aegypti . The copepods were tolerant to dosages of the insecticide temephos that are usually toxic to mosquito larvae . This indicated that copepods could be incorporated into an integrated control system . To determine whether pathogenic microbes might be introduced with copepods into drinking water, microbial studies were done on the copepods . These showed the presence of only Aeromonas sobria, Pseudomonas sp., Alcalignes sp., and gram-positive bacilli . Although none of these are highly pathogenic to humans, the application of these copepods has not yet been recommended for use in drinking water.

J Med Microbiol, 1997 Mar, 46(3), 260 - 2
Transportation of lymph node biopsy specimens in selective Kirchner's liquid medium for culture of tubercle bacilli; Vanajakumar et al.; Lymph node biopsy specimens, obtained from 297 paediatric and adult patients with tuberculous lymphadenitis at Madurai, were transported in selective Kirchner's liquid medium (KL-T) to the Tuberculosis Research Centre, Madras and processed for culture . Mycobacterium tuberculosis was isolated from 201 (68%) specimens . Of the 192 specimens received within 4 days of resection, 134 (69.8%) yielded M . tuberculosis on culture and of the 105 specimens received after 5 days, 67 (63.8%) were culture positive; the difference was not statistically significant . By incubating KL-T alone further, after removing the gland for processing, it was found that mere contact with the excised node during transportation was enough to retrieve 77 (38.3%) of the total of 201 positive isolates obtained, the delay did not affect the culture positivity rate . Thus, lymph node specimens for culture of tubercle bacilli can be stored in the refrigerator for up to 15 days and transported in KL-T at ambient temperature for 18-20 h without any loss in culture positivity.

Urology, 1997 Mar, 49(3), 363 - 6
Incidence of granulomatous prostatitis and acid-fast bacilli after intravesical BCG therapy; LaFontaine PD et al.; OBJECTIVES: To determine the incidence of granulomatous prostatitis and acid-fast bacilli (AFB) after intravesical bacillus Calmette-Guerin (BCG) therapy for superficial bladder transitional cell carcinoma (TCC) or carcinoma in situ (CIS) . METHODS: One hundred nineteen men underwent radical cystoprostatectomy for invasive bladder cancer from January 1, 1980 through December 31, 1995 . Twelve patients had received intravesical BCG therapy before undergoing cystoprostatectomy . Nine men who did not receive intravesical BCG therapy before undergoing cystoprostatectomy served as controls . The surgical specimens were examined with a Ziehl-Neelsen stain for the presence of granulomatous prostatitis and for the presence of AFB . RESULTS: Granulomatous prostatitis was identified in 9 of 12 patients (75%) who had received intravesical BCG therapy . AFB were identified in 7 of 9 patients (77%) with granulomatous prostatitis . CONCLUSIONS: Pathologic evidence of granulomatous prostatitis with AFB is a common occurrence after intravesical BCG therapy and its incidence is far greater than the reported incidence of symptomatic granulomatous prostatitis . AFB discovered during the evaluation of either an increased level of prostate-specific antigen or prostate nodule in otherwise asymptomatic men may require no specific therapy.

Acta Cytol, 1997 Mar-Apr, 41(2), 348 - 50
Cytomorphologic patterns in Calmette Guerin bacillus lymphadenitis; Gupta K et al.; OBJECTIVE: To study the cytomorphologic patterns of Calmette Guerin bacillus (BCG) lymphadenitis and compare it to those of tuberculous lymphadenitis . STUDY DESIGN: A retrospective cytomorphologic study of 136 cases of clinically diagnosed BCG adenitis . All fine needle aspiration smears of lymphadenitis in the age group 2 months to 2 years during a three-and-half-year period were analyzed . RESULTS: Three distinct cytomorphologic patterns were seen in 112 cases . They were acid-fast bacilli in a necrotic background (62), granulomas with necrosis (47) and granulomas in a reactive lymphoid background (3) . CONCLUSION: The cytomorphologic patterns in BCG lymphadenitis were similar to those seen in tuberculous lymphadenitis; however, an exudative response and high acid-fast bacillus positivity was seen more frequently in BCG lymphadenitis . Moreover, Ziehl-Neelsen staining helped to distinguish these cases from pyogenic abscesses.

Clin Chest Med, 1997 Mar, 18(1), 115 - 22
Short-course chemoprophylaxis for tuberculosis; Bishai WR et al.; The current practice of using INH for tuberculosis prevention is limited by the necessity for at least 6 months of therapy and the problem of INH-induced hepatitis, particularly in older individuals and those with chronic liver disease . Bacteriologic models suggest that, in their persistent form, tubercle bacilli are relatively resistant to INH but become more sensitive to other drugs . Similarly, animal models of latent tuberculosis have suggested that alternative, short-course combinations such as RIF/PZA may be effective, and clinical trials of that two-drug regimen are continuing . At the present time, 3 months of daily RIF, 2 months of RIF/PZA, and 3 months of rifabutin can be considered reasonable alternatives to INH in selected patients . Routine use of these agents in preference to INH cannot yet be endorsed, however, as the standard of care . Without highly effective vaccines for tuberculosis, an important strategy for breaking the cycle of tuberculosis transmission lies in inexpensive, convenient, and effective preventive therapy.

Ann Surg, 1997 Mar, 225(3), 317 - 26
Role of bacterial adherence and the mucus barrier on bacterial translocation: effects of protein malnutrition and endotoxin in rats; Katayama M et al.; OBJECTIVE: The purpose of the study was to investigate the potential relations between mucosal bacterial adherence, intestinal mucus and mucin content, and bacterial translocation . SUMMARY BACKGROUND DATA: The attachment of bacteria to mucosal surfaces is the initial event in the pathogenesis of most bacterial infections that originate at mucosal surfaces, such as the gut . The intestinal mucus layer appears to function as a defensive barrier limiting micro-organisms present in the intestinal lumen from colonizing enterocytes . Consequently, studies focusing on the biology of bacterial adherence to the intestinal mucosa likely are to be important in clarifying the pathogenesis of gut origin sepsis . METHODS: To explore the relations between intestinal bacterial adherence, mucus bacterial binding, and bacterial translocation, two models were used . One (protein malnutrition) in which profound alterations in intestinal morphology occurs in the absence of significant translocation and one (endotoxin challenge) in which bacterial translocation occurs and intestinal morphology is relatively normal . RESULTS: Protein malnutrition was not associated with bacterial translocation and measurement of enteroadherent, mucosally associated bacterial population levels documented that the total number of gram-negative enteric bacilli adherent to the ileum and cecum was less in the protein-malnourished rats than in the normally nourished animals (p < 0.01) . Furthermore, there was an inverse relation between the duration of protein malnutrition and bacterial adherence to the intestinal mucosa (r = 0.62, p < 0.002) . In contrast, after endotoxin challenge, the level of enteroadherent bacteria was increased and bacterial translocation was observed . The binding of Escherichia coli to immobilized ileal mucus in vitro was decreased significantly in protein-malnourished rats, whereas E . coli binding to insoluble ileal mucus was increased in the rats receiving endotoxin . CONCLUSIONS: This study indicates that the adherence of bacteria to the intestinal mucosal surface is an important factor in bacterial translocation, that intestinal mucus modulates bacterial adherence, and that increased levels of mucosally associated bacteria are associated with a loss intestinal barrier function to bacteria.

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