Bacillus

Antimicrob Agents Chemother, 1997 Mar, 41(3), 578 - 82
In vitro susceptibilities of Bartonella henselae, B . quintana, B . elizabethae, Rickettsia rickettsii, R . conorii, R . akari, and R . prowazekii to macrolide antibiotics as determined by immunofluorescent-antibody analysis of infected Vero cell monolayers; Ives TJ et al.; The in vitro susceptibilities of Bartonella (Rochalimaea) henselae, B . quintana, B . elizabethae, Rickettsia akari, R . conorii, R . prowazekii, and R . rickettsii to different concentrations of azithromycin, clarithromycin, dirithromycin, erythromycin, and roxithromycin in Vero cell cultures were evaluated . Bartonella and Rickettsia spp . were allowed to initiate infection of the antibiotic-free Vero cell monolayers, which were maintained in 16-chamber microscope slides in the absence of antibiotics at 32 degrees C in a CO2-enriched atmosphere . The monolayers were then incubated for 3 h to allow for initial host cell intracellular penetration by infecting species . After inoculation, inocula were replaced and tested with media containing 12 different concentrations of each antibiotic in replicate (10 wells of each antibiotic dilution) for each species, and the monolayers were reincubated . Tetracycline served as the control . Growth status of Bartonella spp . and Rickettsia spp . was determined by evaluation of immunofluorescent staining bacilli . Five days later, when antibiotic-free, control-infected cell monolayers demonstrated significant fluorescence, media were removed for all cell monolayers, the monolayers were fixed, and all specimens were stained with standard indirect immunofluorescent antibody reagents . Fluorescent foci were enumerated by counting such foci on random fields visualized with an epifluorescence microscope . The extent of antibiotic-induced focus inhibition was recorded for each dilution of antibiotic and compared with that of an antibiotic-negative control . Effective antibiotic dilution endpoints for inhibition of Bartonella and Rickettsia proliferation, as judged by absence of increase of significant fluorescence (as compared with no-growth controls), were enumerated by determining the number of cell culture chambers at various antibiotic dilutions that were negative or positive for significant Bartonella- or Rickettsia-specific fluorescence . All of the macrolide agents tested were readily active against all three Bartonella organisms, and azithromycin, clarithromycin, and roxithromycin may have potential in the treatment of Rickettsia infections . Animal model-based clinical trials are warranted to define the specific treatment role of the newer macrolide antibiotics.

Am J Clin Pathol, 1997 Mar, 107(3), 317 - 20
Fine-needle aspiration of peripheral lymph nodes in patients with tuberculosis and HIV; Lapuerta P et al.; Previous studies of fine-needle aspiration (FNA) specimens from lymph nodes of patients with tuberculosis (TB) and infection with the human immunodeficiency virus (HIV) have often involved small numbers of specimens and have produced conflicting results . We reviewed 93 FNA specimens from peripheral lymph nodes in a consecutive series of 79 patients with TB to compare results for patients with and without HIV infection . The 45 patients with HIV infection in the series were more frequently male, more likely to have negative results on a purified protein derivative tuberculin skin test, and they had more disseminated disease . Granulomatous inflammation, a positive result on a culture, acid-fast bacilli, or necrosis was found in 71% of the studies . Identification of granulomatous inflammation occurred at a similar rate in FNA specimens from patients with HIV infection (16%) and without HIV infection (21%; P = .56) . Necrosis was the sole reported finding in a significant subset of cases (16%), occurring in patients with and patients without HIV infection . FNA of peripheral lymph nodes of patients with TB was an effective diagnostic test . Granulomatous inflammation and other FNA findings in peripheral lymph nodes of patients with TB were similar in those with and those without HIV infection.

J Immunol, 1997 Feb 15, 158(4), 1742 - 8
Differential responses to challenge with live and dead Mycobacterium bovis Bacillus Calmette-Guérin; Chambers MA et al.; Bacillus Calmette-Guerin (BCG) vaccination has been shown to protect against challenge with virulent Mycobacterium tuberculosis in a range of experimental animal models: in each case, protective efficacy requires vaccination with live bacteria . With the goal of moving to a new generation of safer, nonliving vaccines, efforts have been made to identify the factors that determine the efficacy of live vaccination . We show that injection of live, but not dead, BCG induces localized swelling in the mouse footpad model . Live and dead bacteria induce similar responses during the first week after vaccination as determined by immunohistochemical analysis of the site of injection and of the draining lymph node . The subsequent differential response is characterized by migration of acid-fast bacilli to the draining lymph node in the case of the live vaccine . This is accompanied by an increase in mononuclear cells in the lymph node and by expression of inducible nitric oxide synthase (iNOS) both in the lymph node and at the site of injection . The ability of the bacteria to migrate to the lymph node may be an important element in the efficacy of live BCG vaccination.

Ryumachi, 1997 Feb, 37(1), 36 - 41
{A case with systemic lupus erythematosus complicated with tuberculosis sacroiliac arthritis}; Sugiyama K et al.; A 26-year-old woman was admitted to our hospital because of fever of unknown origin . She had been treated with prednisolone, elcatonin and alfacalcidol under the diagnosis of systemic lupus erythematosus (SLE) and aseptic necrosis of femoral bone head . Six months ago she began to have a fever and subsequently left low back pain, for which extensive examinations were performed in other hospital but their causes remained unclear . She was referred to our hospital for further evaluation and therapy in October 1995 . Bacteriological, immunological or serological examinations did not reveal the origin of fever . CT and ultrasonic examination did not show any abnormality . However, MRI, which was taken for the evaluation of aseptic necrosis of femoral bone head, showed the abscess shadow in sacroiliac joint . Open biopsy was performed and Mycobacterium tuberculosis bacilli were detected from the abscess . To our best knowledge, this is the first report of SEE with tuberculosis sacroiliac arthritis.

Postgrad Med J, 1997 Feb, 73(856), 89 - 92
Tropical liver abscess; Yeoh KG et al.; Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed . Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate . The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type . The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae . Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material . As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin . Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications . We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses . We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.

Infect Control Hosp Epidemiol, 1997 Feb, 18(2), 136 - 7
A pseudo-outbreak of Mycobacterium chelonae infections related to bronchoscopy; Cox R et al.; Mycobacterium gordonae and rapidly growing "atypical" mycobacteria including Mycobacterium chelonae are commonly found in tap water . This article describes a pseudo-outbreak of M chelonae infections related to bronchoscopy . Because patients may be treated and isolated unnecessarily when positive with acid-fast bacilli before the species are known, the financial burden for patients and hospitals may be great.

Kekkaku, 1997 Feb, 72(2), 99 - 107
{Saprophytic and invasive pulmonary aspergillosis}; Nagai H; The characteristics of chest x-ray films in 19 patients with saprophytic pulmonary aspergillosis secondary to acid-fast bacilli infection were reported . The saprophytic form, exemplified by the classic fungus ball or mycetoma, results from the growth of fungal mycelia within a pre-existing area of destroyed lung, typically a pre-existing cavity such as that resulting from tuberculosis . Aspergillus fumigatus was detected in 52.6% of sputum cultures from 19 patients . Aspergillus precipitin test was positive in 68.4% of patients . Thickening of cavitary walls was first found in 85% of chest x-ray films . Eighty percent of patients had pulmonary aspergillosis within 3 years after cavitary lesions were stable . Invasive pulmonary aspergillosis (IPA) is characterized by hyphal invasion and destruction of pulmonary tissue . The risk of acquiring IPA correlates with the duration and degree of immunosuppression or neutropenia . IPA recently has been encountered in patients with human immunodeficiency virus (HIV) infection . The number of case reports on chronic necrotizing pulmonary aspergillosis is increasing, but it is supposed the clinical entity of this disease still has not been established.

Kekkaku, 1997 Feb, 72(2), 73 - 7
{A case of acquired immunodeficiency syndrome with disseminated Mycobacterium avium complex infection in which M . avium was isolated from bone marrow}; Ohse H et al.; A 46-year old man was admitted to a hospital because of cough and dyspnea . He was diagnosed as interstitial pneumonia and was treated with prednisolone (PSL) and antibiotics . The symptoms improved temporarily but he soon developed acute respiratory failure and was transferred to our hospital . Chest X-ray and CT revealed ground-glass opacities in both lung fields . He was treated with methyl PSL, antibiotics, and antimycobacterial drugs but he died on the fourth hospital day . Retrospectively, hematologic laboratory examinations revealed that CD4+ cell count was 0/microliter and serological tests for HIV were positive by both EIA and Western blot methods . The culture of the bone marrow specimens was positive for mycobacteria other than M . tuberculosis, and the bacilli were identified as Mycobacterium avium . Thus, his disease was eventually diagnosed as disseminated Mycobacterium avium complex (MAC) infection . In the past reports, the diagnosis of disseminated MAC infection was most often made by blood cultures, however, the isolation of MAC from bone marrow is another sensitive and specific method for the diagnosis of this infection . In some cases, bone marrow examination would be useful to diagnose disseminated MAC infection.

Kekkaku, 1997 Feb, 72(2), 67 - 72
{Clinical course of HIV-infected tuberculosis patients who admitted to the tuberculosis isolation ward: current problems of medical care}; Fujita A et al.; To clarify the problems of medical care of HIV-infected tuberculosis patients, we investigated clinical course of six cases admitted to our tuberculosis isolation ward . All cases were sputum smear positive for tubercle bacilli at the time of diagnosis of tuberculosis . HIV-positive was confirmed at the same time or soon after the diagnosis of tuberculosis in four cases . CD4+ cell count was on the average 21/mm3 on admission, and all cases were defined as acquired immunodeficiency syndrome (AIDS) by the criteria of AIDS surveillance committee in Japan . Two patients presented with miliary tuberculosis and five documented evidence for intrathoracic and/or cervical lymph node involvement . All cases but one responded well to antituberculosis drugs, and sputum smears and cultures became negative soon after the initiation of therapy . However, the patients were still needed to be hospitalized for the treatment and control of complications other than tuberculosis after sputum negative conversion, and they stayed in the isolation rooms of our tuberculosis ward for 110 +/- 49 days . During the treatment for tuberculosis, each patient developed 3 to 8 complications of HIV infection such as pneumocystis carinii pneumonia (PCP) (four cases), bacterial infection (four cases), neuropathy (four cases), and HIV encephalopathy (three cases) . The last two complication worsened active daily life . White blood cell count was more likely to fall when sulfamethoxazole/trimethoprim mixture for the prevention of PCP and antituberculosis drugs were administered together . In three cases, ST mixture could not be continued, then two patients developed PCP after changing to an alternative pentamidine inhalation . Although three patients discharged from our tuberculosis ward, four died of AIDS related complications other than tuberculosis, one died of tuberculosis (multidrug-resistant M . tuberculosis strain was not documented initially but was detected five months later), one died of tuberculosis meningitis after the discharge, and one was lost because he returned to his own country . The survival time between the start of treatment and death ranged from 90 to 244 days in five cases . Integrated medical care system both for HIV and tuberculosis is warranted for the management of HIV-infected tuberculosis patients since they suffer many complication in addition to tuberculosis . A guideline of methods and duration of isolation for tuberculosis is needed for the most effective care of HIV-infected tuberculosis patients in Japan.

Histopathology, 1997 Feb, 30(2), 129 - 34
Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid; Hara K et al.; We present five cases of granulomatous phlebitis of the skin and compare them with a case of miliary tuberculosis with granulomatous phlebitis . All five patients were hypersensitive to purified protein derivative, but without active tuberculosis . Although anti-tuberculous drugs were effective, no tubercle bacilli were isolated from the skin . Clinically, subcutaneous nodules were felt along the course of the leg vein . Histologically, epithelioid cell granulomas with Langhans' giant cells were observed within the walls of the cutaneous veins . In a later stage, granulomatous panniculitis was often associated . Using the polymerase chain reaction method . Mycobacterium tuberculosis DNA was detected in four of the five cases of granulomatous phlebitis of the skin . Granulomatous phlebitis of the skin seems to represent a relatively early phase of delayed-type hypersensitivity reactions to Mycobacterium tuberculosis and may represent a distinct entity different from other types of tuberculid-a new tuberculid . Nevertheless, before making the diagnosis, the possibility of true tuberculosis must always be excluded . Nodular granulomatous phlebitis of the skin would be an appropriate name for the newly described condition.

J Natl Med Assoc, 1997 Feb, 89(2), 142 - 3
Elevation of carcinoembryonic antigen and CA-125 in a patient with multivisceral tuberculosis; Mansour M et al.; A case of a middle-aged African-American woman with weight loss, ascites, a bilateral pleural effusion with no infiltrate, and a clinical diagnosis of a metastatic gynecological tumor is presented . Her carcinoembryonic antigen (CEA) and CA-125 levels were elevated (400 micrograms/L and 331 micrograms/L, respectively) . She underwent an exploratory laparotomy and a dilation & curettage for biopsies and cultures . Pathological examination showed Langhans' type giant cells on peritoneal biopsy . An endometrial curette biopsy showed granulomatous endometritis and acid-fast bacilli . Cultures grew Mycobacterium tuberculosis . The patient presented with a fibroid tumor that could have contributed to her elevated CA-125 level, but after antituberculous treatment was started and tumor markers were repeated after 1 year, the CEA level decreased to 1.2 micrograms/L and CA-125 to 9 micrograms/L without surgical resection of the tumor . A review of the literature revealed only three cases in which patients had elevated CA-125 in multivisceral tuberculosis . No cases were reported in which both CEA and CA-125 levels were elevated in multivisceral tuberculosis . Possible causes of elevated CEA and CA-125 levels are discussed.

Am J Clin Pathol, 1997 Feb, 107(2), 224 - 8
Evaluation of cultures of percutaneous core needle biopsy specimens in the diagnosis of pulmonary nodules; Chitkara YK; The value of cultures of tissue obtained by image-directed core needle biopsy of lung nodules has not been determined . Of the 250 biopsies performed during a 5-year period in an area endemic for coccidioidomycosis, 225 (90%) were diagnostic . Granulomas were identified in 75 specimens, whereas 3 specimens revealed abscess . Ziehl-Neelsen stain was positive for acid-fast bacilli (AFB) in 2 cases . Spherules of Coccidioides immitis were seen in 54 of the biopsy specimens with granulomas . Microbiologic cultures were positive for C immitis in 5 (9.6%) of 52 biopsy specimens . Both of the AFB-positive cases were negative by culture . Organisms were demonstrated in cases with abscess; however, the cultures submitted in 2 cases were negative . Cultures were uniformly negative in cases where special stains failed to reveal organisms . Cultures of core needle biopsy specimens are insensitive in the detection of specific microorganisms and need not be routinely performed.

Infect Immun, 1997 Feb, 65(2), 387 - 94
Analysis of culture filtrate and cell wall-associated antigens of Mycobacterium paratuberculosis with monoclonal antibodies; Mutharia LM et al.; Proteins secreted by Mycobacterium species have been suggested as major immune targets in the early phase of infection . In this study, we sought to identify specific antigens in culture filtrates and in soluble cell extracts of Mycobacterium paratuberculosis . The release of antigens into the culture medium during growth of the bacilli and the distribution of specific epitopes within the Mycobacterium species were investigated by immunoblot analysis with monoclonal antibodies (MAbs) raised against M . paratuberculosis antigens . MAb B6A interacted with a cellular antigen with an apparent molecular mass of 34.5 kDa in lysates of M . paratuberculosis . MAb B6A did not interact with lysates from any other mycobacterial species, suggesting recognition of an M . paratuberculosis species-specific epitope . MAb FL1-A1 reacted with an antigen of 44.3 kDa in M . paratuberculosis and a 9-kDa antigen in Mycobacterium kansasii . MAb PII-B1 reacted with concanavalin A (ConA)-binding cellular and filtrate molecules of M . paratuberculosis and with lysates of Mycobacterium kansasii and Mycobacterium avium 18 . The affinity-purified glycosylated antigens migrated as a diffuse band of between 35 and 45.6 kDa and reacted strongly with ovine and bovine paratuberculosis serum and polyclonal serum against M . tuberculosis lipoarabinomannan antigens . These glycoconjugates were the earliest antigens detected in culture filtrates of M . paratuberculosis . Deglycosylation of the ConA-binding molecules with alpha-mannosidase enzyme abolished the reaction with MAb PII-B1 and with bovine but not ovine paratuberculosis serum, suggesting selective immunogenicity in the different animal species.

J Clin Microbiol, 1997 Feb, 35(2), 364 - 8
Comparison of the Mycobacteria Growth Indicator Tube (MGIT) with radiometric and solid culture for recovery of acid-fast bacilli; Pfyffer GE et al.; In a multicenter study involving three reference centers for mycobacteria, the rate of recovery of acid-fast bacilli (AFB) and the mean time to their detection from clinical specimens was determined by using the Mycobacteria Growth Indicator Tube (MGIT) . These parameters were compared to those assessed by the radiometric BACTEC 460 TB system and by cultivation on solid media . Clinical specimens (n = 1,500) were pretreated with N-acetyl-L-cysteine (NALC)-NaOH . The contamination rates for MGITs were 2.0% (center 1), 13.8% (center 2), and 6.1% (center 3) . A total of 180 mycobacterial isolates were detected (M . tuberculosis complex, n = 113; nontuberculous mycobacteria {NTM}, n = 67) . When using a combination of liquid and solid media (the current "gold standard" for culture), MGIT plus solid media detected 156 (86.7%) of the isolates, whereas BACTEC plus solid media recovered 168 (93.3%) of all AFB . Between these two gold standards there was no statistically significant difference (P > 0.05) . The combination of MGIT plus BACTEC detected 171 (95.0%) of all isolates (compared with MGIT plus solid media, P < 0.01; compared with BACTEC plus solid media, P > 0.05) . Considering the efficacies of the different media separately, MGIT was superior to solid media (although not significantly; P > 0.05) in detecting AFB but was inferior to the BACTEC system (P < 0.01) . The mean time to the detection of M . tuberculosis complex was 9.9 days with MGIT, 9.7 days with BACTEC, and 20.2 days with solid media . NTM needed, on average, 11.9, 13.0, and 22.2 days to appear by the three methods, respectively . In conclusion, MGIT proved to be a valuable alternative to the radiometric cultivation system.

J Urol, 1997 Feb, 157(2), 492 - 8
Evolution and clinical significance of the T cell proliferative and cytokine response directed against the fibronectin binding antigen 85 complex of bacillus Calmette-Guerin during intravesical treatment of superficial bladder cancer; Zlotta AR et al.; PURPOSE: The antitumorigenic effect of intravesical bacillus Calmette-Guerin (BCG) in superficial bladder cancer was reported to be initiated by the attachment of BCG to the bladder wall via fibronectin . The antigen 85 complex secreted in BCG culture filtrate binds specifically to fibronectin and is a powerful T cell stimulus . Therefore, we investigated the evolution and clinical significance of the cellular proliferative response and cytokine production during intravesical BCG therapy against this purified antigen 85 complex . MATERIALS AND METHODS: Evolution of the lymphoproliferation, interleukin-2 and interferon-gamma production of peripheral blood lymphocytes against tuberculin (purified protein derivative), purified antigen 85, BCG culture filtrate, whole BCG bacilli and pokeweed mitogen was tested before and after 6 weekly intravesical BCG instillations in 29 patients with superficial bladder cancer at intermediate or high risk for recurrence . RESULTS: A major increase in the lymphoproliferative response against purified protein derivative, antigen 85, BCG culture filtrate, whole BCG and pokeweed mitogen was observed in 69.0, 65.5, 79.3, 48.3 and 65.3% of the patients, respectively, analyzed after BCG therapy . Reactivity returned to baseline values at 6 months of followup . Of the patients who received a second BCG course because of tumor recurrence 66% had a novel increase in lymphoproliferation against antigen 85 . An increase in the production of interleukin-2 and interferon-gamma by peripheral lymphocytes against antigen 85 was noted in 42.1 and 50% of the treated patients, respectively, after a single BCG course . During a mean followup of 23.11 months 48.5% of the patients remained tumor-free . No correlation could be found between the immunological response against any of the BCG antigens and the clinical evolution of the response . CONCLUSIONS: Intravesical BCG instillations induce a transient (less than 6 months) peripheral immune activation against several purified BCG antigens and among them the fibronectin binding antigen 85 complex . Reactivation is observed in most cases after additional BCG courses . The absence of long lasting immune activation after a single 6-week course of BCG could be related to the increased clinical efficacy observed with BCG maintenance instillations.

Schweiz Rundsch Med Prax, 1997 Jan 21, 86(4), 98 - 101
{Therapy of spontaneous bacterial peritonitis}; Grater H; The outcome of untreated spontaneous bacterial peritonitis (SBP) is fatal . In the onset of SBP clinical manifestations may be subtle, therefore every patient with hepatogenic ascites has to be examined for SBP at admission . If polynuclear cell count in ascitic fluid exceeds 250/microliter, antibiotic therapy has to begin immediately, until irreversible complications develop . Aerobic gram-negative bacilli of the normal intestinal flora are responsible for most cases of SBP, followed by gram-positive organisms and anaerobes . Antibiotic agents with extended spectrum, such as third-generation cephalosporins are considered the drugs of choice for SBP . In severe cases combination with metronidazole is recommended . As soon as repeated paracenteses show polynuclear cells beyond 250/microliter, the antibiotic therapy can be stopped . Selective decontamination of the gut with norfloxacin is effective to prevent SBP in high-risk patients . Trimethoprim-sulfamethoxazole is superior due to its activity even against gram-positive organisms . Overall prognosis of patients with SBP, however, is determined mainly to complications specific for cirrhosis, e.g . variceal bleeding, coma etc.

Dtsch Med Wochenschr, 1997 Jan 17, 122(3), 51 - 3
{Cervical lymphadenitis in an immunocompetent patient: Mycobacterium gordonae as the cause?}; Fleisch F et al.; HISTORY AND FINDINGS: A 76-year-old man went to an ENT outpatient clinic because of stabbing pain in the left throat and difficult swallowing . He was found to have tonsillitis on the left and cervical lymphadenitis . The symptoms regressed on treatment with amoxycillin and clavulanic acid, but the cervical lymphadenitis persisted . Fine-needle biopsy of the cervical swelling was not diagnostic . Computed tomography of the neck showed an encapsulated liquid space-occupying lesion with infiltration of surrounding soft tissues . TREATMENT AND COURSE: The cervical lymph-node mass was excised and histologically found to contain epithelioid granulomas with a few giant cells and scattered centrally caseous necroses . Tuberculostatic treatment was started; drainage fluid from the wound grew acid-fast bacilli, identified by gene probe as Mycobacterium gordonae . CONCLUSIONS: Mycobacterium gordonae is ubiquitous in the environment and is being identified ever more frequently in microbiological laboratories, usually as contaminant . It rarely causes infections of soft tissues and the lungs or systemically.

Lancet . 1997 Jan 4;349(9044):31.
Finger clubbing and HIV infection in Malawian children; Graham SM et al.; PIP: While it is unusual for children to present with finger clubbing, the authors began to frequently see such cases in the University of Malawi's Department of Pediatrics, College of Medicine . Clubbing was recognized in 52 children during February-May 1996 . An 8-year-old boy died with a diagnosis of endomyocardial fibroelastosis . The remaining 51 children were aged 4 months to 12 years of mean age 37 months . 26 of the 31 children tested for infection with HIV were HIV-ELISA seropositive . A clinical diagnosis of pediatric AIDS according to the World Health Organization criteria was made in 35 cases . A provisional diagnosis of pulmonary tuberculosis was made in 29 . Two of the older children had acid-fast bacilli in sputum; one was HIV-positive . Digital clubbing in Malawian children may be associated with chronic lung disease and HIV infection, presenting as early as infancy . In regions where childhood HIV infection is common and resources are scarce, clinical findings which improve diagnostic specificity could prove useful .

Bull Soc Pathol Exot, 1997, 90(2), 75 - 7
{A case of Mycobacterium shimoïdei lung infection in Madagascar}; Auregan G et al.; In 1980, a 32 years-old Madagascan female developed a pulmonary tuberculosis, bacteriologically confirmed . She cured with right apical cavitary sequellae . In 1989, she presented haemoptysis again . Antituberculous treatment was adopted without bacteriological confirmation and did not improve clinical symptoms . In 1991 and 1992 cultures from sputa and bronchi aspiration yielded acid-fast bacilli identified as Mycobacterium shimoidei . M . tuberculosis could not be detected . The patient died during treatment . This case is the fourth one in the literature . Whereas previous cases have been reported in Europe, Australia, Asia, this new case shows M . shimoidei is also present in Africa.

J Gynecol Obstet Biol Reprod (Paris), 1997, 26(4), 367 - 73
{Peritoneal tuberculosis . Value of laparoscopy}; Kasia JM et al.; We report 6 cases of tuberculous peritonitis, focusing on the contribution of laparoscopic exploration . The initial diagnosis was erroneus in all cases: the polymorphous clinical presentations suggested another infectious disease or cancer disease . Laparoscopy was performed in 5 patients who had ascitis and in 1 with plastic peritonitis . At laparoscopy, the peritoneum showed miliary granulations and inflammatory adherences on the visceral or parietal sheats . Bacteriological analyses of the ascitic fluid were positive in only one case . The diagnosis was confirmed after culture of biopsy specimens and identification of the Kock bacilli or on the basis of objective evidence of an epithelioid giant-cell granuloma with caseous necrosis . Outcome was favorable after appropriate antibiotic therapy.

Respiration, 1997, 64(4), 300 - 3
Pulmonary infection due to Mycobacterium gordonae in an adolescent immunocompetent patient; Resch B et al.; We report the case of 17-year-old male adolescent immunocompetent patient with an operated transposition of the great arteries after the Mustard technique admitted to our hospital because of a cough and hemoptysis . Two nodules and an area of ground glass appearance located in the lower lobe of the left lung were diagnosed by ultrafast computed tomography (UF-CT) after ruling out cardiovascular complications . The gastric aspirate revealed acid-fast bacilli despite a repeatedly negative tuberculin skin test identified as Mycobacterium gordonae by the Gen-Probe Rapid Diagnostic Test . After an initial standard antimycobacterial therapy with isoniazid, rifampin and pyrazinamide the therapy was changed to clarithromycin and after a treatment course of 14 days, the UF-CT revealed a normal scan of both lungs . The case described suggests that one has to consider M . gordonae as a rare cause of infection even in immunocompetent patients.

Scand J Infect Dis, 1997, 29(3), 297 - 300
Influence of low dose ciprofloxacin on microbial colonization of the digestive tract in healthy volunteers during normal and during impaired colonization resistance; van de Leur JJ et al.; Ciprofloxacin in low doses is, in volunteers, effective for decontaminating the digestive tract {elimination of aerobic Gram-negative bacilli (GNB)} without disturbing colonization resistance . Before using this concept in neutropenic patients, we investigated if a low dose quinolone is still effective when the colonization resistance is disturbed by another antimicrobial agent . Ciprofloxacin 20 mg daily was effective in eliminating Gram-negative bacilli from the digestive tract in 4/5 volunteers, in 1 volunteer the GNB persisted in low concentration . No colonization with exogenous resistant GNB occurred . Following impairment of colonization resistance by addition of clindamycin 300 mg daily, 3/5 volunteers became colonized by spontaneously acquired exogenous GNB resistant to ciprofloxacin . We conclude that selective decontamination with a quinolone in low dosage cannot be recommended in neutropenic patients because there is, in the case of disturbed colonization resistance, a real risk of acquisition of quinolone-resistant strains.

J Hepatol, 1997 Jan, 26(1), 88 - 95
Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination . A retrospective study of 229 spontaneous bacterial peritonitis episodes; Llovet JM et al.; BACKGROUND/AIMS: Selective intestinal decontamination with norfloxacin is widely used to prevent spontaneous bacterial infections in cirrhosis . The study was performed to compare the spontaneous bacterial peritonitis occurring in patients with and without prophylactic norfloxacin . METHODS: Two hundred and twenty-nine consecutive episodes of spontaneous bacterial peritonitis, (193 in patients without (Group A) and 36 in patients with norfloxacin prophylaxis (Group B)), were retrospectively analyzed . In 100 episodes (86 and 14, respectively), the responsible organism was isolated in ascitic fluid . RESULTS: Clinical and laboratory data at diagnosis were comparable in both groups . There were marked differences (p < 0.001) between group A and B in the frequency of peritonitis caused by gram-negative (67.4% vs . 14.3%) and gram-positive (30.2% vs . 78.6%) bacteria . There were three polymicrobial episodes . Bacteria resistant to cefotaxime and gram-negative bacilli resistant to quinolones were isolated in ascitic fluid in nine (seven in Group A and two in Group B) and three episodes (all in Group A), respectively . No differences in the course of infection and patient survival were observed between groups . CONCLUSIONS: Spontaneous bacterial peritonitis in patients with and without prophylaxis with norfloxacin are not different in clinical features, response to treatment and prognosis . Spontaneous bacterial peritonitis caused by gram-negative organisms resistant to quinolones is extremely uncommon in patients with cirrhosis receiving prophylactic norfloxacin.

Indian J Pathol Microbiol, 1997 Jan, 40(1), 51 - 4
Cultivation of Mycobacterium tuberculosis from pleural tissue and its histopathology in suspected cases of tuberculous pleural effusion; Katiyar SK et al.; The majority of idiopathic pleural effusion are considered to be of tuberculous etiology . The culture of bacilli provide most authentic evidence of disease process . This study was carried out on 21 cases of suspected tuberculous pleural effusion . The pleural fluid and tissue was subjected for smear examination, and cultivation of tubercle bacilli along with pleural biopsy . Overall the diagnosis could be made out of 8 (38.09%) cases . The cultivation of Mycobacterium tuberculosis from pleural tissue was more sensitive (33.33%) as compared to histopathology (19.05%) . However, the triad of cultivation of Mycobacterium tuberculosis from pleural tissue, pleural histopathology and pleural fluid smear examination or culture should be done in each suspected case of tuberculous effusion.

Z Kardiol, 1997 Jan, 86(1), 15 - 9
{Isolated tuberculosis of the heart: a clinical and echocardiography follow-up}; Immer FF et al.; A case of isolated right ventricular myocardial tuberculoma with pericardial effusion is presented . The diagnosis of myocardial tuberculoma was initially suggested by echocardiography and later by magnetic resonance imaging . The diagnosis of cardiac tuberculosis was confirmed by demonstration of tubercle bacilli in the pericardial fluid . This is a very rare condition which is usually diagnosed only by necropsy . Myocardial tuberculoma should figure on the list of intraparietal masses visualized at echocardiography.

Mikrobiologiia, 1997 Jan-Feb, 66(1), 42 - 9
{Formation of resting cells in microbial suspensions undergoing autolysis}; Muliukin AL et al.; Under experimentally selected conditions favoring spontaneous or induced autolysis of cell suspensions, the asporogenous bacteria Escherichia coli and Methylococcus capsulatus, the bacilli Bacillus cereus (under conditions of suppressed sporulation), and the yeast Saccharomyces cerevisiae were shown to be capable of forming cystlike resting cells . Their number was influenced by (1) cell density in the suspensions; (2) the presence of Ca2+ ions in nutrient-limited medium; (3) pH of medium; and (4) autolysis rate, dependent on the concentration of oleic acid (a chemical analogue of the autolysis-inducing d2 factor) introduced into the cell suspensions.

Surg Today, 1997, 27(5), 447 - 9
Bacterial translocation as a cause of septic shock in humans: a report of two cases; Tani T et al.; While bacterial translocation has been reported to occur under numerous conditions in animal models, there has been no paper to date focusing on bacterial translocation as a direct cause of septic shock in humans . We present herein the cases of two patients who developed septic shock believed to have been directly caused by bacterial translocation . Neither of the patients had a focus of infection, the intestinal walls were intact in gross appearance, and the peritoneal cavity had not been contaminated by surgery . Moreover, in both patients, the same organisms were detected in the blood, ascites fluid, and mesenteric lymph nodes, and bacilli were found in the intestinal wall.

Ann Biol Clin (Paris), 1997 Jan-Feb, 55(1), 33 - 5
{Isolation of Escherichia vulneris in drinking water}; Le Querler L et al.; Over a 2-year period, we performed 33 bacteriological controls of drinking water supplied by refrigerated fountains located in a nursing home . Amongst 24 strains of gram-negative bacilli isolated from 16 samples . 10 were identified as belonging to the species Escherichia vulneris . Viable bacterial counts were always less than 10 ufc/100 ml . During the same period no clinical isolate of E . vulneris was recovered from the nursing home . The signification of E . vulneris in drinking water is unknown . However, considering that E . vulneris has been implicated as cause of various infections, its presence in potable water supply systems would seem to be a potential risk factor for severely immunocompromised patients.

Eur Urol, 1997, 31 Suppl 1, 31 - 41
BCG update: intravesical therapy; Martinez-Pineiro JA et al.; BCG is currently the most active immunotherapy agent for intravesical use and is considered the first-line treatment for patients with aggressive T1 G3 and Tis superficial tumors of the bladder . Its main drawback, toxicity, is being addressed by several prospective studies that try to find the lowest active dose and optimal schedule, as well as by studies investigating the efficacy of antigenic bacterial fractions, devoid of the toxicity of the living bacilli . Efforts to improve the efficacy by combination with chemotherapy and biomodulating natural remedies are also under way . In this review we discuss: (1) the indications, limits and contraindications of BCG; (2) the efficacy; (3) the strains; (4) route of administration; (5) dose; (6) schedule; (7) the problem of toxicity, and (8) how to improve BCG therapy.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Jan, 35(1), 61 - 6
{Tuberculosis in the crew of a submarine}; Suzuki S et al.; We report the apparent spread of mycobacterial tuberculosis among a submarine crew from a crew member with a low grade of infectivity . The air-conditioning system of submarines requires completely closed recirculation of ambient air . If a person with pulmonary tuberculosis were in a submarine, one would expect to find a high incidence of tuberculosis among others on the ship . The index patient was a 35-year-old member of a submarine crew . An abnormal shadow was found on a chest roentgenogram during an annual medical checkup, and he was hospitalized for examination . Acid-fast bacilli were found in his gastric secretions, but he did not complain of coughing and no tuberculosis bacilli were found in his sputum . All members of the submarine crew were examined, and some who were on board with the index patient reacted strongly . Because those who were also suspected to be infected were usually not close to the index patient's living quarters and had little contact with the patient in the submarine, we strongly suspect that the closed ventilation system contributed to the spread of the infection . Control of tuberculosis in a sealed environment requires detailed investigation of the environment and completion of chemoprophylaxis . Adequate ventilation and ultraviolet radiation are more effective than decontamination with disinfectants for the control of infectious droplet nuclei . Ships should be equipped with those systems.

Respir Med, 1997 Jan, 91(1), 21 - 9
Immunotherapy with Mycobacterium vaccae in the treatment of tuberculosis in Romania . 2 . Chronic or relapsed disease; Corlan E et al.; In this study of 102 patients with culture-positive chronic treatment failure or repeatedly relapsed pulmonary tuberculosis receiving chemotherapy, 56 received an injection of killed Mycobacterium vaccae as immunotherapy after 1 month of treatment . At the start of treatment, there was little difference between those receiving immunotherapy and the 46 patients in the control group receiving chemotherapy alone . Thereafter, the two groups diverged so that 1 yr later, 43 of 56 (77%) patients receiving M . vaccae had a successful outcome, in comparison with 24 of 46 (52%) patients receiving chemotherapy alone (P < 0.02) . Successful results were obtained from patients infected with drug-resistant bacilli, 20 of 32 (63%) patients compared with 11 of 25 (44%) patients, respectively, as well as from fully drug-sensitive cases (23 of 24 compared with 12 of 21 patients; P = 0.004) . At the final follow-up after 22 months, 13 of 56 patients receiving immunotherapy had an unfavourable outcome compared with 26 of 46 members of the control group (P = 0.0006) . During the study, 16 patients died of tuberculosis (six after immunotherapy), and 12 were lost to follow-up . Not only was bacteriological success improved by immunotherapy, chest X-ray showed markedly better resolution of cavities and other radiological lesions, recovery of body weight was improved, and the mean erythrocyte sedimentation rate returned almost to normal (P < 0.001) in comparison with those receiving chemotherapy alone . These changes were seen even in those failing bacteriological cure, suggesting that the immunotherapy had been effective, but that bacilli were replicating in an extracellular situation, protecting them from its effects.

Respir Med, 1997 Jan, 91(1), 13 - 9
Immunotherapy with Mycobacterium vaccae in the treatment of tuberculosis in Romania . 1 . Newly-diagnosed pulmonary disease; Corlan E et al.; In this study, 206 previously untreated patients with sputum culture positive pulmonary tuberculosis were randomized to receive an injection of killed Mycobacterium vaccae as immunotherapy, or of saline as placebo, after 1 month of a 6-month chemotherapeutic regime . Not surprisingly in a disease for which there is good chemotherapy, the difference in numbers which were culture negative at the end of treatment was small, and the final outcome at the latest post-treatment follow-up did not reach statistical significance between the two arms of the study . Nonetheless, those receiving immunotherapy showed better progression in every parameter measured, suggesting faster and more complete cure . Whereas seven of 97 patients receiving immunotherapy required a course of re-treatment and five still had active disease after a mean follow-up of 2 yr, 13 of 109 placebo recipients required re-treatment and nine still had active disease at the end of the study . Only one patient receiving M . vaccae plus chemotherapy died of tuberculosis, compared with four of those receiving chemotherapy alone . A degree of drug resistance was shown by the bacilli cultured from 25 of 175 (14%) patients, and seven of them (4.0%) were multi-drug resistant . Fourteen patients received immunotherapy of whom 13 were cured, including all three of those showing multi-drug resistance . Of the 11 patients with drug resistance in the control group, eight were cured, and one patient with multi-drug-resistant disease died of tuberculosis during re-treatment.

J Submicrosc Cytol Pathol, 1997 Jan, 29(1), 85 - 90
Subcellular localization of the 65-kDa heat shock protein in mycobacteria by immunoblotting and immunogold ultracytochemistry; Esaguy N et al.; The 65-kDa heat shock protein (hsp65) is an immunodominant antigen in mycobacterial infections and also the key etiologic factor in mycobacteria-induced autoimmune arthritis . Because the subcellular distribution of hsp65 in the mycobacteria may be relevant to understand its immunoreactivity, we have investigated the presence of hsp65 in the envelope and cytoplasmic compartments of the bacilli . Anti-hsp65 antibodies were used in western blottings to investigate the presence of hsp65 in cell fractions (membrane, envelope and cytosol) of Mycobacterium avium and M . smegmatis, and also to label hsp65 in situ by the immunogold method on thin-sectioned mycobacteria, including the non-cultivable M . leprae, that were studied by transmission electron microscopy . All of the three subcellular mycobacterial fractions showed significant labelling by anti-hsp65 antibodies . Immunogold ultracytochemistry revealed the presence of hsp65 in both the cytoplasm and the envelope of mycobacteria . The data indicate that hsp65 molecules are commonly present not only in the cytoplasm but also in the envelope of mycobacteria . The latter topography of hsp65 may contribute to the strong immunogenicity of hsp65 since it may correspond to export hsp65 molecules captured before being secreted into the extracellular milieu, thus making hsp65 a mycobacterial antigen readily available for presentation to the immune system of infected hosts.

Acta Derm Venereol, 1997 Jan, 77(1), 49 - 51
Histopathological and bacteriological findings in prurigo nodularis; Mattila JO et al.; Prurigo nodularis is a chronic disease with unknown aetiology . Biopsy specimens of 43 patients with prurigo nodularis were taken for histopathological and mycobacteriological analyses . By conventional histopathology, 25 (58%) samples, and by immunostaining for S100 protein, 31 (72%) samples had changes relevant to prurigo nodularis . Twelve (28%) of the samples were positive for acid fast bacilli in tissue staining by Ziehl-Neelsen technique, including 4 of the 6 samples also positive for mycobacteria in cultivation . The results verified the usefulness of S100 staining in detection of neural hyperplasia in dermal nerves, a feature regarded as diagnostic for prurigo nodularis . They also indicated that atypical mycobacteria may be a contributing factor in prurigo nodularis.

Infection, 1997 Jan-Feb, 25(1), 60 - 2
Diagnosis of tuberculosis and other diseases caused by mycobacteria; Salfinger M; The adequate diagnosis and treatment of tuberculosis depends on many events, including rapid pathogen detection, patient isolation, species identification, and drug susceptibility testing . Well trained staff, using state-of-the-art technology, are necessary in the mycobacteriology laboratory to produce timely results that are necessary for the patients' care and public health measures . Mycobacteriology laboratories still play a pivotal role in the control of tuberculosis, which is especially true in view of the spread of multidrug-resistant tuberculosis . One way to optimize diagnostic efforts in spite of limited financial resources might be to sort and allocate specimens according to a system of priorities, e.g., diagnostic versus follow-up specimens . A "fast track" program for tuberculosis testing, which should be established as part of a dynamic diagnostic network, should focus on the highly infectious patient population . Collaboration between clinicians and mycobacteriologists remains the basis of dynamic diagnostic teamwork . Immediate screening of smears for acid-fast-bacilli in patients suspected of tuberculosis, followed by immediate processing of smear-positive specimens using modern mycobacteriological technology, should be given high priority . Diagnosis of disease due to nontuberculous mycobacteria can be difficult . Nontuberculous mycobacteria are commonly found in nature, and assessment as to whether a nontuberculous mycobacterium isolate is clinically significant can be a difficult task.

Kekkaku, 1997 Jan, 72(1), 53 - 6
{The indication of surgical management in patients with pulmonary disease caused by Mycobacterium avium-intracellulare complex}; Maekura R; The surgical management of patients with nontuberculous Mycobacteriosis caused by Mycobacterium avium complex (MAC) was studied regarding the following cases: (1) We investigated whether there had been an appropriate time for surgical management of patients with MAC who had not responded to medication and who died after their conditions became worse retrospectively . During the past 10 years, 49 patients diagnosed with MAC died at the Toneyama national hospital . 26 patients of them died of respiratory failure, apparently due to the worsening of MAC . Excluding 2 patients who were extremely elderly, we investigated whether surgical management could have been applied in the remaining 24 patients . We found that surgical management would have been possible in only one patient, and that at the time of diagnosis of MAC in 23 patients, surgical management was already not possible . (2) There are patients with MAC who do not respond to medication and who continue to excrete bacilli, chest X-ray findings gradually become worse for several years . In 1989 we retrospectively studied chest X-ray findings from MAC patients and found that 36 out of 103 patients (35%) showed worsening chest X-ray findings . The strains were identified in 44 of the 103 patients by the DNA probes method . However, of 37 patients with M.avium (41%), 15 had worsening of chest X-ray findings, while none out of 7 patients with M . intracellulare had worsening of chest X-ray findings . We then observed the clinical course of 37 patients who showed continuous excretion of bacilli and whose serotypes had been identified (20 with serovars 4, 1 with serovars 6, 6 with serovars 8, 2 with serovars 12, 4 with serovars 14 and 5 with serovars 16) by using the fast-atom bombardment mass spectrometry (FAB/MS) . Chest X-ray findings later worsened in 14 (70%) of 20 patients with serovars 4 . Nine of these patients have since died; excluding one patient who had liver cancer, eight died of respiratory failure due to worsening of MAC . In 17 patients with serotypes except serovars 4, 4 (24%) patients had worsening of chest X-ray findings, but none of the 5 deaths in this group were due to respiratory failure owing to worsening of MAC . These results suggest that it is difficult to establish the indication of surgical management in MAC patients, except for patients with repeated hemoptysis at present . The prognosis and surgical management of pulmonary disease caused by M . avium complex should be considered.

Kekkaku, 1997 Jan, 72(1), 39 - 42
{The role of surgery for chronic empyema of the advanced ages}; Iuchi K et al.; Chronic empyema, a sequelae of pulmonary tuberculosis, is now a only tuberculosis-related disease which was remained to be treated surgically . The candidates who have basically poor respiratory function are now attained advanced age . Over a 15 years period (1980-95), 22 patients 70 years of age or older underwent surgical intervention for chronic empyema at our hospital . There were 17 men and 5 women, ranging from 70 to 80 years of age (median age 75.0) . They were 15.3% of all 145 surgically treated patients during same period . The empyema continued latent from 25 to 58 years (average 39.8 years) . On admission they complained of productive cough (9), fever (9), hemosputam (5) and mass on the chest wall . Their Hugh-Johnes classification for dyspnea was I.: 4, II.: 6, III.: 11, IV.: 1 respectively . Their %VC ranged from 31.5 to 79.0 (average 54.8) . In fifteen patients, tubercle bacilli (5), aspergillus (3) and other bacteria (9) were discovered in the empyema space . Surgical procedures consisted of 1 pneumonectomy (4.5%), 12 decortication or curettage of empyema wall (54.5%), 4 extraperiosteal air plombage (18%) and 5 other procedures (muscle or omental plombage, thoracoplasty, fenestration and others) (22.7%) . There were no operative death and no lethal postoperative complication . In contrast, lethal postoperative complications such as GVIID, MOF and gastrointestinal bleeding occurred in the younger group . There were 2 cases of late respiratory failure in 70 years or older and 6 cases in younger group . Seventy-four years man who, preoperative %VC 33.0, underwent pneumonectomy died of asphyxia 6 month postoperatively . Another 74 years man who, preoperative %VC 76.1, developed respiratory failure after relapse of pulmonary tuberculosis . Four patients of younger group who developed late respiratory failure had all received thoracoplasty as a second operation . Other 2 patients, preoperative %VC 33.0 and 27.4 respectively, had undergone pneumonectomy . The risk of lethal postoperative complication or late respiratory failure were dependent mainly on preoperative respiratory function or surgical procedure selected rather than the age of patients.

Kekkaku, 1997 Jan, 72(1), 35 - 8
{Surgically unsuccessful cases with pulmonary tuberculosis}; Yano M et al.; Because of the development of effective drugs, surgical treatment for pulmonary tuberculosis has decreased in recent years, but there are some cases which require surgical operation in patients with drug resistant tuberculosis . Between 1979 and 1994, 52 patients with pulmonary tuberculosis underwent surgical operations for the negative conversion of drug resistant bacilli . Pulmonary resection was the principal procedure and when a patient was not tolerant to this procedure, thoracoplasty or cavernostomy was selected . Continuation of bacilli positive sputum after the operation was seen in 12 cases (23.1%) . The main causes of the failure were multiple drug resistance and remaining lesions . The unsuccessful rate in the patients with bacilli completely resistant to all of the 5 main drugs (SM, KM, INH, RFP, EB) was extremely high amounting to 57.1% . When 2 or more of the 5 main drugs were effective, the unsuccessful rate was 11.1% . A total of 21 cases had tuberculous lesions remaining in the lung postoperatively, because of bilateral lesions or poor lung function . In such cases, the unsuccessful rate was 42.3% . In the 31 cases that had no remaining lesion, the rate was 9.7% . There was no unsuccessful case in the patients who had 2 or more effective drugs and no remaining lesion . We reoperated on 6 patients and 5 of them got negative conversion . In the 2 of other patients who didn't undergo reoperation, their sputum became negative after long term postoperative chemotherapy, and the other 2 patients had only a few bacilli in ther sputum postoperatively . Nine cases were able to return to normal daily life.

Kekkaku, 1997 Jan, 72(1), 25 - 34
{Surgical treatment of multidrug resistant pulmonary tuberculosis cases}; Nakajima Y; We report on the results of surgical treatment of pulmonary tuberculosis cases intractable to ordinary therapy due to acquired drug-resistance against multiple anti-tuberculosis drugs (MDR-Tbc) . MATERIAL AND METHOD: From 1983 to 1994, 54 patients were administered surgical treatments (60 interventions in all) for pulmonary tuberculosis . Among them, 46 were MDR Tbc cases (52 interventions in all) and were enrolled for this study . The Japanese criteria for drug resistance were referred to, the threshold of resistance in each drug being as follows, INH 0.1, RFP 50, EB 2.5, SM 20, KM 100, TH 25, EVM 100, CPM 100, CS 40, PAS 1 microgram/ml . Bacteriological examinations of sputa were repeated in the postoperative period until upto several years, and the continued absence of Tbc . bacilli for more than 12 months was considered as cured . RESULTS: (1) 37 patients underwent removal of lung mass including tuberculous foci mainly fibrous cavitary lesions (40 interventions in all) . The procedures are as follows 22 upper lobectomies and/or partial resections of adjacent lobes . 1 middle lobectomy . A lower lobectomy, 14 pneumonectomies, 2 segmentectomies . In 3 cases, multiple operations were carried out on 2 occasions; 2 upper lobectomies followed by completion pneumonectomies . 1 right upper lobectomy followed by left S3 segmentectomy . Except 2 cases having died of pneumonia and suicide within 12 months after operation, we have 38 cases available for evaluation . Bacteriological relapses were confirmed in 7 among 38 cases postoperatively . 2 of these 7 relapsed cases underwent additional completion pneumonectomies and attained complete cure . Bacteriological relapse-rate was therefore 18.4% (7/38) and the ultimate cure rate of pulmonary MDR-Tbc was 88.6% (31/35) . (2) 7 patients underwent thoracoplasties (not corrective, once for each patient) . In 2 cases bacteriological relapse was confirmed . Other 5 cases remained bacteriologically silent over a long postoperative period . (3) 4 patients underwent cavernostomies, 3 of them got satisfactory result in reducing the bacterial presence in the sputum (preoperative abundant bacilli (Gaffky 7, 8) turned mean-negative within 2 months after cavernostomy) . CONCLUSION: With the above-mentioned results we conclude that surgical treatment is highly effective in intractable pulmonary MDR Tbc cases.

Kekkaku, 1997 Jan, 72(1), 15 - 20
{2 cases of lung disease caused by Mycobacterium avium complex occurred in middle-aged women without underlying disorders, which we observed for more than 30 years}; Takakura S et al.; We reported 2 cases of Mycobacterium avium complex lung disease occurred in middle-aged women without underlying disorders, which we could observe for more than 30 years . One case was a 42-year-old woman started with bloody sputum, and the other was a 43-year-old woman with cough and sputum . In both cases, chest X ray films were normal on their first visit . More than 15 years after their first visit, Mycobacterium avium complex was isolated from their sputum or bronchial washing . During the observation, a cluster of small nodules in the periphery of the lung and bronchiectasis appeared and deteriorated, and excretion of the bacilli increased gradually . Their past history and family history were normal . Since lung disease caused by Mycobacterium avium complex progresses very slowly, long-time observation would be necessary to consider its pathogenesis.

Kekkaku, 1997 Jan, 72(1), 9 - 13
{The combination of amoxicillin-clavulanic acid and ofloxacin in the treatment of multidrug-resistant Mycobacterium tuberculosis}; Iwanaga T et al.; A 67-year-old {correction of 53} man with multidrug resistant tuberculosis (MDR-TB) had been persistently positive for acid-fast bacilli (AFB) both on sputum smear and also on culture with the Ogawa egg medium for 30 years since 1951 . The case had been treated previously with isoniazid, rifampin, streptomycin, ethambutol, kanamycin, ethionamide, paraaminosalicylate and cycloserine; however, M . tuberculosis strains isolated from this patient acquired a high resistance to all of these agents . Then, a new regimen of chemotherapy, INH combined with ofloxacin (OFLX) and amoxicillin-clavulanic acid (AMPC/ CVA), was applied to the case . He was successfully treated with this regimen, and a marked decrease in the amount of AFB on smear as well as on culture was observed during the course of chemotherapy . No adverse effects were seen meanwhile . These data suggest that it is worth while to try a regimen containing AMPC/CVA and OFLX in the treatment of MDR-TB.

Kekkaku, 1997 Jan, 72(1), 1 - 7
{The clinical study of clarithromycin for pulmonary Mycobacterium avium-intracellulare complex infection}; Yamamoto M et al.; A nationwide study was conducted to investigate the efficacy of Clarithromycin (CAM) on pulmonary atypical mycobacteriosis caused by the Mycobacterium avium-Mycobacterium intracellulare complex, including intractable cases . Out of total 97 patients examined, the analysis for bacteriological efficacy was possible in 69 cases . The negative conversion of bacilli was observed in 18 cases (26.1%), and 5 out of 12 cases in which the follow-up was conducted turned out continued negative status . The efficacy of CAM was relatively high in the following cases: the duration of the disease was less than 6 months the extent of pulmonary lesions on chest roentogenograms was limited or moderate; and antituberculous agents which were previously unused were applied in combination with CAM . Also, the efficacy was high in cases where the dose of CAM was 600 mg/day or higher . Major side effect was mill to moderate digestive symptoms . In conclusion, at daily dose of 600 mg or higher, CAM was effective in the elimination or reduction of M avium M . intracellulare complex that caused atypical mycobacteriosis, without developing serious side effect . Treatment with this drug should be attempted in intractable cases.

Immunol Invest, 1997 Jan-Feb, 26(1-2), 105 - 16
Critical assessment of gene amplification approaches on the diagnosis of tuberculosis; Forbes BA; The resurgence of tuberculosis prompted the development of a number of new options for the rapid laboratory diagnosis of Mycobacterium tuberculosis (MTB) . One of the most promising and exciting methodologies has been the introduction of assays employing amplification technology to detect MTB directly in clinical specimens . Although amplification assays hold significant promise to improve the laboratory diagnosis of tuberculosis, the decision to perform or not perform these assays is complicated . The performance of in-house polymerase chain reaction (PCR) assays and two commercially-prepared assays . GenProbe's AMTD test and Roche's AMPLICOR PCR assay are reviewed . Regardless of the amplification format, all assays have decreased sensitivity with specimens that are acidfast bacilli (AFB) stain-negative . Data from these studies and others indicate possible potential pitfalls of amplification assays, those being sampling errors, the presence of substances in clinical specimens that inhibit the amplification assay, and clinical utility . In light of these findings, the possible roles for these assays in the clinical microbiology laboratory are reviewed . In addition, factors such as cost, assay performance, etc . are discussed in order to facilitate the decision-making process concerning whether an amplification assay would be appropriate in a particular laboratory setting.

Infect Control Hosp Epidemiol, 1997 Jan, 18(1), 28 - 31
Correlation between frequency of tuberculosis and compliance with control strategies; Roy MC et al.; OBJECTIVE: To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers . DESIGN: Survey using a written questionnaire . SETTING AND PARTICIPANTS: 159 Veterans' Administration facilities . RESULTS: Hospitals that reported that > 80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel . Facilities in which < 20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P < .001 for patients and P = .31 for healthcare workers) . The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12 . There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility . CONCLUSION: Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients . More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities . These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.

Antimicrob Agents Chemother, 1997 Jan, 41(1), 17 - 23
Therapeutic efficacy of liposomal clofazimine against Mycobacterium avium complex in mice depends on size of initial inoculum and duration of infection; Kansal RG et al.; The therapeutic efficacy of liposomal clofazimine (L-CLF) against Mycobacterium avium complex (MAC) was evaluated in the acute and chronic infection models of the beige mouse (C57BL/6J bgj bgj) . The maximum tolerated dose of L-CLF was inversely proportional to the infection level . L-CLF showed higher antibacterial activity than free clofazimine . Treatment with 25 mg of L-CLF per kg of body weight (intravenously) was started at days 1, 8, 15, and 22 postinfection and was studied at three levels of MAC infection (10(4), 10(5), and 10(6) bacilli/mouse) . L-CLF treatment caused a significant (P < 0.05 to 0.001) reduction in the numbers of viable bacteria in lung, liver, and spleen at all infection levels, irrespective of time of treatment . However, the best results were obtained when an already established infection was treated (day 22) . The organ-related differences in response to the treatment were also affected by the level of infection . A marked reduction in the numbers of CFU was observed in the lungs of mice with lower infection levels, whereas liver and spleen were treated more efficiently at higher infection levels . These studies might help in evaluations of host responses to therapy.

Infect Immun, 1997 Jan, 65(1), 305 - 8
Sequestration of Mycobacterium tuberculosis in tight vacuoles in vivo in lung macrophages of mice infected by the respiratory route; Moreira AL et al.; Following aerosol infection of mice with Mycobacterium tuberculosis, single mycobacteria or pairs of bacilli were observed within individual phagocytic vacuoles bound by tightly apposed vacuolar membranes . The virulent organism was not observed free in the cytoplasm of the parasitized cells or in the extracellular space of the lung granulomata . This study indicates that in vivo, virulent mycobacteria survive and probably replicate within a unique tight vacuole in the infected phagocyte within the lung.

J Clin Microbiol, 1997 Jan, 35(1), 307 - 10
Direct detection of Mycobacterium tuberculosis complex in nonrespiratory specimens by Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test; Gamboa F et al.; The Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (AMTDT) was adapted for the detection of Mycobacterium tuberculosis complex in 224 nonrespiratory specimens from 188 patients . The sensitivity and specificity of the AMTDT for such specimens, after resolution of discrepant results, were 85.7 and 100%, respectively . Pretreatment of nonrespiratory specimens with sodium dodecyl (lauryl) sulfate is mandatory to obtain consistent and reproducible AMTDT results . The use of 500 microliters of decontaminated specimen improves the sensitivity of the test . Because the AMTDT detects stable rRNA from noncultivable bacilli, it is not useful for monitoring patients receiving treatment.

J Clin Microbiol, 1997 Jan, 35(1), 213 - 6
Comparison of identifications of human and animal source gram-negative bacteria by API 20E and crystal E/NF systems; Peele D et al.; This study compared the abilities of API 20E and BBL Crystal E/NF identification systems to correctly identify human and animal source gram-negative bacilli of known identifications, as provided by the American Type Culture Collection, Rockville, Md., and the Research Diagnostic and Investigative Laboratory, Columbia, Mo . Also addressed in the comparison are the cost, the relative ease of performing and interpreting the tests, and the potential problems surrounding each system . The two systems were comparable in terms of their respective costs and abilities to identify the bacteria tested . The cost per test was calculated as $4.69 for API 20E and $4.62 for Crystal E/NF . Of the animal source bacteria tested, Crystal E/NF identified 68% to the correct genus and species and 90% to the correct genus or group . The remaining 10% of the animal source bacteria were unidentified by Crystal . Human source bacteria tested by BBL Crystal E/NF gave very similar results: 47% correctly identified to genus and species, 90% correctly identified to genus or group, 7% unidentified, and 3% incorrectly identified . API 20E results were as follows for animal source bacteria: 53% correctly identified to genus and species, 76% correctly identified to genus or group, and 24% unidentified; the results for human source bacteria were as follows: 40% correctly identified to genus and species, 83% correctly identified to genus or group, and 17% unidentified . API 20E has a slightly more labor-intensive protocol for setting up the test than BBL Crystal E/NF but produced fewer questionable results.

J Clin Microbiol, 1997 Jan, 35(1), 106 - 10
Rapid differentiation of bovine and human tubercle bacilli based on a characteristic mutation in the bovine pyrazinamidase gene; Scorpio A et al.; Bovine tuberculosis (TB) caused by Mycobacterium bovis is an important veterinary disease that can also afflict humans . Although M . bovis shares an almost identical genome with M . tuberculosis, subtle differences in host specificity and several biochemical parameters can be used to distinguish the two closely related species . The current method for distinguishing M . bovis from M . tuberculosis relies on tedious testing of biochemical parameters, including natural resistance to pyrazinamide and defective pyrazinamidase (PZase) activity of M . bovis strains . In this study, we report the development of a rapid PCR-single-strand conformation polymorphism (SSCP) assay to differentiate M . bovis from M . tuberculosis strains, based on the detection of a single characteristic point mutation in the PZase gene (pncA) of M . bovis . Eighty-seven of 89 M . bovis strains could be distinguished from M . tuberculosis strains . Surprisingly, two animal isolates which were initially identified as M . bovis were shown to be M . africanum because they had a wild-type pncA sequence with positive PZase . These two M . africanum strains contain multiple (three and six) copies of insertion sequence IS6110, a feature they have in common with M . tuberculosis . The implication of this finding for the taxonomy of M . tuberculosis complex is discussed in relation to host preference and epidemiology . The development of a rapid PCR-SSCP test for distinguishing M . bovis from M . tuberculosis will be useful for monitoring the spread of bovine TB to humans in areas where bovine TB is endemic and for directing the treatment of human TB caused by M . bovis.

Schweiz Med Wochenschr, 1996 Dec 28, 126(51-52), 2241 - 3
{An unusual presentation of tuberculosis}; Lefkovits M et al.; A 67-year-old male was hospitalized because of nonspecific symptoms and bilateral pleural effusions . He gave no history of cough, dyspnea or thoracic pain . The blood counts showed moderate anemia and high-grade lymphopenia . The tuberculin test and the anergy-panel were both negative . Testing for HIV was negative . Analysis of pleural fluid showed an exudate with 47% lymphocytes and absence of acid-fast bacilli on Ziehl-Neelsen smear . On histologic examination, the pleural tissue showed no evidence of granuloma . However, cultures for mycobacteria of pleural tissue yielded M . tuberculosis . In this case of pleural tuberculosis, leading symptoms were absent and the tuberculin test was negative in the presence of active tuberculosis . In addition, the cells in the pleural effusion were not predominantly lymphocytic . Patients presenting with unclear effusion should undergo extensive investigations, including a tuberculin test, and anergy panel, pleural fluid cultures, and pleural biopsy with cultures for microorganisms, with the object of establishing or ruling out pleural tuberculosis.

J Toxicol Environ Health, 1996 Dec 27, 49(6), 619 - 30
Effect of influenza virus infection on ovalbumin-specific IgE responses to inhaled antigen in the rat; Lebrec H et al.; Upper respiratory tract viral infections have been reported in clinical studies to serve as risk factors for allergic sensitization . In order to study the relationship linking influenza virus illnesses to development of allergy, murine models of allergen sensitization were previously employed . These models showed that lethal influenza viruses were able to trigger allergen-specific immunoglobulin E (IgE) production and to inhibit tolerance to repeated exposure to aerosolized allergen in the mouse . The disadvantage of these murine models consists in the utilization of virulant and lethal strains of influenza virus . A nonlethal rat-adapted influenza virus (RAIV) host resistance model has been developed in our laboratory . It was used to evaluate the effect of influenza virus infection on IgE responses to inhaled ovalbumin (OA) in the rat . The high IgE-responder Brown-Norway (BN) rat was chosen for further study after comparing the IgE response to OA in Fischer 344 (F344) and BN rats . On d 1, BN rats were sensitized by administration of 1 mg OA subcutaneously alone or together with aluminum hydroxide (200 mg) and Bordetella pertussis (15 x 10(9) killed bacilli per rat in 1 ml), or only received saline . Rats were either infected with RAIV or sham-infected on d 0 (24 h prior to sensitization) or on d 15, 17, or 57 . Rats were exposed for 3 min to aerosolized OA (OA 3% in phosphate-buffered saline) every week, starting on d 18 . Serum OA-specific IgE was evaluated by reverse enzyme-linked immunosorbent assay (ELISA) 3 d after each OA challenge . BN rats elicited a detectable OA-specific IgE response that decreased after repeated aerosol exposures . Influenza virus infection transiently increased the OA-specific IgE response when rats were immunized with OA alone and were infected 1 d prior to the first challenge and also when rats received only saline on d 1, were exposed each week to aerosolized OA, and were infected prior to the seventh challenge . These results, with data previously reported in mice, emphasize the importance of upper respiratory tract viral infection in increasing IgE responses to allergens and may be of importance in human disease.

Southeast Asian J Trop Med Public Health, 1996 Dec, 27(4), 734 - 7
In vitro activity of cefoperazone-sulbactam: Singapore experience; Kumarasinghe G et al.; In vitro activity of commonly used antimicrobial agents against consecutively isolated 521 strains of Gram negative bacilli causing serious infections in the National University Hospital, Singapore were tested in parallel with cefoperazone-sulbactam combination . With the combination complete resistance of 2% and intermediate resistance of 5% were noted among the 521 strains tested . Resistance to imipenem was low (5%) but resistance against other antimicrobial agents varied from 12% (amikacin) to 80% (ampicillin) . In vitro data demonstrated a possible future role for cefoperazone-sulbactam in the treatment of sepsis caused by Gram negative bacilli in our hospital.

Tuber Lung Dis, 1996 Dec, 77(6), 491 - 5
Combined effect of pyrazinamide and ofloxacin within the human macrophage; Sbarbaro JA et al.; SETTING: Recent reports of outbreaks of multidrug resistant tuberculosis have raised questions as to the most appropriate therapeutic response for those exposed to such organisms . A recent Centers for Disease Control National Action Plan suggests the combination of pyrazinamide (PZA) and a quinolone as a potential preventive therapy regimen . OBJECTIVE: Prior studies in the ex-vivo human macrophage model have shown PZA to have only a bacteriostatic effect and, in addition, to diminish the bactericidal effect of rifampin . This study was designed to quantify the intramacrophage antimycobacterial effect of PZA when combined with a quinolone (ofloxacin) . DESIGN: Forty micrograms/ml of PZA was combined with varying concentrations of ofloxacin and administered to human macrophages infected with virulent tubercle bacilli; drug sequencing was also studied . RESULTS: A clinically achievable level of PZA enhances the antimycobacterial effect of low, non-bactericidal levels of ofloxacin and does not impede the bactericidal effect of a higher clinically effective level of ofloxacin . Unlike the combination of PZA and rifampin, these interactive effects are not affected by the sequence of drug administration . CONCLUSIONS: Findings support the use of these agents as a potentially effective preventive therapy combination for individuals exposed to multidrug resistant tuberculous organisms.

J Dermatol, 1996 Dec, 23(12), 883 - 9
Squamous cell carcinoma arising from lupus vulgaris on an old burn scar: diagnosis by polymerase chain reaction; Hagiwara K et al.; A 66-year-old Japanese woman with a squamous cell carcinoma (SCC) arising from lupus vulgaris (LV) on an old burn scar on the left lower extremity is described . Ziel-Neelsen stain of a direct smear from the surface exudate showed acid-fast bacilli . Repeated culture for tubercle bacilli was negative, probably due to a technical error . The diagnosis of LV was successfully made by polymerase chain reaction (PCR) . LV and burn scar are common preceding diseases for SCC . The former is rare in the U.S., Europe, and Japan . We were unable to determine whether only one of the two conditions or a combination of both was the true predisposing factor responsible for the development of this SCC . However, this case may be the first report of SCC arising from coexistent LV and a burn scar in which the diagnosis was confirmed by PCR.

Int J Lepr Other Mycobact Dis, 1996 Dec, 64(4), 428 - 32
Pterygium in lepromatous leprosy; Daniel E et al.; Pterygia from the eyes of three lepromatous leprosy patients were histopathologically studied . All of the specimens contained acid-fast bacilli (AFB) and exhibited features of chronic inflammation . In the etio-pathogenesis of the pterygium that occurs in leprosy patients, the chronic inflammation that is a feature of the disease, the involvement of the nerves within the pterygium, the increased exposure to sunlight, dust and wind (especially in patients having lagophthalmos), and the ostrasization by society that necessitates living predominantly outdoor lives, should be taken into account.

Int J Lepr Other Mycobact Dis, 1996 Dec, 64(4), 417 - 27
Enzyme-linked immunosorbent assay (ELISA) with mycobacterial crude antigens for the sero-epidemiological diagnosis of active tuberculosis; Escobar-Gutierrez A et al.; In search for reliable, nonexpensive procedures for tuberculosis diagnosis suitable for seroepidemiological studies in leprosy-endemic areas, enzyme-linked immunosorbent assays (ELISAs) with whole intact bacilli, whole lipid-free bacilli and protein-enriched soluble extracts from the H37Rv Mycobacterium tuberculosis strain were evaluated . Sera tested came from 47 active, pulmonary tuberculosis adult cases, 60 household contacts of active tuberculosis cases, 20 lepromatous leprosy adult patients, and 67 healthy adult controls obtained from low and high leprosy and tuberculosis endemicity areas . There was no influence of such endemicity levels in the number of positive results in control sera . Antibody levels obtained with each of the antigens in ELISAs were significantly different in tuberculosis patients and the control groups . Ten percent of tuberculosis contacts were positive with some of the antigens and three of them showed suggestive chest radiographs . The best combination for a high number of positive results with tuberculosis sera and low positive results with leprosy sera was the BCG soluble extract (91% and 15%, respectively) . This preparation also yielded excellent sensitivity and specificity values for tuberculosis (91.5% and 92.5%, respectively) . These data suggest that BCG soluble extract ELISAs could provide helpful information to estimate tuberculosis prevalence only in leprosy-free areas, under a situation of unavailability of purified antigens . In pulmonary cases, sputum microscopic examination and culture have higher sensibility than serodiagnosis; therefore, the utilization of BCG soluble extract ELISAs as a diagnostic aid in individual patients with suspected active tuberculosis only can be useful in extrapulmonary cases.

Int J Lepr Other Mycobact Dis, 1996 Dec, 64(4), 409 - 16
Detection of M . leprae by gene amplification; combined ethidium-bromide staining and probe hybridization; Sharma RK et al.; Biopsy and skin-scraping specimens from 130 leprosy cases across the disease spectrum (56 TT/BT/I, 73 BB/BL/LL, and 1 neuritic case) and 50 healthy contacts were studied to assess the application of gene amplification . The nucleic acids from these clinical specimens were extracted by an integrated freeze-thawing--optimized lysozyme-/proteinase-k treatment-purification and fractionation procedure . The nucleic acids from cultured organisms were isolated by the stepwise procedure earlier standardized at this laboratory . Gene amplification for a 360-bp fragment of the 18-kDa protein gene was carried out using primer and the procedure described by its developers, and a 360-bp fragment on Southern blot was taken as the yardstick of positivity . The polymerase chain reaction product was analyzed by electrophoresis, ethidium-bromide (EB) staining, and blot (B) hybridization . Overall sensitivity ranged from 71% in specimens with undetectable acid-fast organisms to 100% in specimens with demonstrable acid-fast bacilli . A positivity of 73% in TT/BT/I specimens and 93% in BB/BL/LL specimens was observed . Four combinations were discerned: EB+, B+ (71%); EB-suspicious, B+ (14%); EB-, B+ (3%) and EB-, B- (12%) . By combining the blot hybridization with EB staining, the sensitivity could be significantly improved as compared to EB staining alone . The test was found to be absolutely specific by the absence of any false positivity in control specimens as well as with purified DNAs from mycobacterial as well as non-mycobacterial organisms, grown from these specimens . It is recommended that for optimum sensitivity and specificity both EB staining and blot hybridization should be done.

Int J Lepr Other Mycobact Dis, 1996 Dec, 64(4), 404 - 8
Polymerase chain reaction of nasal swabs from tuberculosis patients and their contacts; Warndorff DK et al.; Previous studies have found Mycobacterium leprae in nasal swabs from leprosy patients, their contacts, and persons living in endemic areas . It might be expected that M . tuberculosis would be present on nasal mucosa of pulmonary tuberculosis patients, but whether they can be detected in patients or contacts is unknown . We used the polymerase chain reaction (PCR) technique on nasal swabs from tuberculosis patients, contacts of tuberculosis patients, leprosy patients, and London controls to look for both M . tuberculosis and M . leprae . Swabs dipped in sputum specimens from smear-positive patients were used as positive controls . The PCRs were conducted in two independent laboratories . M . tuberculosis was detected in nasal swabs from 6/16 smear-positive tuberculosis patients and from 1/10 household contacts by one of the laboratories . All of the sputum swabs were positive for M . tuberculosis, and all of the London controls were negative . M . leprae were found in nasal swabs from 2/5 leprosy patients, but one laboratory also reported M . leprae in swabs from 4/21 tuberculosis patients and from one sputum specimen . The results show that M . tuberculosis can be found in the noses of some tuberculosis patients, and suggest that the bacilli also may be detected in some household contacts . The comparisons with M . leprae and between the two laboratories give further insights into the sensitivity and specificity of the technique.

Int J Lepr Other Mycobact Dis, 1996 Dec, 64(4), 392 - 5
Short-term follow up of patients with multibacillary leprosy and HIV infection; Jacob M et al.; During a period of 9 years, four male patients with HIV and Hansen's disease were detected in Tamil Nadu, South India . The sequence as to which infection came first is not known . All had high-risk sexual behavior with commercial sex workers and a past history of genital ulcer disease . Their spectrum of leprosy was multibacillary . Patient no . 1 had pure neural leprosy of the lepromatous type, which is rare . He also had a single episode of type 1 reaction which did not require steroid therapy . Despite having taken inadequate treatment, patient no . 2 remained clinically and bacteriologically quiescent after 4 years of follow up . He had a low CD4 count of 330 cells/mm3 . The third patient completed a full course of multibacillary multidrug therapy, and a year later is clinically and bacteriologically inactive . The fourth patient died of AIDS within 2 months of the dual diagnosisPIP: Since the detection of HIV infection in the Christian Medical College and Hospital, Tamil Nadu, in 1986, patients attending the sexually transmitted disease (STD) clinic are counselled and screened for HIV antibodies using ELISA . Over the course of 9 years, 4 males, all from Tamil Nadu, were identified at the clinic with concurrent HIV infection and leprosy . The men were aged 20-27 years and had had multiple heterosexual contacts with prostitutes and a past history of genital ulcer disease . They were in the multibacillary (MB) spectrum of the disease as evidenced by the presence of numerous acid-fast bacilli in the nerve biopsy in 1 case and positive skin smears in the other 3 cases . Mitsuda tests conducted in 3 patients were negative, consistent with the MB spectrum of Hansen's disease (HD) . The patients had concurrent infections, but it is unclear which infection occurred first . One patient developed a type 1 reaction which rapidly recovered with nonsteroidal antiinflammatory drugs . Observation of the patient over 3 years revealed no further episodes of reaction . No patient developed an erythema nodosum leprosum (ENL) reaction . One patient died 2 months after being diagnosed with HIV and HD . The other patients were followed for 3-5 years after the diagnosis of dual infection . Over that period, neither their leprosy worsened nor did their HIV infection progress to clinical AIDS . HIV infection therefore does not appear to influence an infection with Mycobacterium leprae .

Kekkaku, 1996 Dec, 71(12), 655 - 61
{Serodiagnosis of tuberculosis by detection of antituberculous glycolipid antigen (TBGL antigen) antibodies in serum using enzyme-linked immunosorbent assay: clinical evaluation of anti-TBGL antibodies assay kit}; Toyoda T et al.; Kyowa Medex Co., Ltd . developed the kit for the sero-diagnosis of tuberculosis, which detects IgG antibodies against tuberculous glycolipids antigen containing cord factor (TBGL antigen) prepared from M . tuberculosis using the enzyme-linked immunosorbent assay technique . We evaluated the kit using clinical specimens and the results are as follows: 1) In total, 34 out of 39 cases (87.2%) with active pulmonary tuberculosis showed positive anti-TBGL antibody . 2) Patients with cavity, patients with extensive lesions and patients excreting large amount of acid fast bacilli tended to show high positivity rates . 3) The antibody titers increased in 7 out of 11 cases after starting the antituberculous chemotherapy . 4) The use of the antibody is unsuitable for the determination of the activity of tuberculosis since the antibody titers only slightly decreased even after chemotherapy for two years . 5) Two out of four nontuberculous mycobacteriosis cases showed high antibody titers 6) All three AIDS patients with tuberculosis showed low antibody titers . 7) The antibody was negative in almost all healthy controls showing a positive PPD skin test after vaccination with BCG, and it was therefore assumed that the antibody titer is not increased by BCG vaccination . 8) The antibody titers of the staff members working in the tuberculosis wards were not high compared with those of staff members working in the other wards.

J Formos Med Assoc, 1996 Dec, 95(12), 923 - 8
Clinical features of tuberculosis associated with HIV infection in Taiwan; Hsieh SM et al.; To understand the clinical characteristics and outcome of tuberculosis (TB) in patients with acquired immunodeficiency syndrome (AIDS) in Taiwan, we reviewed the medical records of 118 adult AIDS patients who were hospitalized at National Taiwan University Hospital between January 1988 and September 1995 . Among them, 29 (24.6%) had TB . The mean age of the AIDS patients with TB was 37 years (range, 25-66 yr) . Most patients were in the advanced stages of AIDS when human immunodeficiency virus (HIV) infection and/or TB were first diagnosed . The mean CD4+ lymphocyte count was 0.037 x 10(9)/L (range, 0-0.152 x 10(9)/L) at the time TB was diagnosed . There was no statistically significant difference in the mean CD4+ lymphocyte count between patients with isolated pulmonary TB and those with extrapulmonary involvement . Twenty-two patients (75.8%) had extrapulmonary TB with the most common site being the lymph nodes (72.7%) . Clinical symptoms were nonspecific, and the chest physical examination was not helpful in the diagnosis . Acid-fast bacilli were detected in sputum smears from eight patients (36.4%) . A primary tuberculosis pattern (hilar adenopathy, pleural effusion, middle or lower lobe infiltrates) in the chest radiographs was the most common radiologic finding (36.4%) in patients with pulmonary TB . The reactivation pattern (predominant upper-lobe infiltrates with or without cavitation) could only be found in cases of pulmonary TB without extrapulmonary involvement . Atypical patterns (diffuse interstitial infiltrates mimicking Pneumocystis carinii pneumonia or other patterns) and normal chest radiographs were noted in nearly one-third of the patients with pulmonary TB . A good response to antituberculosis drugs and a favorable outcome were demonstrated in the patients, except for two with drug-resistant Mycobacterium tuberculosis infection . Early identification of TB in HIV-infected patients requires clinical awareness of the unusual clinical presentations, especially among patients in the advanced stages of AIDSPIP: The medical records of 118 adult AIDS patients who were hospitalized at National Taiwan University Hospital between January 1988 and September 1995 were reviewed to gain insight into the clinical characteristics and outcome of tuberculosis (TB) among people with AIDS in Taiwan . The 29 AIDS patients with TB were of mean age 37 years and most were in the advanced stages of AIDS when HIV infection and/or TB were first diagnosed . The mean CD4+ lymphocyte count was 0.0037 x 109/liter when TB infection was diagnosed . There was no statistically significant difference in the mean CD4+ lymphocyte count between patients with isolated pulmonary TB and those with extrapulmonary involvement . 22 patients had extrapulmonary TB most commonly (72.7%) located in the lymph nodes . Clinical symptoms were nonspecific and the chest physical examination was not helpful in the diagnosis . Acid-fast bacilli were detected in sputum smears from eight patients, while a primary TB pattern in chest radiographs was the most common radiologic finding (36.4%) in patients with pulmonary TB . A reactivation pattern was found only in cases of pulmonary TB without extrapulmonary involvement . Atypical patterns and normal chest radiographs were noted in almost one-third of the patients with pulmonary TB . A good response to antituberculosis drugs and a favorable outcome were demonstrated in the patients, except for two with drug-resistant Mycobacterium tuberculosis infection . The early identification of TB in HIV-infected patients requires clinical awareness of the unusual clinical presentations, especially among patients in the advanced stages of AIDS .

J Pediatr Gastroenterol Nutr, 1996 Dec, 23(5), 538 - 46
Surface features of small-intestinal mucosa in childhood diarrheal disorders; McClean P et al.; The pathophysiology of diarrhea, especially in the otherwise healthy child, is still poorly understood . The aim of this study was to use the scanning electron microscope (SEM) to examine the surface of the jejunal mucosa of children with chronic nonspecific diarrhea (CNSD) (n = 9) and to compare the findings with specimens obtained from children with (n = 21) and without (n = 11) other gastrointestinal diseases . Light microscopy of the specimens from children with CNSD was normal . However, SEM showed the presence of bacterial colonization with predominantly coccoid organisms in 100% of cases . This colonization was associated with loss of glycocalyx and clumping of the microvilli . The children with celiac disease (n = 9) all showed characteristic appearances with light microscopy, but only one had bacterial colonization on SEM . The surface features of specimens from children with other gastrointestinal disorders (food intolerance, postenteritis syndrome, protracted diarrhea of infancy, and immune deficiency states) were very similar to those from the CNSD group . Bacteria were visible on 89% of specimens, and in half of these cases the organisms were bacilli . SEM of specimens from children with no gastrointestinal disease (ages 11-107 months) suggested an increased density of villi/unit area with advancing age . Bacteria were present in only two cases and did not include bacilli . The findings suggest that bacterial colonization of the surface of the small intestine is common in children with several gastrointestinal diseases and may play a part in their pathogenesis . Routine SEM examination of jejunal biopsies provides information not available from standard light microscopy, which may be relevant to the treatment of children with chronic diarrhea.

Am J Respir Cell Mol Biol, 1996 Dec, 15(6), 760 - 70
Selective receptor blockade during phagocytosis does not alter the survival and growth of Mycobacterium tuberculosis in human macrophages; Zimmerli S et al.; Mycobacterium tuberculosis survives and replicates within human macrophages, but the mechanisms whereby tubercle bacilli resist killing are incompletely understood . We tested the general model in which M . tuberculosis evades killing by entering naive macrophages through receptors that are unable to activate cellular microbicidal activities . Complement receptor types 1 (CR1), 3 (CR3), and 4 (CR4) were blocked with monoclonal antibodies, and mannose receptors were blocked with a competitive ligand, mannosylated bovine serum albumin (MBSA) . Survival and replication of M . tuberculosis (Erdman) were evaluated after the bacteria were phagocytosed in the presence of blocking agents (directing binding to the unblocked receptors) . Although there was significant variation in the growth rate of virulent M . tuberculosis in monocyte-derived macrophages from different donors, the intracellular survival and replication of mycobacteria were equivalent regardless of the receptor(s) used for binding and phagocytosis . We conclude that the mechanisms whereby M . tuberculosis evades killing by human macrophages are independent of the receptor-mediated route of entry, and operate at one or more steps common to all entry pathways . Blocking complement and mannose receptors in combination did not completely abrogate binding of M . tuberculosis to macrophages . However, we found that two polyanionic scavenger-receptor ligands exhibited a concentration-dependent ability to block binding of M . tuberculosis to macrophages . Moreover, blocking class A scavenger receptors abrogated nearly all binding that persisted after blocking complement and mannose receptors . This indicates that class A scavenger receptors are quantitatively important mediators of M . tuberculosis-macrophage interactions . M . tuberculosis has evolved multiple mechanisms to promote its efficient entry into macrophages . This suggests that passage of the organism through macrophages may be an essential early step in the pathogenesis of tuberculosis.

Am J Gastroenterol, 1996 Dec, 91(12), 2602 - 4
Endoscopic diagnosis and management of hepatobiliary tuberculosis; Bearer EA et al.; Primary hepatobiliary tuberculosis is difficult to diagnose and treat . We describe a woman with obstructive jaundice, a common hepatic duct stricture, and granulomatous hepatitis diagnosed with biliary tract tuberculosis when acid-fast bacilli were found in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) . The hilar stricture resulted from either primary biliary tuberculosis or secondary inflammation related to tuberculous periportal adenitis and persisted despite adequate medical treatment for tuberculosis, apparently the result of postinflammatory stenosis . After 20 months, the patient had persistently elevated bilirubin due to the stricture, and liver biopsy revealed early secondary biliary cirrhosis . Placement of a permanent metal biliary stent produced excellent results . Both diagnosis of hepatobiliary tuberculosis by bile aspirate and treatment of a biliary stricture with a permanent metal biliary stent are newly described advances in the management of biliary tuberculosis made possible by ERCP.

J Clin Microbiol, 1996 Dec, 34(12), 3206 - 7
Improved sensitivity of direct microscopy for acid-fast bacilli: sedimentation as an alternative to centrifugation for concentration of tubercle bacilli; Miorner H et al.; There is a great need for improved methods for the diagnosis of tuberculosis by techniques that are appropriate for control programs in low-income countries . Liquefaction of sputum with sodium hypochlorite followed by concentration of bacilli through overnight sedimentation significantly increases the sensitivity of direct microscopy, and this method could be an alternative for diagnostic centers not equipped with a centrifuge.

Ned Tijdschr Geneeskd, 1996 Nov 2, 140(44), 2181 - 7
{Shortening of therapy duration in patients with pulmonary tuberculosis from 9 to 6 months only justifiable on the basis of published data}; van Loenhout-Rooyackers JH et al.; OBJECTIVE: To determine if in the Netherlands, just like in other countries, the treatment of pulmonary tuberculosis with adequately sensitive tubercle bacilli may be shortened from 9 to 6 months . DESIGN: Literature study . SETTING: Municipal Health Service, Nijmegen, the Netherlands . METHOD: The relevant literature was analysed, using the percentage of recurrences as the criterion . The study was restricted to patients with pulmonary tuberculosis in whom the diagnosis had been confirmed bacteriologically and in whom a human, normally sensitive tubercle bacillus had been isolated . The treatment schedule had to include at least isoniazid, rifampicin and pyrazinamide . There were no studies with treatment of 9 months' duration . The studies with 6 months' treatment were selected on the basis of the predetermined criteria from among articles included in Medline in 1980-1991 . RESULTS: The treatment schedules of 6 months' duration (n = 44) from 25 articles were suitable for analysis . Treatment for 6 months' resulted in a proportion of recurrences of tuberculosis of 2.4% (95%-confidence interval: 2.0-2.8), with follow-up periods of 12 to 94 months after discontinuation of the treatment . Addition of streptomycin or ethambutol during the initial phase, self-medication or controlled treatment, daily or intermittent treatment made no difference as regards the ultimate results . No comparison with the proportion of recurrences of 1% (0.2-2.9) after 9 month's treatment without pyranizamide was possible . A recent calculation of the number of Dutch nationals with recurrent tuberculosis resulted in a proportion of recurrences of 2.5 (1.8-3.2) . The guideline adopted was that mentioned by the American Thoracic Society, a proportion of recurrences of < 5% . CONCLUSION: On the basis of the known percentages of recurrence, it could be decided in the Netherlands as well to shorten the duration of treatment from 9 to 6 months.

Am J Kidney Dis, 1996 Nov, 28(5), 747 - 51
Optimal treatment and long-term outcome of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis; Lui SL et al.; A retrospective study of the treatment and short- and long-term outcomes of tuberculous peritonitis (TBP) complicating continuous ambulatory peritoneal dialysis (CAPD) among our dialysis patients over a 6-year period was performed . Ten cases of TBP complicating CAPD were identified among 601 dialysis patients between January 1988 and December 1994 . There were four male and six female patients . The most common clinical features were abdominal pain, fever, and cloudy peritoneal fluid (PDF) . Two patients had concurrent bacterial peritonitis . Extraperitoneal tuberculosis was not observed . The majority of the patients showed neutrophil predominance in the PDF . Only one patient had a positive acid-fast bacilli smear of the PDF . The acid-fast bacilli culture of the PDF was positive in all patients . The patients were treated with isoniazid, rifampicin, and pyrazinamide for 9 to 12 months (mean, 11 months) . Continuous ambulatory peritoneal dialysis was continued in all patients . Two patients died, one from multiorgan failure at 2 months and the other from sudden cardiac death at 9 months . Two patients were converted to hemodialysis at 3 months . Six patients continued to receive CAPD after completion of the antituberculous treatment . Four of these six patients were still alive 5 years after the TBP . Three patients were still undergoing CAPD with satisfactory ultrafiltration and solute clearance . None of the patients developed relapse of TBP . We concluded that (1) TBP is a rare but important complication of CAPD, (2) removal of the Tenckhoff catheter is not mandatory in the management of TBP complicating CAPD, and (3) long-term continuation of CAPD is possible after TBP.

Sante, 1996 Nov-Dec, 6(6), 389 - 92
{Preliminary study on tuberculin sensitivity in north Lebanon}; Hamze M et al.; Tuberculosis remains a severe public health problem, and is a major cause of infant disease in North Lebanon . We investigated tuberculin sensitivity in 1,405 school children (2 to 15 years old) not previously vaccinated with BCG in a deprived suburb of Tripoli (Lebanon) . The Intra-Dermal Reaction (IDR) technique was used with 10 units of tuberculin (Pasteur-Merieux, France) . The prevalence was 4.3% . The score was higher in the lowest socio-economic group (5.7%) than in the middle socio-economic group (2.4%) . No members of the upper socio-demographic group live in this area . There were no significant differences between the sexes . The diameter of induration was over 10 mm in 83.6% of cases (95.6% in the lower class and 46.6% in the middle class) . The prevalence was higher among children over 10 years old . Chest X-rays were obtained for children with a positive reaction, and all were normal . Similarly, their sputum was tested for Acid Fast Bacilli (AFB) by a double staining technique (Ziehl-Nielsen and auramine), and all scored negative.

Nihon Hansenbyo Gakkai Zasshi, 1996 Nov, 65(3), 174 - 9
{An experimental nerve lesion simulating leprous neuropathy produced in the nude mice by the inoculation of a leproma-derived and cultivable mycobacterium HI-75}; Sidik H; Among the lesions caused by mycobacteriosis, peripheral neuropathy has been regarded as the pathognomonic one peculiar to leprosy which is caused only by M . leprae (ML) which can not be cultivated . If that whole sentence is correct, no past report should be in existence concerning the peripheral neuropathy caused by the experimental inoculation of certain cultivated mycobacterium and not of ML . There was, however an exception challenging to that theory which was done by Sasaki et al . in 1985 . The author, therefore, tried to reproduce this type of lesion in the nude mice modifying their method to know whether a leproma derived and cultivable mycobaceterium HI 75 (III 75) still have the ability to cause neuropathy as they observed . The mycobacterium utilized in the study was originally separated from a leproma by Skinsnes et al . as M . leprae (ML) III 75 in 1975 and was identified as M scrofulaceum (MS) by Stanford et al . in 1977 . The strain was kept on cultivating in his laboratory till 1984 and in our thereafter . The groups of mice served for the present experiments consisted of two . The mice in the first group were infected intravenously and those in the latter group were by subcutaneous injections in the cheeks mixed with hyaluronic acid . The first one was unsuccessful to make remarkable neuropathy, however, the second one showed the marked invasions of the bacilli in peripheral nerves encompassed by numerous macrophages which were heavily loaded with the mycobacteria . The author believes that the present result is helpful to solve the question about the differences of the characteristics of HI-75 before and after causing neuropathy in vivo, the mutual relationship between ML, MS and III 75 and the causative organism beside ML if present.

Pediatr Pathol Lab Med, 1996 Nov-Dec, 16(6), 995 - 1001
Recurrent villitis of bacterial etiology; Redline RW; Recurrent placental villitis is an uncommon clinicopathologic entity associated with a very high perinatal mortality rate . While most cases are idiopathic, other cases may have a treatable infectious cause . Here, a mother with recurrent fetal losses, each showing chronic villitis associated with rod shaped bacilli as demonstrated by Steiner stain, is presented . The key feature separating this and other similar cases from idiopathic villitis is a pleomorphic inflammatory infiltrate including lymphocytes, macrophages, eosinophils, plasma cells, and neutrophils.

J Formos Med Assoc, 1996 Nov, 95(11), 857 - 65
Low-grade gastric B-cell lymphoma of mucosa-associated lymphoid tissue: clinicopathologic analysis of 19 cases; Chiang IP et al.; Low-grade gastric B-cell lymphoma of mucosa-associated lymphoid tissue type (MALToma) is a recently recognized disease entity . We report the clinicopathologic features of 19 patients with MALToma in Taiwan . The 19 patients included eight men and 11 women, ranging in age from 26 to 77 years, with a mean age of 58.8 years . Most complained of abdominal pain or gastrointestinal bleeding . The endoscopic and gross features of the gastric lesions revealed erosion (flat type), ulceration (depressed type), cobblestone appearance or abnormal gastric folds (elevated type), mimicking chronic gastritis, ulcer or early gastric carcinoma . Typical histopathologic features included lymphoepithelial lesion and extensive mucosal infiltration of centrocyte-like cells in all cases . Clonality analysis of the variable-diversity-joining region of the immunoglobulin gene by semi-nested polymerase chain reaction demonstrated monoclonality in 72% of the cases . Helicobacter pylori bacilli (H . pylori) could be identified on histologic sections in 15 cases (78.9%); the serologic test for H . pylori was positive in 12 of 13 patients tested (92%) . In six patients receiving triple therapy (amoxicillin, bismuth subcitrate and metronidazole), five showed significant histologic regression with eradication of H . pylori 4 to 6 months after the start of treatment; one patient showed persistent lesions and presence of H . pylori . However, persistence of residual lymphoid cells and monoclonality of the immunoglobulin gene, could still be demonstrated in four cases . Of nine patients treated with surgery or chemotherapy, two died: one due to concomitant gastric carcinoma and the other one due to sudden apnea . No recurrence was observed in the remaining seven patients . The remaining four patients were lost to follow-up . Our experience confirmed that gastric MALToma is a low-grade neoplastic process . The dramatic response of gastric MALToma to anti-H . pylori treatment suggests that H . pylori infection is closely related to the pathogenesis of low-grade gastric MALToma . However, long-term follow-up is mandatory due to the persistence of the monoclonality of the immunoglobulin gene in the residual lymphoid cells after treatment.

Nihon Kyobu Shikkan Gakkai Zasshi, 1996 Nov, 34(11), 1264 - 70
{Two cases of pulmonary disease caused by Mycobacterium chelonae subsp . abscessus}; Naoki K et al.; We encountered two-cases of pulmonary disease caused by M . chelonae subsp . abscessus, {Case 1} A 72-year-old man was admitted to the hospital because of fever . He had been observed for one year after being given a diagnosis of pulmonary disease caused by Myocobacterium avium complex . Sputum examination revealed acid-fast bacilli (Gaffky 9) . He recovered after administration of clarithromycin (CAM) and other drugs . {Case 2} A 61-year-old man was admitted to the hospital because of coughing and sputum production . He had been observed for 4 years after being given a diagnosis of pulmonary M . fortuitum disease . Sputum examination revealed acid-fast bacilli (Gaffky 7) . His symptoms deteriorated even though he received anti-tuberculosis agents and CAM . After measurement of minimal inhibitory concentration (MIC), he was given amikacin (AMK) . In both cases, the bacilli found in sputum obtained on admission were identified as M . chelonae subsp . abscessus by DNA hybridization . They were completely resistant to all anti-tuberculosis agents . However, the disk method show that they were sensitive to AMK, imipenem and CAM . The MIC value of those strains to CAM was 0.78 microgram/ml in case I and more than 100 micrograms/ml in case 2 . The results obtained by MIC measurement were consistent with the clinical outcome . AMK, cefoxitin (CFX), and CAM had been used to treat M . chelouae subsp . abscessus in Europe, but the MIC value differed from strain to strain within a species . Thus the present data suggest that measurement of the MIC value of CAM would be necessary to predict its therapeutic effect.

Acta Cytol, 1996 Nov-Dec, 40(6), 1253 - 6
Tuberculous orchitis diagnosed by fine needle aspiration cytology; Kumar PV et al.; OBJECTIVE: To study the role of the fine needle aspiration cytology (FNAC) in the diagnosis of testicular lesions . STUDY DESIGN: Seven adult males (55-68 years) presented to the clinic with unilateral enlargement of the testis for the previous few months . Clinically, a malignant tumor was suspected . Fine needle aspiration was performed for rapid diagnosis . RESULTS: The smears revealed many groups of epithelioid histiocytes, giant cells, a few plasma cells and occasional spindle-shaped fibroblasts . Acid-fast stain revealed a few acid-fast bacilli . The cases were diagnosed as tuberculosis and treated with orchiectomy and antituberculous drugs . The patients did well . Histologic sections confirmed the cytologic diagnosis . CONCLUSION: FNAC is useful in the diagnosis of tuberculous orchitis.

Kekkaku, 1996 Nov, 71(11), 603 - 6
{The usefulness of induced sputum in the diagnosis of pulmonary tuberculosis}; Kawada H et al.; This study was designed to compare the results of culture for tubercle bacilli using induced sputum by an ultrasonic nebulizer and gastric aspirates from same patients who were suspected of having active tuberculosis with little or no sputum and had received no prior chemotherapy . 22 patients included in this series were either culture positive for tubercle bacilli or showed unequivocal radiographic improvement after three months of therapy with three anti-tuberculosis drugs . Induced sputum from 17 patients and gastric aspirates from seven patients were culture positive for M.tuberculosis . This difference is significant (p < 0.01) . Paired induced sputum and gastric aspirates were both positive for tubercle bacilli in seven patients . The finding of acid-fast bacilli on microscopy or tubercle bacilli in culture in four of the seven patients were available much earlier with induced sputum than with gastric aspirates . Positive gastric aspirates and negative induced sputum for tubercle bacilli was not seen . These results suggest that induced sputum by an ultrasonic nebulizer is superior to gastric aspirates in terms of high sensitivity and early finding for tubercle bacilli and induced sputum and gastric aspirates do not supplement each other.

Vet Pathol, 1996 Nov, 33(6), 717 - 20
Gastric attaching and effacing Escherichia coli lesions in a puppy with naturally occurring enteric colibacillosis and concurrent canine distemper virus infection; Wada Y et al.; A puppy suffering from chronic diarrhea was humanely killed at 90 days of age . Numerous Gram-negative bacilli were found adhering to the surface of as well as within epithelial cells from the stomach to the colon . Canine distemper virus inclusions were in the epithelial cytoplasm of the esophageal, gastric, and intestinal mucosa . Typical attaching and effacing ultrastructural lesions were in the stomach, and some bacilli were in the cytoplasm of the epithelial cells . Escherichia coli, isolated from the contents of the small intestine, belonged to serotype 0118: NM and were negative for plasmid-encoded EPEC adherence factor (EAF) and positive for the E . coli attaching effacing (eae) gene . Immunohistologically, bacilli attached to the epithelium from the stomach to the colon were positive for antisera against E . coli 0118 . E . coli 0118: NM inoculated into human tissue culture cells (HEp-2 cells) were attached to the surface of the cells and within the cytoplasm . This is the first report of attaching and effacing E . coli (AEEC) infection in the stomach of the dog.

Clin Infect Dis, 1996 Nov, 23(5), 1043 - 8
Slowly growing mycobacteria and chronic skin disorders; Mattila JO et al.; We evaluated the role of mycobacteria in chronic skin manifestations . The etiologies of chronic skin disorders in 90 patients were analyzed by culture, histopathologic examination, and skin testing for mycobacteria . There were 20 clinical diagnoses; prurigo nodularis was the most common diagnosis (43 patients) . Cultures were incubated at 32 degrees C and 36 degrees C for 6 months . Fourteen cultures (16%) yielded the following mycobacteria: Mycobacterium tuberculosis (5), Mycobacterium avium/Mycobacterium intracellulare complex (3), Mycobacterium malmoense (2), and other mycobacteria (4) . Acid-fast bacilli were detected in 24 (28%) of the 86 histopathologic specimens examined, including nine of the 14 culture-positive specimens . Granulomatous infection was present in three specimens (3%); cultures of two of these specimens yielded M . tuberculosis, and culture of one was negative . Skin reactivity to 12 mycobacterial antigens was tested . The patients for whom staining and/or culture was positive for mycobacteria had significantly larger skin reactions to M . malmoense antigen (P < .001) than did the patients with bacteriologically negative skin disorders . There was no correlation between the species isolated and the skin reactivity to the species-specific antigen.

Clin Exp Immunol, 1996 Nov, 106(2), 312 - 6
Increase of tuberculous infection in the organs of B cell-deficient mice; Vordermeier HM et al.; Protective immunity against infection with Mycobacterium tuberculosis is imparted by T cells rather than antibodies, but B cells can play a role as antigen-presenting cells and in granuloma formation . We re-evaluated the role of B cells in the course of tuberculous infection in mu-chain knock-out (Ig-) mice . Surprisingly, the organs of M . tuberculosis-infected Ig- mice were found to have three- to eight-fold elevated counts of viable bacilli compared with normal littermates at 3-6 weeks post-infection . Splenic interferon-gamma responses to whole antigen were unimpaired, whilst proliferation to certain mycobacterial peptides was found to be diminished . However, bacille Calmette-Guerin (BCG) vaccination significantly reduced the infection in Ig- mice . The mechanisms by which B cells can influence primary tuberculous infection need further study.

Antimicrob Agents Chemother, 1996 Nov, 40(11), 2459 - 67
Effects of isoniazid on ultrastructure of Mycobacterium aurum and Mycobacterium tuberculosis and on production of secreted proteins; Bardou F et al.; Isoniazid (INH), one of the most effective antimycobacterial drugs, specifically inhibits, at an early stage of its action, the biosynthesis of mycolic acids, specific mycobacterial lipids which play a central role in the cell envelope architecture of mycobacteria . In the present study, the consequences of the action of INH on the cell morphology of Mycobacterium tuberculosis and Mycobacterium aurum were examined . Electron microscopy was used to observe bacilli which were previously treated with either subinhibitory concentrations of INH or the MIC of the drug, leading to a decrease of 20 to 35% (by weight) of their mycolic acid contents . The earlier effect of INH on the ultrastructure of mycobacteria, as revealed by negative staining of bacilli, was the alteration of the bacterial poles; this event was observed prior to the bacteriostatic action of the drug and was accompanied by a release of material from the poles into the extracellular medium . In a later stage of the drug's action, cell deformation occurred and more extracellular material was seen . The material released following the action of the drug on susceptible mycobacterial cells was identified as being almost exclusively composed of proteins . Labeling of amino acids with 35S prior to and during the action of INH on M . aurum and subsequent analysis of the labeled proteins led to the conclusion that they consisted of secreted proteins which were up to 20-fold oversecreted in the presence of the drug . Competitive enzyme-linked immunosorbent assay with the secreted 45/47-kDa antigen complex of M . tuberculosis demonstrated up to 20-fold oversecretion of these proteins . Taken together, the production of oversecreted proteins following the decrease of the cell envelope mycolate content by INH strongly suggests that mycolic acids may act as a barrier in the export of proteins secreted by mycobacteria.

Arch Otolaryngol Head Neck Surg, 1996 Nov, 122(11), 1214 - 8
Reverse transcriptase in situ polymerase chain reaction in atypical mycobacterial adenitis; April MM et al.; OBJECTIVE: To determine whether reverse transcriptase (RT) in situ polymerase chain reaction (PCR) can facilitate the diagnosis of nontuberculous ("atypical") mycobacterial (NTM) cervical adenitis . DESIGN: Retrospective review of 12 patients with neck masses clinically diagnosed as NTM cervical adenitis . SETTING: University medical center caring for both ambulatory and hospitalized children . PATIENTS: Twelve pediatric patients (all younger than 9 years) with cervicofacial masses . INTERVENTION: Surgical excision of the presenting mass . MAIN OUTCOME MEASURES: Reverse transcriptase in situ PCR was used to detect mycobacterial RNA in excised tissue . All specimens were also cultured and stained for acid-fast bacilli . RESULTS: Reverse transcriptase in situ PCR was positive for NTM in 7 of 12 cases . CONCLUSIONS: Infection with NTM may be an extremely indolent process, and the success of RT in situ PCR depends on the presence of mycobacterial nucleic acids . Even in cases in which the findings of RT in situ PCR were positive, infected cells were few in number . Because of the sparsity of infection in the positive cases, NTM may be even more rare in the negative cases, ie, those in which mycobacterial nucleic acids do not exist and cannot be detected by any means, including RT in situ PCR . Although RT in situ PCR, cultures, stains for acid-fast bacilli, and tuberculin tests using purified protein derivative are all helpful in diagnosing NTM cervical adenitis, when nucleic acids are present RT in situ PCR is the simplest, most reliable, and quickest to perform and the results are easiest to interpret.

FEMS Microbiol Lett, 1996 Nov 1, 144(2-3), 167 - 70
Identification of the sugars involved in mycobacterial cell aggregation; Anton V et al.; Incubation of Mycobacterium tuberculosis and M smegmatis cells with the sugar components of their surface-exposed glycans demonstrated that D-arabinose but not alpha-D-glucose or D-mannose, led to the dispersion of the large clumps formed by the bacilli in stationary liquid cultures . These results confirm the presence of arabinose-containing glycans on the mycobacterial cell surface and demonstrate the implication of selective sugars in cell aggregation, suggesting that the clumping of mycobacterial cells is probably mediated by lectin-carbohydrate interactions.

Infect Immun, 1996 Nov, 64(11), 4776 - 87
Cavitary tuberculosis produced in rabbits by aerosolized virulent tubercle bacilli; Converse PJ et al.; Liquefaction of solid caseous tuberculous lesions and the subsequent cavity formation are probably the most dangerous processes in the pathogenesis of human pulmonary tuberculosis . In liquefied caseum, the tubercle bacilli grow extracellularly for the first time since the onset of the disease and can reach such large numbers that mutants with antimicrobial resistance may develop . From a cavity, the bacilli enter the bronchial tree and spread to other parts of the lung and also to other people . Of the commonly used laboratory animals, the rabbit is the only one in which cavitary tuberculosis can be readily produced . This report is the first to describe and analyze the complete course of cavitary tuberculosis, produced by aerosolized virulent bovine-type tubercle bacilli in commercially available New Zealand white rabbits . After the inhalation of 220 to 880 bacillary units, all of the rabbits were overtly well until they were sacrificed at 33 weeks . After the inhalation of 3,900 to 5,800 bacillary units, half of the rabbits died of progressive tuberculosis between 5 and 9 weeks and the other half lived until they were sacrificed at 18 weeks . Pulmonary cavities developed in both low- and high-dose groups, some beginning as early as 6 weeks . Bacilli from primary cavities sometimes caused nearby secondary cavities, but more frequently, they ascended the bronchial escalator, were swallowed, and caused secondary tubercles in the lymphoid tissue of the appendix and ileocecal junction . Histologically, and by culture, the number of bacilli found in the liquefied caseum varied from many to comparatively few . Strong tuberculin reactions at 4 weeks after infection were associated with fewer primary lesions, while strong tuberculin reactions at 33 weeks were associated with more cavitary lesions . In the tuberculous granulation tissue surrounding caseous and liquefied pulmonary foci and cavities, we found many mature epithelioid macrophages that contained high levels of the proteinase cathepsin D . Therefore, cathepsin D probably plays a major role in the liquefaction of solid caseous material and in the subsequent cavity formation.

Proc Natl Acad Sci U S A, 1996 Oct 15, 93(21), 11786 - 91
Major histocompatibility class I presentation of soluble antigen facilitated by Mycobacterium tuberculosis infection; Mazzaccaro RJ et al.; Cell-mediated immune responses are essential for protection against many intracellular pathogens . For Mycobacterium tuberculosis (MTB), protection requires the activity of T cells that recognize antigens presented in the context of both major histocompatibility complex (MHC) class II and I molecules . Since MHC class I presentation generally requires antigen to be localized to the cytoplasmic compartment of antigen-presenting cells, it remains unclear how pathogens that reside primarily within endocytic vesicles of infected macrophages, such as MTB, can elicit specific MHC class I-restricted T cells . A mechanism is described for virulent MTB that allows soluble antigens ordinarily unable to enter the cytoplasm, such as ovalbumin, to be presented through the MHC class I pathway to T cells . The mechanism is selective for MHC class I presentation, since MTB infection inhibited MHC class II presentation of ovalbumin . The MHC class I presentation requires the tubercle bacilli to be viable, and it is dependent upon the transporter associated with antigen processing (TAP), which translocates antigenic peptides from the cytoplasm into the endoplasmic reticulum . The process is mimicked by Listeria monocytogenes and soluble listeriolysin, a pore-forming hemolysin derived from it, suggesting that virulent MTB may have evolved a comparable mechanism that allows molecules in a vacuolar compartment to enter the cytoplasmic presentation pathway for the generation of protective MHC class I-restricted T cells.

J Indian Med Assoc, 1996 Oct, 94(10), 379 - 80, 390
Demonstration of acid-fast bacilli in buffy coat and bone marrow smear--a diagnostic tool in pulmonary tuberculosis; Sen R et al.; Buffy coat smears prepared from peripheral blood and bone marrow aspirate obtained from proved 60 untreated cases of pulmonary tuberculosis were stained with Ziehl-Neelsen method and thoroughly screened for presence of tubercle bacilli . Acid-fast bacilli were detected in 55% cases in buffy coat, 48.3% cases in bone marrow, 38.3% cases both in buffy coat and bone marrow and 65% cases either in buffy coat or in bone marrow or in both . Considering the fact that demonstration of acid-fast bacilli may not be possible in more than 25-50% of the suspected cases of tuberculosis, these techniques are recommended for evaluation of their utility in establishing diagnosis of tuberculosis, particularly in reference to sputum negative cases of pulmonary tuberculosis and tuberculosis of inaccessible extrapulmonary sites.

J Indian Med Assoc, 1996 Oct, 94(10), 376 - 8
Sensitivity of EIA in the diagnosis of tuberculosis using 38-kDa antigen; Chander J et al.; Patients, who reported to Government Medical College Hospital, Chandigarh with suspected signs and symptoms of pulmonary tuberculosis, were examined . Their sputum was investigated for the presence of acid-fast bacilli, using the routine Ziehl-Neelsen staining, for 3 consecutive days . The positive cases were referred for treatment and the rest were referred for supplementary tests like x-ray, Mantoux test, FNAC and the presence of IgG antibodies in their serum against recombinant 38-kDa antigen derived from Mycobacterium tuberculosis, using micro-ELISA plates . It was found that 37.8% of the cases who were negative for acid-fast bacilli found to be positive for the presence of antimycobacterial IgG antibodies with an antibody titre greater than the cut off value in addition to one of the above mentioned positive supplementary finding . Hence, EIA for tuberculosis is more sensitive as compared to the routine acid-fast bacilli staining.

Indian J Lepr, 1996 Oct-Dec, 68(4), 315 - 24
Sensitization and reactogenicity of two doses of candidate antileprosy vaccine Mycobacterium w; Gupte MD et al.; M.w vaccine is one of the antileprosy vaccines under test in an ongoing comparative vaccine trial in South India . The objective of the present study was to examine the sensitizing ability, as measured by skin test reactions to Rees' MLSA and lepromin, and reactogenicity of M.w vaccine in the local population . Two doses of M.w, 1 x 10(9) bacilli and 5 x 10(9) bacilli, were used, in two separate studies of 395 and 400 "healthy" individuals aged 1-65 years . In each study, the study subjects received either M.w vaccine or normal saline (control), by random allocation . The results showed that healing of vaccination lesions was uneventful although the healing process was somewhat prolonged with the higher dose . The mean size of lesions was 7.0 mm and 9.5 mm with the low and high doses of the vaccine, respectively . The results also showed that M.w vaccine in a dose of 1 x 10(9) bacilli, failed to induce post-vaccination sensitization as measured by reactions to Rees' MLSA and by Fernandez and Mitsuda reactions to lepromin-A . However, when the dose of the vaccine was increased to 5 x 10(9) bacilli the mean sizes of post-vaccination reactions to Rees' MLSA and lepromin-A (both early and late) were significantly larger in the vaccine group compared to that in the control group . The sensitizing effect attributable to the vaccine was of the order of 1.5 mm to 1.8 mm.

Avian Dis, 1996 Oct-Dec, 40(4), 941 - 4
An occurrence of avian tuberculosis in hooded merganser (Lophodytes cucullatus); Sato Y et al.; Two imported male hooded mergansers (Lophodytes cucullatus) were introduced into a zoological aviary in Japan, and one of them died 10 mo later . Postmortem revealed numerous white yellowish nodules of various sizes in the liver . Two large nodules were also observed below the right lung and on the top of the left kidney . Histopathologically, a large number of tubercles with acid-fast bacilli were seen in the liver . The amyloid was deposited in the connective tissue of the tubercles . Bacteriologically, Mycobacterium avium serovar 1 was isolated from the liver.

Tuber Lung Dis, 1996 Oct, 77(5), 429 - 36
Impact of short-course therapy on tuberculosis drug resistance in South-West Burkina Faso; Ledru S et al.; SETTING: The Regional Tuberculosis Centre and the Muraz Centre in Bobo-Dioulasso, Burkina Faso . OBJECTIVES: To observe the trend of primary drug resistance in pulmonary tuberculosis patients 5 years into a short-course treatment programme and to assess the possible implementation of a further programme . DESIGN: Bacteriological study of stains isolated from all newly diagnosed tuberculosis patients (n = 300), all relapse cases (n = 20) and all failure cases (n = 58) from the Houet province, during the period from April 1992 to April 1994 . Human immunodeficiency virus (HIV) serostatus was determined for the first 119 patients included in the study . RESULTS: Mycobacterium tuberculosis was the predominant species as shown by 75.1% of the isolates; next was M . africanum, then atypical mycobacteria and finally M . bovis, representing 18.4%, 6.5% and 0.4% of the isolates respectively . Primary resistance (excluding atypical strains) was as follows: isoniazid 7.6%, ethambutol 1.0%, rifampicin 2.5%, and streptomycin 12.4%; 33.6% of the patients tested for HIV were HIV positive . There was no relationship between HIV serostatus and the identity of strains or drug resistance . However, negative acid-fast bacilli smear microscopy with positive culture was significantly more frequent in HIV-positive patients than in HIV-negative patients . CONCLUSION: This study shows a drop in primary resistance compared with previous studies carried out in Bobo-Dioulasso under the same conditions (setting, materials and methods, sampling procedures) in 1982 and 1986 . This is consistent with the hypothesis that treatment monitoring and the introduction of short-course therapy in 1989 (2 HERZ/4 HR or 2 HRSZ/4 HR) have contributed to lower rates of primary drug resistance.

Tuber Lung Dis, 1996 Oct, 77(5), 425 - 8
Relapse after short-course chemotherapy of patients with sputum smear-positive pulmonary tuberculosis under routine conditions with additional information on side effects and contact tracing; Martinez FD et al.; SETTING: The region of Leon/Chinandega in Western Nicaragua . OBJECTIVE: To assess the relapse rate after short course chemotherapy with thioacetazone in the continuation phase in patients with sputum smear-positive pulmonary tuberculosis . DESIGN: A cohort of 247 new sputum smear-positive patients with pulmonary tuberculosis, started on the national short-course treatment (2SRHZ/6TH) between October 1986 and April 1988 as part of the National Tuberculosis Programme, were followed up for 17-32 months after completion of treatment . Two thirds of the patients spent the first 2 months hospitalized, the rest received the whole treatment as out-patients . RESULTS: 204 (83%) completed treatment, seven failure cases were cured with retreatment, 24 defaulted, 10 were transferred out and two died . The patients who completed treatment continued to undergo smear examination for acid-fast bacilli every three months . Of the 204 patients who completed treatment, five died and 10 were lost to follow-up . The remaining 189 patients were followed up for a total of 388 person-years . Three relapses appeared (1.6%), one relapse during 129 person years of observation . Two of the relapse cases were hospitalized, and the third received the full treatment as an out-patient . In the 223 patients who first entered the study, contact tracing detected 24 new smear-positive and 43 smear-negative cases . Adverse reactions (jaundice) required suspension of treatment in one patient, but only temporarily . CONCLUSION: Short course chemotherapy with an ambulatory continuation phase with isoniazid and thioacetazone seems to have a low relapse rate under routine conditions and should continue to be used.

Tuber Lung Dis, 1996 Oct, 77(5), 391 - 400
Gender differentials in tuberculosis: the role of socio-economic and cultural factors; Hudelson P; This paper reviews current knowledge about the role that socio-economic and cultural factors play in determining gender differentials in tuberculosis (TB) and tuberculosis control . The studies reviewed suggest that socio-economic and cultural factors may be important in two ways: first, they may play a role in determining overall gender differences in rates of infection and progression to disease, and second, they may lead to gender differentials in barriers to detection and successful treatment of TB . Both have implications for successful TB control programmes . The literature reviewed in this paper suggests the following: Gender differentials in social and economic roles and activities may lead to differential exposure to tuberculosis bacilli; The general health/nutritional status of TB-infected persons affects their rate of progression to disease . In areas where women's health is worse than men's (especially in terms of nutrition and human immunodeficiency virus status), women's risk of disease may be increased; A number of studies suggest that responses to illness differ in women and men, and that barriers to early detection and treatment of TB vary (and are probably greater) for women than for men . Gender differences also exist in rates of compliance with treatment; The fear and stigma associated with TB seems to have a greater impact on women than on men, often placing them in an economically or socially precarious position . Because the health and welfare of children is closely linked to that of their mothers, TB in women can have serious repercussions for families and households . The review points to the many gaps that exist in our knowledge and understanding of gender differentials in TB and TB control, and argues for increased efforts to identify and address gender differentials in the control of TB.

Kansenshogaku Zasshi, 1996 Oct, 70(10), 1111 - 5
{A case of severe acute hepatorenal failure due to Aeromoas hydrophila septicemia}; Yokoba M et al.; A case of septicemia due to Aeromonas hydrophila (A . hydrophila) in a 54-year-old male suffering from progressive severe jaundice and fatigue is reported . The patient developed multiple organ failure despite aggressive therapy including plasma exchange and glucose-insulin therapy . Upon admission to our hospital, therapy was started with ampicillin (ABPC) 4 g/day, gentamicin (GM) 120 mg/day, hemodialysis, continuous hemofiltration, catecholamines and a respirator, but he expired on the 2nd hospital day . Blood culture and histology revealed A . hydrophila . Postmortem examination showed alcoholic liver fibrosis which was most likely liver cirrhosis . In the literature, patients with septicemia due to Aeromonas had underlying hepatic cirrhosis more often than did those with septicemia due to other gram-negative bacilli . Therefore, it is important-to consider the possibility of liver cirrhosis in patients with A . hydrophila septicemia.

Kansenshogaku Zasshi, 1996 Oct, 70(10), 1103 - 10
Rapid identification of Mycobacterium tuberculosis by a PCR assay combined with a cultivation system using Middlebrook 7H12 medium; Sato K et al.; A newly devised 7H12 cultivation method combined with nested PCR assay using Mycobacterium tuberculosis-specific primers was evaluated for its usefulness to detect and identify tubercle bacilli in 38 sputum samples . This method yielded detection and identification of M . tuberculosis in sputum specimens with excellent sensitivity, specificity, and rapidity, when compared to the cultivation method using Ogawa egg medium or the 7H12 cultivation method in which bacterial growth is monitored by microscopy (7H12-microscopy method) with the same sensitivity as that of the BACTEC 460 TB system.

Kekkaku, 1996 Oct, 71(10), 573 - 85
{Evaluation of a new detection method of Mycobacterium tuberculosis in clinical specimens by amplification of ribosomal RNA and its clinical application}; Osumi M et al.; A new rapid M . tuberculosis detection method, the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD), which allows direct detection of M.tuberculosis in clinical specimens by amplification of M.tuberculosis ribosomal RNA (rRNA), was evaluated . In the present study, MTD and conventional smear and culture examinations were performed on 225 sputum, 36 pleural fluid (PF), nine cerebrospinal fluid (CSF) and 41 bronchoalveolar lavage fluid (BALF) specimens . Among 225 sputum specimens from 132 patients, 20 culture-negative specimens from 14 patients and one specimen which was culture-positive for M.fortuitum on Ogawa's egg medium were MTD-positive . On the other hand, there were 6 M.tuberculosis culture-positive but MTD-negative specimens from 6 patients . The amount of bacilli in all six cases, however, was very few . The sensitivity of M.tuberculosis detection by MTD, as compared with Ogawa's egg medium and MB-Check, was 93 and 92%, respectively, in sputum specimens, and the specificity of MTD was 80 and 85%, respectively . Taking into account not only culture-positive specimens but also MTD-positive specimens from patients clinically diagnosed as active tuberculosis, the sensitivity and specificity of MTD were 93% and 99%, respectively . Among 36 PF specimens from 31 patients, of which 20 specimens from 16 patients were clinically diagnosed as tuberculous, only 4 from 4 patients were culture-positive for M.tuberculosis while 7 from 5 patients were MTD-positive . The results of MTD in 9 CSF specimens coincided well with those of MB-Check, but one MTD-positive specimen yielded a false-negative result with Ogawa's egg medium . Among 41 BALF specimens from 39 patients, only one was culture-positive while one culture-positive and 7 culture-negative specimens were positive on MTD . All these MTD-positive patients were later verified as having pulmonary tuberculosis either by transbronchial lung biopsy and other examinations, or by the clinical course of the disease, particularly the response to anti-tuberculosis drugs . Inconsistent results were seen in 21 sputum specimens from 15 patients, 4 PF specimens from 3 patients and 7 BALF specimens from 7 patients, all of which were culture-negative for M.tuberculosis but MTD-positive . None of these patients had any clinical findings inconsistent with diagnosis as tuberculosis . It was noted that MTD was very useful for rapid detection of M.tuberculosis in sputum as well as other clinical specimens . We observed the clinical course of 20 pulmonary tuberculosis patients by monthly examinations of sputum, using smears, Ogawa's egg medium, MB-Check and MTD . MTD-positivity rates fell down in parallel with decreased pulmonary tuberculous activity . During the clinical course, out of 61 MTD-negative specimens only 4 (6.6%) were culture-positive for M.tuberculosis, while out of 63 smear-and-culture-negative specimens 6 (9.5%) were MTD-positive . These data suggest that MTD is useful to assess the clinical activity and course of tuberculosis.

Kekkaku, 1996 Oct, 71(10), 555 - 9
{Tuberculosis found among foreigners and treated at the National Hiroshima Hospital or Hiroshima Anti-Tuberculosis Association}; Sato H et al.; In this study, we investigated 31 foreign patients who had been diagnosed as having pulmonary tuberculosis at the National Hiroshima Hospital or Hiroshima Anti-Tuberculosis Association between 1982 to 1995 . Their age ranged from 17 to 63 years, and all of them had been in Japan for less than five years . Twelve of the patients came from South America, 18 from Asia, and one from Egypt . Seven Peruvians had been infected in a tuberculosis outbreak . The reasons of their immigration were job-seeking (14 out of 31), education (8 out of 31), and marriage to Japanese men (6 out of 31) . None of them were illegal immigrants . In four women who had married Japanese men, various symptoms such as cough, sputum, and slight fever came on during pregnancy, however, none of them had been diagnosed as having tuberculosis, and consequently they had received no medication during pregnancy . In 6 out of the 8 patients who were college students, their sputa were negative for tubercle bacilli, and they could be treated by chemotherapy as outpatients . In provincial cities, every effort should be made to detect tuberculosis among members of the foreign community who are living under different environments and conditions.

Eur Respir J, 1996 Oct, 9(10), 2031 - 5
Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases; Aktogu S et al.; The aim of the present study was to investigate the epidemiological, clinical, laboratory and radiological features of patients with active pulmonary tuberculosis (TB) (with or without pleural involvement) or with pleural TB (in the absence of radiological parenchymal disease) . A systematic predetermined form, including 60 items regarding the above-mentioned features, was completed for 5,480 patients . Sputum smear and culture data, radiological findings, and additional extrapulmonary involvement were evaluated in the patients with pulmonary TB (n = 5,094) . Epidemiological features, and other clinical and laboratory characteristics were investigated in all patients (n = 5,480) . TB was more common among persons aged 20-39 yrs, males, and those living in large urban centres in our region . There were 4,268 newly detected patients (78%), and 1,212 active ex-patients (22%) who had history of previous antituberculosis treatment . Additional extrapulmonary involvement was found in 455 patients (9%) . Sputum samples were smear-positive in 3,916 (79%), and culture-positive in 3,748 cases (76%) . Most common radiological patterns were parenchymal infiltrate in 5,017 (99%), and cavitation in 3,363 (66%) . Unusual radiological patterns were also noted, i.e., lower lung field TB (LLFTB) in 317 cases (6.2%), pneumothorax in 78 cases (1.5%), and miliary pattern in 66 cases (1.3%) . In conclusion, because of the more frequent occurrence in the younger age group, it is considered that the prevalence of disease is still high and that the transmission of tubercle bacilli is not decreasing in our region . The highest risk group consisted of male subjects and those living in urban centres . The high percentage of active ex-patients suggests that new control programmes for tuberculosis are required in Turkey.

Am J Infect Control, 1996 Oct, 24(5), 359 - 63
Elimination of an outbreak of gram-negative bacteremia in a hemodialysis unit; Humar A et al.; BACKGROUND: The purpose of this study was to identify the cause of an unusual outbreak of gram-negative bacteremia in patients undergoing long-term hemodialysis . METHODS: We performed direct observation and investigation of current dialysis techniques and facilities including microbiologic sampling in a long-term hemodialysis unit in a tertiary care center . We also performed a retrospective review of medical charts and laboratory data of 10 patients undergoing long-term hemodialysis who experienced 11 episodes of gram-negative bacteremia between March 4 and June 28, 1993 . RESULTS: All of these patients underwent dialysis by jugular venous access . Containers used to collect flush solution after priming of dialysis tubing remained unemptied for extended periods of time, and quantitative culture revealed more than 200 colony-forming units/ml gram-negative bacilli, including species isolated in blood cultures . Dialysis tubing and connector were left submerged in flush solution collection containers during priming, and the process of disinfecting tubing before patient connection had recently been discontinued . Control measures included emptying of flush containers after each use and daily decontamination . All dialysis tubing was to be disinfected before patient connection . CONCLUSION: Outbreak was due to contamination during dialysis setup . After institution of appropriate control measures, no new cases have occurred.

Int J Pediatr Otorhinolaryngol, 1996 Oct, 37(2), 151 - 62
Imaging of granulomatous neck masses in children; Nadel DM et al.; Non-tuberculous mycobacterial (NTM) infection is the most common cause of granulomatous inflammation in pediatric neck masses . Diagnosis relies upon culture, acid-fast bacilli (AFB) staining, chest radiograph, purified protein derivative (PPD) test, and clinical features . Computed tomography (CT) and magnetic resonance (MR) imaging may provide valuable information in the work-up of children with cervical masses . We reviewed 11 CT and 5 MR studies of children with a clinical diagnosis of NTM infection . Specific findings included stranding of the subcutaneous fat, thickening and enhancement of the overlying skin, obliteration of the tissue palnes, and multichambered masses . One patient had calcifications within the mass . MR with contrast better demonstrated the soft tissues and is our recommended imaging modality, although CT is more likely to detect calcifications within the neck mass.

Antimicrob Agents Chemother, 1996 Oct, 40(10), 2296 - 9
Bactericidal action of ofloxacin, sulbactam-ampicillin, rifampin, and isoniazid on logarithmic- and stationary-phase cultures of Mycobacterium tuberculosis; Herbert D et al.; The bactericidal actions of ofloxacin and sulbactam-ampicillin, alone and in combination with rifampin and isoniazid, on exponential-phase and stationary-phase cultures of a drug-susceptible isolate of Mycobacterium tuberculosis were studied in vitro . In exponential-phase cultures, all drugs were bactericidal, with the higher concentrations of ofloxacin (5 micrograms/ml) and sulbactam-ampicillin (15 micrograms of ampicillin per ml) being as bactericidal as 1 microgram of isoniazid per ml or 1 microgram of rifampin per ml . In two-drug combinations, both drugs increased the levels of activity of isoniazid and rifampin and were almost as bactericidal as isoniazid-rifampin; they also appeared to increase the level of activity of isoniazid-rifampin in three-drug combinations . In contrast, ofloxacin and sulbactam-ampicillin had little bactericidal activity against stationary-phase cultures and were less active than isoniazid or rifampin alone . Furthermore, in two-drug or three-drug combinations, they did not increase the level of activity of isoniazid, rifampin, or isoniazid-rifampin . These findings suggest that ofloxacin and sulbactam-ampicillin are likely to be most useful in the early stages of treatment and in preventing the emergence of resistance to other drugs but are unlikely to be effective as sterilizing drugs helping to kill persisting lesional bacilli.

Am Surg, 1996 Oct, 62(10), 865 - 8
Abdominal tuberculosis: the surgical perspective; Ko CY et al.; The increasing incidence of pulmonary tuberculosis (TB) has led many to predict a corresponding increase in abdominal TB . This study reports the incidence, presentation, and outcome of abdominal TB to elucidate factors that might assist the surgeon to treat this potentially curable disease . A retrospective review of patients diagnosed with tuberculosis between 1993 and 1995 was performed at two hospitals . Diagnosis of abdominal TB was based on acid fast bacilli on tissue stains and/or culture . Seven patients were diagnosed with abdominal TB . Two patients were HIV positive; six were recent immigrants . Abdominal pain, fever, and significant weight loss were the most common symptoms . All preoperative radiologic tests failed to demonstrate findings suggestive of TB . All patients were brought to operation . Indications included perforated viscus (2), acute abdomen (1), small bowel obstruction (1), colocutaneous fistula (1), pelvic neoplasm (1), and biliary colic (1) . Abdominal TB was either diagnosed or suspected intraoperatively in six patients . Postoperative anti-TB chemotherapy was promptly instituted . Although abdominal TB can be cured medically if treated early enough, the nonspecific presentation delays diagnosis in the majority of cases . Diagnosis of abdominal TB can be made or at least highly suspected intraoperatively such that anti-TB medications can be initiated promptly . Appropriate surgical therapy and prompt initiation of anti-tuberculosis medications can successfully treat abdominal TB.

Gene, 1996 Sep 16, 173(2), 189 - 94
The complete nucleotide sequence of the Bacillus licheniformis NM105 S-layer-encoding gene; Zhu X et al.; A protein present on the cell surface of Bacillus licheniformis (Bl) NM105 was identified as an S-layer (OlpA in this paper), a protein present on many bacterial cell surfaces . Purification, SDS-PAGE and isoelectrofocusing showed one 94-kDa, slightly acidic (pI 6.5) protein band (defined as OlpA) . The pure protein OlpA, has a tetragonal symmetry of its morphological subunits . Following Edman degradation, three 17-mer oligodeoxyribonucleotide (oligo) probes corresponding to the N-terminal sequence of Olpa were synthesized and used for gene cloning . The nucleotide (nt) sequence of the cloned gene (olpA) showed an ORF and encoded an 874 amino acid (aa) protein . In the promoter region of olpA, there appear to be -10 and -35 sigmaA-binding sites, as well as -10 and -35 regions specific for sigmaH . The existence of these two potential promoters suggests that OlpA would be produced during both the vegetative and sporulating stages of growth . The ribosome-binding site (RBS) sequence perfectly matched its consensus sequence, suggesting a high efficiency of translation of olpA . A typical 29-aa leader peptide, characteristic of secretory proteins in Bacilli, is present in the OlpA pre-protein sequence . In olpA, there are two stem-loop structures in tandem, downstream from the stop codon . These stem-loops are probably involved in prolonged olpA expression, by extending the half life of the mRNA.

Schweiz Med Wochenschr, 1996 Sep 7, 126(36), 1515 - 23
{Non-nosocomial pneumonias in the elderly: clinical findings, etiology, therapeutic approach}; Janssens JP et al.; Elderly subjects are at high risk for pneumonia, with an incidence 4 times that of younger adults and a higher mortality . Factors that contribute to this over-mortality and morbidity are age-related modifications of the immune system and of the respiratory system, co-morbidity, colonization of upper airways by gram-negative bacilli, and immunosuppression (iatrogenic or acquired) . Clinical symptoms and signs are sometimes scarce or nonspecific; bacteremia and sepsis are more frequent . Responsible microorganisms are frequently undetermined . S . pneumoniae, H . influenzae, S . aureus and respiratory viruses are the most frequently incriminated organisms; the incidence of infection with gram-negative bacilli rises in institutionalized patients or frail elderly subjects . Atypical pneumonias are rare in elderly patients . In this age group prevention is of major importance and consists mainly in vaccination against influenza and S . pneumoniae.

J Indian Med Assoc, 1996 Sep, 94(9), 334 - 7
Prevalence of tuberculosis in Kishtwar Tehsil of Jammu region in Jammu and Kashmir State; Malhotra P et al.; A study of prevalence of tuberculosis in Kishtwar tehsil of Jammu region was conducted from June 1991 to May 1992 . A total of one thousand two hundred ninety-eight rural as well as urban population suffering from various types of lung diseases was studied for prevalence of tuberculosis and a sizeable number (98) of patients were found to be positive of various types of tuberculosis, viz, pulmonary tuberculosis, tuberculous pleural effusion and miliary tuberculosis . Of the population studied 7.55% were found to be positive for tuberculosis and among them 88.76% patients were anaemic and the commonest type of anaemia was normocytic normochromic and normocytic hypochromic . The ESR was raised in almost of all the patients . Of the population, 80.61% were seen to be positive on skiagram chest and 58.16% were found to be positive on other diagnostic tests like Mantoux's tests, sputum for acid-fast bacilli, etc . Mantoux's test was positive in 27.55% cases and sputum was positive in 30.61% cases . All the cases studied were subjected to special investigations . The changes in parameters are consistent with the diagnosis of tuberculosis . Large family size, poverty, excessive smoking, illiteracy, etc, are the major contributing factors.

Izv Akad Nauk Ser Biol, 1996 Sep-Oct, (5), 535 - 41
{A comparison of the antibacterial activity of the parasporal bodies of different bacilli}; Iudina TG; Solutions of the parasporal bodies of Bacillus sphaericus, B . laterosporus, and several B . thuringiensis subspecies display antibacterial activity showing the potential of membranotropic action of the body proteins . Comparison of the antibiotic effect of various delta-endotoxins of B . thuringiensis made it possible to identify highly active unique proteins . This approach forms the basis of goal-directed search for organisms sensitive to polypeptides of various bodies . It has already been established that delta-endotoxins of B . thuringiensis ssp . amagiensis cause the death of representatives of the fourth (in addition to the three previously known) order of insects, Isoptera.

Rev Soc Bras Med Trop, 1996 Sep-Oct, 29(5), 491 - 6
{Residual histoplasmosis of the lung and bronchopulmonary lymph nodes in autopsies carried out in Uberaba, MG}; Adad SJ et al.; Lungs and broncho-pulmonary lymph nodes were studied from 127 sequential adult autopsies done in Uberaba, MG, Brazil through the years 1992 and 1993 . Calcified lung nodules and/or calcified lymph nodes were found in 39 (30.7%) cases . For 27 (69.2%) out of those 39 autopsies, fungi morphologically compatible with Histoplasma capsulatum were found within those calcified structures . Fite-Faraco stain for acid-fast bacilli was negative for all cases . It is concluded that the majority of calcified pulmonary nodes and calcified regional lymph nodes found at autopsies in Uberaba are related to infection with H . capsulatum . These findings raise the possibility for this fungal disease to be endemic in Uberaba . Such information might be relevant to the diagnosis of this systemic mycosis.

Br J Dermatol, 1996 Sep, 135(3), 457 - 9
Cutaneous tuberculous abscess: a management problem; Harris A et al.; A 66-year-old woman presented with a 6-week history of an indolent ulcerating lesion on the anterior chest wall . She had a past medical history of pulmonary tuberculosis which had been treated successfully in 1947 . Biopsy of the ulcer showed granulomas and acid-fast bacilli . Cultures grew Mycobacterium tuberculosis, sensitive to all antituberculous drugs . After 7 months of treatment with isoniazid and rifampicin, there was little sign of healing . A sinogram showed a fistula leading into the plombage mass in the left upper lobe . Surgery to remove the plombage and excise the fistula was planned but was rejected by the patient as the risks of this operation are considerable . With continued antituberculous medication the discharge has reduced although the ulcer has not healed.

Nihon Kyobu Shikkan Gakkai Zasshi, 1996 Sep, 34(9), 1035 - 9
{Atypical mycobacteriosis (Mycobacterium xenopi) with "initial aggravation"}; Shirayama R et al.; A 66-year-old man was admitted to Nara Medical University Hospital because of sputum production and fevre . A chest X-ray film obtained on admission revealed many cysts and an infiltrative shadow in the right upper lung field . The patient was treated with antimycobacterial drugs (isoniazid 400 mg, streptomycin 0.75 g, and rifampicin 450 mg) because acid-fast bacilli were detected in his sputum . Although the symptoms and laboratory data improved, a new infiltrative shadow developed in the right lower lung field two months after the start of treatment . Transbronchial biopsy specimens showed intraluminal organizing exudate and alveolitis . The new lesion resolved when treated with the same antimycobacterial drugs . Mycobacterium xenopi was cultured from the sputum 80 days later . This is the third reported case of atypical mycobacteriosis (non-tuberculous mycobacteriosis) due to M . xenopi in Japan with the "initial aggravation" seen in some patients with typical pulmonary tuberculosis.

Immunology, 1996 Sep, 89(1), 20 - 5
Diabetes-prone NOD mice are resistant to Mycobacterium avium and the infection prevents autoimmune disease; Bras A et al.; It was recently proposed that the diabetes genes of non-obese diabetic (NOD) mice are linked to the Bcg gene that is associated with resistance to infection by mycobacteria; however, it has not been established whether NOD mice are resistant or susceptible to the infection, although there are previous investigations on response of NOD mice to other intracellular parasites (e.g . Kaye et al., Eur . J . Immunol . 22: 357-364) . We have investigated here this question, as well as the consequences of mycobacterial infection on the natural history of murine diabetes . Female NOD mice were intraperitoneally infected with 10(8) viable bacilli of Mycobacterium avium at 2 months of age, i.e . before the mice show diabetes; they were studied up to the sixth month of age (when more than half of untreated female NOD mice show glycosuria) . To determine whether NOD mice were susceptible or resistant to M . avium infection, we have compared the kinetics of bacterial growths in liver and spleen of the mice with those determined in M . avium-susceptible (BALB/c) and resistant (C3H) strains of mice . NOD mice were able to control the M . avium infection, following a pattern similar to that observed in infected C3H mice . The mycobacterial infection prevented the expression of diabetes in all of the infected NOD mice and it also decreased the incidence of proteinuria in the treated mice . The infected NOD mice showed a marked enhancement in antibodies against the 65,000 mycobacteria antigen (heat-shock protein (hsp) 65) up to the second month of infection and these elevated titres slowly decreased in the following months; anti-hsp 65 antibodies were not detected in age-matched controls . This is the first demonstration that NOD mice are naturally resistant to mycobacterial infection, and we reinforce evidence on the role of immune response triggered by mycobacteria and its hsp 65 antigen in prevention of diabetes in NOD mice.

Rev Soc Bras Med Trop, 1996 Sep-Oct, 29(5), 503 - 6
Parotid enlargement due to adenovirus infection in patient with human immunodeficiency virus infection; Duarte MI et al.; The authors report a case of adenovirus-induced enlargement of the parotid gland involving a patient infected with human immunodeficiency virus (HIV) . Physical examination revealed good general condition, no fever and bilateral enlargement of the parotid region, which was of increased consistency and slightly tender to palpation . Histological examination of the parotid gland demonstrated a slight periductal lymphomononuclear inflammatory infiltrate with the presence of focal points of necrosis . Tests to determine the presence of fungi and alcohol-acid resistant bacilli were negative . Immunohistochemistry for cytomegalovirus, herpes simplex, HIV p24 antigen and adenovirus showed positivity only for adenovirus in the epithelial nuclei of numerous gland ducts . This is the third case of this type reported in the literature, indicating the importance of including adenovirus in the differential diagnosis of this condition.

Spine, 1996 Sep 1, 21(17), 1991 - 5
Detection of Mycobacterium tuberculosis in formaldehyde solution-fixed, paraffin-embedded tissue by polymerase chain reaction in Pott's disease; Berk RH et al.; STUDY DESIGN: Twenty-five formaldehyde solution-fixed, paraffin-embedded tissue blocks from vertebral biopsy specimen materials with presumptive diagnosis of tuberculous spondylitis and nonspecific vertebral osteomyelitis were studied . OBJECTIVES: To evaluate the sensitivity and specificity of polymerase chain reaction in detecting Mycobacterium tuberculosis in formaldehyde solution-fixed, paraffin-embedded tissue samples from histologically proved tuberculous spondylitis . SUMMARY OF BACKGROUND DATA: Diagnosis of a mycobacterial infection is a long and tedious process; because of the slow growth rate of mycobacteria on solid media, identification and antibiotic sensitivity testing can take up to 10 weeks, but the sensitivity of culture can be as low as 50% . Direct microscopy is insensitive because clinical samples may contain only few organisms . Recently, polymerase chain reaction has been applied in the rapid amplification and identification of many organisms, including mycobacteria . METHODS: The DNAs were extracted from 25 paraffin-embedded tissue blocks . An insertion element IS 6110 (Integrated DNA Tec . Inc., Corrallville, IA), a DNA sequence unique to Mycobacterium complex (M . tuberculosis and the subspecies Mycobacterium bovis), was amplified by polymerase chain reaction . Polymerase chain reaction results were compared with those of Mycobacterium culture, acid-fast bacilli staining, and histologic findings . RESULTS: Polymerase chain reaction was positive in 18 cases of 19 tuberculous spondylitis . Three of the polymerase chain reaction test results were positive with concomitant negative culture and positive acid-fast bacilli staining . There were six chronic nonspecific infections, and polymerase chain reaction results were negative in five cases; in the single positive case, DNA amplification results remained positive even after three repeated tests . CONCLUSION: Polymerase chain reaction has a sensitivity of 94.7%, specificity of 83.3%, positive predictive value of 94.7%, and a negative predictive value of 83.3% . Accuracy was calculated as 92%.

Clin Infect Dis, 1996 Sep, 23(3), 592 - 603
Outcome of medical treatment of bacterial abscesses without therapeutic drainage: review of cases reported in the literature; Bamberger DM; The usual treatment of bacterial abscesses, except lung or tubo-ovarian abscesses, includes therapeutic drainage . Increasing evidence suggests that some abscesses respond to antimicrobial therapy without drainage . To study this issue, a MEDLINE search of the literature (1966-1994) was performed for cases of bacterial abscess in which treatment without definitive drainage was attempted . Four hundred sixty-five cases were identified . The most commonly involved organs were the liver, brain, and kidney . The success rate of antimicrobial therapy was 85.9% . Factors that predicted a less favorable outcome were abscess diameter of > or = 5 cm (odds ratio {OR} = 37.7; P = .0003), involvement of > or = 1 organism (OR = 5.2; P = .014), presence of gram-negative bacilli (OR = 3.4; P = .022), length of therapy of < 4 weeks (OR = 49.1; P < .0001), and use of an aminoglycoside as the only active agent (OR = 11.8; P = .008) . Many bacterial abscesses can be treated without drainage; abscess size, the organisms involved, and therapy utilized may influence outcome.

Diabetes Care, 1996 Sep, 19(9), 1011 - 3
Eikenella corrodens infections . Case report in two adolescent females with IDDM; Newfield RS et al.; OBJECTIVE: To alert physicians caring for patients with diabetes to the microorganism Eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli . CASES: We present two cases of extra-oral E . corrodens infections in adolescent females with IDDM . The first patient had diabetes of 4 years' duration, which was moderately well controlled . Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally . Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed . The second patient had poorly controlled diabetes for 5 years . She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics . CONCLUSIONS: E . corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal . Patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E . corrodens infections that can be introduced through oral secretions by licking or biting their skin . Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E . corrodens infections in compromised hosts . Early intravenous administration of antibiotics, bearing in mind E . corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E . corrodens infections.

Chemotherapy, 1996 Sep-Oct, 42(5), 348 - 53
Survey of antibiotic susceptibility among gram-negative bacilli at a cancer center; Rolston KV et al.; A survey of the susceptibility of gram-negative bacilli isolated from cancer patients to broad-spectrum antimicrobial agents was conducted . The organisms were isolated from all patient specimens submitted to the microbiology laboratory during a 3-month study period . Overall, the least resistance was observed against cefoperazone/sulbactam, ciprofloxacin, and imipenem . Of these, cefoperazone/sulbactam has had limited usage at our institution . Drugs used more frequently (piperacillin, aztreonam, cefoperazone, ceftazidime) were associated with greater levels of resistance . Imipenem and ciprofloxacin have enjoyed wide usage but the level of resistance remains low.

Clin Lab Med, 1996 Sep, 16(3), 527 - 50
Biosafety in the clinical mycobacteriology laboratory; Richmond JY et al.; This article presents an expanded agent summary statement for laboratorians working with Mycobacterium tuberculosis . It focuses on reducing the serious risk of infection in clinical laboratories that process specimens from tuberculosis patients or that work with purified cultures of tubercle bacilli . Administrative and engineering controls, practices and procedures, and personal protective equipment are discussed . Guidelines for packaging specimens for transfer to another laboratory also are presented.

J Clin Microbiol, 1996 Sep, 34(9), 2275 - 9
Diagnosis of extrapulmonary tuberculosis by Gen-Probe amplified Mycobacterium tuberculosis direct test; Ehlers S et al.; A total of 294 specimens collected from nonrespiratory sites of 268 patients were tested for direct detection of Mycobacterium tuberculosis complex by the Gen-Probe Amplified Mycobacterium tuberculosis Direct Test (AMTD) . The specimens included ascitic, pleural, pericardial, and synovial fluids, abscess aspirates, and tissue and lymph node biopsy samples, as well as gastric aspirates and cerebrospinal fluid samples . All samples were processed by the N-acetyl-L-cysteine-sodium hydroxide decontamination procedure prior to testing . Twenty samples showed acid-fast bacilli on auramine staining, and 48 samples were positive by AMTD, 9 of which were negative for M . tuberculosis complex by culture . After reviewing the patients clinical charts to resolve discrepancies, the test result of one cerebrospinal fluid sample was considered to be false positive by AMTD . The overall sensitivity, specificity, positive predictive value, and negative predictive value were 83.9, 99.6, 97.9, and 96.3%, respectively . No significant differences were found when AMTD results obtained with specimens of nonrespiratory origin were compared with assay results obtained with samples of respiratory origin (P > 0.05) . In conclusion, our results demonstrate that AMTD performs equally well with all types of specimens.

J Clin Microbiol, 1996 Sep, 34(9), 2240 - 5
Identification of Mycobacterium avium complex in sarcoidosis; el-Zaatari FA et al.; Cell wall-defective bacteria which later reverted to acid-fast bacilli have been isolated from sarcoid tissue . These have not been conclusively shown to be mycobacteria . Specific PCR assays were applied to identify mycobacterial nucleic acids in these cultured isolates and in fresh specimens obtained from patients with sarcoidosis . Positive amplification and hybridization were observed with Mycobacterium avium complex- and/or Mycobacterium paratuberculosis-specific probes in five of the six cultured isolates and two fresh skin biopsy samples and one cerebrospinal fluid specimen . There was no amplification or hybridization with Mycobacterium tuberculosis or M . avium subsp . silvaticum probes, respectively . Patients' sera were also tested for antibody reactivities by immunoblotting with M . paratuberculosis recombinant clones expressing the 36,000-molecular-weight antigen (36K antigen) (p36) and the 65K heat shock protein (PTB65K) . All seven sarcoidosis, four of six tuberculosis, and all six leprosy patient serum specimens showed strong reactivity with p36 antigen . In contrast, 13 of 38 controls showed only weak reactivity with p36 (P = 0.002 for controls versus sarcoidosis samples) . Similarly, PTB65K reacted with high intensity with sera from 5 of 5 sarcoidosis, 5 of 6 tuberculosis, and 5 of 6 leprosy patients, compared with its low-intensity reaction with 5 of 22 controls (P = 0.001 for controls versus sarcoidosis samples) . This study demonstrates the isolation and/or identification of M . paratuberculosis or a closely related M . avium complex strain from sarcoid skin lesions and cerebrospinal fluid . Furthermore, the reactivity of antibodies in sarcoid patient sera against p36 and PTB65K antigens was comparable to the reactivity of sera obtained from patients with known mycobacterial disease . Collectively, these data provide further support for the theory of the mycobacterial etiology of sarcoidosis.

Int J Lepr Other Mycobact Dis, 1996 Sep, 64(3), 311 - 5
Multibacillary nerve histology in clinically diagnosed borderline tuberculoid leprosy patients; Ebenezer GJ et al.; The classification of leprosy into multibacillary (MB) and paucibacillary (PB) patients in almost all clinics is entirely dependent on clinical examination . In a study of 21 patients clinically classified as borderline tuberculoid (BT) and, therefore, belonging to the PB group, skin smears and skin and nerve biopsies were examined . Four patients did not have any histopathological evidence of leprosy . Skin smears showed that 1 patient was positive for acid-fast bacilli (AFB), 2 skin biopsies belonged to the borderline lepromatous (BL) category and showed AFB in their lesions, and AFB were present in 10 nerve biopsies classified as BL . It is possible that reported relapses among PB patients may be in those patients with demonstrable AFB in the lesions, including nerves . A careful follow-up study of this particular group of patients after PB multidrug therapy is suggested to resolve this question.

Int J Lepr Other Mycobact Dis, 1996 Sep, 64(3), 299 - 305
Recognition of lipid antigens by sera of mice infected with Mycobacterium lepraemurium; Luna-Herrera J et al.; Lipids extracted from mouse tissues infected with Mycobacterium lepraemurium (MLM) were analyzed by thin-layer chromatography . Although the extracted lipids were heterogeneous in polarity, the lipids of intermediate polarity were the ones that predominated . All of the lipids of intermediate polarity were glycosylated species . There were also lipids of low and high polarity, the latter being glycolipids . Compared to lipids extracted from normal tissue (mostly to lipids of high and low polarity), all of the additional lipids extracted from the infected tissue corresponded to lipids present in the purified bacteria . Enzyme-linked immunoassays (ELISAs) were then performed with the whole lipids extracted from purified bacilli, the lipids of high, intermediate and low polarity, and the sera from 20 normal and 20 MLM-infected mice . Lipids of intermediate polarity were specifically recognized by MLM-infected mice . Neither sera (diluted 1:500) from normal mice nor infected mice reacted with the lipids of high or low polarity, but a higher concentration (sera diluted 1:100) of some sera from mice in both groups reacted significantly with these lipids . In the ELISAs the whole-lipid extract and the lipids of intermediate polarity were similarly recognized by the sera of the infected mice . Thus, as observed in human leprosy, the mycobacterial disease in the mouse (murine leprosy) is also accompanied by the development of antibodies to the glycolipids of the infecting microorganism.

Int J Lepr Other Mycobact Dis, 1996 Sep, 64(3), 268 - 73
Effect of rhuIFN-gamma treatment in multibacillary leprosy patients; Sampaio EP et al.; Previous studies have shown that when multibacillary leprosy patients were treated with recombinant human interferon gamma (rhuIFN-gamma) for 6-10 months there was an accelerated reduction in the number of acid-fast bacilli in the skin at the site of injection as well as an accelerated bacillary reduction at distal sites . However, this favorable out-come of IFN-gamma treatment was associated with the development of erythema nodosum leprosum (ENL) . The present study was undertaken to investigate whether rhuIFN-gamma-induced bacillary clearance could be disassociated from the induction of ENL . rhuIFN-gamma was administered together with thalidomide and conventional multidrug chemotherapy to newly diagnosed leprosy patients . During treatment with this combination of drugs, the mean reduction in bacterial load was the same as the reduction observed with chemotherapy alone . Moreover, the inclusion of thalidomide in the treatment regimen was associated with a low frequency of ENL episodes . A second group of leprosy patients, who had already completed 2 years of chemotherapy, were treated with rhuIFN-gamma only . In those patients who were skin bacilli negative, ENL did not occur during rhuIFN-gamma treatment . In contrast, in bacilli-positive patients the frequency of ENL during rhuIFN-gamma treatment was higher, as was the occurrence of local erythema and induration . However, rhuIFN-gamma treatment without concomitant chemotherapy did not result in a reduction in the bacterial load in the skin of bacilli-positive patients . These findings, taken together, indicate that rhuIFN-gamma does not, by itself, accelerate bacterial clearance, but requires concomitant chemotherapy to achieve the accelerated reduction in bacillary load . Thalidomide reduces the frequency of IFN-gamma-induced ENL, but also eliminates the IFN-gamma-induced bacillary clearance.

Schweiz Med Wochenschr, 1996 Aug 31, 126(35), 1495 - 9
Spondylodiscitis caused by Tropheryma whippelii; Altwegg M et al.; We describe the first case of spondylodiscitis caused by Tropheryma whippelii in which this so far unculturable organism was shown to be present at the site of infection in a patient without significant gastrointestinal symptoms . The methods used included broad-range PCR amplification with universal primers complementary to constant sequences of the gene coding for 16S rRNA, direct sequencing of the amplified fragment, and comparison of the sequence determined with those deposited in sequence databases . In addition to demonstrating the presence of this organism in the affected vertebral body, we found in our patient that the specific PCR is more sensitive than histology for detecting Whipple's bacilli in bowel biopsy specimens . Because histology of small bowel biopsies from the duodenum were-in contrast to PCR from the same site-not diagnostic for Whipple's disease in our patient, we recommend PCR whenever Whipple's disease has to be excluded.

Rev Med Chil, 1996 Aug, 124(8), 950 - 8
{Management of patients with severe pneumonia in mechanical ventilation: usefulness of bronchoalveolar lavage}; Saldias F et al.; Bacterial pneumonia is a frequent complication in patients requiring mechanical ventilation (9-21%) and carries a significant mortality . The optimal management of these patients remains controversial . Some investigators have advocated invasive diagnostic testing using bronchoscopic techniques . AIM: To asses the diagnostic value of bronchoalveolar lavage (BAL) in patients with suspicion of bacterial pneumonia in mechanical ventilation . PATIENTS: We evaluated 73 community-acquired pneumonia and 94 nosocomial pneumonia in critically ill and mechanically ventilated patients . RESULTS: The mortality was 50% (82 patients) and the principal death's cause was pulmonary sepsis (90%) . 157 subjects received antibiotics before the microbiologic exam (94%) and 30 patients had multiple organ failure (MOF) . Seventy of 167 BAL culture samples demonstrated microbial growth of > 10(4) cfu/ml (sensitivity: 41.9%) . BAL culture samples isolated gram-positive cocci in 27 cases (39%), aerobic gram-negative bacilli in 39 cases (57%) and P carinii in 3 cases (4%) . Correlation between BAL culture and hemocultive results was very insignificant . Prognosis of community-acquired pneumonia and nosocomial pneumonia were very bad in both cases . Mortality of patients with MOF (73%) was higher than patients without MOF (44.8%), (p < 0.01) . Mortality was similar in patients with BAL culture positive (48.6%) and negative (49.5%) . The mortality rate of severe pneumonia in MV was very elevated and the BAL culture results didn't affect significantly the survival.

Oral Microbiol Immunol, 1996 Aug, 11(4), 282 - 8
Detection and prevalence of the tetracycline resistance determinant Tet Q in the microbiota associated with adult periodontitis; Lacroix JM et al.; Subgingival plaque samples were collected from 68 patients with a history of moderate to severe adult periodontitis and enumerated on Trypticase-soy blood agar plates, with and without tetracycline at 4 micrograms/ml . Each different colony morphotype was enumerated, and a representative colony was subcultured for identification and examined for the tetracycline resistance gene tet(Q) by polymerase chain reaction (PCR) amplification and DNA hybridization, using a fragment of tetA(Q)2 from Bacteroides fragilis 1126 . PCR primers (5'-GGCTTCTACGACATCTATTA-3' and 5'-CATCAACATTTATCTCTCTG-3') were chosen to amplify a 755 bp region of tet(Q) . The subgingival plaque samples were also tested by PCR . Approximately 12% of the total cultivable flora was resistant to tetracycline, and the percentage of the tetracycline-resistant cultivable flora with the tet(Q) gene varied greatly from one patient to another with a range from 0.0 to 67% . Half of the 68 subgingival plaque samples were positive or weakly positive for tet(Q) by PCR . Approximately 15% of the 210 isolates subcultured with resistance to tetracycline, (> or = 4 micrograms/ml) contained tet(Q), and 60% contained tet(M) . All of the tet(Q)-resistant isolates were gram-negative anaerobic bacilli and included all of the Prevotella and Bacteroides isolates.

Nihon Kyobu Shikkan Gakkai Zasshi, 1996 Aug, 34(8), 890 - 3
{Costal chondritis treated by resection of the entire costal arch}; Shibata K et al.; A 68-year-old man had chronic pleural empyema, an alveolar fistula, and purulent perichondritis . The pericostal abscess extended beneath both sides of the costal arch and had a cutaneous sinus in the right hypochondrium, but it did not communicate with the cavity of the pleural empyema . In separated operations, the entire costal arch was resected and the alveolar fistula was closed with the pedunculate latissimus dorsal muscle . Neither tuberculosis bacilli nor tubercular granulomas were seen in resected specimens . The postoperative course was uneventful and the pericostal abscess healed, but the alveolar fistula recurred and the patient died of pneumonia 3 years and 6 months after the first surgery.

J Antimicrob Chemother, 1996 Aug, 38(2), 271 - 81
The in-vitro activity of trovafloxacin and nine other antimicrobials against 413 anaerobic bacteria; Bowker KE et al.; The in-vitro activity of trovafloxacin and nine other antimicrobials was determined for 413 non copy anaerobic clinical isolates . Trovafloxacin was the most active quinolone tested with an MIC90 of 0.5 mg/L against Gram-positive cocci (n = 75); MIC90 of 4 mg/L against Gram-positive bacilli (n = 151); MIC90 of 0.5 mg/L for Gram-negative cocci (n = 12) and MIC90 of 1 mg/L for Gram-negative bacilli (n = 175) . Overall the MIC90 of trovafloxacin was 1 mg/L which was equivalent to co-amoxiclav and one dilution higher than that of imipenem . The other seven comparators, including clindamycin and metronidazole, had higher MIC90 values than trovafloxacin . Trovafloxacin is likely to have clinically useful activity against anaerobes from human infection.

J Autoimmun, 1996 Aug, 9(4), 501 - 7
Changes in B and T lymphocytes associated with mycobacteria-induced protection of NOD mice from diabetes; Martins TC et al.; Most female NOD mice spontaneously develop insulin-dependent diabetes mellitus (IDDM) after the 4th month of age . We have recently reported that infection of 2-month-old NOD mice with Mycobacterium avium prevents IDDM expression in these mice . We have searched here for changes in splenic lymphocytes that are associated with the effect of M . avium vaccination . Three experimental groups of female NOD mice were studied: (i) animals infected with 10B viable M . avium bacteria (mice that become protected from IDDM); (ii) mice inoculated with 10B heat-killed (HK) M . avium bacilli, and (iii) untreated age-matched NOD mice . Similar treatments were given to mice of the NON strain which are related to NOD mice but do not develop IDDM . Flow cytometry was used to compare M . avium-infected, HK M . avium inoculated and untreated NOD and NON mice with regard to subpopulations of splenic lymphocytes bearing the surface antigens CD3, CD4, CD8, IgM and B220 . We found that M . avium infection of NOD mice caused a sustained enhancement in T cells that was due to an early and transient increase in CD8+ T cells (detected at day 7 of infection) . This was followed by marked augmentation in the number of CD4+ T cells at days 14 and 30 . There was also elevation in B220+ B cells at days 14 and 30, and of IgM+ B cells at day 30 of infection . Inoculation of NOD mice with HK mycobacteria, which did not prevent IDDM, failed to produce significant changes in the number of T and B cells . No significant enhancement in T and B cells was observed in NON mice that were injected with either viable or HK M . avium bacilli . In NOD mice that reached 16 months of age because of being protected from IDDM (due to the M . avium infection) there was an increase in B220+ B cells . We conclude that: (i) M . avium-induced protection of NOD mice from diabetes depends on the viability of the bacteria; (ii) the protective effect of the infection is associated with an early and marked increase in helper T cells and with a smaller elevation in B cells; (iii) elevation in B cells, but not in T cells, is associated with long term mycobacteria-induced protection of NOD mice from IDDM.

New Horiz, 1996 Aug, 4(3), 385 - 92
Vancomycin-resistant Enterococcus faecium infections in the ICU and quinupristin/dalfopristin; Zervos M; The incidence of vancomycin resistance among enterococci, and Enterococcus faecium in particular, has increased sharply in the last few years . This shift toward infection with resistant Gram-positive organisms is thought to be the consequence of certain features specific to the intensive care setting: a high concentration of severely compromised patients; continued use of indwelling devices and invasive procedures; and widespread, empiric use of antimicrobial agents directed against Gram-negative bacilli . Measures that can be taken to prevent the development of bacterial resistance in the ICU include strict adherence to infection control policies and asepsis, and rational use of antibiotics . Current antimicrobial regimens for serious enterococcal infections consist of a combination of ampicillin, penicillin G, or vancomycin plus streptomycin or gentamicin . High levels of resistances among some enterococcal isolates, however, may render these strategies ineffective . A new agent, quinupristin/dalfopristin (RP 59500), has demonstrated encouraging in vitro activity against vancomycin-resistant E . faecium . Initial clinical reports, though limited, are similarly promising . Although phase III clinical trials with RP 59500 are not completed, the agent is available through an emergency-use program for patients with severe Gram-positive infections who cannot tolerate or do not respond to all other clinically appropriate antibiotics.

S Afr Med J, 1996 Aug, 86(8), 958 - 60
The duration of excretion of viable bacilli in elderly patients on treatment for cavitating pulmonary tuberculosis; Morris CD; OBJECTIVE: To determine the period of excretion of viable tubercle bacilli in cavitating pulmonary tuberculosis in elderly patients while on treatment . DESIGN: 10 consecutive black hospital inpatients over the age of 65 years (6 men, 4 women) with positive acid-fast bacilli smears and Lowenstein-Jenssen culture-proven pulmonary tuberculosis and radiological cavitation had weekly smears and cultures until at least three smears or two cultures were negative . INTERVENTION: Supervised treatment comprising rifampicin, pyrazinamide, ethambutol and isoniazid . RESULTS: It look an average of 5.7 weeks (range 4-9 weeks) for the cultures and 8.2 weeks (range 4-14 weeks) for the smears to become negative . CONCLUSION: Patients with cavitating pulmonary tuberculosis continue to excrete viable tubercle bacilli for approximately 6 weeks despite supervised treatment . It is suggested that allowing such patients back into an environment where three are immunocompromised subjects (e.g . elderly people in retirement homes or HIV-positive subjects) is probably hazardous until the patients are culture or smear negative.

Risk Anal, 1996 Aug, 16(4), 527 - 38
An analytical framework for relating dose, risk, and incidence: an application to occupational tuberculosis infection; Nicas M; An adverse health impact is often treated as a binary variable (response vs . no response), in which case the risk of response is defined as a monotonically increasing function R of the dose received D . For a population of size N, specifying the forms of R(D) and of the probability density function (pdf) for D allows determination of the pdf for risk, and computation of the mean and variance of the distribution of incidence, where the latter parameters are denoted E{SN} and Var{SN}, respectively . The distribution of SN describes uncertainty in the future incidence value . Given variability in dose (and risk) among population members, the distribution of incidence is Poisson-binomial . However, depending on the value of E{SN}, the distribution of incidence is adequately approximated by a Poisson distribution with parameter mu = E{SN}, or by a normal distribution with mean and variance equal to E{SN} and Var{SN} . The general analytical framework is applied to occupational infection by Mycobacterium tuberculosis (M . tb) . Tuberculosis is transmitted by inhalation of 1-5 microns particles carrying viable M . tb bacilli . Infection risk has traditionally been modeled by the expression: R(D) = 1 - exp(-D), where D is the expected number of bacilli that deposit in the pulmonary region . This model assumes that the infectious dose is one bacillus . The beta pdf and the gamma pdf are shown to be reasonable and especially convenient forms for modeling the distribution of the expected cumulative dose across a large healthcare worker cohort . Use of the the analytical framework is illustrated by estimating the efficacy of different respiratory protective devices in reducing healthcare worker infection risk.

J Clin Microbiol, 1996 Aug, 34(8), 1880 - 4
Detection of extended-spectrum beta-lactamase (ESBL)-producing strains by the Etest ESBL screen; Cormican MG et al.; Resistance to contemporary broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamase (ESBL) enzymes, is an increasing problem worldwide . The Etest (AB Biodisk, Solna, Sweden) ESBL screen uses stable gradient technology to evaluate the MIC of ceftazidime alone compared with the MIC of ceftazidime with clavulanic acid (2 micrograms/ml) to facilitate the recognition of strains expressing inhibitable enzymes . In the present study, ESBL-producing strains (17 Escherichia coli transconjugants) were studied to define "sensitive" interpretive criteria for the Etest ESBL screen . These criteria (reduction of the ceftazidime MIC by > 2 log2 dilution steps in the presence of clavulanic acid) defined a group of 92 probable ESBL-positive organisms among the 225 tested strains of Klebsiella species and E . coli having suspicious antibiogram phenotypes . With a subset of 82 clinical strains, the Etest ESBL screen was more sensitive (100%) than the disk approximation test (87%) and was more convenient . The MICs of ciprofloxacin, gentamicin, and tobramycin at which 50% of isolates are inhibited were 16- to 128-fold higher (coresistance) for the ESBL screen-positive group of strains than for the ESBL screen-negative group of strains . Some strains for which cephalosporin MICs were elevated and which were Etest ESBL screen negative were also cefoxitin resistant, i.e., consistent with a chromosomally mediated AmpC resistance phenotype . The Etest ESBL screen test with the ceftazidime substrate appears to be a useful method for detecting or validating the presence of enteric bacilli potentially producing this type of beta-lactamase.

J Epidemiol, 1996 Aug, 6(3 Suppl), S75 - 9
"Tuberculosis"; Aoki M; Tuberculosis has decreased so rapidly and has changed its epidemiological feature so markedly in these several decades in Japan, that tuberculosis epidemiologists had done and have to do numerous studies to understand the situations and to adjust tuberculosis control programme of high prevalent country to that of low prevalent country . Main themes of epidemiological research are being focused on 1) the causes of stagnation of the decrease of tuberculosis incidence and estimation of future trend in Japan, 2) risk factors of development of disease at present when more than 95% of diseases are the exacerbation of the remote infection, 3) the efficacy and efficiency of each control measure to improve the existing programme in Japan, 4) the mode of tuberculosis infection in the community using RFLP analysis of tubercle bacilli, 5) epidemiology of tuberculosis in the developing countries where tuberculosis is increasing at present, and so on . Because of the increase of tuberculosis in the world, epidemiological research in tuberculosis is becoming more and more active to-day . It is being expected that epidemiological research on tuberculosis will have more and more fruitful results in near future.

Biochim Biophys Acta, 1996 Jul 31, 1308(1), 74 - 80
Sequence of the gene encoding a highly thermostable neutral proteinase from Bacillus sp . strain EA1: expression in Escherichia coli and characterisation; Saul DJ et al.; The gene for a highly thermostable neutral proteinase (Npr) was isolated from Bacillus sp . strain EA1 by the polymerase chain reaction using consensus primers based on the sequences of npr genes from related species . The gene was sequenced and shown to be closely related to a neutral proteinase gene from Bacillus caldolyticus strain YP-T; the mature form of the enzyme differing by only a single amino acid . Enzyme samples were prepared from both the native organisms and also from recombinant Escherichia coli expressing the two npr genes . The proteinase from strain EA1 was shown to be significantly more thermostable than that from B . caldolyticus and that this difference is the result of a single amino acid substitution which is situated proximal to a region of the enzyme known to be crucial to conferring thermal stability . The phylogenetic relationship of EA1 to other Bacilli is also described.

Biochim Biophys Acta, 1996 Jul 18, 1275(1-2), 21 - 6
Energetic problems of extremely alkaliphilic aerobes; Krulwich TA et al.; Over a decade of work on extremely alkaliphilic Bacillus species has clarified the extraordinary capacity that these bacteria have for regulating their cytoplasmic pH during growth at pH values well over 10 . However, a variety of interesting energetic problems related to their Na(+)-dependent pH homeostatic mechanism are yet to be solved . They include: (1) the clarification of how cell surface layers play a role in a category of alkaliphiles for which this is the case; (2) identification of the putative, electrogenic Na+/H+ antiporter(s) that, in at least some alkaliphiles, may completely account for a cytoplasmic pH that is over 2 pH units lower than the external pH; (3) the determination of whether specific modules or accessory proteins are essential for the efficacy of such antiporters; (4) the mechanistic basis for the increase in the transmembrane electrical potential at the high external pH values at which the potential-consuming antiporter(s) must be most active; and (5) an explanation for the Na(+)-specificity of pH homeostasis in the extremely alkaliphilic bacilli as opposed to the almost equivalent efficacy of K+ for pH homeostasis in at least some non-alkaliphilic aerobes . The current status of such studies and future strategies will be outlined for this central area of alkaliphile energetics . Also considered, will be strategies to elucidate the basis for robust H(+)-coupled oxidative phosphorylation by alkaliphiles at pH values over 10 . The maintenance of a cytoplasmic pH over 2 units below the high external pH results in a low bulk electrochemical proton gradient (delta p) . To bypass this low delta p, Na(+)-coupling is used for solute uptake even by alkaliphiles that are mesophiles from environments that are not especially Na(+)-rich . This indicates that these bacteria indeed experience a low delta p, to which such coupling is an adaptation . Possible reasons and mechanisms for using a H(+)-coupled rather than a Na(+)-coupled ATP synthase under such circumstances will be discussed.

Roum Arch Microbiol Immunol, 1996 Jul-Sep, 55(3), 205 - 14
Serodiagnosis of tuberculous meningitis by enzyme-linked immunosorbent assay (ELISA); Niculescu D et al.; IgG antibodies against glycolipids and proteins isolated from M . tuberculosis and BCG suspension were determined by ELISA in sera, in CSFs and in serum and CSF paired samples, from patients with tuberculous meningitis and from healthy control subjects . With specificities between 90 and 94% for the antigens used, we obtained senitivities of 75% for Pr-ELISA, 60% for G1-ELISA and 35% for BCG-ELISA . As specific antibodies were detected in serum and CSFs, only one sample is enough to perform the test . We concluded that Pr-ELISA and G1-ELISA could be used as a supporting test in TBM diagnosis, especially when repeated bacteriological methods failed to prove the presence of tubercle bacilli and in cases without evidence of pulmonary tuberculosis.

Vojnosanit Pregl, 1996 Jul-Aug, 53(4), 281 - 6
{Personal experience in the treatment of tuberculosis in patients in war areas}; Acimovic S et al.; In the four-year period (1991-1995), 96 tuberculosis patients from the war areas of former Yugoslavia were treated in the Clinic for Lung Diseases of Military Medical Academy, that makes 31% of total number of sick and treated for tuberculosis-309 (100%) . In group I (patients from war areas) there were 45 cases of cavernous pulmonary tuberculosis (47%), 28 bilateral (29%), 16 pleurisy (16.7%) and 6 cases of extensive pulmonary tuberculosis (5.1%) . Among 213 patients (100%) from group II (patients from FR Yugoslavia), 81 patients had cavernous pulmonary tuberculosis (38%), 49 patients had bilateral (23%), 33 patients had pleurisy (15.5%) and 6 patients had extensive pulmonary tuberculosis (2.8%) . In group I the diagnosis was bacteriologically and/or histopathologically proved in 94.8% cases: by finding of acid-resistant bacilli in sputum and other biological materials in 69 patients (72%), by positive Lowenstein's cultures in 73 patients (76%) and by histopathological result of tuberculosis inflammation in 34 patients (35.4%) . In group II tuberculosis was bacteriologically and/or histopathologically proved in 134 patients (63%) by acid-resistant bacilli in sputum and other biological materials, in 141 patient (66%) by positive Lowenstein's culture and in 71 patient by positive histopathological results . Pulmonary tuberculosis in war areas is characterized by greater frequency of severe clinical forms (cavernous, bilateral and extensive) and by high direct bacillarity.

Rev Hosp Clin Fac Med Sao Paulo, 1996 Jul-Aug, 51(4), 131 - 5
{Predictive factors of abandoning treatment in tuberculosis patients}; Deheinzelin D et al.; In spite of the efforts to control the spread of tuberculosis worldwide this disease remains one of the biggest problems in public health . Multiresistance has a dramatic effect in this scenario . Non compliance with treatment is directly related to disease spread and the appearance of multiresistance bacilli . Aiming to verify if it is possible to identify patients prone to non compliance from data obtained in the first visit we have studied a population enrolled in a prospective study . Among 257 consecutive patients evaluated between january 1991 and january 1994, we compared 87 patients that abandoned treatment before six months (group A) with 97 that completed six months of treatment (group C) . The abandon rate in this group as 33.85% which is larger than 12.9% rate reported by the Health Ministry . Comparing A to C, only the prevalence of alcoholism (A 33.3% x C 22.5%, p = 0.015) and risk behavior for HIV infection (A 27.6% x C 10.2%, p = 0.046), as well as the frequency of non pulmonary disease (A 38.0% x C 24.5%, p = 0.034) were significantly different between both groups . Regarding the moment of abandon (0, 1st or 3rd month) there was no difference in the A group . We conclude that patients at high risk of abandoning tuberculosis treatment can be identified with data obtained at the first visit, allowing to establish a different policy such as supervised treatment for this population.

Pol Merkuriusz Lek, 1996 Jul, 1(1), 15 - 7
{Bacterial flora of the respiratory tract in artificially ventilated patients}; Jarosz-Cencora B et al.; Patients treated in ICUs are at particular risk for nosocomial infections . Within this group a ventilator-associated pneumonia still constitutes a major problem . Highly virulent hospital strains, existing in ICUs, can colonize patients' upper respiratory tract . Therefore this study aimed at analysing the organisms found in patients who required mechanical ventilation in ICUs . The same types of bacteria with the same (high) rate colonized upper airways, trachea and stomach of patients treated at the intensive Care Unit . It is suggested that the presence of Gram negative bacilli may serve as a marker of possible pneumonia in artificially ventilated patients . It is also important to check whether the organisms isolated from the larynx or trachea are only colonizing agents or are representative for the etiologic factors of pneumonia . Antibiotic therapy based on the sensitivity tests could be inadequate.

Bacteriol Virusol Parazitol Epidemiol, 1996 Jul-Dec, 41(3-4), 141 - 4
{The isolation of Arcanobacterium haemolyticum from the pharyngeal exudate of children}; Coman G et al.; A . haemolyticum is involved in acute pharingotonsillitis in present, reaching a maximal incidence between 10 and 30 years of age . The authors examined 7402 throats swabs obtained from children between March 1995 and February 1996 . The swabs were plated on a selective culture medium: 5% sheep blood agar added with 3.5% NaCl; the plates were incubated for 48 h in aerobic conditions . The colonies of A . haemolyticum have been suspected on the basis of a) the growing time interval (48 h); reduced size (diameter less than 1 mm); c) the presence of a narrow zone of incomplete beta-haemolysis and d) the typical pitting of the culture medium beneath the colony . The definitive identification was realised on the basis of the microscopical appearance (diphtheroid gram-positive bacilli), negative catalase test and inverse CAMP test (narrowing of the haemolytic zone produced by staphylococcal beta-lysine) . The frequency of A . haemolyticum in the throat swabs investigated was 0.07% (5 cases), comparing with S . pyogenes which was found in 8.21% of cases.

Mol Microbiol, 1996 Jul, 21(2), 205 - 11
Recombination in mycobacteria; McFadden J; Mycobacterium tuberculosis, the causative agent of tuberculosis (TB) is thought to infect a quarter of the world's population and accounts for 3 million deaths each year . Leprosy, caused by Mycobacterium leprae continues to afflict millions . In many countries, the incidence of TB is increasing due to its association with acquired immune deficiency syndrome (AIDS) and the emergence of multidrug resistance strains of tubercle bacilli . Genes that encode major antigens, enzymes, potential virulence determinants and drug resistance in mycobacteria have been isolated and characterized; however, further genetic analysis of pathogenic mycobacteria has been severely hampered by the difficulty in precisely defining the phenotype of both wild-type and mutant genes by utilizing homologous recombination to perform allele exchange . Recombination mechanisms have been intensely studied in Escherichia coli but it is unclear how far mechanistic pathways elucidated in this species are applicable to other organisms, such as mycobacteria . The aim of this review is to examine what is currently known about homologous recombination in mycobacteria . A model is proposed to account for both low levels of homologous recombination and high levels of illegitimate recombination found in the tubercle bacillus.

Zentralbl Bakteriol, 1996 Jul, 284(2-3), 329 - 47
Comparison of BBL Crystal ANR ID Kit and API rapid ID 32 A for identification of anaerobic bacteria; Moll WM et al.; BBL Crystal ANR ID Kit and the API System rapid ID 32 A are miniaturized identification systems for anaerobes using enzymatic tests . The incubation period of both systems is 4 hours . A comparative evaluation of the BBL Crystal Identification System Anaerobe ID Kit (Becton Dickinson Microbiology Systems, Cockeysville, USA) with anaerobes grown on Columbia and Schaedler agar plates (Becton Dickinson Microbiology Systems, Cockeysville, USA) and the API System rapid ID 32 A (BioMerieux SA, Lyon, France) with bacteria grown on Columbia agar (Becton Dickinson Microbiology Systems, Cockeysville, USA) which is recommended by the manufacturer as cultivation medium, was performed with 207 mostly fresh clinical anaerobe isolates, including 104 gram-negative bacilli, 12 gram-negative cocci, 15 gram-positive cocci, 14 gram-positive sporeforming bacilli and 62 representatives of gram-positive non-sporeforming bacilli . With supplemental testing the Crystal system with inocula from Columbia and Schaedler agar and API inoculates from Columbia agar identified to genus level 144 (69.6%), 152 (73.4%) and 109 (52.7%) isolates, respectively . Misidentification to genus level was found by Crystal from Columbia and Schaedler agar and by API from Columbia agar in 17 (8.2%), 15 (7.3%) and 12 (5.8%) isolates, respectively . 36 isolates were not determined to species level by classical anaerobic methods or the systems only identified to genus level . 26 anaerobes were not included in the database of the Crystal or API system . From the remaining 145 clinical isolates with supplemental testing, Crystal from Columbia and Schaedler agar plates correctly identified 91 (62.8%) and 102 (70.3%), respectively, and API, 69 (47.6%) isolates . For the correct identification to genus and species level of the 207 clinical isolates tested, the Crystal system from Columbia and Schaedler agar and API system from Columbia agar required supplemental testing, as specified by the manufacturer, for 39 (27.1%), 34 (22.4%) and 14 (12.8%) isolates, respectively . Among the 207 clinical isolates tested, 27 had been frozen and 26 had been lyophilized . In a comparative evaluation, the fresh isolates showed a slightly to significantly better identification rate than the frozen or lyophilized specimens in all three tests . The individual reproducibility of the Crystal ANR ID, which had been tested before the accuracy study was performed, ranged from 90.8% to 100% . The overall reproducibility was determined to be 97.3% . Time consumption studies and cost analysis did not show a significant difference between both systems, but Crystal ANR ID was found to be easier to use than API rapid ID 32.

Vet Pathol, 1996 Jul, 33(4), 445 - 7
Morphological evidence of a filamentous cilia-associated respiratory (CAR) bacillus in goats; Fernandez A et al.; A filamentous cilia-associated respiratory (CAR) bacillus was discovered in 12 3-4 month-old goats experimentally infected with two different strains of mycoplasmas belonging to the Mycoplasma mycoides type . The CAR bacilli were always arranged parallel to the cilia, and the morphology of these bacilli is very similar to that of other bacilli described previously in other species from various parts of the world.

J Clin Microbiol, 1996 Jul, 34(7), 1821 - 4
Oerskovia xanthineolytica infection of a prosthetic joint: case report and review; Harrington RD et al.; Oerskovia spp . are gram-positive, Nocardia-like bacilli which inhabit the soil and rarely cause human infections . Previously reported cases of Oerskovia infection have been characterized by a nonaggressive course and an association with foreign bodies . We report the first case of a patient with a prosthetic joint infection due to Oerskovia xanthineolytica . Our patient presented with a prolonged, indolent course and was thought to have aseptic loosening of his prosthesis until the time of surgery . He was cured of his infection by removal of the prosthesis, antibiotic therapy, and delayed reimplantation . Review of the previous 10 reported cases of Oerskovia infection in humans supports the recommendation that foreign-body-associated infections should be treated with a strategy that includes removal of the foreign material.

Infect Immun, 1996 Jul, 64(7), 2523 - 31
Interleukin-12 production by human monocytes infected with Mycobacterium tuberculosis: role of phagocytosis; Fulton SA et al.; Mycobacterium tuberculosis and its antigens are potent inducers of cytokine expression by mononuclear phagocytes . In this study, the ability of live M . tuberculosis to stimulate interleukin-12 (IL-12) expression by human monocytes was examined . Monocytes were purified from peripheral blood mononuclear cells by adherence and either infected with M . tuberculosis or exposed to soluble protein antigens of M . tuberculosis (purified protein derivative {PPD}) . Live M . tuberculosis (10(6) to 10(7) CFU/ml) was a potent stimulus for interleukin-12 (IL-12) . By using reverse transcription-PCR, p40 mRNA was detected at 3 h, peaked at 6 to 12 h, and decayed to baseline levels at 18 to 24 h following infection . Bioactive IL-12 (p70) was measured by the phytohemagglutinin blast proliferation assay and confirmed the p40 mRNA results . In contrast, soluble PPD at concentrations known to readily induce IL-1 and tumor necrosis factor alpha expression by monocytes (10 to 100 microg/ml) was a poor stimulus for IL-12 p40 mRNA expression . The different efficiencies of M . tuberculosis bacilli and PPD for IL-12 expression by monocytes was in part due to a requirement for phagocytosis . Induction of IL-12 in response to M . tuberculosis was reduced by cytochalasin D . Furthermore, phagocytosis of dead M . tuberculosis or inert 2-micron-diameter polystyrene beads by monocytes induced IL-12 p40 mRNA . In contrast, 0.5-micron-diameter beads, which can enter cells through pinocytosis, did not stimulate IL-12 expression . Functionally, IL-12 readily enhanced PPD-stimulated IFN-gamma production and CD4+ T-cell-mediated cytotoxicity by peripheral blood mononuclear cells from healthy tuberculin-positive donors but induced less enhancement when live M . tuberculosis was the antigen . These results suggest that IL-12 is upregulated as part of the early cytokine response of mononuclear phagocytes to M . tuberculosis and that the cellular events associated with phagocytosis are themselves a potent signal for IL-12 production . IL-12 released by infected macrophages in turn can further upregulate M . tuberculosis-specific CD4+ T-cell effector function.

Acta Cytol, 1996 Jul-Aug, 40(4), 751 - 5
Fine needle aspiration diagnosis of intramuscular bacillary angiomatosis . A case report; Sanchez MA et al.; BACKGROUND: Bacillary angiomatosis (BA) is a localized infectious process that affects primarily patients with the acquired immunodeficiency syndrome . The microorganisms implicated in the pathogenesis of this disease belong to the Rickettsiaceae family . CASE: A 43-year-old, human immunodeficiency syndrome-positive male presented with diffuse swelling in the right deltoid area . A neoplastic process was considered in the differential diagnosis . Fine needle aspiration biopsy showed proliferation of blood vessels lined with plump endothelial cells, and the interstitial space was occupied by neutrophilic infiltrate, leukocytoclastic debris and clumps of characteristic amphophilic, granular material . Warthin-Starry stain demonstrated clusters of bacilli diagnostic of bacillary angiomatosis . CONCLUSION: The diagnosis of this entity, made by fine needle aspiration cytology (as the only diagnostic procedure), was instrumental in preventing further surgical manipulation and in initiating appropriate and immediate antibiotic therapy.

Schweiz Med Wochenschr, 1996 Jun 22, 126(25), 1112 - 8
{Tuberculosis in Switzerland in 1996: prevention and treatment}; Zellweger JP; Tuberculosis is currently a rare disease in Switzerland and its incidence is slowly decreasing . Nevertheless, the increase in the proportion of foreign-born patients, the occurrence of multidrug-resistant bacilli and the increase of tuberculosis in HIV-infected individuals give rise to concern and have prompted changes in the management of the disease . The first aim is to cure the patients with adequate chemotherapy in order to prevent relapses and the development of drug-resistant germs . The best way to do so is to provide directly supervised treatment, particularly in cases where compliance with the treatment may be uncertain . Tuberculosis is transmissible to sensitive individuals . Therefore, some preventive measures are still indicated in settings where patients with a known or unknown bacillary form of tuberculosis may be cared for.

J Immunol, 1996 Jun 15, 156(12), 4764 - 73
Mycobacterium avium- and Mycobacterium tuberculosis-containing vacuoles are dynamic, fusion-competent vesicles that are accessible to glycosphingolipids from the host cell plasmalemma; Russell DG et al.; The vacuoles inhabited by viable Mycobacterium avium and Mycobacterium tuberculosis show limited fusion with endosomal and lysosomal compartments . This ability to regulate the maturation of their phagosomal compartments and restrict their differentiation into hydrolytically active vacuoles appears to correlate with the survival of the bacilli . Data presented in this current study demonstrate that despite the apparent isolation of mycobacterial vacuoles from the lysosomal network, they are dynamic, fusion-competent vesicles . Exploiting the ability of cholera toxin B subunit to bind to GM1 ganglioside on the macrophage plasmalemma, we demonstrate that these glycosphingolipids have ready access to the mycobacterial vacuoles . Entry into mycobacterial vacuoles is rapid, within 5 min of addition to the cells, and does not proceed through a brefeldin A-sensitive pathway . Furthermore, the gangliosides follow a route that differs from that taken by fluid-phase markers . TLC analysis gangliosides isolated from Mycobacterium-containing vacuoles, and IgG-bead phagosomes reveal similar profiles . These data indicate that rather than being fusion incompetent, mycobacterial vacuoles are actually highly dynamic, fusion-competent vesicles that behave like an extension of the recycling endosomal apparatus.

Science, 1996 Jun 14, 272(5268), 1641 - 3
Compensatory ahpC gene expression in isoniazid-resistant Mycobacterium tuberculosis; Sherman DR et al.; Mutations that eliminate KatG catalase-peroxidase activity prevent activation of isoniazid and are a major mechanism of resistance to this principal drug for the treatment of Mycobacterium tuberculosis infections . However, the loss of KatG activity in clinical isolates seemed paradoxical because KatG is considered an important factor for the survival of the organism . Expression of either KatG or the recently identified alkyl hydroperoxidase AhpC was sufficient to protect bacilli against the toxic effects of organic peroxides . To survive during infection, isoniazid-resistant KatG mutants have apparently compensated for the loss of KatG catalase-peroxidase activity by a second mutation, resulting in hyperexpression of AhpC.

Clin Exp Immunol, 1996 Jun, 104(3), 419 - 25
Proliferation of distinct human T cell subsets in response to live, killed or soluble extracts of Mycobacterium tuberculosis and Myco . avium; Esin S et al.; The proliferative responses of distinct cell subsets from healthy, bacille Calmette-Guerin (BCG)-vaccinated blood donors were assessed after in vitro stimulation with live or UV-killed Mycobacterium tuberculosis and Myco . avium or with soluble extracts obtained from either mycobacterial species . Proliferation of cell subsets was evaluated by flow cytometric determination of 5-bromo-2'-deoxy-uridine incorporation into DNA and simultaneous identification of surface phenotypic markers . In the presence of monocytes, the response to whole (live or killed) bacteria was characterized by a predominant proliferation of CD4+ alphabeta+ T cells and, to a lesser extent, of CD8+ alphabeta+ T cells . Proliferation of CD8+ alphabeta+ T cells was primarily elicited by live rather than killed bacilli (P < 0.05) . Conversely, when soluble bacterial extracts were used as stimulators, a preferential proliferation of gammadelta+ T cells, expressing predominantly Vgamma9+ and Vdelta2+ T cell receptor chains, was recorded . Moreover, when monocyte-depleted cell populations were directly cultured with live bacteria, a marked proportion of CD3- CD16+ (natural killer (NK)) cells was detected among the responding cells . Although both alphabeta, gammadelta and NK cells have been previously shown to react with mycobacteria in vitro, their relative contributions to the response have been difficult to assess . Using a flow cytometric technique which allows direct identification of proliferating cells within complex cell populations, our study demonstrates significant differences in the ability of various mycobacterial antigen preparations to elicit proliferation of distinct cell subsets.

Genetika, 1996 Jun, 32(6), 740 - 3
{Identification and classification of strains of microorganisms using genomic fingerprinting with biotinylated phage M13 DNA}; Oreshkova SF et al.; To analyze DNA polymorphisms of various bacterial strains, a nonradioactive variant of the genomic fingerprinting method was developed . The method was based on the application of biotin-labeled single-stranded phage M13 DNA as a probe . Characteristic patterns of fingerprints obtained by MvaI, HaeIII, and HinfI restriction enzymes are presented for several species of bacilli and other bacteria . The advantages of this method in microbiology for the identification and characterization of different microbial strains are shown.

Liver, 1996 Jun, 16(3), 218 - 20
Focal tuberculosis of the liver with local hemorrhage in a patient with acquired immunodeficiency syndrome; Brmbolic BJ et al.; Tuberculosis of the liver is common in patients with acquired immunodeficiency syndrome (AIDS) . Tuberculous liver granulomas in such patients are usually atypical . The liver granulomas may be even totally absent, but liver tissue usually reveals numerous acid-fast bacilli . Focal tuberculosis of the liver is a less common form of liver tuberculous infection . We present a 33-year old white homosexual man infected with the human immunodeficiency virus . He had three tumour-like lesions in the left liver lobe, which were subsequently diagnosed as focal hepatic tuberculosis with local hemorrhage . This unusual presentation of liver tuberculosis indicates the necessity of an aggressive diagnostic approach for the evaluation of focal liver lesions in patients with AIDS.

J Hematother, 1996 Jun, 5(3), 289 - 94
The significance of microbial cultures of the hematopoietic support for patients receiving high-dose chemotherapy; Cohen A et al.; The use of hematopoietic support for patients receiving high-dose chemotherapy has increased over the past 10 years . Various quality controls are performed on the hematopoietic cells, including microbiologic cultures . There is considerable expense associated with the serial cultures performed at different times during the collection, processing, and use of the cells . We reviewed all the microbiologic cultures performed on bone marrow harvests and leukaphereses over a 17 month period . Of the 227 bone marrow harvests, 16 cultures were positive, but only 3 (1.3%) were repeat positives with the same organism after processing or at the time of reinfusion . Of the 560 leukaphereses, 4 (0.7%) were cultured positive at the time of collection and reinfusion . Two patients were bacteremic with gram-negative bacilli at the time of leukaphereses despite being asymptomatic, and these were the only two products that had to be collected again . No patient suffered an adverse clinical result after receiving culture-positive cells . Bone marrow and peripheral blood progenitor cells can be safely collected, and a culture after processing is adequate to ensure the safety of the product.

Lab Anim Sci, 1996 Jun, 46(3), 275 - 9
Hemorrhagic typhlocolitis associated with attaching and effacing Escherichia coli in common marmosets; Thomson JA et al.; We describe the necropsy results from three common marmosets presented during an outbreak of hemorrhagic diarrhea in a colony of 230 common marmosets (Callithrix jacchus) . Necropsy revealed consistent hemorrhagic typhlocolitis and variable ileitis associated with gram-negative bacilli closely adherent to enterocytes . Electron microscopy revealed bacilli attached intimately to shallow cup-like projections of enterocyte apical membranes with loss of microvilli (attaching and effacing) . Escherichia coli isolates from affected marmosets were serogroup O26 and were positive for the E . coli attaching and effacing locus and negative for shiga-like toxin I and II, heat-stable enterotoxins a and b, and heat-labile enterotoxin by DNA probe hybridization . Results of a Vero cell cytotoxicity assay confirmed that the E . coli isolates did not produce shiga-like toxin . The increased availability of diagnostic probes for specific virulence factors such as attaching and effacing E . coli should lead to a greater understanding of the frequency of E . coli as a cause of diarrhea in nonhuman primates.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996 Jun, 81(6), 665 - 71
Respiratory scleroma: a clinicopathologic and ultrastructural study; Sedano HO et al.; Respiratory scleroma (rhinoscleroma) is a chronic granulomatous infection produced by Klebsiella rhinoscleromatis, a gram-negative aerobic coccobacillus . This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China . Sporadic cases have been reported in the United States, especially in persons who migrated from the aforementioned areas . The majority of cases affect the nose, but extension to the soft and hard palate, upper lip, and maxillary sinuses also is frequent . This study comprises 11 patients (6 females and 5 males) with respiratory scleroma identified over a 6-year period in Guatemala . Their ages ranged from 16 to 60 years . Light microscopy showed a dense plasmacytic infiltrate, Mikulicz histiocytes, and Russell bodies within the plasma cells . Ultrastructural study revealed Mikulicz histiocytes, cytoplasmic vacuoles containing bacilli, and so-called A and B granules . We favor the term respiratory scleroma for this lesion because it affects not only the nose but also the upper and lower respiratory tracts as well as the mouth.

Clin Infect Dis, 1996 Jun, 22(6), 997 - 1003
Randomized controlled trial of selective bowel decontamination for prevention of infections following liver transplantation; Arnow PM et al.; Nonabsorbable antibiotics for selective bowel decontamination (SBD) sometimes are administered to liver transplant patients to prevent postoperative infections, but the efficacy of SBD is not known . Accordingly, we prospectively studied 69 patients randomly assigned to receive conventional prophylaxis with systemic antibiotics (control patients) or conventional prophylaxis plus oral nonabsorbable antibiotics for SBD (SBD patients) . Overall rates of bacterial and/or yeast infections were nearly equal among control patients (42%) and SBD patients (39%) . However, the infection rate at SBD key sites (abdomen, bloodstream, surgical wound, and lungs) was lower among patients who received the SBD regimen > or = 3 days before transplantation (23%) than among control patients (36%) . Administration of the SBD regimen was complicated by gastrointestinal intolerance and noncompliance but not by increased stool colonization with antibiotic-resistant gram-negative bacilli . Practical problems associated with administering an SBD regimen to patients awaiting cadaver liver transplants limit the regimen's usefulness, but we found a trend toward reduced key site infection when the regimen was given > or = 3 days before transplantation.

Chest, 1996 Jun, 109(6), 1562 - 5
Incidence and significance of acid-fast bacilli in sputum smears at the end of antituberculous treatment; Vidal R et al.; OBJECTIVE: A group of patients with pulmonary tuberculosis (PT) who received and correctly completed antituberculous therapy were studied to determine the incidence and significance of positive acid-fast bacilli (AFB) in sputum smears at the end of this treatment . DESIGN: Retrospective chart review of persons with bacteriologically proved PT . PATIENTS: Of 1,052 patients diagnosed as having PT between 1988 and 1992, 453 who fulfilled the following criteria were included in the study: (1) diagnosis established by positive AFB and positive culture in sputum smears; (2) no previous antituberculous treatment had been received; (3) HIV serologic test results were negative; (4) treatment was correctly completed; (5) they were followed up throughout the period of treatment; and (6) expectoration was still present at the end of treatment and at least two spontaneous sputum samples could be obtained . RESULTS: Positive AFB of sputum smears were found at the end of treatment in 10 (2.2%) of the 453 patients studied . Five patients had only one positive smear, and the other five had more than one . Of these ten cases, sputum culture was negative in eight, which were considered to be unviable bacilli, and positive for nontuberculous mycobacteria in two . Clinical symptoms or worsening on chest radiograph were observed only in one patient with unviable bacilli, but they were caused by a concomitant nonspecific respiratory tract infection . CONCLUSIONS: Positive AFB smear results at the end of completed treatment regimens analyzed in this study have occurred because of unviable bacilli and nontuberculous mycobacteria colonization . The presence of more than one positive smear seems not to increase the probability of treatment failure and is more frequently due to nontuberculous mycobacteria . Results of culture can thus be awaited without the need to prolong or modify antituberculous therapy.

Rev Clin Esp, 1996 Jun, 196(6), 378 - 80
{Pulmonary and laryngeal tuberculosis . Study of 26 patients}; Vidal R et al.; A description is reported of tuberculosis cases (TBC) with symptomatic laryngeal involvement diagnosed and treated from 1982 to 1994 . Twenty-six out of 2,800 (0.9%) patients diagnosed with TBC had laryngeal symptoms . Twelve patients underwent laryngeal biopsy and the disease was diagnosed in 11; the remaining 15 patients were diagnosed on the basis of the typical lesions at laryngoscopy and resolution with specific therapy; in all of them there was a pulmonary TBC associated . The mean time of clinical laryngeal symptoms was five months and the most common symptom was dysphonia . There were factors which increased the risk for TBC in 16 patients (61.5%), alcoholism being the most common symptom in 10 (38%) patients . X-Ray examination revealed bilateral infiltrates or cavitation in 81% of patients . Sputum examination for acid-fast bacilli was positive in 15 (58%) and culture for Mycobacterium tuberculosis was positive in all of them . All patients adhered correctly to the therapeutic regimen and the clinical course was towards healing: no patient had laryngeal carcinoma after one year of follow-up . The incidence of symptomatic laryngeal TBC in our environment is low and usually presents in patients with risk factors, particularly alcoholism, with a long evolution of the disease and associated with extensive pulmonary TBC . The coexistence with laryngeal carcinoma is exceptional; therefore, when the association of laryngeal symptoms and active pulmonary TBC is present it is reasonable to reserve the laryngeal biopsy for those patients with lymph node enlargement, risk factors, or when symptoms persist after a correct therapeutic regime has been instituted.

Tuber Lung Dis, 1996 Jun, 77(3), 285 - 6
Lymph node biopsy as an aid in the diagnosis of intracranial tuberculosis; Schutte CM et al.; This report describes five patients with intracranial tuberculosis (TB): four with tuberculous meningitis and one with intracranial tuberculomas . In all cases the diagnosis was confirmed by excision biopsy of an enlarged cervical or axillary lymph node . The biopsies showed caseating granulomas and acid fast bacilli, confirming the diagnosis of TB within 48 h of admission . Lymphnode biopsies may be an effective and practical aid in diagnosing intracranial TB.

Enferm Infecc Microbiol Clin, 1996 Jun-Jul, 14(6), 370 - 6
{Antibiotic sensitivity of anaerobic bacteria isolated during one year (1993)}; Duran MT et al.; BACKGROUND: The aim of this study was to determine the antimicrobian susceptibility of the anaerobe bacteria isolated from clinical samples in the authors' department in 1993 . METHODS: The minimum inhibitory concentrations of 10 antimicrobians were determined in microgram/ml for 129 anaerobe bacterias by the microdilution in broth method recommended by the NCCLS . RESULTS: All The strains were sensitive to chloramphenicol . Metronidazole inhibited all the isolates except A . meyeri and 50% of other non spored gram-positive bacilli . Imipenen and piperacillin-tazobactam were the most active beta lactamics, with only 1 B . fragilis being resistant to both . Clavulanic amoxycillin presented good activity with only 5% from the B . fragilis group, 1 F . mortiferum and 2 P . anaerobius being resistant . In the B . fragilis group 10% were resistant to cefoxitin and 15% to piperacillin . The remaining isolates were sensitive to both antimicrobians . Resistance to clindamycin in the B . fragilis group was 16.7% . There were also strains resistant to Peptostreptococcus, Prevotella and aerotolerant non spored gram-positive bacilli . Penicillin and amoxycillin were the least active antimicrobians . CONCLUSIONS: Chloramphenicol, metronidazole, imipenem, piperacillin-tazobactam and clavulanic amoxycillin were very effective and showed a wide spectrum of activity versus the strains studied . Cefoxitin, piperacillin and clindamycin maintain good antianaerobe activity.

Enferm Infecc Microbiol Clin, 1996 Jun-Jul, 14(6), 352 - 6
{Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms}; Fortun J et al.; BACKGROUND: The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis . METHODS: All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed . All cases of cervical adenitis were not included . RESULTS: Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal) . In the laryngeal forms, all patients were male except for one, and all were smokers . The duration of the symptoms was greater than 3 months in all the cases . Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord . Twenty-nine percent did not present with coincident pulmonary tuberculosis . None of the extra-laryngeal forms showed pulmonary involvement . All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis . The evolution with medical treatment was favorable in all cases . During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital . CONCLUSIONS: Tuberculosis of the upper respiratory tract is infrequent . Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms . Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy . Response to medical treatment is usually good.

Kekkaku, 1996 Jun, 71(6), 399 - 405
{Rapid detection of acid-fast bacilli with Mycobacteria Growth Indicator Tube (MGIT)}; Saito H et al.; The BBL MGIT Mycobacteria Growth Indicator Tube is a novel broth based culture system for the detection of mycobacteria from clinical specimens . The tubes consist of a fluorescent indicator embedded in silicone on the bottom of a 16x100 mm round-bottom tube, filled with 4ml of an enriched BBL Middlebrook 7H9 broth base, with 0.25% glycerol . Actively growing mycobacteria consume the oxygen dissolved in the medium and fluorescence will occur when the tubes are observed with a 365nm transilluminator . The purpose of this study is to evaluate comparatively MGIT with 1% Ogawa egg medium by using two hundred and forty-five clinical specimens . The samples were digested, decontaminated and concentrated for culture using N-acetyl-L-cysteine-sodium hydroxide method . Fifty-nine of 245 (24%) clinical samples were culture positive for mycobacteria (43 M . tuberculosis complex, 12 M . avium complex and 4 other species) by one or both test systems . The MGIT detected 4 isolates of M . tuberculosis complex and 6 isolates of M . avium complex not recovered by the Ogawa egg medium, respectively . The mean time of detection of M . tuberculosis complex was 13 days (range: 2-26 days) and 19 days (range: 8-31 days) for MGIT and Ogawa egg medium, respectively, and that of M . avium complex was 5 days (range: 2-8 days) and 16 days (range: 6-22 days) for the MGIT and Ogawa egg medium, respectively . Overall, the MGIT is a sensitive culture system for the detection of mycobacteria from clinical specimens, is easy to use and may be applicable to clinical laboratories.

Kekkaku, 1996 Jun, 71(6), 391 - 8
{The characteristics of clinical features of pulmonary tuberculosis in female}; Matsushita Y et al.; We studied the clinical features of culture-positive, previously untreated patients with pulmonary tuberculosis (77 in females and 200 in males), with special reference on the gender differences in clinical features . The mean age was 50.8 y.o . for female and 54.4 y.o . for male, and the age distribution was almost similar to that of newly-registered patients of whole Japan in 1993, namely, small peak in 20s decade and large peaks in the age group over 50 in female, and gradual increase up to 50 years and get to plateau in male . Thirty-nine % in female and fifty-four % in male had various past histories and/or complications which might affect to the deterioration of tuberculosis, such as diabetes mellitus, liver function distress, respiratory failure, malignancy, stomach resection and so on . The rates with each complication were, in general, higher in male than in female . The positive rate to Mantoux reaction was higher in female than in male, and stronger reactions were observed in female than in male . According to the classification of pulmonary tuberculosis designed by the Japanese Society for Tuberculosis (GAKKAI classification), the site(s) of affected lung, the stage and the extent of lesions were more advanced in male than in female, and the positive rate and the amount of bacilli on smear were higher in male than in female . The most marked difference was the location of the main lesions, 80% in the apical and posterior segments of upper lobe (S1,2) and 8% in the superior segments of lower lobe (S6) in male, while 60% in S1,2 and 25% in S6 in female . The rate of complete resistance against to anti-tuberculosis agents was higher in male than in female, but the combination chemotherapy of isoniasid and refampicin with streptomycin or ethambutol was almost equally effective both in males and females, and almost all patients converted to bacilli negative within three months after the initiation of the chemotherapy, except in a few male patients.

Nihon Kyobu Shikkan Gakkai Zasshi, 1996 Jun, 34(6), 621 - 6
{Three cases of tuberculous mediastinal lymphadenitis}; Iwanaga T et al.; Mediastinal lymph node involvement is uncommon in intrathoracic tuberculosis . We report three cases of this disease, each of which had a different clinical course . Chest CT scans showed preferential involvement of right paratracheal nodes, central areas of relatively low density with peripheral rim enhancement after injection of contrast medium . Specimens obtained by mediastinoscopy and fiberoptic bronchoscopy revealed acid-fast bacilli in all cases . In view of its relative frequency, tuberculous mediastinal lymphadenitis in adults must be distinguished from other causes of mediastinal masses.

Indian J Med Res, 1996 Jun, 103, 294 - 5
A comparison of sputum examination for acid fast bacilli by modified Schaeffer & Fulton stain, Ziehl-Neelsen stain & cold stain; Deshmukh SR et al.; A comparative study of Ziehl-Neelsen stain, cold stain and modified Schaeffer and Fulton stain was carried out to evaluate the efficiency of modified Schaeffer and Fulton method in sputum examination for acid fast bacilli (AFB) . Of 187 sputum samples studied, 67 (35.82%) were reported positive by Ziehl-Neelsen stain and cold stain method while 66 (35.29%) were reported positive by modified Schaeffer and Fulton method . In comparison with Ziehl-Neelsen staining, 98.58 per cent positivity was reported by modified Schaeffer and Fulton method . Modified Schaeffer and Fulton method is found to be simple, reliable, less expensive and as efficient as Ziehl-Neelsen stain and cold stain for demonstration of acid fast bacilli in sputum.

Microbiology, 1996 Jun, 142 ( Pt 6), 1513 - 20
Extracellular and surface-exposed polysaccharides of non-tuberculous mycobacteria; Lemassu A et al.; We studied the outermost constituents of the cell envelopes, which are involved in the interaction between the bacilli and the host cells, of five pathogenic and non-pathogenic mycobacterial species for comparison with those we have previously characterized from M . tuberculosis . The extracellular materials (ECMs) were isolated by ethanol precipitation and compared to the surface-exposed materials (SXMs) extracted by mechanical means . The materials from both sources were composed almost exclusively of polysaccharides and proteins . Two groups of mycobacteria were clearly distinguishable . The first group comprised the pathogenic species M . kansasii which produced large amounts of ECM, the glycosyl composition of which was similar to that of the SXM . The second group comprised M . avium and the non-pathogenic strains of M . gastri, M . phlei and M . smegmatis which produced small amounts of ECK This latter group could be subdivided into those which produced carbohydrate-rich ECM (M . avium and M . gastri) and those forming protein-rich ECM (M . phlei and M . smegmatis), a classification that correlated with the difference in the growth rate of the two subgroups . The glycosyl composition of the ECM of a given species was qualitatively similar to that of the SXM, except for M . avium and M . phlei whose SXM were devoid of arabinose . In addition to glucose, mannose and arabinose, xylose was detected in the hydrolysis products of the ECM and SXM of M . smegmatis, the SXM of M . phlei and the ECM of some batches of M . avium . The polysaccharide constituents of the ECM and SXM of the different mycobacteria were purified by anion-exchange and gel-filtration chromatography; all were found to be neutral compounds devoid of acyl substituents . The extracellular polysaccharides consisted of high-molecular-mass glycogen-like glucans, arabinomannans and mannans, structurally similar to the corresponding substances previously characterized from the capsule of M . tuberculosis . The same types of polysaccharides were characterized from the SXM of all the strains, except M . avium and M . phlei which were devoid of arabinomannans . This study questions the unique and universal representation of the mycobacterial cell envelope and the existence of the so-called acidic polysaccharide-rich outer layer.

Int J Lepr Other Mycobact Dis, 1996 Jun, 64(2), 123 - 7
Fixed-duration therapy (FDT) in multibacillary leprosy; efficacy and complications; Vijayakumaran P et al.; The World Health Organization (WHO) recommended a multidrug therapy (MDT) regimen for multibacillary (MB) leprosy patients in 1982 which was to be administered for a minimum period of 2 years or until a skin smear was negative for acid-fast bacilli, whichever was later . This regimen contains rifampin, dapsone and clofazimine . A single dose of rifampin was shown to effect a high degree of bacterial killing (99.9%) . The combined therapy administered for 2 years may be adequate to bring about "total" bacterial killing and to prevent the emergence of drug resistance and persisters . In this study, 360 smear-positive and previously untreated MB leprosy patients were treated with WHO/MDT for 2 years; 22.8% of these MB patients developed lepra reaction during therapy and 10.7% during surveillance . The bacterial index continued to decline even after termination of fixed-duration therapy . None of these patients relapsed during 886 person-years of surveillance.

Infect Immun, 1996 Jun, 64(6), 2062 - 9
An in vitro model for sequential study of shiftdown of Mycobacterium tuberculosis through two stages of nonreplicating persistence; Wayne LG et al.; It was demonstrated previously that abrupt transfer of vigorously aerated cultures of Mycobacterium tuberculosis to anaerobic conditions resulted in their rapid death, but gradual depletion of available O2 permitted expression of increased tolerance to anaerobiosis . Those studies used a model based on adaptation of unagitated bacilli as they settled through a self-generated O2 gradient, but the model did not permit examination of homogeneous populations of bacilli during discrete stages in that adaptation . The present report describes a model based on culture of tubercle bacilli in deep liquid medium with very gentle stirring that keeps them in uniform dispersion while controlling the rate at which O2 is depleted . In this model, at least two stages of nonreplicating persistence were seen . The shift into first stage, designated NRP stage 1, occurred abruptly at a point when the declining dissolved O2 level approached 1% saturation . This microaerophilic stage was characterized by a slow rate of increase in turbidity without a corresponding increase in numbers of CFU or synthesis of DNA . However, a high rate of production of glycine dehydrogenase was initiated and sustained while the bacilli were in this state, and a steady ATP concentration was maintained . When the dissolved O2 content of the culture dropped below about 0.06% saturation, the bacilli shifted down abruptly to an anaerobic stage, designated NRP stage 2, in which no further increase in turbidity was seen and the concentration of glycine dehydrogenase declined markedly . The ability of bacilli in NRP stage 2 to survive anaerobically was dependent in part on having spent sufficient transit time in NRP stage 1 . The effects of four antimicrobial agents on the bacilli depended on which of the different physiologic stages the bacilli occupied at a given time and reflected the recognized modes of action of these agents . It is suggested that the ability to shift down into one or both of the two nonreplicating stages, corresponding to microaerophilic and anaerobic persistence, is responsible for the ability of tubercle bacilli to lie dormant in the host for long periods of time, with the capacity to revive and activate disease at a later time . The model described here holds promise as a tool to help clarify events at the molecular level that permit the bacilli to persist under adverse conditions and to resume growth when conditions become favorable . The culture model presented here is also useful for screening drugs for the ability to kill tubercle bacilli in their different stages of nonreplicating persistence.

Hum Reprod, 1996 Jun, 11(6), 1227 - 31
Antibiotic treatment based on seminal cultures from asymptomatic male partners in in-vitro fertilization is unnecessary and may be detrimental; Liversedge NH et al.; We questioned the policy of routine microbiological culture of semen prior to in-vitro fertilization (IVF) with a view to prescribing antibiotics to reduce the risk of introducing seminal infection into the embryo culture system . An initial retrospective study examined serum microbiology reports of 449 couples undergoing IVF or gamete intra-Fallopian transfer (GIFT) . In semen samples taking >/=1 days to reach the microbiology laboratory compared with same-day delivery there was increased frequency of significant culture of enterococci (27 versus 15%, P < 0.01) . In samples taking >/=2 days there was increased frequency of significant culture of Gram-negative bacilli (31 versus 12%, P < 0.01) and of overall culture of other potentially pathogenic organisms (26 versus 14%, P < 0.01) . We questioned diagnostic accuracy and relevance . Therefore, in a prospective study, semen and high vaginal swabs obtained on the day of oocyte collection were cultured from 100 couples having IVF or GIFT, of whom 52 male partners had been treated with antibiotics following positive pre-IVF semen culture . The presence of bacteria in semen samples used only for IVF (n = 90) did not reduce fertilization rates nor lead to infection of the embryo culture system . However, there was an increased incidence of significant culture of vaginal Gram-negative bacilli in patients with treated partners compared with untreated partners {15/52 (29%) versus 5/48 (10%), P < 0.05} . Thus antibiotic therapy in the male partner may increase the likelihood of inoculation of antibiotic-resistant pathogenic bacteria from the vagina into the embryo culture system during vaginal oocyte collection . In asymptomatic patients, microbiological screening of semen samples prior to IVF treatment and subsequent treatment with antibiotic therapy in those with positive cultures appears to be unnecessary and may be detrimental to IVF outcome.

Indian J Exp Biol, 1996 May, 34(5), 468 - 71
Release of superoxide anion from activated mouse peritoneal macrophages during Mycobacterium tuberculosis infection; Khanna M et al.; Mouse peritoneal macrophage monolayers infected with M . tuberculosis were cultured in RPMI up to 7 days . Release of superoxide was assayed on different days in presence or absence of Phorbol myristate acetate (PMA), a known stimulator of NADPH oxidase which is involved superoxide production . Basal level of superoxide release was significantly higher in M . tuberculosis infected peritoneal mouse macrophages (P < 0.01) as compared to normal mouse macrophages . When normal and tuberculoid macrophage cultures were stimulated with PMA, increased superoxide anion release was observed in both the cultures but the increase of superoxide was significantly higher in normal macrophages as compared to tuberculoid stimulated macrophages . Superoxide release was maximum in 4 day old cultured macrophages and gradually it declined in older cultures by day 7, both in vitro and in vivo . A defective macrophage function in killing of M . tuberculosis bacilli was observed after 4 days of in vitro and in vivo cultures.

Mem Inst Oswaldo Cruz, 1996 May-Jun, 91(3), 389 - 94
Phenotypes of lung mononuclear phagocytes in HIV seronegative tuberculosis patients: evidence for new recruitment and cell activation; Lapa e Silva JR et al.; Mycobacterium tuberculosis preferentially resides in mononuclear phagocytes . The mechanisms by which mononuclear phagocytes keep M . tuberculosis in check or by which the microbe evades control to cause disease remain poorly understood . As an initial effort to delineate these mechanisms, we examined by immunostaining the phenotype of mononuclear phagocytes obtained from lungs of patients with active tuberculosis . From August 1994 to March 1995, consecutive patients who had an abnormal chest X-ray, no demonstrable acid-fast bacilli in sputum specimens and required a diagnostic bronchoalveolar lavage (BAL) were enrolled . Of the 39 patients enrolled, 21 had microbiologically diagnosed tuberculosis . Thirteen of the 21 tuberculosis patients were either HIV seronegative (n = 12) or had no risk factor for HIV and constituted the tuberculosis group . For comparison, M . tuberculosis negative patients who had BAL samples taken during this time (n = 9) or normal healthy volunteers (n = 3) served as control group . Compared to the control group, the tuberculosis group had significantly higher proportion of cells expressing markers of young monocytes (UCHM1) and RFD7, a marker for phagocytic cells, and increased expression of HLA-DR, a marker of cell activation . In addition, tuberculosis group had significantly higher proportion of cells expressing dendritic cell marker (RFD1) and epithelioid cell marker (RFD9) . These data suggest that despite recruitment of monocytes probably from the peripheral blood and local cell activation, host defense of the resident lung cells is insufficient to control M . tuberculosis.

J Pediatr Hematol Oncol, 1996 May, 18(2), 218 - 22
Fatal Mycobacterium avium complex disease in a patient with acute nonlymphoblastic leukemia; Martinez-Arroyo L et al.; PURPOSE: The objective of this article was to present the diagnosis of a fatal infection by Mycobacterium avium complex (MAC) in a child with acute myelogenous leukemia, a disease rarely reported in non-HIV infected children . METHODS: Specific identification of MAC was made by culture in BACTEC system from an open lung biopsy . RESULTS: A 5-year-old girl diagnosed with acute nonlymphoblastic leukemia was admitted because of fever during the maintenance phase after achieving a complete remission of her malignancy . A mild dry cough started on day 4 of admission, and a chest roentgenogram revealed a pulmonary infiltrate . An insidious respiratory distress developed and mechanical ventilation was undertaken . An open-lung biopsy, carried out on day 10 of ventilatory support, revealed acid-fast bacilli subsequently grown as MAC . In spite of combined antimycobacterial treatment, the patient followed a downhill course and died on day 41 of hospitalization . CONCLUSION: This report describes a new case of fatal MAC infection in an immunocompromised, non-HIV infected child . MAC must be added to the list of infectious microorganisms that can infect children with acute nonlymphoblastic leukemia . As modern immunosuppressive therapeutic modalities evolve, it is likely that MAC will become a more common and recognized pathogen in the immunocompromised child.

Am J Otolaryngol, 1996 May-Jun, 17(3), 161 - 6
Ultrastructure of eustachian tube mucosa in chronic otitis media with cholesteatoma; Chao WY et al.; PURPOSE: Acquaintance with the severity of inflammatory condition and mucociliary destruction of the protympanic eustachian tube (ET) mucosa may provide some insight for management during surgery for cholesteatoma . MATERIALS AND METHODS: Protympanic eustachian mucosa was obtained from 25 patients undergoing ear surgery for cholesteatoma and from 5 cadavers undergoing dissection for a gross anatomy course . The specimens were processed for both scanning electron microscopy (SEM) and transmission electron microscopy (TEM) . RESULTS: According to SEM, decreased ciliated cells were noted . Residual ciliated cells and numerous white blood cells (WBC) were noted in the protympanic mucosa of the eustachian orifice . Bacilli were commonly noted at the mucosal surface . Cilia might be collapsed and stagnated with mucus secretion . This finding was consistent with those of the TEM: that cilia of varied directions were embedded in mucus . Mucociliary function was impaired under such conditions . The mucosal alteration was severe in some children; there was no ciliated cell visible . According to the TEM, the mucosal cells contained numerous secretory granules and mitochondria . Polymorphous nuclear cells were noted in the submucosal area that was edematous . Compound cilia were rather common . Mucus blanket covered mucosal cells with widening intercellular spaces . In addition, neither cilia nor microvilli were visible in severe mucosal alteration . CONCLUSIONS: These occurrences indicated the presence of inflammatory reaction and impairment of clearance function of eustachian mucosa in cholesteatomatous ears . Thorough irrigation during surgery and antimicrobial therapy after surgery are warranted.

Trans R Soc Trop Med Hyg, 1996 May-Jun, 90(3), 258 - 61
The yield of acid-fast bacilli from serial smears in routine microscopy laboratories in rural Tanzania; Ipuge YA et al.; Routine results of direct examination of sputum smears for acid-fast bacilli from 34 laboratories in Tanzania were analysed . These represented 8 regions providing 94 laboratory-years of work; 61,580 tuberculosis suspects were evaluated with the aid of 141,371 smears . The average proportion of cases found among suspects was 18.9% (range 14.3-23.8% in the 8 regions) . The number of cases missed among suspects with incomplete examinations was calculated based on the number observed among suspects with a complete set of 3 smears examined, and an incremental yield of 83.4% with the first, 12.2% with the second, and 4.4% with the third smear was estimated for the total number of expected cases . These data suggest that (i) the method frequently employed for calculating requirements for laboratory supplies in low income countries, based on the estimate that 10 suspects need examination to identify one case of sputum smear-positive tuberculosis, is generous in the context of Tanzania and (ii) under routine conditions the incremental yield from a third smear examination after 2 negative examinations is relatively small.

Arch Androl, 1996 May-Jun, 36(3), 239 - 46
Treatment of tuberculous epididymitis by intratunical rifampicin injection; Shafik A; The results of treating 4 patients with tuberculous epididymitis by rifampicin injection into the tunica vaginalis sac were compared with the results in another 4 patients treated with the common oral antituberculous drugs . Oral treatment consisted of daily administration of rifampicin (600 mg), isoniazid (300 mg), and ethambutol (25 mg/kg body weight) . Rifampicin (600 mg) was injected intratunically every 4 to 6 days . Treatment continued for 6 months in both groups, with 3 months follow-up thereafter . Periodic clinical assessment as well as semen and hydrocele fluid examination were performed . In the intratunical injection group, epididymal swellings disappeared in 3 to 6 months; semen and hydrocele fluid became sterile in 4 months . The oral group showed partial diminution of the epididymal mass in one patient only; one patient developed scrotal fistula . Semen remained positive for tubercle bacilli, and hydrocele fluid became negative in one patient only . The satisfactory results with the intratunical rifampicin administration seem to be due to the drug reaching the epididymis in high concentrations . The tunica vaginalis is a part of the peritoneum and, like it, is believed to have a high absorptive power . Furthermore, the intratunical injection treatment uses a single drug, in contrast to the oral therapy, which, by its multidrug administration, enhances the incidence of side effects.

Vet Pathol, 1996 May, 33(3), 346 - 8
Conjunctival mycobacteriosis in two emus (Dromaius novaehollandiae); Pocknell AM et al.; Avian tuberculosis was diagnosed in two young adult female commercial emus (Dromaius novaehollandiae) with granulomatous conjunctivitis . Histologically, the granulomas appeared typical of avian tuberculosis . Caseonecrotic cores were surrounded by a broad ring of palisading epithelioid macrophages and multinucleate giant cells with a moderate admixture of heterophils, lymphocytes, and plasma cells . One conjunctival granuloma had multifocal mineralization . At necropsy, granulomas were also found in visceral organs of both birds . Acid-fast bacilli were demonstrated in all lesions using Ziehl-Neelsen or Fite's stains . Culture confirmed the bacilli to be Mycobacterium avium (complex).

J Am Anim Hosp Assoc, 1996 May-Jun, 32(3), 189 - 93
Feline leprosy: spontaneous remission in a cat; Roccabianca P et al.; A two-year-old, male domestic shorthair with a solitary lesion of the right forelimb was presented for fine-needle aspiration biopsy of a suspected cutaneous, neoplastic process . Neutrophils, lymphocytes, and acid-fast bacilli packed in the cytoplasm of foamy macrophages and giant cells were seen on cytological examination . Bacteriological culture of the material from the skin lesion was negative for Mycobacterium spp . Intraperitoneal injection of homogenized material from the lesion resulted in generalized mycobacteriosis in one mouse after 10 months . Based on these results, a diagnosis of feline leprosy was made . No medical or surgical therapy was performed . Nonetheless, the lesion showed progressive and complete spontaneous remission within 3.5 months from the time of diagnosis; after 14 months, the cat still is free of disease.

J Clin Microbiol, 1996 May, 34(5), 1065 - 8
Evaluation of Amplicor MTB test as adjunct to smears and culture for direct detection of Mycobacterium tuberculosis in the French Caribbean; Devallois A et al.; A total of 784 specimens collected from 370 individuals between January and August 1995 were analyzed by using the Amplicor Mycobacterium tuberculosis test (Roche Diagnostic System, Basel, Switzerland), a PCR-based test for the direct detection of organisms of the M . tuberculosis complex . The PCR results were compared with standard bacteriological data, including those obtained by acid-fast microscopy, culture, and biochemical identification as well as final clinical diagnosis for each patient . Several parallel controls were used: the kit DNA positive control, 10(3) CFU of M . tuberculosis, and three negative controls for each independent assay . No false-positive PCR results were obtained, and overall, M . tuberculosis was detected in 20 of 370 individuals screened . Five additional patients during the same time were found to be infected with mycobacteria other than tubercle bacilli; their specimens gave positive smear and/or culture test results, but Amplicor tests were always negative . The sensitivity, specificity, positive predictive value, and negative predictive value for the Amplicor MTB test compared with culture per specimen were 76.7, 97.7, 66.0, and 98.6%, respectively . For resolved cases, these values were, respectively, 69.4, 100, 100, and 96.8%; however, the sensitivity and negative predictive value increased to 90.9 and 99.2%, respectively, if PCR-negative nonrespiratory specimens (gastric washings) were not considered . When only specimens from proven tuberculosis patients were considered (n = 114) and the sum of PCR-positive and/or culture-positive samples from proven tuberculosis patients was considered the total number of positive samples, PCR had a sensitivity of 83.3% compared with 71.6% for culture . Results per patient (about three samples each) yielded 100% sensitivity and 100% specificity . We conclude that the Amplicor MTB test is highly specific and rapid for routine use in a clinical laboratory . However, in order to obtain a higher degree of sensitivity, it should be run as an adjunct to smears and culture with at least three samples for each patient, and a single-sample PCR-negative results must be considered carefully because of potential false-negatives.

Indian J Med Res, 1996 May, 103, 250 - 2
Isolation of Mycobacterium tuberculosis from cerebrospinal fluid by the centrifugation & filtration methods; Selvakumar N et al.; Cerebrospinal fluid (CSF) samples were collected in 2 bottles each, from 112 children, examined clinically for tuberculous meningitis (TBM) One was processed by the centrifugation method and the other by the filtration method for the isolation of M . tuberculosis . Of these specimens, 11 and 13 yielded M . tuberculosis by the centrifugation method and the filtration method, respectively . In 7 specimens M . tuberculosis was isolated by both the methods; in 4, only by the centrifugation method, and in 6, only by the filtration method . Using both the methods, 17 (15.2%) of 112 specimens were culture positive for M . tuberculosis . The improvement in the rate of isolation, thus obtained, assumes importance as the confirmation of the diagnosis of TBM in all the clinically suspected cases is always desired . Moreover, the filtration method is simple and inexpensive and it can be carried out even in remote hospitals and the membranes, after filtration, can be transported to central mycobacteriology laboratory for culture of tubercle bacilli.

Kekkaku, 1996 May, 71(5), 357 - 61
{A case of posterior tuberculous spondylitis of the lumbar vertebra with the skull inoculated by acupuncture}; Sasaki Y et al.; A 77-year-old male consulted an orthopedist with complaints of lumbago and a lumbar swelling, and was treated with acupuncture . As the symptoms deteriorated, and smear of a specimen aspirated from the lumbar swelling was positive for acid fast bacilli which were later identified as Mycobacterium tuberculosis, he was hospitalized in the National Chiba Higashi Hospital . On admission to our hospital, CT-scan of lumbar vertebrae showed the destructive change of spinous process of the third lumbar vertebra accompanied by the abscess formation, and an occipital swelling with the destructive change of skull was also detected . Whole body examinations with CT-scan and bronchoscopy did not reveal any other abnormal findings suspective of tuberculous lesions . The above lesions were both gradually improved by antituberculous chemotherapy with INH, RFP, and EB . He was finally diagnosed as posterior tuberculous spondylitis of the lumbar vertebra with cold abscess, and also clinically diagnosed as skull tuberculosis caused presumably by the inoculation of tubercle bacilli from the lumbar lesion by acupuncture.

Kekkaku, 1996 May, 71(5), 345 - 9
{A case of AIDS with bronchial tuberculosis}; Naganuma M et al.; A case is 48 years-old Japanese man who had a history of frequent sexual contact with prostitutes in Thailand and the Philippines . He presented with chief complaint of chest discomfort in April 1995 . His chest X-ray film showed right mediastinal lymph node swelling in other hospital and the sputum smear was strongly positive for acid fast bacilli . In May 1995, he was admitted to our hospital and serological tests for HIV were positive both by EIA and Western blot methods . The CD4 lymphocyte count was 167/microliters . He was diagnosed as a case of AIDS according to the criteria proposed by the AIDS surveillance committee of the Japanese Ministry of Health and Welfare . Although numerous tubercule bacilli were detected in sputum, the chest X-ray did not show abnormal shadow in lung fields . So the diagnosis of bronchial tuberculosis was suspected by these apparently contradictory findings and the bronchoscopy was performed . Biopsy specimen of the bronchial mucous membrane obtained by bronchoscopy confirmed the presence of acid fast bacilli by Ziehl-Neelsen's staining method, however, histological findings were atypical of tuberculosis . A month after the initiation of treatment with isoniazid, rifampicin and ethambutol and AZT, his clinical symptoms improved and the sputum smear and the culture tests for tubercule bacilli converted to negative . Complications of AIDS, (Pneumocystis carinii infection, Cytomegalo virus infection, Kaposi's sarcoma, etc) other than tuberculosis have not developed to date . In the past reports, we could not find reports of bronchial tuberculosis with AIDS . Tuberculous granuloma formation was scarce in this case, and it was suspected that bronchial tuberculosis with AIDS would show characteristic sign as same as pulmonary tuberculosis with AIDS.

Can J Cardiol, 1996 May, 12(5), 463 - 4
A symptomatic atypical mycobacterial infection masquerading as a vascular ring on chest x-ray; Dodo H et al.; Atypical mycobacterium is rare in children . There are few case reports of childhood pulmonary diseases caused by atypical mycobacterium . The case of a 20-month-old boy who had stridor and respiratory distress is presented . Chest x-ray showed right-sided narrowing of the trachea and left-sided aortic knob . Ziehl-Neelsen stain showed acid-fast bacilli . The culture showed Mycobacterium malmoense.

Arch Pathol Lab Med, 1996 May, 120(5), 429 - 35
Mycobacterial testing in clinical laboratories that participate in the College of American Pathologists Mycobacteriology Surveys . Changes in practices based on responses to 1992, 1993, and 1995 questionnaires; Woods GL et al.; OBJECTIVE--To determine whether the trend of increasing use of rapid methods of mycobacterial testing among participants in the College of American Pathologists (CAP) Mycobacteriology E Proficiency Testing Survey noted between 1992 and 1993 continued through 1995, and to collect information concerning mycobacterial staining and culture protocols from laboratories that do limited mycobacterial testing . METHODS--The 1993 CAP E Survey questionnaire addressing mycobacterial laboratory practices, test volumes, and rate of recovery of drug-resistant Mycobacterium tuberculosis was included with the CAP 1995 E-A Survey . A shortened list of these same questions, excluding those addressing mycobacterial identification and susceptibility test methods, was added to the CAP 1995 E1-A Survey, to which laboratories that do limited mycobacterial testing subscribe . RESULTS--A total of 802 and 1490 participants in the E and E1 surveys, respectively, returned responses to the CAP by the cutoff date for data analysis . For E Survey participants who answered questions concerning test methods in the years being compared, the percentage who used rapid techniques increased significantly over the study period . More participants used the fluorochrome stain (58% in 1992, 62% in 1993, and 72% in 1995), BACTEC TB plus a solid medium for culture (36% in 1992, 42% in 1993, and 50% in 1995), DNA probes for identification of M tuberculosis (68% in 1993, 79% in 1995), and BACTEC TB for susceptibility testing (65% in 1993, 71% in 1995) . The percentages of E1 Survey participants who used a fluorochrome stain for detection of acid-fast bacilli and both a liquid and a solid medium for mycobacterial culture were lower than the percentages of E Survey participants who used these methods . Among participants who responded in all years being compared, the percentage processing respiratory specimens at least 7 times per week increased from 26% in 1992 to 30% in 1993 and 43% in 1995 (P < .001), and the percentages reporting an identification of M tuberculosis within 21 days and susceptibility test results within 28 days increased significantly over the study period (29% in 1992, 40% in 1993, and 56% in 1995 for identification; 13% in 1992, 19% in 1993, and 30% in 1995 for susceptibility testing) . Turnaround times for E Survey participants were significantly shorter than those for E1 Survey participants . The number of specimens tested per month appeared to remain relatively stable between 1993 and 1995; however, the number of new patients with tuberculosis and the number of known tuberculosis patients with positive cultures declined significantly . CONCLUSIONS--The recent emphasis placed on utilization of rapid methods of mycobacterial testing appears to have influenced laboratories that subscribe to the CAP E Survey . Significantly more of these laboratories were following the Centers for Disease Control and Prevention's recommendations in 1995 than in 1993 and 1992 . However, many laboratories that provide only limited mycobacterial testing still have not adopted the more rapid techniques . Because tuberculosis remains a public health problem, the efforts directed at its control must not wane if the recent downward trend in incidence is to be maintained.

Lancet, 1996 Apr 20, 347(9008), 1082 - 5
Peripheral-blood-based PCR assay to identify patients with active pulmonary tuberculosis; Condos R et al.; BACKGROUND: There is a need for rapid diagnosis of pulmonary tuberculosis . We have previously used a PCR to detect circulating Mycobacterium tuberculosis DNA in blood samples from patients (mostly HIV-infected) with pulmonary tuberculosis . We have now prospectively investigated the role of this blood-based PCR assay for diagnosis of this disease in a clinical setting . METHODS: Our PCR assay is specific for the IS6110 insertion element of the M tuberculosis complex of organisms . We used it to test peripheral blood from 88 consecutive patients admitted to a chest ward with suspected pulmonary tuberculosis . Personnel who carried out the assay did not know the results of any clinical investigations and ultimate diagnosis, and clinicians did not know the PCR results . Results of the PCR assay were compared with the final clinical diagnosis . A subgroup of 15 patients had blood samples assayed serially to track the PCR signal over time . FINDINGS: 41 patients had a final clinical diagnosis of tuberculosis, and the cases were typical of those seen at our hospital: HIV infection was common, and most cases were not sputum-smear positive for acid-fast bacilli . The PCR assay correctly identified 39 of 41 patients with proven pulmonary tuberculosis, 26 (63%) of whom were sputum-smear negative . There were five patients in whom a positive PCR result did not accord with the final clinical diagnosis, and two of the 44 negative PCR results were classified as false negatives . The overall sensitivity and specificity of the PCR assay for a diagnosis of tuberculosis was 95% and 89%, respectively . In 15 patients with pulmonary tuberculosis and a positive blood assay,the PCR result remained positive after 1 month of therapy, but had reverted to negative in 13 of the 15 by 4 months of therapy . INTERPRETATION: We conclude that peripheral-blood-based PCR detection for the diagnosis of tuberculosis is a technically feasible approach that has a potentially important role in the diagnosis of pulmonary tuberculosis.

Microbiology, 1996 Apr, 142 ( Pt 4), 927 - 35
The outermost capsular arabinomannans and other mannoconjugates of virulent and avirulent tubercle bacilli; Ortalo-Magne A et al.; It has been shown that phagocyte mannose receptors play an important role in phagocytosis of virulent tubercle bacilli, but not of avirulent strains . Accordingly, we investigated the occurrence and structure of the outermost mannoconjugates of the capsule of five strains of the tubercle bacillus differing in their degrees of virulence . The extracellular and surface-exposed arabinomannan-containing polysaccharides were chemically characterized as being composed mainly of neutral fatty-acyl-free arabinomannans (AMs) possessing a reducing end consisting of mannose . Although no lipoarabinomannan (LAM) was detected, small amounts of acidic polysaccharides, exhibiting the same electrophoretic mobility as LAM, were identified as succinylated AMs (two to three residues per molecule) lacking the phosphatidylinositol anchor of LAM . AMs from the different strains shared the same structural features, notably the capping of a large portion of the arabinan segments with mannosyl residues . However, no correlation was observed between either the percentage of capping or the amount of AMs and the degrees of virulence of the strains . The occurrence and amounts of other mannoconjugates (phosphatidylinositol mannosides and the mannose-associated 19 and 38 kDa lipoproteins) in the various tubercle bacilli were also examined . Although both classes of compounds were identified in all the examined strains, a correlation between the amounts of the glycoconjugates and the degrees of virulence of the strains could not be established . These data do not support the implication of these promising mannosylated molecules in the selective phagocytosis of virulent tubercle bacilli and indicate that the involvement of mannose receptors in phagocytosis of virulent M . tuberculosis needs to be re-investigated.

Indian J Med Res, 1996 Apr, 103, 201 - 11
Immune response & modulation of immune response induced in the guinea-pigs by Mycobacterium avium complex (MAC) & M . fortuitum complex isolates from different sources in the south Indian BCG trial area; Kamala T et al.; A total of 139 guineapigs were used to study the immune response and its modulation induced by Mycobacterium avium complex (MAC) and M . fortuitum complex strains obtained from different sources in the south Indian BCG trial area . The guineapigs were divided into groups and some were directly sensitised/immunised with different MAC strains . M . fortuitum complex strain or BCG and others were sensitised with MAC or M . fortuitum complex and then immunised with BCG . The resulting delayed type hypersensitivity (DTH) response in the different groups of guineapigs was studied by skin tests using PPD-RT23 and PPD-B, and protective response was studied by challenging the guineapigs with a south Indian low virulent strain of M . tuberculosis and enumerating the bacilli in spleen at different points of time . The 3 strains of MAC induced similar low levels of DTH to PPD-RT23 but much higher and varying levels of DTH to PPD-B . MAC strains from soil and sputum induced different levels of immune modulation during subsequent immunisation with BCG on the DTH response to PPD-RT23 and PPD-B . At 2 wk after challenge, 23.8, 81 and 90.5 per cent protection was induced by the standard strain, soil isolate and sputum isolate of MAC, respectively, while 33.3 per cent protection was induced by the M . fortuitum complex strain compared to the protection induced by BCG alone . Prior exposure to MAC or M . fortuitum complex did not have any modulatory effect on the protective immunity due to BCG at this time point . However, at 6 wk after challenge, while the guineapigs immunised with BCG were protected, modulation of the protective response resulting from BCG was observed in the guineapigs sensitised with MAC and M . fortuitum from soil.

J Korean Med Sci, 1996 Apr, 11(2), 127 - 32
Application of PCR from the fine needle aspirates for the diagnosis of cervical tuberculous lymphadenitis; Kim SS et al.; Tuberculosis remains a major public health problem worldwide . A definitive and accurate diagnosis of tuberculosis in cervical lymphadenopathy is important because satisfactory results can be achieved with chemotherapy alone, obviating surgery . Recently, fine needle aspiration cytology (FNAC) has provided an alternative and easy procedure for collection of material for cytomorphologic and bacteriologic examination . But the detection rate for M . tuberculosis from the aspirate material is still low with Ziehl-Neelson stain and even with culture . The authors therefore performed polymerase chain reaction (PCR) for mycobacterial DNA sequences in 31 cases of cytodiagnosis of tuberculous lymphadenitis and compared conventional bacteriologic methods . Ziehl-Neelson staining for acid-fast bacilli (AFB) was positive in 3 cases (10%) in direct smears, and the cultures for M . tuberculosis were positive in 6 cases (19%) . In 19 (61%) among 31 samples, mycobacterial DNA fragments were detected, using the PCR method . With combined conventional and PCR method, the rate of detection was increased to 68 percent high . In conclusion, PCR is the most sensitive technique in the demonstration of M . tuberculosis in patient with clinically suspected as tuberculosis, who have AFB stain or culture negative cytology . Combined conventional and PCR methods as well as cytologic findings are of further help in the detection and characterization of M . tuberculosis.

J Clin Microbiol, 1996 Apr, 34(4), 991 - 2
Etiological agents of mycobacterioses in pet birds between 1986 and 1995; Hoop RK et al.; Between May 1986 and June 1995, mycobacteriosis was diagnosed by histology and microscopy in 204 (3.8%) of 5,345 necropsied pet birds . The predominant macroscopic changes were enlargement of the liver and spleen and thickening of intestinal walls . Attempts to cultivate mycobacteria were made in 110 cases . Acid-fact bacilli grew in 66 specimens (60%) only . In 18 cases we failed to obtain subcultures . Therefore, species identification could be performed for only 48 isolates . Identification was carried out by conventional biochemical tests as well as by PCR-mediated sequencing of the 16S rRNA gene . The majority of the isolates were Mycobacterium genavense (34 isolates), followed by M . avium complex (8), M . fortuitum (2), M . tuberculosis (2), M . gordonae (1), and M . nonchromogenicum (1) . The significance of M . genavense as a zoonotic agent remains to be determined.

Methods, 1996 Apr, 9(2), 220 - 32
Granulomas Induced by Mycobacterium leprae
Adams LB, Krahenbuhl JL.
Leprosy, a chronic infectious disease caused by Mycobacterium leprae, affects primarily the skin, mucous membranes, and peripheral nerves . It is characterized by a spectrum of symptoms, largely a result of the immunological response of the host to the antigens of M . leprae . At one pole {lepromatous leprosy (LL)} there is an enormous growth of the bacilli in the tissues resulting from a specific and profound lack of cell-mediated immunity (CMI) of the host to M . leprae . At the opposite pole {tuberculoid leprosy (TT)}, patients are responsive to M . leprae antigens, and there are few bacilli present in the lesions . A variety of techniques have been applied in the analyses of leprosy granulomas, from standard histological examination to molecular immunological probes . Each technique provides a limited, yet distinctive, look into the constitution of the granuloma . Together, they offer a comprehensive view into the regulation of leprosy granuloma development.

Genetika, 1996 Apr, 32(4), 469 - 81
{Defective phages of bacilli: cell parasites or chromosomal components}; Prozorov AA; A review of data on defective phages of bacilli is presented . The genetics and morphology of this group of phages, the peculiarities of their induction, and data of sequence analysis of the segment of the bacterial chromosome in which the phage genome is localized are considered . It is concluded that the genome of defective phages should probably be considered a part of the bacterial chromosome rather than the genome of a parasite virus of the bacteria.

Intern Med, 1996 Apr, 35(4), 323 - 6
Disseminated nontuberculous mycobacteriosis caused by mycobacterium kansasii in a patient with myelodysplastic syndrome; Komeno T et al.; A 38-year-old man with pancytopenia due to myelodysplastic syndrome exhibited persistent pyrexia and mediastinal lymphadenopathy . A biopsy specimen of the lymph nodes showed diffuse infiltration of epitheloid cells, including acid-fast bacilli identified as Mycobacterium kansasii . Cultures from gastric lavage and stool yielded M . kansasii, and granulomas were found in the bone marrow . A diagnosis of disseminated nontuberculous mycobacteriosis (DNTM) was established . The patient's condition improved after treatment with isoniazid, rifampicin, ethambutol and granulocyte colony-stimulating factor . Although DNTM due to M . kansasii is rare in Japan, it should be recognized as a possible cause of opportunistic infections.

Thorax, 1996 Apr, 51(4), 397 - 402
High resolution computed tomographic findings in pulmonary tuberculosis; Hatipoglu ON et al.; BACKGROUND: Although chest radiographs usually provide adequate information for the diagnosis of active pulmonary tuberculosis, minimal exudative tuberculosis can be overlooked on standard chest radiographs . The aim of the present study was to assess the findings of active pulmonary tuberculosis on high resolution computed tomographic (HRCT) scans, and to evaluate their possible use in determining disease activity . METHODS: Thirty two patients with newly diagnosed active pulmonary tuberculosis and 34 patients with inactive pulmonary tuberculosis were examined . The diagnosis of active pulmonary tuberculosis was based on positive acid fast bacilli in sputum and bronchial washing smears or cultures and/or changes on serial radiographs obtained during treatment . RESULTS: With HRCT scanning centrilobular lesions (n = 29), "tree-in-bud" appearance (n = 23), and macronodules 5-8 mm in diameter (n = 22) were most commonly seen in cases of active pulmonary tuberculosis . HRCT scans showed fibrotic lesions (n = 34), distortion of bronchovascular structures (n = 32), emphysema (n = 28), and bronchiectasis (n = 24) in patients with inactive tuberculosis . CONCLUSIONS: Centrilobular densities in and around the small airways and "tree-in-bud" appearances were the most characteristic CT features of disease activity . HRCT scanning clearly differentiated old fibrotic lesions from new active lesions and demonstrated early bronchogenic spread . These findings may be of value in decisions on treatment.

J Chemother, 1996 Apr, 8(2), 137 - 43
Rifabutin as salvage therapy for cases of chronic multidrug-resistant pulmonary tuberculosis in Taiwan; Lee CN et al.; This study was aimed at assessing the efficacy and tolerability of rifabutin for the re-treatment of cases of chronic, multidrug-resistant pulmonary tuberculosis . The study design was self-controlled, single center . Rifabutin was administered as part of an individual-tailored multidrug regimen . In-patients suffering from pulmonary tuberculosis, infected with Mycobacterium tuberculosis bacilli resistant to isoniazid, rifampicin and other drugs with progressive disease unresponsive to prior courses with standard anti-tuberculosis medications were treated . Overall, 43 patients were enrolled and treated with rifabutin at 300 or 450mg/day according to body weight in conjunction with available anti-tuberculous drugs for a mean time of 353 days (range 42-678) . Of these, 36 met all eligibility criteria (i.e . positive baseline culture of sputum with bacilli resistant to rifampicin at least) and were retained for the analysis of efficacy . Seventeen patients (47%) achieved a sustained conversion to a negative culture of sputum in a mean time of 47.7 days with a range of 14-120 days . Treatment prevented deterioration in most patients and resulted in clinical and radiological cure or marked improvement in more than half of cases . No correlation was found between treatment outcome and use of medication concomitant to rifabutin or susceptibility of bacilli to the drugs used . Four deaths occurred due to disease progression, in no case being related to study drugs . Ten patients reported a total of 18 adverse events that led to treatment discontinuation in 5 cases . Rifabutin should be considered for inclusion in regimens for cases of pulmonary multidrug-resistant tuberculosis which fail to respond to previous therapy.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996 Apr, 81(4), 415 - 20
Oral tuberculosis; Eng HL et al.; Tuberculous lesions of the oral cavity have become so infrequent that it is virtually a forgotten disease entity and may pose a diagnostic problem . Fifteen patients with conditions that were histologically diagnosed as oral tuberculosis were reviewed . All were men ranging in age from 29 to 78 years . The most common clinical presentation was odynophagia with a duration from less than 1 week to several years . The most frequently affected sites were the tongue base and gingiva . The oral lesions took the form of an irregular ulceration or a discrete granular mass . Mandibular bone destruction was evident in two patients . Two patients had a fever, and four had cervical lymphadenopathy . Eight cases were clinically suspicious for malignancy before biopsy . Only four patients had a history of tuberculosis, but 14 of the 15 patients were later found to have active pulmonary tuberculosis . Acid-fast bacilli were demonstrated in all patients . Tuberculosis should be considered in patients with an inflamed ulcer lesion . A biopsy specimen for histologic study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis with other conditions . If a tuberculous lesion is suspected, a chest radiograph is indicated to investigate the possibility of pulmonary involvement.

An Med Interna, 1996 Apr, 13(4), 185 - 7
{Bacteremia caused by Capnocytophaga sp: presentation of 2 cases, one with endocarditis . Review of the literature}; Roig PP et al.; Capnocytophaga sp . is a gram-negative bacilli, scarcely documented as the cause of bacteremias . Two cases of bacteremia caused by Capnocytophaga sp, one of them with endocarditis, are reported here . A review of previous published cases is also presented . One of the patients was immunocompromised, because of chemotherapy, the other, suffered from a rheumatic-cardiopathy which was complicated with endocarditis . Both patients developed an alteration of the oral mucosa . Antibiotic therapy proved to be effective with two patients.

Kekkaku, 1996 Apr, 71(4), 311 - 6
{Four cases of pulmonary tuberculosis resembling pulmonary abscess with a so-called niveau-like shadow in a medical school hospital: discussion concerning the formation mechanism of niveau-like shadows}; Kobashi Y et al.; Four cases of pulmonary tuberculosis resembling pulmonary abscess radiographically were reviewed from their clinical features, chest X-ray and chest CT, and the mechanism of formation of so-called niveau-like shadows was discussed . Only one case showed a newly formed tuberculous cavity with air fluid level on chest X-ray, however, even in this case, the possibility of the infection with tubercle bacilli of an emphysematous bulla of the lung could not be completely excluded as several bulla were found on chest CT . The remaining three cases showed a slightly different mechanism of the formation of niveau-like shadows . Namely, mycobacterium tuberculosis spread into an existed bulla and a tubercle bacilli infected bulla was formed . Regarding the clinical features, no remarkable findings were detected and we could find no differences with common tuberculosis . Based on these experiences, the presence of pulmonary tuberculosis resembling the shadow of pulmonary abscess should be emphasized.

Kekkaku, 1996 Apr, 71(4), 293 - 301
{Clinical evaluation on causes of death in patients with active pulmonary tuberculosis}; Kuba M et al.; Seventy one patients with active pulmonary tuberculosis who died during the past 5 years (1989 to 1993) were evaluated on their causes of death . Twenty two patients (31%) died directly of tuberculosis, and among them, 18 patients (81%) of 22 patients who died of tuberculosis) had very advanced tuberculosis . The majority of them (64%) were old age over 70 years and were bedridden due mostly to cerebrovascular injuries . The serum level of albumin was low in all 17 patients in whom it was measured . Establishment of diagnosis of tuberculosis was delayed over one month after the onset of symptoms in 59% of patients who died of severe disease . Sixty one percent (11/18) of patients died within the first month after the initiation of chemotherapy and about 90% (16/18) died within 3 months . Two patients died from massive hemoptysis and other patients died of either respiratory failure or tuberculosis meningitis . From these observations it was found that very advanced tuberculosis was the major cause of death in patients who died of tuberculosis and that the advanced disease was chiefly caused by the delay on the establishment of diagnosis, and it was most important to detect tuberculosis as early as possible, with regular check up of chest X-ray and frequent examination for AFB (acid-fast bacilli) for tuberculosis suspected patients . On the other hand, the majority of patients (49/71) died of complicating medical problem unrelated to tuberculosis . Seventeen patients died from malignancy (seven lung cancer, four lymphoma, two laryngeal cancer, etc) . Ten deaths were the result of bacterial superinfection . Other patients died from respiratory failure due to COPD, arteiosclerotic heart disease, or cerebrovascular injuries, etc . Two patients of old age died of hepatic failure possibly caused by adverse reaction of TB chemotherapy . It was found that diseases unrelated to tuberculosis were the cause of death in approximately 70% of patients with active tuberculosis, and it should be emphasized to detect early and to treat these diseases, in particular malignancy . And it is also imperative that the chemotherapy for TB must be instituted very carefully with frequent monitoring of liver function in patients with old age.

South Med J, 1996 Apr, 89(4), 414 - 6
Spontaneous resolution of a lung mass due to infection with Mycobacterium terrae; Spence TH et al.; A 61-year-old smoker had a large right lung mass suggestive of bronchogenic carcinoma . Bronchoscopy showed what appeared to be tumor occlusion of a right middle lobe subsegment . Biopsies were nondiagnostic for malignancy . A scheduled percutaneous needle aspiration biopsy 1 week later was canceled because of a significant reduction in size of the lung mass . Acid-fast bacilli were subsequently found in bronchoscopic specimens, and treatment was started with isoniazid, rifampin, pyrazinamide, and ethambutol . The organism was identified as Mycobacterium terrae . In vitro resistance was noted to isoniazid . The early reduction in size of the mass before antimycobacterial therapy suggested that spontaneous regression may be part of the natural history of pulmonary infection with Mycobacterium terrae.

J Bone Joint Surg Am, 1996 Apr, 78(4), 512 - 23
Infection after total hip arthroplasty . A study of the treatment of one hundred and six infections; Tsukayama DT et al.; We evaluated the results of treatment for ninety-seven patients (106 infections in ninety-eight hips) who had had either an infection after a total hip arthroplasty or positive intraoperative cultures of specimens obtained during revision of a total hip arthroplasty for presumed aseptic loosening . The patients were managed according to various protocols on the basis of the clinical setting (positive intraoperative cultures, early postoperative infection, late chronic infection, or acute hematogenous infection) . Aerobic gram-positive cocci accounted for 109 (74 per cent) of the 147 microbial isolates; gram-negative bacilli, for twenty-one (14 per cent); and anaerobes, for twelve (8 per cent) . The white blood-cell count and erythrocyte sedimentation rate were elevated in association with seventeen (16 per cent) and sixty-seven (63 per cent) of the 106 infections, respectively . The mean duration of follow-up was 3.8 years (range, 0.3 to eleven years) . A good result was noted after the initial treatment of twenty-eight (90 per cent) of the thirty-one infections that had been diagnosed on the basis of positive intraoperative cultures at the time of the revision, twenty-five (71 per cent) of the thirty-five early postoperative infections, twenty-nine (85 per cent) of the thirty-four late chronic infections, and three of the six acute hematogenous infections . Of the twenty++-one infections for which the initial therapy failed, twelve eventually were eradicated after additional treatment and the hip had a functional prosthesis at the time of follow-up . Of the ninety-seven infections that were treated successfully (there was a functional retained or exchange prosthesis in place at the time of the most recent follow-up and infection had not recurred at least two years after the discontinuation of antibiotic therapy), nine were associated with subsequent aseptic loosening of the prosthesis . The factors associated with recurrent infection were retained bone cement, the number of previous operations, potential immunocompromise, and early postoperative infection after arthroplasty without cement.

Clin Exp Immunol, 1996 Apr, 104(1), 103 - 7
Prevention of adjuvant arthritis in Lewis rats by neonatal bacille Calmette-Guerin (BCG) infection; Esaguy N et al.; Tolerization of pathogenic antigens is one of the experimental strategies that has been proposed to prevent autoimmune disease . We have investigated here whether neonatal intraperitoneal infection of Lewis rats with Mycobacterium bovis-BCG has any effect on the expression of adjuvant arthritis (AA), an autoimmune disease that is produced by immunization of the rats with dead mycobacteria in mineral oil (i.e . Freund's complete adjuvant (FCA)) . We found that neonatal infection with 10(8) viable BCG bacilli rendered all Lewis rats resistant to the expression of AA after FCA immunization . This BCG-induced protection from reactive arthritis was not seen in Lewis rats infected with smaller inocula (10(6) BG bacilli) or if the infection was performed after the neonatal period (e.g . at 3 weeks of age) . Neonatal administration of 65-kD mycobacterial heat shock protein (hsp65, a key antigen in the etiopathogenesis of AA) failed to protect Lewis rats from AA; injection of lactoferrin (an autoantigen that may be involved in the physiopathology of autoimmune arthritis) to newborn Lewis rats decreased the severity of AA observed after FCA immunization of the animals . Western blotting revealed that Lewis rats that had acquired resistance to AA also showed changes in their repertoire of antibody specificities; among these alterations was decreased anti-hsp65 reactivity . We conclude that neonatal infection with BCG, but not hsp65 injection, renders Lewis rats resistant to AA and that the phenomenon is associated with change in the repertoire of specificities of circulating antibodies.

Transplantation, 1996 Mar 27, 61(6), 972 - 3
Gastric aspiration for diagnosis of pulmonary tubercolosis in adult renal allograft recipients; John GT et al.; Of 213 renal allgraft recipients suspected to have had pulmonary tuberculosis, 132 had sputum examinations and 14 showed acid-fast bacilli . Of the remaining 118 patients, 25 had gastric aspirations, 18 had bronchoalveolar lavage, and 75 did not require further investigation because of spontaneous improvement or confirmation of an alternative diagnosis . While 9 of the 25 patients' gastric aspirate examination was positive, all the 18 who had bronchoalveolar lavage were negative for acid-fast bacilli . Eighty-one patients without expectoration had gastric aspiration directly and 14 showed acid-fast bacilli . Of the remaining 67 patients only 17 had bronchoalveolar lavage, of which three were positive for AFB and the rest did not require further testing for tuberculosis . A total of 106 patients had gastric aspiration . Acid-fast bacillus positivity was significantly more (P<.01) in patients with abnormal chest radiographs as compared with patients with normal chest radiographs as compared with patients with normal chest radiograph results . We suggest gastric aspiration for AFB in all renal transplant recipients who have fever, scanty expectoration, and abnormal chest radiograph with clinical suspicion of pulmonary tuberculosis.

Presse Med, 1996 Mar 23, 25(10), 503 - 7
{Cat scratch disease . Atypical forms}; Bourrillon A et al.; First described by Robert Debre in 1950, cat scratch disease, usually observed in children and young adults (80% of the case occur in subjects under 18), is the principal cause of chronic benign lymph node enlargement . The Centers for Disease Control at Atlanta currently recognize Afipia felis and Rochalimaea henselae as the causal agents of cat scratch disease . Cats transmit the disease to humans by skin scratches or by licking open wounds . The bacilli can also be transmitted by dogs, monkeys, squirels or inert objects . The contaminating cats are usually young . There is no interhuman transmission . There are several uncommon manifestations of cat scratch disease which may misguide diagnosis . In atypical forms, the positive diagnosis of this benign disease can only be confirmed by serology or molecular biology techniques . In order to reduce the duration of the disease, antibiotic treatment is recommended in forms with systemic involvement and in atypical forms although there has been no proof of efficacy.

Srp Arh Celok Lek, 1996 Mar-Apr, 124(3-4), 98 - 102
{Neurologic disorders in Whipple's disease}; Jovic NS et al.; The disease is named after George H . Whipple who, in 1907, was the first to describe an intestinal "lipodystrophy" . Although Whipple's disease is generally recognized as a multisystem chronic granulomatous disease, primarily involving the digestive system, it can also appear as a primary neurological disorder in rare cases . Most often it is manifested with loss of weight, diarrhea, malabsorption, abdominal pain, lymphadenopathy, cardiopathy, hyperpigmentation and hypotension . The presence of periodic acid-Schiff (PAS)-positive macrophages in biopsy specimens (not only jejunal) and demonstration of "Whipple's bacilli" visible by electron microscopy, are diagnostic signs of active Whipple's disease . Whipple's disease confined to the CNS is rare . It is rarely found in the differential diagnosis of patients with progressive neurological deterioration . The most common neurological picture includes progressive dementia, external ophalmoplegia, myoclonus, seizures, ataxia, hypothalamic dysfunction (sleep disorders, hyperphagia, polydipsia) and meningitis . Oculofacial-skeletal myorhythmia as a movement disorder, associated with Whipple's disease, is reported . Fulminant course of cerebral Whipple's disease is unusual and unfavourable . The confusing and nonspecific clinical appearance is typical for primary CNS involvement . It has recently been suggested that CNS involvement occurs in all cases, although only 10-20% of patients may show it . The CNS is the most common site of disease relapse . The CT scans and MRI of the brain are often normal, but may show cortical/subcortical atrophy, hydrocephalus, focal or intracerebral mass lesions . The cerebrospinal fluid can sometimes contain PAS-positive macrophages . Brain biopsy is suggested as a diagnostic method in cases of high suspicion of CNS Whipple's disease . However, the lesions are frequently inaccessible and false negative . Without extended antibiotic therapy, the course of Whipple's disease is lethal . Now, the prognosis is good, although the optimal antimicrobial regimen is not clearly established . Initial parenteral therapy (tetracycline, penicilline, streptomycine, chloramphenicol, ampicilline) and peroral long-term treatment with trimetoprime-sulphametoxasole, are recommended . As CNS relapse of Whipple's disease may occur after several years, long-term treatment should include antibiotics that are able to cross the blood-brain barrier . The CNS relapse, in contrast to the systemic ones, is resistant to the treatment . Appropriate therapy instituted earlier in the course of the disease is associated with a better neurological outcome . Early recognition can be critical in Whipple's disease because of irreversible neurological sequelae seen later in the course of this potentially treatable condition . In cases with high clinical suspicion in which Whipple's disease cannot be diagnosed with procedures such as jejunal biopsy, antibiotic therapy is recommended . Recovery of an established neurological deficit may rarely occur . Longterm follow-up studies would help to identify the optimal antibiotic regimen and duration of treatment.

Gastroenterol Hepatol, 1996 Mar, 19(3), 156 - 8
{Tuberculous pancreatic abscess: differential diagnosis and favorable response to medical treatment}; Boadas J et al.; Pancreatic tuberculosis is rare and may present differential diagnostic problems, specially with cancer of the pancreas . An immunocompetent patient with a pancreatic tuberculous abscess whose clinical manifestations were epigastric pain and a toxic syndrome of one month of evolution is presented . A cystic mass was detected on computerized axial tomography in the tail of the pancreas suggestive of irresectable carcinoma because of vascular invasion with negative percutaneous cytologic puncture for malignant cells . The patient was surgically treated with no histologic confirmation of malignancy . A second laparotomy was performed at 6 months since spontaneous size reduction, external pancreatic fistula with miliary peritoneal dissemination and biopsy compatible with tuberculous granulomas was found . Staining for resistant acid-alcohol bacilli were always negative . Medical treatment achieved complete disappearance of the pancreatic tumor in one year.

J Clin Microbiol, 1996 Mar, 34(3), 762 - 4
Evaluation of mycobacteria growth indicator tube for recovery and drug susceptibility testing of Mycobacterium tuberculosis isolates from respiratory specimens; Palaci M et al.; The new BBL mycobacteria growth indicator tube (MGIT) was evaluated for its ability to detect mycobacteria directly from patient specimens and to determine the drug susceptibility of Mycobacterium tuberculosis isolates . A total of 85 respiratory specimens were tested . Specimens were digested, concentrated, examined microscopically for acid-fast bacilli, and inoculated into MGITs and onto Lowenstein-Jensen slants by standard procedures . The tubes were incubated at 37 degrees C and were examined daily for fluorescence to 365-nm UV light . All 25 specimens smear positive for acid-fast bacilli were tested for drug susceptibility in MGITs containing 1.0 mu g of rifampin per ml, 0.1 mu g of isoniazid per ml, 2.0 mu g of streptomycin per ml, and 2.0 mu g of ofloxacin per ml . These results were compared with those obtained by testing the same M . tuberculosis isolates by the indirect proportion method at drug concentrations of 4.0 mu g of rifampin per ml, 0.2 mu g of isoniazid per ml, 2.0 mu g of ethambutol per ml . 4.0 mu g of streptomycin per ml, and 2.0 mu g of ofloxacin per ml . No significant difference in the sensitivity of detection of M . tuberculosis isolates was found between the two methods . However, the time to detection was significantly shorter in MGITs . Drug susceptibility test results for M . tuberculosis isolates by the two methods demonstrated an excellent correlation . The mean time to reporting of drug susceptibility results was 5 days for MGITs versus 16 days for Lowenstein-Jensen slants . The results of this preliminary study indicate that the MGIT system appears to have potential for routine use in mycobacteriology for both the detection and the drug susceptibility testing of M . tuberculosis isolates . However, it is important to emphasize that simple nonautomated equipment should be developed to improve the accuracy of fluorescence detection.

Kekkaku, 1996 Mar, 71(3), 277 - 82
{Two cases of tubercle bacilli infected pulmonary bulla}; Yanase K et al.; Two cases of tubercle bacilli infected bulla are reported . Case 1; A 78-year-old man visited our hospital complaining of fever and chest pain . The chest radiograph revealed the bulla with air fluid level in the left upper lung field . Mycobacterium tuberculosis was detected in the fluid obtained by percutaneous lung aspiration . He was treated with anti-mycobacterial drugs and showed improvement . Case 2; A 66-year-old man visited our hospital complaining of fever, chest pain and dry cough . The chest radiograph revealed the bulla with air fluid level in the left upper lung field . A diagnosis of tubercle bacilli infected bulla was considered because of high level of ADA in the fluid obtained by percutaneous lung aspiration, and anti-mycobacterial drugs were administered . His symptoms were improved and the frequent chest radiograph showed gradual absorption of the fluid . It is suggested that ADA and bacteriological examinations of the fluid obtained by percutaneous lung aspiration are useful for early diagnosis of tubercle bacilli infected bulla.

Clin Infect Dis, 1996 Mar, 22(3), 471 - 6
Isolation of presumptive Streptobacillus moniliformis from abscesses associated with the female genital tract; Pins MR et al.; We report three cases in which Streptobacillus moniliformis was isolated from abscesses . Abscess material in each case contained small, pleomorphic, gram-negative to gram-variable bacilli . Anaerobic blood agar cultures yielded pinpoint colonies adjacent to small gray-white colonies . The pinpoint colonies did not gram stain, and the gray-white colonies varied from gram-variable coccobacilli to long, curly, gram-variable rods . The pinpoint colonies microscopically resembled L-forms on Dienes-stained agar preparation . Subculture to serum-supplemented thioglycolate broth demonstrated "puff ball" colonies . Fatty acid profiles obtained with use of gas chromatography coupled with mass spectrometry showed major peaks for C16:0, C18:2, C18:1, and C18:0 fatty acids, a profile characteristic of S . moniliformis . Results of biochemical testing of each isolate were equivocal . S . moniliformis, bacterial L-forms, and common isolates from genital tract abscesses are discussed.

Lepr Rev, 1996 Mar, 67(1), 4 - 12
Serological reactivity to a synthetic analog of phenolic glycolipid I and early detection of leprosy in an area of low endemicity; Gonzalez-Abreu E et al.; A total of 23,863 individuals living in an area of low endemicity for leprosy were tested by enzyme-linked immunosorbent assay with a semisynthetic analogue of the phenolic glycolipid I antigen of Mycobacterium leprae . The proportion found positive was 3.86% which was significantly higher than that in a sample of a population known to be free of leprosy . Clinical examinations as well as Mitsuda and skin smear tests were organized for those defined as seropositive . The proportion of individuals with lepromin reactions of less than 3 mm increased 18.9% per serological interval as antibodies rose though it was not statistically significant . As a result of the clinical and bacteriological examinations, 2 cases with clinical signs and heavy bacillary load were found, whereas acid-fast bacilli were demonstrated in 2 other individuals without clinical manifestations of leprosy . The usefulness of the system for control purposes is discussed.

Ann Trop Paediatr, 1996 Mar, 16(1), 61 - 8
Bacteraemia in malnourished rural African children; Reed RP et al.; During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so . The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs . The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%) . Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination . The case fatality rate of severely malnourished bacteraemic children was 20.8% . In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%) . In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conductedPIP: There are an estimated 170 million children in the world who are malnourished, 20 million severely . The authors determined the prevalence of bacteremia in malnourished children admitted to Shongwe Mission Hospital, documented the effect of bacteremia upon mortality, and provide a basis for antimicrobial use in malnourished children with suspected bacteremia . 323 of 863 children under age 5 years admitted to the hospital between May 23 and October 22, 1992, were malnourished, 66% severely . There was a 9.6% prevalence of bacteremia in malnourished children, 11.8% in those severely malnourished, and 5.8% in nutritional dwarfs . Gram-negative enteric bacilli were retrieved in 48.5% of cases . 95.8% of all isolates among the severely malnourished children were sensitive to the combination of intravenous ampicillin and gentamicin . There was a 20.8% case fatality rate among severely malnourished bacteremic children . In malnutrition categories overall, the case fatality rate for bacteremic children (22.6%) was significantly greater than in those without bacteremia (9.3%) . The authors note that it may not be necessary to fully identify bacteria in hospitals with limited resources as long as regular surveillance for emerging resistance is conducted .

Am J Pathol, 1996 Mar, 148(3), 911 - 7
Detection of transforming growth factor-beta 1 in dermal lesions of different clinical forms of leprosy; Goulart IM et al.; Immunohistochemical studies were performed to determine the presence and distribution of polypeptide transforming growth factor (TGF)-beta 1, a cytokine with macrophage-suppressing activity, in skin biopsies from 41 patients with different clinical forms of leprosy . We used an anti-TGF-beta 1 polyclonal antibody and the avidinbiotin-peroxidase (ABC complex) method . The results demonstrated that the lesions of the lepromatous and borderline lepromatous forms presented intense cytoplasm staining for TGF-beta 1 in the cells of the dermal infiltrate . A reaction of moderate intensity was observed in the cells of granulomas from borderline borderline cases, whereas no detectable immunoreaction was observed in granuloma cells from the tuberculoid and borderline tuberculoid forms . Considering that in the lepromatous leprosy form Mycobacterium leprae multiplies in the cytoplasm of macrophages and the lesions are diffuse and consist of poorly differentiated young macrophages, we believe that these alternations may be explained at least in part by the presence of TGF-beta 1 in the dermal infiltrate . Production of the cytokine may be induced by the presence of the bacillus itself and of its constituents, causing a mechanism of parasite evasion . Similarly, the absence of TGF-beta 1 in tuberculoid leprosy, which progresses with a specific immune response to M . leprae, may explain the intense differentiation of macrophage cells with the formation of well defined epithelioid granulomas capable of eliminating most of the bacilli.

Respir Med, 1996 Mar, 90(3), 139 - 43
Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis; Lai RS et al.; In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs . The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis . One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy . Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance . Of 170 patients, 120 (70.6%) had lung cancer (including three with metastatic cancer), 40 (23.5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5.9%) patients had other benign pulmonary lesions . The overall diagnostic rate in SPNs was 62.4% (106 of 170) . Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70.0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40) . In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum) . The percentage of positive diagnosis correlated with diameter of the SPN . Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35.3% of cases (6 of 17; cancer 40% vs . Tb 29%) . In contrast, the diagnostic rates in SPNs with diameters 2-4 cm and greater than 4 cm were 64.5% (78 of 121; cancer 72.0% vs . Tb 62.5%) and 68.8% of cases (22 of 32), respectively . Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.

Br J Clin Pract, 1996 Mar, 50(2), 116 - 7
Melioidosis: a rare but not forgotten cause of fever of unknown origin; Handa R et al.; Melioidosis is widely prevalent in Southeast Asia and northern Australia . Although it is believed to pose no current threat to the populations of developed countries, the increased mobility of people around the world and of Southeast Asian refugees to Western countries may change this . Its long incubation period may put a relatively large number of currently asymptomatic people at risk . It should be considered in the differential diagnosis of any febrile illness in a person who has visited an endemic area, especially if the presenting features are those of fulminant respiratory failure, if multiple pustular or necrotic skin or subcutaneous lesions develop, or if there is a radiologic pattern of tuberculosis from which tubercle bacilli cannot be demonstrated.

J Infect, 1996 Mar, 32(2), 157 - 60
Tuberculous pericarditis in a child; Coulter JB et al.; A 14-year-old boy with tuberculous pericarditis and tamponade is described . Confirmation was by culture of pericardial aspirate . Though he did not have a cough, acid-fast bacilli were detected following induced sputum . Chest X-ray did not show evidence of pulmonary tuberculosis, but enlarged mediastinal nodes were detected by computerized tomography . He made an excellent response to anti-tuberculous chemotherapy and corticosteroids.

Geburtshilfe Frauenheilkd, 1996 Mar, 56(3), 156 - 60
{Initial manifestation of tuberculoid leprosy in pregnancy . Guidelines for diagnosis and therapy}; Neuer A et al.; Pregnancy has long been associated with the first presentation of clinical leprosy or aggravation of the existing disease . In Germany leprosy has been diagnosed in 107 patients since 1980 . A 27-year-old Singhalese female, gravida 2 at 14 weeks' gestation was admitted with well defined, elevated, erythematous lesions on her cheeks and nose . Clinical examination revealed central anaesthesia in the lesions . No further signs of leprosy in the skin, the mucosae and the peripheral nerves were found . Fite-Faraco staining of the skin biopsy showed sporadic acid-fast bacilli and confirmed an active subpolar tuberculoid leprosy (TTs) . Outpatient treatment was immediately initiated with oral rifampin 600 mg monthly and dapsone 100 mg daily . During the 4-month treatment cycle the skin lesions vanished completely . Additional leprosy reactions did not occur and the medication was well tolerated . However, in the 32nd gestational week the patient was readmitted with premature labour and 3 weeks later Caesarean section was performed because of cardiotocographic pathology . Polymerase chain reaction (PCR) for M . leprae of placental tissue was negative . Antibodies against phenolic glycolipid 1 (PGL 1) of M . leprae (IgM-Elisa and Dot-Elisa) from cord blood, maternal and newborn blood were not found . On the fifth postpartal day the healthy mother and her baby were discharged . In conclusion, leprosy in pregnancy can be treated safely and successfully by combined drug therapy.

Int J Dermatol, 1996 Mar, 35(3), 185 - 8
Diagnosis of cutaneous tuberculosis by polymerase chain reaction using a species-specific gene; Faizal M et al.; BACKGROUND . Diagnosis of tuberculosis (TB), especially cutaneous TBC, by conventional microbiologic methods is still a very laborious process and the results are usually inconclusive . Our purpose was to identify M . tuberculosis bacilli in uncultured clinical samples from skin lesions by means of the rapid, specific, and sensitive polymerase chain reaction (PCR) . METHODS . The PCR, using a set of species-specific primers, was performed on biopsies and fluid secretions from lesions . RESULTS . A positive amplification reaction was observed in three of the four samples studied . For one of the samples, the result was confirmed by a positive culture in Lowenstein-Jensen medium and for the other two, by molecular hybridization and the clinical course of the patients after treatment . Samples obtained from a patient with panniculitis of Christian-Weber and a normal skin biopsy were included as negative controls . CONCLUSIONS . We propose the PCR method as a tool for the diagnosis of cutaneous TBC . The presence of the M . tuberculosis in an erythema induratum of Bazin suggests a revision of the concept of this disease as a tuberculide reaction.

Am J Gastroenterol, 1996 Mar, 91(3), 565 - 8
Clinicocolonoscopic profile of colonic tuberculosis; Singh V et al.; BACKGROUND: Colonic tuberculosis is common in developing countries . However, its diagnosis is difficult . Nevertheless, colonoscopy and biopsy examination have shown promising results . METHODS: We evaluated the clinical spectrum and colonoscopic features of 62 patients with colonic tuberculosis . RESULTS: Abdominal pain, fever, anorexia, weight loss, and change in bowel habit were seen in more than 50% of the patients . Massive rectal bleeding was frequently (13%) observed . Colonoscopy revealed strictures in 17, deformed ileocecal valve in 34, ulcers in 52, nodules in 49, polypoidal lesions in three, and fibrous bands in five patients . Segmental tuberculosis, lesions mimicking carcinoma, and multiple site involvement were observed in 19%, 20%, and 50% of the patients, respectively . Histopathologically, well formed granulomas were seen in 27, collections of epithelioid cells in 18, and chronic, nonspecific inflammatory changes in 17 of the cases . Acid-fast bacilli could not be isolated from any of the patients . All of the patients responded to the anti-tubercular treatment . Follow-up colonoscopy in 22 patients demonstrated regression of lesions . CONCLUSIONS: Colonic tuberculosis is common in India . Our findings indicate that colonoscopy is useful for its diagnosis . However, histopathology many not always be helpful . Therefore, in a given clinical and colonosopic setting, a therapeutic trial may be indicated.

J Bacteriol, 1996 Mar, 178(5), 1274 - 82
Molecular analysis of genetic differences between Mycobacterium bovis BCG and virulent M . bovis; Mahairas GG et al.; The live attenuated bacillus Calmette-Guerin (BCG) vaccine for the prevention of disease associated with Mycobacterium tuberculosis was derived from the closely related virulent tubercle bacillus, Mycobacterium bovis . Although the BCG vaccine has been one of the most widely used vaccines in the world for over 40 years, the genetic basis of BCG's attenuation has never been elucidated . We employed subtractive genomic hybridization to identify genetic differences between virulent M . bovis and M . tuberculosis and avirulent BCG . Three distinct genomic regions of difference (designated RD1 to RD3) were found to be deleted from BCG, and the precise junctions and DNA sequence of each deletion were determined . RD3, a 9.3-kb genomic segment present in virulent laboratory strains of M . bovis and M . tuberculosis, was absent from BCG and 84% of virulent clinical isolates . RD2, a 10.7-kb DNA segment containing a novel repetitive element and the previously identified mpt-64 gene, was conserved in all virulent laboratory and clinical tubercle bacilli tested and was deleted only from substrains derived from the original BCG Pasteur strain after 1925 . Thus, the RD2 deletion occurred after the original derivation of BCG . RD1, a 9.5-kb DNA segment found to be deleted from all BCG substrains, was conserved in all virulent laboratory and clinical isolates of M . bovis and M . tuberculosis tested . The reintroduction of RD1 into BCG repressed the expression of at least 10 proteins and resulted in a protein expression profile almost identical to that of virulent M . bovis and M . tuberculosis, as determined by two-dimensional gel electrophoresis . These data indicate a role for RD1 in the regulation of multiple genetic loci, suggesting that the loss of virulence by BCG is due to a regulatory mutation . These findings may be applicable to the rational design of a new attenuated tuberculosis vaccine and the development of new diagnostic tests to distinguish BCG vaccination from tuberculosis infection.

Presse Med, 1996 Feb 10, 25(5), 193 - 6
{Acid-alcohol-resistant bacilli detected by microscopic analysis of exhaled air from HIV-infected patients: tuberculosis or mycobacteriosis?}; Meynard JL et al.; OBJECTIVES: The incidence of atypical mycobacterial infections has increased with the AIDS epidemic . To present, microscopic examinations of airway specimens positive for acid-fast bacteria were highly suggestive of tuberculosis . However, since the AIDS epidemic, certain authors have reported an increase in Mycobacterium avium intracellulare found in respiratory specimens . The aim of this work was to determine what factors might distinguish between these two infections revealed discovery of an acid-fact bacilli . METHODS: Hospital files of all HIV seropositive patients seen between November 1992 and March 1995 and with at least one airway specimen positive for acid-fast bacilli were studied retrospectively . RESULTS: Mycobacterium tuberculosis was isolated in 19 patients, Mycobacterium avium intracellulare in 8 and culosis and M . avium intracellulare . There was no difference for age, sex, geographical origin, transmission mode, antigen positivity, radiologic findings or clinical signs between patients with the different types of mycobacterium . The CD4 count was however significantly lower in patients with an atypical mycobacteriosis (14.5/mm3) than in patients with tuberculosis (91.7 +/- 83.7) (p = 0.004) . CONCLUSION: These findings show that in HIV-infected patients with a CD4 count under 100/mm3, the presence of acid-fact bacilli can indicate either M . tuberculosis or M . avium intracellulare . Combined anti-tuberculosis and antimycobacteriosis therapy thus would appear to be justified until the germ can be identified.

Immunol Cell Biol, 1996 Feb, 74(1), 45 - 51
Bacterial metabolism, cytokine mRNA transcription and viability of bovine alveolar macrophages infected with Mycobacterium bovis BCG or virulent M . bovis; Aldwell FE et al.; Mycobacterium bovis causes tuberculosis in cattle and many other animals including humans while BCG, an attenuated form of M . bovis, has been used widely as a safe vaccine . Both strains infect host macrophages and their fate is determined by their ability to survive within these phagocytic cells . We compared interactions of these two strains with bovine alveolar macrophages in order to gain an understanding of virulence mechanisms involved in the early pathogenesis of M . bovis infection . Macrophages were infected with bacilli at varying multiplicities of infection and cultured for 1-4 days . Bacterial metabolism within macrophages was assessed by {3H}-uracil uptake and bacterial growth was assessed by culture and acid-fast staining . Induction of TNF-alpha, IL-1 beta and IL-6 cytokine mRNA transcription in macrophages was determined by reverse transcriptase-polymerase chain reaction . Infection of macrophages by virulent M . bovis resulted in enhanced bacterial metabolism, enhanced induction of macrophage cytokines and reduced viability of macrophages when compared to M . bovis BCG-infected macrophages . These differences may reflect virulence mechanisms contributing to the early pathogenesis of bovine tuberculosis.

Nippon Rinsho, 1996 Feb, 54(2), 396 - 404
{Structure and expression of the human neutrophil elastase gene--regulatory mechanism and its relevance to the respiratory diseases}; Yoshimura K et al.; Human neutrophil elastase is a 29 kDa, 220-residue single chain glycoprotein which functions as a powerful serine protease . Because NE is capable of destroying a broad range of substrates including cross-linked elastin and the major forms of collagen as well as the cell walls of gram-negative bacilli, it possesses the two-edged sword property that is required for normal tissue turnover and host defense, yet potentially harmful in its ability to destroy normal tissues simultaneously . In this regard, NE plays a central role in the pathogenesis of pulmonary emphysema by destroying the alveolar walls of the lung in the conditions that antiproteases in the lung such as alpha 1-antitrypsin (alpha 1-AT) are inactivated-e.g., cigarette smoking, or alpha 1-AT deficiency caused by mutations of the alpha 1-AT gene-resulting in excess burden of NE in the lung . The gene encoding the NE protein has 5 exons and is located at chromosome 19p13.3 . Expression of the NE gene is tightly controlled mainly at the transcriptional level, and limited to the early stage of myeloid cell differentiation in bone marrow cells, mostly in promyelocytes . The knowledge on the modulation of lineage- and differentiation-specific NE gene expression could offer the possible therapeutic strategy to the diseases such as pulmonary emphysema.

Antimicrob Agents Chemother, 1996 Feb, 40(2), 429 - 32
Activity of KRM-1648 alone or in combination with both ethambutol and kanamycin or clarithromycin against Mycobacterium intracellulare infections in beige mice; Yamamoto T et al.; The in vivo activities of KRM-1648 alone or in combination with both ethambutol (EB) and kanamycin (KM) or clarithromycin (CAM) were tested against Mycobacterium intracellulare infections in beige mice . KRM-1648 was more active than rifampin (RFP) when each drug was used alone, and the efficacy of KRM-1648 was similar to those of both kanamycin and clarithromycin . The combination KRM-1648-KM-EB was strongly active and rapidly reduced the numbers of bacilli both in lungs and in spleens compared with RFP-KM-EB . The combination KRM-1648-CAM had greater therapeutic effects than RFP-CAM; this difference in efficacy was more pronounced for lungs than for spleens . These findings suggest that KRM-1648 is a promising candidate for combination therapy with other potent antimycobacterial drugs.

Acad Emerg Med, 1996 Feb, 3(2), 157 - 60
Mycobacterial sepsis following intravesical instillation of bacillus Calmette-Guérin; Garyfallou GT; Intravesical bacillus Calmette-Guerin (BCG) administration for bladder cancer may lead to BCG dissemination in the compromised host . A case of a 63-year-old man with shock secondary to BCG sepsis is reported . The recognition and treatment of disseminated BCG infection are discussed . In addition to standard therapy for urosepsis, early therapy with steroids and coverage with antitubercular medications should be initiated for patients with this condition . In general, the author recommends that all febrile patients who have received BCG immunotherapy within three years, and who have no obvious source for their fever, have acid-fast bacilli blood cultures done for Mycobacterium bovis, and that these patients be admitted to the hospital for further evaluation.

J Clin Microbiol, 1996 Feb, 34(2), 319 - 23
Mycobacteriosis caused by Mycobacterium genavense in birds kept in a zoo: 11-year survey; Portaels F et al.; We report on a disease in 27 birds (1 bird belonging to the order Coraciiformes, 3 to Piciformes, 4 to Galliformes, 7 to Psittaciformes, and 12 to Passeriformes) caused by fastidious mycobacteria . All birds were caged at the Antwerp Zoo and died suddenly between 1983 and 1994 . Seventeen birds had no previous signs of disease, and 10 birds showed emaciation . Gross necropsy findings were generally nonspecific, but all the birds were smear positive for acid-fast bacilli (AFB) . Histopathologic evaluation performed on 14 birds revealed predominantly intracellular AFB . Extracellular AFB were more abundant in advanced lesions, especially in necrotic areas . In the intestine the mucosal area was generally heavily infiltrated, suggesting an intestinal origin of the infection . There was extensive invasion of the lungs in most birds . In 11 birds sparse growth was obtained after at least 6 months of incubation on Lowenstein-Jensen medium or on Ogawa medium supplemented with mycobactin . Subculture was unsuccessful in all instances . The 16S rRNA gene sequence of the cultured organisms or tissues from seven birds revealed the characteristic signature sequence for Mycobacterium genavense . Direct bird-to-bird transmission in the zoo was unlikely, and the pathogenicity of M . genavense in birds seems to be limited . The source of M . genavense in nature and the epidemiology of the disease in birds remain obscure . As suspected for human cases of M . genavense infection, an oral route of infection has been suggested, and contaminated local water distribution systems may have been the source of the infection . Our study confirms that infections caused by M . genavense should be suspected in birds (especially in Passeriformes and Psittaciformes orders) that die suddenly without previous symptoms and that have AFB in tissues that are difficult to grow on conventional media.

Eur Respir J, 1996 Feb, 9(2), 284 - 7
Characteristics of sputum smear-positive tuberculosis patients with and without HIV infection in a hospital in Zimbabwe; Schoch OD et al.; Human immunodeficiency virus (HIV) infection has a large impact on tuberculosis in Africa . In this study, the prevalence of HIV infection in a population of hospitalized tuberculosis patients in Zimbabwe was determined and demographic characteristics, clinical signs and symptoms, as well as radiographic appearance were compared in tuberculosis patients with and without HIV infection . During a 5 month observation period, information on tuberculosis patients referred to Driefontein Tuberculosis Sanatorium, Mvuma, Zimbabwe was collected, computerized and analysed with commercially available software . Of 467 patients admitted, 255 were sputum smear positive for acid-fast bacilli . Of 196 patients with complete information, 127 (65%) were HIV-seropositive . When compared to the 69 HIV-seronegative patients, HIV-infected patients were not different in age, gender, the period of delay between the onset of symptoms and diagnosis, radiographic appearance, history of previous antituberculosis treatment and symptoms and signs reported, with the exception of herpes zoster and other sexually-transmitted disease . The prevalence of HIV infection in our population of tuberculosis patients was large . However, since demographic and clinical characteristics are remarkably similar in tuberculosis patients with and without HIV infection, case-finding activities need not be altered in the wake of the HIV epidemicPIP: During April-September 1992, demographic, clinical, and bacteriological information was collected on all 467 tuberculosis (TB) patients aged 15 years and older admitted to the Driefontein Tuberculosis Sanatorium serving people from the Midlands and Masvingo provinces in Zimbabwe . 255 people had at least one sputum smear positive for acid-fast bacilli . Researchers retained 196 of these for analysis and compared demographic characteristics, clinical signs and symptoms, and radiographic appearance in TB patients with and without HIV infection . 127 (65%) people tested positive for HIV . HIV-infected TB patients were not significantly different compared to HIV-negative TB patients in age, gender, the period of delay between the onset of symptoms and diagnosis (about 2 months for both groups), radiographic appearance, history of previous anti-TB treatment, and symptoms and signs reported . They were more likely than HIV-negative TB patients to have a history of sexually transmitted diseases (adjusted odds ratio = 3.4; p = 0.01) and herpes zoster infection (9 vs . 0 patients) . These findings suggest that health workers need not change case finding activities in the wake of the HIV epidemic . In conclusion, the most cost-effective intervention continues to be identification and curative treatment of sputum smear-positive TB patients irrespective of their HIV status .

J Chemother, 1996 Feb, 8 Suppl 2, 105 - 11
The position of recently developed broad-spectrum cephem antibiotics in bacterial septicemia; Shah PM; In-vitro studies with cefpirome or cefepime prove that both agents are highly active against Gram-negative bacilli and Gram-positive cocci . They possess a broader spectrum of activity than ceftazidime . In clinical trials cefpirome at doses ranging from 1 g to 2 g b.i.d . was compared to ceftazidime at a dose ranging from 1 g to 2 g b.i.d . or 2 g t.i.d . Cefepime at a dose of 2 g b.i.d . was compared to ceftazidime at a dose of 2 g t.i.d . Both cefpirome and cefepime were found to be as effective as ceftazidime in patients with septicemia . These new compounds are a valuable addition to the range of drugs available for empiric treatment of serious bacterial infections.

Thorax, 1996 Feb, 51(2), 137 - 9
Comparison of characteristics of patients and treatment outcome for pulmonary non-tuberculous mycobacterial infection and pulmonary tuberculosis; Al Jarad N et al.; BACKGROUND: Patients with non-tuberculous mycobacteria are usually started on conventional antituberculous triple therapy once acid fast bacilli are detected, before the exact type of mycobacteria has been identified . The ability to identify the characteristics of patients with tuberculous and non-tuberculous mycobacteria may be helpful in identifying before treatment those patients more likely to have non-tuberculous infection . METHODS: A retrospective study was conducted of all patients in one unit in whom non-tuberculous mycobacteria were identified in sputum or bronchoalveolar washings in the period 1987-93 . The pattern of drug resistance was determined from laboratory records, and all case notes and chest radiographs were reviewed to identify the underlying disease and treatment outcome . All cases were compared with a matched control group of patients with culture positive Mycobacterium tuberculosis diagnosed during the same period . RESULTS: In the period studied there were 70 non-tuberculous and 221 tuberculous isolates . The non-tuberculous bacteria were typed as follows: M xenopi 23 (33%), M kansasii 19 (27%), M fortuitum 14 (20%), others 14 (20%) . Of those with non-tuberculous mycobacteria, 83% were white subjects compared with 47% for tuberculosis . Patients with non-tuberculous mycobacteria were older than those with tuberculosis . Pre-existing lung disease or AIDS was present in 81% of patients with non-tuberculous mycobacteria and in 17% of patients with tuberculosis . Sensitivity to rifampicin and ethambutol was seen in 95% of M xenopi and 96% of M kansasii isolates . Relapse occurred in 60% of cases infected with M xenopi, 20% infected with M kansasii, and in 7% of cases with tuberculosis . CONCLUSIONS: In the population studied non-tuberculous mycobacteria occurred most frequently in elderly white subjects with pre-existing lung disease . If mycobacteria are detected in this group, consideration should be given to the possibility of non-tuberculous infection before embarking on treatment . A combination containing rifampicin and ethambutol is effective . The relapse rate for infection with M xenopi is high and prospective studies of the effect of the above combination of antituberculosis drugs are needed.

J Pathol, 1996 Feb, 178(2), 221 - 6
Diagnostic value of different PCR assays for the detection of mycobacterial DNA in granulomatous lymphadenopathy; Totsch M et al.; Diagnosis of mycobacterial infection is made by assessment of characteristic histological features, staining of acid-fast bacilli, or agar culture . Recent advances in molecular biology have provided alternative approaches for the detection of mycobacteria, but only limited data are available dealing with the comparative evaluation of these methods . In order to determine the diagnostic applicability of polymerase chain reaction (PCR)-based assays, 20 formalin-fixed and paraffin-embedded lymph nodes with bacille Calmette-Guerin (BCG) lymphadenitis were investigated which in Lowenstein Jensen agar culture were either positive or negative (ten cases each); ten lymph nodes with non-specific lymphadenitis served as negative controls . Ziehl-Neelsen staining as well as three different PCR assays (including nested PCR), amplifying a specific sequence of the Mycobacterium tuberculosis complex or sequences of the 65 kD antigen gene, were performed . Positive culture was only obtained from lymph nodes which had been surgically removed within 20 weeks after vaccination (P < 0.001) . In contrast to microscopic examination, which yielded no more information than agar culture, PCR detection of mycobacterial DNA was unrelated to culture findings . Combined use of different assays, as well as DNA extraction from at least three paraffin sections from each specimen, resulted in the detection of mycobacterial DNA in all lymph nodes with amplifiable DNA (18 out of 20 cases) . Controls remained consistently negative . Thus, the combined use of different PCR assays is proposed as a rapid and sensitive technique for the detection of mycobacterial DNA in formalin-fixed and paraffin-embedded tissue.

J Gastroenterol Hepatol, 1996 Feb, 11(2), 183 - 6
Does Crohn's disease need differentiation from tuberculosis?
Jayanthi V, Robinson RJ, Malathi S, Rani B, Balambal R, Chari S, Taghuram K, Madanagopalan N, Mayberry JF.
Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist . Clinically and radiologically, the diseases are similar . In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants . Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD . Aphthoid ulceration, pseudopolyps and filiform mucosa at endoscopy are suggestive of CD and a negative tuberculin test us useful . The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli . Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis . TB is known to affect all age groups and fistulous communication, although uncommon, does occur . In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis . In developing countries, CD is uncommon and remains largely a diagnosis of exclusion . A trial of anti-tuberculosis therapy may often be prescribed before definitely diagnosing CD . The development of molecular biology techniques had led to a revival of interest in mycobacteria as a possible aetiological agent in CD . DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established . However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.

J Am Acad Dermatol, 1996 Feb, 34(2 Pt 1), 224 - 8
Mycobacteria in prurigo nodularis: the cause or a consequence?
Mattila JO, Vornanen M, Vaara J, Katila ML.
BACKGROUND: Prurigo nodularis (PN) is a chronic skin disorder; its cause remains unknown . OBJECTIVE: We evaluated mycobacteria as a possible cause of PN . METHODS: Forty-three patients with PN were examined . Skin biopsy specimens were obtained for microbiologic and histopathologic studies . The patients were tested for intracutaneous reactivity to 12 mycobacterial antigens with the Mantoux technique . RESULTS: Six specimens (14%) grew mycobacteria in culture: M . avium-intracellulare (3), M . malmoense (1), and Mycobacterium sp . (2) . Histopathologically, 12 samples (28%) were positive for acid-fast bacilli, and granulomatous changes were present in one sample . Patients whose cultures were positive for mycobacteria had significantly larger skin reactions to mycobacterial antigens . Two patients underwent 2 years of antituberculous chemotherapy; one had an excellent response and the other a partial response . CONCLUSION: Detection of mycobacteria by culture or staining, combined with elevated skin reactivity to mycobacteria in a high proportion of patients with PN, suggests a mycobacterial cause.

S Afr Med J, 1996 Feb, 86(2), 155 - 8
Early bactericidal activity of ethambutol, pyrazinamide and the fixed combination of isoniazid, rifampicin and pyrazinamide (Rifater) in patients with pulmonary tuberculosis; Botha FJ et al.; The early bactericidal activity (EBA) of ethambutol, pyrazinamide and the fixed combination of isoniazid, rifampicin and pyrazinamide (Rifater: Mer National) was evaluated in patients with pulmonary tuberculosis who were sputum-positive on microscopy for acid-fast bacilli . Twenty-eight patients (mean age 33 years and weight 51 kg on average; range 40-59 kg) were studied . The fall in viable counts of Mycobacterium tuberculosis in sputum collections during the 2 days following the start of treatment was estimated from counts of colony-forming units (CFUs) of M . tuberculosis per ml of sputum cultured on selective 7H10 agar medium . The EBA for ethambutol determined in 9 patients was 0.245 +/- 0.046, log10 CFU/ml sputum/day, that for pyrazinamide was 0.003 +/- 0.014 log10 CFU/ml sputum/day and that for Rifater 0.558 +/- 0.054 log10 CFU/ml sputum/day . The results obtained are similar to those reported in a previous study of the first 2 days of treatment, but in smaller numbers of patients, and confirm the moderate EBA of ethambutol while pyrazinamide is again shown to have very little EBA . Rifater has a marked EBA which may be due mainly to the action of isoniazid . This methodology may be valuable in the rapid evaluation of the bactericidal activity of new antituberculosis agents and the comparison of different dose sizes of agents of the same class.

Fertil Steril, 1996 Feb, 65(2), 367 - 70
Results of in vitro fertilization and embryo transfer in women with infertility due to genital tuberculosis; Gurgan T et al.; OBJECTIVE: To determine the results of IVF-ET in women with infertility due to genital tuberculosis . DESIGN: Retrospective case-control study . SETTING: In vitro fertilization and ET unit of a university hospital . PATIENTS: Forty-four cycles of IVF-ET were undertaken in 24 women with genital tuberculosis and the results were compared with 366 cycles in 274 nontuberculous tubal factor couples . INTERVENTIONS: All women with genital tuberculosis were evaluated with hysteroscopy, endometrial biopsy, and acid fast bacilli stain before treatment with IVF-ET . RESULTS: Subjects with genital tuberculosis had higher basal FSH levels, required more exogenous gonadotropins for controlled ovarian hyperstimulation, reached lower peak E2 levels, and yielded fewer oocytes and embryos when compared with tubal factor patients . Furthermore, in women with genital tuberculosis, clinical pregnancy rate per cycle was lower and spontaneous abortion rate was higher . CONCLUSIONS: Women with genital tuberculosis appear to represent a less favorable subset within other tubal factor patients when treated with IVF-ETPIP: At Hacettepe University Hospital in Ankara, Turkey, 24 women with genital tuberculosis had undergone 44 cycles of in vitro fertilization-embryo transfer (IVF-ET) and 274 women with tubal infertility not related to genital tuberculosis (controls) had undergone IVF-ET . Physicians compared the results of IVF-ET in these two sets of women . Women with genital tuberculosis had significantly higher day-3 follicle stimulating hormone (FSH) levels than the controls (11.6 vs . 7.7 mIU/ml; p 0.001) . Thus, they had a higher number of ampules of hMG than the controls (27.3 vs . 18.4; p 0.05) to achieve peak estradiol levels on the day of human chorionic gonadotropin (hCG) and the number of days of follicle stimulation . Peak estradiol levels were lower among cases than controls (852 vs . 1141 pg/ml; p 0.05), while the number of days of follicle stimulation was higher among cases than controls (10.3 vs . 7.5; p 0.01) . Women with genital tuberculosis also had a significantly lower number of aspirated oocytes and of transferred embryos than controls (5.8 vs . 7.7 and 2 vs . 2.9, respectively; p 0.01 for both) . They also had a much lower clinical pregnancy rate than controls (9.1% vs . 21.3%; p 0.001) . Women with genital tuberculosis also had a significantly higher spontaneous abortion rate than controls (75% vs . 19.2%; p 0.05) . The only woman with genital tuberculosis who delivered a live infant had undergone hysteroscopic lysis of dense intrauterine synechia . The lower pregnancy rate was largely due to the fewer embryos available for transfer among the women with genital tuberculosis . The implantation rates per transferred embryo were not significantly different between the two groups (5.85% for cases vs . 8.6% for controls) . These findings suggest that women with genital tuberculosis are a less favorable subset among tubal factor patients when treated with IVF-ET . Physicians should anticipate these women to have a reduced ovarian reserve, lower intrauterine pregnancy, and higher miscarriage rates .

Infect Immun, 1996 Feb, 64(2), 452 - 9
H2O2 induces monocyte apoptosis and reduces viability of Mycobacterium avium-M . intracellulare within cultured human monocytes; Laochumroonvorapong P et al.; Mycobacterium avium-M . intracellulare, an intracellular parasite of mononuclear phagocytes, rarely causes disease in immunocompetent individuals . In contrast, in human immunodeficiency virus type 1-infected patients, M . avium-M . intracellulare can infect almost every tissue and organ . This suggests that immunocompetent individuals have a protective mechanism to control or prevent the infection . How mycobacterial may be killed by the host immune response is unclear . We have recently reported that induction of apoptosis of Mycobacterium bovis BCG-infected macrophages with ATP4- was associated with killing of the intracellular mycobacteria . In the present study, a long-term culture of M . avium-M . intracellulare-infected monocytes was used to further evaluate the interaction between M . avium-M . intracellulare and primary human monocytes . In our system, M . avium-M . intracellulare parasitized the human monocytes and appeared to replicate slowly over 14 days within the host cells . To examine the role of apoptotic mechanisms in survival or death of intracellular mycobacteria, M . avium-M . intracellulare-infected human monocytes were treated with a monoclonal antibody to Fas receptor (APO-1/CD95) or with various concentrations of H2O2 . Although both of these exogenous agents induced monocyte apoptosis, optimal killing (65% reduction in CFU) of intracellular M . avium-M . intracellulare was observed only when M . avium-M . intracellulare-infected cells were treated with 10 mM H2O2 . Fas-induced apoptosis did not affect M . avium-M . intracellulare viability . Our results suggest that not all stimuli of monocyte apoptosis induce killing of intracellular M . avium-M . intracellulare . Since release of H2O2 following phagocytosis of mycobacteria has been documented, H2O2-induced apoptotic death of M . avium-M . intracellulare-infected monocytes and its association with killing of the intracellular bacilli may be a physiological mechanism of host defense against M . avium-M . intracellulare.

Vet Rec, 1996 Jan 27, 138(4), 87 - 8
A pathological study of a mycobacterial infection in a cat caused by a variant with cultural characteristics between Mycobacterium tuberculosis and M bovis; Blunden AS et al.; A histological examination of a biopsy from a firm submandibular mass in a seven-year-old domestic short-haired cat revealed a granulomatous lymphadenitis associated with the presence of small numbers of acid-fast bacilli . The cat was euthanased and subjected to a detailed post mortem examination which revealed extensive granulomatous inflammation in the right and left bronchial, para-aortic, mesenteric and colic lymph nodes, with small or early lesions in the lung and Peyer's patches of the ileum . Mycobacteria were isolated from the submandibular, mesenteric and cervical lymph nodes . The bacilli reacted with a DNA probe specific for the tuberculosis complex, including Mycobacterium tuberculosis and M bovis, but had cultural characteristics intermediate between these two species . The pathological findings are compared with previous reports of mycobacterial infections in cats, and the public health implications are discussed.

Zhonghua Er Bi Yan Hou Ke Za Zhi, 1996, 31(1), 50 - 2
{Wound infection and recurrence after total laryngectomy}; Wang Q et al.; 95 patients who received total laryngectomy for laryngeal carcinoma were reviewed . They were divided into two groups, those with postoperative wound infection and those without . The relations between postoperative wound infection and local recurrence were discussed . The results showed that the recurrence rate of postoperative infection group was higher than that of no postoperative infection (P < 0.001), and the patients with gram-negative bacilli infection also had much higher recurrence rates (P < 0.05) . For the laryngeal cancer, the development of a wound infection after total laryngectomy may be related to the local tumour recurrence within one year.

Med Dosw Mikrobiol, 1996, 48(3-4), 123 - 30
{Staphylococcal utilization of siderophores produced by bacilli of the genus Bacillus}; Szarapinska-Kwaszewska J et al.; The ability of utilization by 24 staphylococcal strains of the siderophores of B . megaterium PCM 2010 and B . subtilis S was investigated . B . megaterium PCM 2010 produced hydroxamate class siderophores and B . subtilis S-catecholate class . The majority of staphylococcal strains--thirteen--could utilize these siderophores: eight strains from both these species and three strains did not possess any receptors for these chelators . The staphylococcal strains producing catecholate siderophores utilized catecholate chelators from B . subtilis S.

Ann Fr Anesth Reanim, 1996, 15(7), 1080 - 7
{Pulmonary tuberculosis in 1996 . Recent data and practical consequences for the anesthesiologist}; Veber B; Tuberculosis is one of the most widespread diseases, occurring in more than eight million persons, and about three million die annually of tuberculosis . In industrialized countries, the incidence has increased significantly over the last 10 years . HIV infection is a main factor leading to this increase . Outbreaks of nosocomial tuberculosis among patients and healthcare workers have been reported . Tuberculosis is often caused by multidrug-resistant bacilli in patients with HIV infection . Physicians must be aware of this danger and careful adherence to guidelines is required to prevent further nosocomial spread of the disease . Airborne transmission by inhalation of infectious aerosol justifies appropriate measures for respiratory isolation to protect medical staff and other patients from the transmission of tuberculosis . In combination with some anaesthetic agents, antituberculous drugs may be responsible for hepatic toxicity . Influence of tuberculosis on regional anaesthesia and mechanical ventilation is also considered.

Ann Med Interne (Paris), 1996, 147(8), 590 - 4
{Systemic scleroderma and sarcoidosis: 3 new cases}; Bandt MD et al.; We observed 3 patients with successive scleroderma (SS) and (what is considered to be) sarcoidosis (SA) . The diagnosis SS included in the 3 patients: Raynaud's syndrome with pulpal necrosis and capillaritis, sclerodactylia and acro-osteolysis, multiple joint pain and FAN+ . Also observed were: esophagus involvement (n = 3), pulmonary artery hypertension (n = 1), telangiectasia (n = 2) and anti-Scl 70 (n = 2) . Initially, all patients had restrictive pulmonary disease . SS was diagnosed 5 to 9 years prior to SA in 2 patients . Diagnosis of SA was based on the following arguments: Loefgren's syndrome with erythema nodosa (n = 1), parotiditis (n = 2), sicca syndrome (n = 2), myalgia (n = 2), joint involvement (n = 2), non-infectious pluropericarditis (n = 2), epitheloid and giant cell granulomas without caseous necrosis (lung = 3, liver = 1, lymph nodes = 1, salivary glands = 1, synovia = 1), negative search for bacilli, elevated conversion enzyme (n = 1) and, in each case, by the lack of any other cause . One patient died from lung cancer and another from respiratory failure . Nome of the patients had primary biliary cirhosis . This rare association between SS and SA demonstrates the confluent limits of certain systemic diseases and raises a difficult problem to differentiate pulmonary involvement in these diseases . The gravity of this localization and the poor sensitivy to corticosteroids.

Microbios, 1996, 88(354), 19 - 26
Susceptibility of severe combined immunodeficient mice to Mycobacterium leprae; Ishaque M et al.; The susceptibility of severe combined immunodeficient (SCID) mice to human leprosy bacilli was investigated . Nude mice were used as controls . SCID mice were found to be highly susceptible to Mycobacterium leprae and the progress of infection was comparatively 2-3 months earlier than observed in the nude mice . After reaching a maximum of approximately 1 x 10(9) acid fast bacilli/foot pad at about 8 months postinfection the number of bacilli gradually decreased . The progress of infection in nude mice was different from that found in SCID mice . The multiplication of M . leprae in the foot pads of nude mice continued and reached approximately 2.0 x 10(10) bacilli/foot pad and then nearly remained the same . The results indicate that SCID mice can be used as a suitable model for screening antileprosy drugs while nude mice should be involved in the production of M . leprae for use in other fields of leprosy research.

Rev Pneumol Clin, 1996, 52(6), 387 - 9
{Uncommon site of Bergeyella zoohelcum . Apropos of a case}; Grimault E et al.; Bergeyella zoohelcum is a Gram negative bacillus which can be found in several pathological localizations in man: leg abscesses, septicemia, meningitis . We observed a case of community-acquired pneumonia caused by Bergeyella zoohelcum . On history taking it was found that the patient was exposed to a dog which may have been the carrier of the Gram negative bacilli . The clinical course was long, one year, with persistent excavation.

Biotherapy, 1996, 9(4), 249 - 56
Effect of Z-100, an immunomodulator extracted from human type tubercle bacilli, on the pulmonary metastases of Lewis lung carcinoma in attempt to regulate suppressor T cells and suppressor factor, IL-4; Emori Y et al.; In the present study, anti-metastatic effect of Z-100 on the spontaneous pulmonary metastases of Lewis lung carcinoma (3LL) was examined in an attempt to regulate suppressor T cells . When Z-100 (10 mg/kg) was daily injected i.p . after 3LL inoculation, survival rate of these mice was increased significantly (p < 0.05) . In addition, the number of pulmonary metastatic colonies of 3LL in Z-100-treated mice were significantly decreased by 38% at 21 days, as compared with that of control mice (p < 0.05) . Along with the decrease of pulmonary metastases, suppressor cell activity was also gradually reduced in these mice, as compared with that of control mice . When splenic suppressor cells (5 x 10(7) cells) from 3LL-bearing mice were adoptively transferred into normal mice (recipients) just before inoculation of 3LL, the development of pulmonary metastases in recipients was significantly accelerated . However, splenocytes from 3LL-bearing mice treated with Z-100 did not affect the development of pulmonary metastasis . The potential to accelerate the metastasis of splenic mononuclear cells from 3LL-bearing mice was decreased significantly by the treatment with anti-Thy 1.2 monoclonal antibody (mAb), anti-Lyt 2.2 mAb or anti-CD 11b mAb followed by complement . IL-4 activity in the sera of 3LL-bearing mice was detected 15 days after tumor inoculation (13 pg/ml) and gradually increased (18 pg/ml) 20 days after tumor inoculation . However, when Z-100 (10 mg/kg) was daily injected i.p., IL-4 activity in sera was decreased significantly, and the IL-4 activity was not detected in these mice on day 20 . These results suggest that Z-100 could inhibit the pulmonary metastases in 3LL-bearing mice through the inhibition of suppressor T cell activity and a possible candidate of its effector molecule, IL-4.

Scand J Infect Dis, 1996, 28(5), 469 - 72
Use of polymerase chain reaction for primary diagnosis of pulmonary tuberculosis in the clinical laboratory; Bahrmand AR et al.; A nested polymerase chain reaction (PCR) has been used for the rapid detection of tubercule bacilli in respiratory specimens from 287 patients suspected of tuberculosis . The results of PCR testing were compared with isolation methods (conventional culture and Bactec system) in 110 smear-positive and 177 smear-negative patients . There were only 4 false negative results by PCR in the 171 specimens that were M . tuberculosis complex culture-positive . Of 92 PCR-positive samples prepared from the smear-positive specimens 90 (97.8%) were confirmed by culture . However, a poor correlation was obtained between initial 122 PCR-positive results and combined 81 culture recovered organisms in smear-negative patients . After verification of the efficacy of isolation method, retesting PCR-positive culture-negative samples, and studies of patients' clinical histories, only 18 of the cases were found to be associated with the disease . The other 29 results out of the original 47 discrepants were considered PCR false positives, possibly due to contamination . In conclusion, the PCR assay described is suitable for implementation in daily routine work with respiratory specimens, however it should be validated with culture, especially for the smear-negative patients.

J Assoc Acad Minor Phys, 1996, 7(4), 99 - 103
Early bronchoscopic diagnosis of concomitant tuberculosis and Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection; Albino JA et al.; Pulmonary infections, including mixed infections, are common in patients with human immunodeficiency virus (HIV), and a specific diagnosis is desirable to direct therapy . In a retrospective study of patients suspected of having Pneumocystis carinii pneumonia, we examined the usefulness of fiberoptic bronchoscopy in the immediate diagnosis of tuberculosis . In 267 patients, pneumocystis pneumonia was diagnosed in 115 (43%), of whom 5 (4%) also had concomitant tuberculosis . Bronchoalveolar lavage gave an immediate diagnosis of tuberculosis by positive acid-fast bacilli stain in 3 patients, while the transbronchial biopsy was suggestive in a fourth . Four of these patients developed respiratory failure, and 2 died . In patients with pneumocystis pneumonia, respiratory failure was significantly more common in those with tuberculosis (P = .0077) . In 156 (58%) of the 267 cases, bronchoalveolar lavage was negative for pneumocystis pneumonia, while tuberculosis was diagnosed in 14 (9%), and an immediate diagnosis was made in 10 (71%) . In a series of HIV-infected patients suspected mainly of having pneumocystis pneumonia, tuberculosis was found instead in 19 (7%), and both diseases were present in 5 (2%) . Bronchoscopy provided an early diagnosis of tuberculosis in 63% . Patients with concomitant pneumocystis pneumonia and tuberculosis had a high rate of respiratory failure.

Eur Arch Otorhinolaryngol, 1996, 253(1-2), 56 - 61
Ultrastructure of the middle ear mucosa in patients with chronic otitus media with cholesteatoma; Chao WY et al.; Mucosa of the middle ear was obtained from the promontory wall in each of 20 patients during cholesteatoma surgery . Specimens were processed for both scanning and transmission electron microscopy . Non-ciliated mucosal cells were commonly found, with most being secretory cells with secretory droplets and microvilli . The patterns of distribution of microvilli on the surface of these cells were variable . The interciliary spaces were stagnated with secretion . Bacilli were present in five cases . Falloff of mucosal cells was common and intercellular spaces were widened . Compound cilia were observed sporadically . Polymorphic nuclear inflammatory cells, macrophages and fibroblasts appeared in the submucosal area . These findings indicate that although remaining adjacent mucosa after removal of cholesteatoma looks free of disease under the operating microscope, it is actually in a diseased condition with impaired mucociliary function . The cells and bacteria seen microscopically may account for postoperative inflammation, thus warranting continued postoperative antimicrobial medication.

Med Trop (Mars), 1996, 56(2), 156 - 8
{Tuberculosis screening of patient contacts in 1993 and 1994 in Yaounde, Cameroon}; Kuaban C et al.; To achieve early diagnosis in close contacts of tuberculosis patients and determine the most useful screening procedures for this purpose in Cameroon, 336 tuberculosis patients hospitalized in Unit B of the chest clinic of the Jamot Hospital in Yaounde from September 1993 to September 1994 were asked to bring their close contacts in for screening . Each contact underwent thorough clinical examination, standard postero-anterior chest X-ray, and a tuberculin skin test . If respiratory symptoms and/or chest X-ray lesions were present, acid fast bacilli (AFB) detection testing was performed on bronchial secretions . Only 104 of the 336 tuberculosis patients brought in their close contacts for evaluation . A total of 346 people were examined . Tuberculosis was detected in 50 (14.6%) . Half of the new cases were under 14 years old . The most useful screening procedures tuberculosis were clinical examination, chest X-ray, and AFB testing if respiratory symptoms were present . The tuberculin skin test was not helpful.

Pneumonol Alergol Pol, 1996, 64(5-6), 261 - 6
{Evaluation of effects of antituberculous treatment on the course of sarcoidosis}; Puscinska E et al.; From 1960 to 1994 2150 sarcoid patients were observed in our Sarcoidosis Clinic . Before the diagnosis of sarcoidosis was confirmed, 52 of those patients were treated with tuberculostatics because of the radiological changes in the lung, diagnosed as tuberculosis . In no case any conventional method-smear examination for acid bacilli or culture identification was positive . There was no radiological improvement after treatment in any patient . Subsequently in all those patients sarcoidosis was diagnosed, by typical histology (48 cases) or on clinical grounds (4 patients) . In 15 cases spontaneous remission was observed . 37 patients were treated with steroids and in 31 of them radiological improvement was found . In six cases stabilization of the disease was noted . The observation time after steroids treatment was from one year to 27 years . In only one case tuberculosis of the lung has developed.

Dev Biol Stand, 1996, 87, 251 - 61
Stabilisation of BCG vaccines; Gheorghiu M et al.; Aquired resistance against tuberculosis depends on the survival, multiplication and persistence of BCG in the host organs . Therefore, the viability and stabilisation during storage of BCG vaccine constitute a major attribute for good immunogenicity . Different factors which influence BCG viability have been studied . Among the more important ones it was found that a very large number of viable bacilli are killed when vaccine is manufactured in the conventional way by ball milling the surface-grown bacillary mass . The dispersed deep-grow BCG offers the advantage that all bacilli are live in the fresh suspension before stabilisation procedures are applied . Two procedures of stabilisation have been used, freezing and freeze-drying . Preservation by resuspending BCG in different cryoprotective solutions has been followed by storage at low temperatures . Complete survival is obtained when this vaccine was frozen in glycerol solutions and stored for many years at -70 degrees C . Freeze-drying killed more than 50% of the live bacilli in the fresh suspension; the remaining freeze-dried live bacilli were preserved at -30 degrees C for 20 years or at 4 degrees C for at least one year . They also resist exposure to 37 degrees C for one month . Nevertheless, most of the BCG bacilli in freeze-dried vaccines are dead . In conclusion the best BCG viability is obtained with young dispersed-grown bacilli by both freezing and freeze-drying . Freezing is a good method of stabilisation for research purposes or cancer immunotherapy, and freeze-drying for BCG vaccination campaings in tuberculosis prevention . However, BCG stabilisation still needs improvement.

Infection, 1996 Jan-Feb, 24(1), 47 - 8
Infection of the upper extremity by Mycobacterium marinum in a 3-year-old boy--diagnosis by 16S-rDNA analysis; Feddersen A et al.; A 3-year-old boy developed several subcutaneous nodular lesions on his right arm . Based on the histological examination of one of these nodules furunculosis was suspected and cefuroxime was tentatively given . However, acid-fast bacilli were then detected in the tissue specimen and a few colonies of acid fast, gram-positive rods grew on blood agar . Definitive species diagnosis (Mycobacterium marinum) was rapidly achieved by automated sequencing of amplified 16S-rDNA and antimicrobial therapy was adjusted according to the available literature . After 3 weeks of treatment with clarithromycin, rifampicin and protionamid regression of the nodular lesions was evident.

Kekkaku, 1996 Jan, 71(1), 57 - 63
{Nutritional status and support in chronic intractable pulmonary tuberculosis}; Yoneda T; Nutritional assessment was conducted in 30 patients with chronic, intractable pulmonary tuberculosis . More prevalent and severer protein-energy malnutrition was found in the chronic patients compared with that in newly-diagnosed, drug-sensitive tuberculous bacilli-excreting patients . Duration of excreting bacilli in 163 newly-diagnosed patients was found to be significantly associated with ChE, hypersensitivity reaction to PPD, lymphocytes transformation response to ConA before treatment . The grade of malnutrition was significantly associated with the reduction in delayed-type hypersensitivity response, ratio of CD4/CD8, IL-2 production by peripheral blood mononuclear cells and NK cell activity . Nutritional and immunological spectrum, which was classified with the combination of serum albumin level, hypersensitivity response to DNCB and NK cell activity, was significantly associated with clinical course and manifestations in patients with chronic, intractable pulmonary tuberculosis . TNF-alpha production by peripheral blood monocytes was significantly higher in moderately to mildly-malnourished tuberculous patients than that in healthy controls . TNF-alpha production in patients with severely-malnourished patients was significantly lower than that in healthy controls . Level in TNF-alpha production was inversely related with visceral proteins and the ratio of plasma amino acid BCAA/AAA . In conclusion these findings suggested that nutritional support should be taken in consideration in combination with conventional chemotherapy in treating chronic, intractable pulmonary tuberculosis.

Kekkaku, 1996 Jan, 71(1), 43 - 6
{From the immunological aspect--interleukin-10 production by human blood mononuclear cells stimulated with multidrug-resistant Mycobacterium tuberculosis}; Fujiwara H et al.; Interleukin-10 (IL-10) has been shown to down-regulate a number of different macrophage functions, including microbicidal activity against intracellular bacteria or parasites . In this study, peripheral blood mononuclear cells (PBMC) obtained from a healthy tuberculin-reactor were stimulated in vitro with various strains of multidrug-resistant Mycobacterium tuberculosis (MDRTB) or drug-sensitive M . tuberculosis (DSTB) to produce IL-10 . We obtained one mycobacterial strain from each patient, preparing a total of 10 strains of DSTB, 5 strains of MDRTB . PBMC were cultured with LPS or mycobacterial preparations for 1, 3 and 5 days . IL-10 concentration in the culture supernatants was measured by ELISA using IL-10-specific monoclonal antibodies . The mean IL-10 production by PBMC stimulated with MDRTB was greater than that with DSTB, statistically significant at day 3 (MDRTB 171.4 +/- 18.2 pg/ml, DSTB 106.3 +/- 17.2 pg/ml, p < 0.05) . Cell separation experiments indicated that cells producing IL-10 when stimulated with M . tuberculosis or LPS were monocytes, not T lymphocytes . Next, we examined PBMC from refractory tuberculosis patient who had continuously excreted MDRTB . PBMC from those patients secreted greater, but statistically not significant, amounts of IL-10 in response to LPS or TB bacilli than those of healthy subjects . Increased production of IL-10 by MDRTB-stimulated PBMC might be responsible for intractable tuberculosis.

Kekkaku, 1996 Jan, 71(1), 37 - 41
{From the views of bacteriology--focusing on drug susceptibility test}; Ogata H; Totally 2630 culture positive pulmonary tuberculosis cases were admitted in our hospital during 17 years from 1976 to 1992 . Clinical and bacteriology status of this cases were compered retrospectively between 3 groups; 1938 cases with initial treatment, 513 cases with retreatment excluding chronic tubercle bacilli excreters (CTBEs) and 179 chronic tubercle bacilli excreters . Mean age of the groups of CTBEs is 50.9 years . Sex ratio of it is 4.3:1 . These figures are similar to those of the group of the cases with retreatment . Mean age of these groups is higher than 45 years in group of cases with initial treatment . Sex ratio in these group is higher than 3.1:1 in group of cases with initial treatment . Proportion of cases with complication of DM in group of CTBEs is 16.1%, statistically significantly higher than 10% in group of cases with initial treatment and 9% in group of cases with retreatment . Most CTBEs show resistant to both INH and RFP in drug susceptibility test if 0.1 gamma is adopted as clinical concentration of resistance to INH . 40% of CTBEs show susceptibility to SM and 35% of CTBEs show susceptibility to EB in the test . However in a large proportion of these cases with susceptibility result in each of these drugs, more than 34% in SM and more than 40% in EB, effect of the drugs was not observed clinically . Therefore previous treatment history as well as the result of drug susceptibility test should be considered in choice of anti-tuberculosis drug for treatment of CTBEs.

Kekkaku, 1996 Jan, 71(1), 31 - 6
{Epidemiologic study of the actual investigation of chronic excretors of Mycobacterium tuberculosis bacilli}; Tsuchiya T et al.; Of 1,295 patients with tuberculosis who were admitted in 33 Japanese national sanatoriums from September to October, 1994, actual investigation of patients with persistent expectorate tubercle bacilli continuously for more than 12 months was carried out by questionnaire . From the result, numbers of patients who had persistently expectorated bacteria were 85 (6.6% of inpatient) . The rate of male and female was 3:1, and mean age was 63.5 years old . Many slim type patients (less than 90% of the standard body weight) were observed at the rate of 55.8% . The rate of the inpatient whose admission period was for more than 10 years were found in 22% . The past history of the tuberculosis and surgical therapy were existent at the rate of 83.3% and 18.8% respectively . The chief complications such as diabetes mellitus (12.4%), pyothorax (10.1%), alcoholism (10.1%) and hepatic dysfunction (6.7%) were observed at the respective rate . As chest X-ray findings on admission, severe cases with cavity of I or II 3 by the classification of the Japanese society for tuberculosis were found in 32.2%, and many cases with much amount persistently excreted bacteria such as more than number 7 of Gaffky scale (24.7%) or 3+ by culture (55.8%) were detected by sputum-test on admission . From the result drug-resistance, resistance of the main drugs early found from initial medication, and high degree resistance of isonicotinic acid hydrazide (INH; 80%), rifampicin (RFP; 94.4%), ethambutol (EB; 85.6%) and streptomycin (SM; 76.4%) was found . As intractable causes which were indicated by doctor in charge, drug-resistance, drug allergy, disorder of life, unfavorable medication-compliance and unsuitable treatment were considered.

Kekkaku, 1996 Jan, 71(1), 25 - 9
{II . multidisciplinary analysis of chronic excretors of Mycobacterium tuberculosis bacilli}; Kondo A et al.; For the most patients with pulmonary tuberculosis, treatment are successful and the chemotherapy can be finished within a year . Few patients, though receiving standard anti-tuberculous chemotherapy, expectorate tubercle bacilli continuously for more than a year . They are named "chronic excretors of mycobacterium tuberculosis bacilli" or "intractable tuberculosis patients" . Being suspected that this phenomenon is produced by many factors, it is necessary to correspond suitably to these patients for eradication of tuberculosis . This symposium was organized to search for some factors on the bacterium and on the host, which caused patients to be the chronic excretors or intractable patients . We hope that our discussion may contribute to take the appropriate measures for such hard diseases . The main results are summarized as follows . 1) Dr . TSUCHIYA conducted a epidemiologic study by questionaire method to 33 Japanese national sanatoriums . The total number of tuberculosis patients admitted to these hospitals on a optimal day from September to October 1994 were 1,295 . Numbers of patients who had expectorated bacilli continuously for more than 12 months were 85 (6.6%) . The male/female ratio was about 3, their average age was 64 . They had a tendency of thin-physique and most of them had past histories of tuberculosis, being the refractory cases . The average clinico-epidemiologic conditions of the patients came before our eyes . 2) Dr . OGATA analysed the results of drug sensitivity tests of mycobacterium tuberculosis bacilli from 2,630 pulmonary tuberculosis patients which contained 179 chronic excretors . The only 2.2% of bacilli from the chronic excretors were sensitive to RFP (50 gamma) . The 99.4% of bacilli showed to be resistant to INH (0.1 gamma) . The 39.1% of bacilli were sensitive to streptomycin (20 gamma) . To EB (2.5 gamma) 34.1% of bacilli were sensitive . However, the ratio of chronic excretors in tuberculosis patients was not increased in these 17 years, and for many cases of these chronic excretors, they are all inexperienced in PZA, multi-sensitive-drug chemotherapy including PZA and OFLX were useful . Some of them underwent lobectomy combined for effective chemotherapy . The chronic excretors are likely to be affected multidrug-resistant bacilli, and it is important for such cases to treat intensively with several kinds of sensitive drugs . 3) Dr . FUJIWARA studied Interleukin-10 (IL-10) producing function of monocytes stimulated by Mycobacterium tuberculosis (M-TB) . The IL-10 usually down-regulates a number of different macrophage functions, including microbicidal activity against intracellular bacteria such as Mycobacterium species . They found that the mean IL-10 production by peripheral blood mononuclear cells (PBMC) obtained from a healthy tuberculin-reactor stimulated with multidrug-resistant M-TB was greater than that with drug-sensitive M-TB . The IL-10 producing cells were monocytes, not T-lymphocytes . They moreover found that PBMC from intractable tuberculosis patients secreted greater amounts of IL-10 than those of healthy subjects . These data may give a hint for development of new immunotherapeutic methods for multi-drug-resistant tuberculosis patients . 4) Dr . HARA analysed clinical courses of 580 consecutive cases of bacilli positive pulmonary tuberculosis admitted in his hospital from a point of underlying diseases . All of dead 24 cases had some underlying diseases; diabetes mellitus 3, chronic liver diseases 4, others 17 (malignant neoplasms, central nerve vascular diseases, malnutritional condition, etc) . (ABSTRACT TRUNCATED)

Kekkaku, 1996 Jan, 71(1), 19 - 23
{Basic studies on tuberculosis and tubercle bacilli in U.S.-Japan medical cooperative program tuberculosis panel}; Azuma I; The U.S.-Japan Medical Cooperative Program has been started in 1965 and Tuberculosis Panel is one of the most important field of the programs . In this lecture, the recent advances in the basic studies on tuberculosis researches which were reported in Tuberculosis panel of the program were summarized . The host defence mechanisms against M . tuberculosis infection were the most important subject . The role of Th1-mediated cytokins such as IL-2, IFN gamma and TNF beta in the host-defence mechanism against mycobacterial infection was extensively discussed . Bcg gene of the mice is the example case for the genetic background of host against mycobacterial infection . The virulence factor, however of M . tuberculosis is still unknown . The technique of molecular biology was applied to the diagnosis of tuberculosis . The PCR and RFLP methods are the useful strategies for the rapid diagnosis and analysis of the mode of infection with M . tuberculosis . The development of detection techniques of drug-resistant tubercle bacilli is also urgently required . Another approach by molecular biology to tuberculosis research is the cloning of gene of tuberculin protein and the production recombinant protein of M . tuberculosis . The amino acid sequences of several proteins have been determined and their immunological properties of recombinant proteins were investigated . The immunological functions of lipid fractions of tubercle bacilli such as cord factor (TDM) and lipoarabinomannan (LAM) have been described . Especially the immunomodulating activities and the role of TDM as diagnostic antigen in the tuberculosis patients were described . The adjuvant activity of mycobacterial cell wall was well established and the minimum structural requirement was reported to be N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) . The several MDP derivatives were selected as the cytokine inducers . Especially MDP-Lys (L18) was widely used as drug for the increasing the number of white blood cells and platelets in cancer patients . The effectiveness of MDP derivatives on the stimulating of mucosal immunity was also recently reported . The preventing activities of virus infection and cancer metastasis of MDP derivatives were shown in mice models.

Kekkaku, 1996 Jan, 71(1), 13 - 7
{Antituberculous drug-resistance among homeless peoples}; Toyota E et al.; We studied on the prevalence of drug-resistance among 65 homeless cases who were admitted and treated for active tuberculosis at the Nakano National Chest Hospital during the period from 1990 to 1992 and at the International Medical Center of Japan during the period from 1993 to 1994 . Resistance to one or more first line antituberculous drug were revealed in 14 cases out of 65 (21.5%) in initially treated cases 6 out of 43, and in retreated cases 8 out of 22 . The prevalence of drug resistance in this study was significantly higher compared with 2 out of 39 cases (5.1%) in our previous report during the period from 1986 to 1988 . In these drug-resistant cases, multidrug-resistant cases, namely, resistant to at least 2 drugs including both INH and RFP were founded in 6 cases (9.2%) . Compared with drug-sensitive cases, the negative convertion rate of bacilli was lower and the number of defalters was significantly larger . It was suggested that higher prevalence of drug-resistance and defalting from the adequate treatment in homeless cases of tuberculosis possibly makes the prognosis of drug-resistant tuberculosis worse and treatment of such cases more difficult.

Kekkaku, 1996 Jan, 71(1), 7 - 12
{Incidence, risk factors relating to bacillary tuberculosis and secondary infections from registered patients in Hunai-Gun, Kyoto Prefecture}; Yamasaki M et al.; To review how to strengthen tuberculosis program in Hunai-Gun, Kyoto Prefecture, the recent trend of incidence of tuberculosis and 148 index cases with pulmonary tuberculosis newly registered from 1987 to 1992 were analyzed regarding the mode of detection, conditions when consulting medical facilities, risk factors, bacteriological findings, and secondary infections among contacts . 1 . The high crude incidence of tuberculosis in Hunai-Gun is explained by the high proportion (19.3%) of the elderly population of 65 years old and over in Hunai-Gun compared with the average (12.6%) in the Prefecture and the high tuberculosis incidence among age group of 70 years old and over in Hunai-Gun compared with the prefectural average . However, the reason of higher incidence of tuberculosis among the elderly in the district was not clear . 2 . The proportion of bacillary as well as culture positive cases were higher among patients who were diagnosed by consulting medical facilities than those detected by regular health check . The proportion of bacillary cases without risk factors for tuberculosis among patients who were diagnosed at medical facilities was the highest among those newly attending medical facilities due to complaints related to tuberculosis (group A), followed by those patients regularly attending medical facilities for other diseases but consulting because of additional complaints related to tuberculosis (group B), and lowest among patients regularly attending medical facilities but detected by chance while being examined for other diseases (group C) . The severer the diseases stage, the higher the proportion of bacillary cases, however, there were no difference in the proportion of bacillary cases among the above three groups including those with risk factors . It is explained by the fact that the ratio of patients with risk factors was high in group C, which masked the higher proportion of bacillary cases among patients with risk factors . 3 . As future activities of public health center on tuberculosis control, it is important to give health education to those with risk factors on the fact that the progression of the disease is faster among them in addition to the increased risk of the disease onset, and advise them to attend regular health check and visit medical facilities when they have any symptom related to tuberculosis . 4 . Considering the fact that the risk of secondary infection to contacts is higher among smear positive patients than bacilli negative patients, it is needed to examine all contacts of sputum smear positive patients thoroughly . In addition, it is advisable to follow-up contacts of smear negative but culture positive patients with the similar intensity with those for smear positive patients because their risk of secondary infection to contacts was also higher than bacilli negative patients although it was not statistically significant.

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