Kekkaku, 1993 Sep, 68(9), 581 - 8 {The factors related to the stagnation in the decline of tuberculosis incidence in Japan}; Ohmori M; The mortality from tuberculosis in Japan had extremely decreased from the end of the 1940's to the beginning of the 1950's, due to the end of chaos after World War II and also due to the introduction of antituberculosis drugs . The rapid decline of mortality usually leads to the reduction in the infection risk of tuberculosis in the general population . Such a drastic change in the history of tuberculosis have been dividing general population into two groups, i.e . those who were born during the rapid spread of infection with tubercle bacilli and others who were born after . With the passage of time, the limiting age between those two groups reached 40-50 years old as of 1980 . The elderly people who were infected with tubercle bacilli in the remote past, have a high risk of development of tuberculosis by endogenous breakdown . In addition, the population of the aged in Japan has been expanding very fast as compared to that in European countries . Owing to such a change of historical and demographical background, the proportion of the elderly cases developed to tuberculosis have increased considerably and it played a major role in a small decrease of tuberculosis incidence rates since 1980 . On the other hand, a generation gap on the prevalence of tuberculosis infection caused the recent smallest reduction rate of incidence among young adults . As the majority of young people have not been infected with tubercle bacilli, since 1980, the micro-epidemic among adolescent and young adults have been reported often.(ABSTRACT TRUNCATED AT 250 WORDS) Kekkaku, 1993 Sep, 68(9), 577 - 9 {The 68th annual meeting symposium . III . Changes in the disease picture of pulmonary tuberculosis}; Ishibashi T; In the symposium on 'Changes in the disease picture of pulmonary tuberculosis', the themes mentioned above were discussed . Dr . Ohmori analyzed the present state of the epidemiology of tuberculosis in Japan . The stagnation in the decline of incidence rate of tuberculosis has been observed from the end of the 1970's . It is remarkable in the population aged 15-29 years . She noted two factors as the reason of such stagnation . Firstly, the number of tuberculosis cases increases in the high-aged subjects who were infected with tubercle bacilli in the past, as the population with high-age is expanding . Secondly, sporadic mass outbreak of tuberculosis is found often in the young subjects who have not been infected with tubercle bacilli . Dr . Miyazaki reported that 57 cases (8.5%) were classified as lower lung tuberculosis in 672 new cases with pulmonary tuberculosis during the last ten years . He noted the usefulness of fiberoptic bronchoscopy for diagnosis to lower lung field tuberculosis . Dr . Nagata analyzed the present state of mycobacterial disease in 5041 autopsy cases . The rate of cases with active mycobacteriosis was about 1% during the last 5 years . A large proportion of cases with fatal mycobacteriosis was received corticosteroid therapy . Antemortem diagnosis of mycobacteriosis was made in 25.9-20.0% of cases with fatal mycobacteriosis . Dr . Yamagishi showed the data of pulmonary tuberculosis in compromised hosts in a National Hospital . There were 82 cases associated with various type of cancer (4.2%) and 21 cases treated with corticosteroids (1.1%) among 1954 cases with pulmonary tuberculosis for the last 6 years.(ABSTRACT TRUNCATED AT 250 WORDS) Int J Lepr Other Mycobact Dis, 1993 Sep, 61(3), 428 - 32 Ambiguities in leprosy histopathology; Porichha D et al.; This paper presents the percentage of definite or suggestive evidence present in 482 biopsies from different types of leprosy . The presence of acid-fast bacilli (AFB) and nerve involvement were taken as definite features for a diagnosis of leprosy, and infiltration of the dermal appendages, neurovascular bundles and dermis by granuloma cells and lymphocytes were regarded as suggestive signs of leprosy . Using these criteria, all cases were categorized into three groups having definite, suggestive, or no signs of leprosy . The results showed definite and suggestive features in 72.2% and 14.1% of the cases, respectively . The remaining 13.7% had none of these signs . These cases were mostly healed lesions . Large, epithelioid cell granulomas without any nerve element present and healed cases proved difficult for a definite diagnosis . Emphasis is placed on searching for residual nerve elements in AFB-negative sections because this increases the certainty level of the diagnosis . Also, it is suggested that for uniformity of understanding and reporting, terminologies need to be narrowed down and restricted to only definite, suggestive, or no diagnosis of leprosy. Int J Lepr Other Mycobact Dis, 1993 Sep, 61(3), 415 - 20 Preservation of Mycobacterium leprae in vitro for four years by lyophilization; Kohsaka K et al.; Although the viability of Mycobacterium leprae suspended in distilled water with or without 10% fetal calf serum was reduced approximately 10(-2) to 10(-4) from that of the starting material during the process of lyophilization, bacilli capable of multiplication in nude mouse foot pads were found in the lyophilized samples stored for 4 years at 4 degrees C . The multiplication rate of the lyophilized bacilli which were suspended in 10% serum-water was much higher than that of the bacilli suspended in water only . On the other hand, no reduction of the viability of M . leprae suspended in 10% skim milk-water was demonstrated during the process of lyophilization as well as storage for 2 years at 4 degrees C . From the results obtained here, it could be suggested that M . leprae might be preserved in vitro by means of lyophilized M . leprae was extremely stable during cryopreservation when the bacilli were suspended in 10% skim milk-water . Therefore, the composition of the solution for suspending the bacilli is definitely critical for the maintenance of M . leprae viability by means of lyophilization. Int J Lepr Other Mycobact Dis, 1993 Sep, 61(3), 398 - 405 Reconstitution of Mycobacterium leprae immunity in severe combined immunodeficient mice using a T-cell line; Azouaou N et al.; To test whether Mycobacterium leprae-immune T cells can confer protection against infection with leprosy bacilli, severe combined immunodeficient (SCID) mice were reconstituted with a BALB/c-derived, M . leprae-responsive, T-cell line . Flow cytometric analysis of spleen and peripheral blood cells confirmed reconstitution with T cells . In vitro lymphokine production and the proliferation of spleen cells from the reconstituted animals established that the donor cells had maintained their functional activity for the duration of the study (275 days) . The transfer of immune T cells 24 hr before foot pad infection with leprosy bacilli resulted in a profound reduction in M . leprae multiplication, as compared to the nonreconstituted SCID mice . The yield of acid-fast bacilli in the foot pads of SCID mice reconstituted with the M . leprae-immune T cells also was significantly lower than that found in naive BALB/c mice, and at levels previously found only in BALB/c mice that had been immunized effectively . These experiments demonstrate that M . leprae-immune T cells home effectively and control M . leprae infection in SCID mice. AIDS, 1993 Sep, 7(9), 1221 - 5 The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa; Bem C et al.; OBJECTIVES: To evaluate wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis . SETTING: Department of Surgery, University Teaching Hospital, Lusaka, Zambia . PATIENTS: Three hundred and four patients presenting to one surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989-1990 . DESIGN: Prospective study in which wide-needle aspiration routinely preceded open surgical biopsy . MAIN OUTCOME MEASURES: Histology and mycobacterial culture of the surgically biopsied lymph node; HIV-1 serology; successful aspiration of material, naked-eye appearance of aspirate, presence of acid-fast bacilli and/or microscopic caseation in the aspirate . RESULTS: One hundred and eighty-eight out of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 out of 183 (84.7%) tested HIV-1-seropositive . Material was successfully aspirated from 180 out of 188 (95.7%) of patients with proven tuberculous lymphadenitis . Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 out of 120 (40.8%) consecutive aspirates from tuberculous nodes . Acid-fast bacilli and/or microscopic caseation were seen in 116 out of 155 (74.8%) aspirates from tuberculous nodes for which smears stained both by Ziehl-Nielsen and haematoxylin & eosin were available . CONCLUSIONS: It is recommended that all patients with suspected tuberculous lymphadenitis in Africa, undergo wide-needle aspiration before surgical biopsy or empirical treatmentPIP: This study evaluated wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis . 304 patients presenting to 1 surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989 and 1990 at the Department of Surgery, University Teaching Hospital, Lusaka, Zambia, were involved in this prospective study in which wide-needle aspiration routinely preceded open surgical biopsy . Histology and mycobacterial culture of the surgically biopsied lymph node, HIV-1 serology, successful aspiration of material, naked-eye appearance of aspirate, and presence of acid-fast bacilli and/or microscopic caseation in the aspirate were the main outcome measures . 188 of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 of 183 (84.7%) tested HIV-1 seropositive . Material was successfully aspirated from 190 of 188 (95.7%) patients with proven tuberculous lymphadenitis . Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 of 120 (40.8%) consecutive aspirates from tuberculous nodes . Acid-fast bacilli and/or microscopic caseation were seen in 116 of 155 (74.8%) aspirates from tuberculous nodes for which smears stained by both Ziehl-Nielsen and hematoxylin and eosin were available . It is recommended that all patients with suspected tuberculous lymphadenitis in Africa undergo wide-needle aspiration before surgical biopsy or empirical treatment . author's modified Indian J Pediatr, 1993 Sep-Oct, 60(5), 659 - 67 Prevention of tuberculosis in infancy; Maniar BM; A prospective study was conducted on 185 consecutive hospitalized cases of tuberculosis below the age of one year, and 41 mothers comprised half of the 83 contacts detected . Maternal and infant infection was analyzed to determine whether the disease could have been prevented under the existing medico-socio-economic conditions . Most mothers had delayed diagnosis and extensive disease . Earlier imperfect courses of chemotherapy were not uncommon . Ten mothers were sputum-positive for acid-fast bacilli . The concerned medical personnel failed to give proper advice with respect to chemoprophylaxis and surveillance of infants . Majority of infants had progressive pulmonary and disseminated disease although, 41% of them were BCG vaccinated . A practical strategy in the Indian context for the management of tuberculosis in the mother-infant pair is outlined. J Natl Med Assoc, 1993 Sep, 85(9), 685 - 7 Miliary tuberculosis in pregnancy; Henderson CE et al.; Although miliary tuberculosis is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection . This article reports two antepartum cases of miliary tuberculosis without any of these risk factors . Bronchial washings for Pneumocystis carinii and HIV screening were negative for both patients . Acid-fast bacilli stains of the bronchial washing and ascitic fluid were also negative . Several weeks were required for ascitic fluid and bronchial biopsy Mycobacterium cultures to be positive . In contrast, acid-fast bacilli were seen within 24 hours in multiple sections of the delivered placentas . Confirming the diagnosis of miliary tuberculosis is an arduous process requiring a high index of suspicion . During pregnancy, pathologic examination of tissue obtained by placental biopsy may facilitate making an early diagnosis of extrapulmonary tuberculosis. Riv Eur Sci Med Farmacol, 1993 Sep-Dec, 15(5-6), 205 - 7 An unusual case of ileal tuberculosis: only ascites at presentation and absence of caseous necrosis and granulomatous inflammation on biopsy; Cavallo-Perin P et al.; An unusual case of ileal tuberculosis presenting with only ascites, without evidence of previous or active pulmonary tuberculosis, and absence of caseous necrosis and granulomatous inflammation is discussed . Diagnosis was established on biopsy specimens of ileocaecal region collected at colonscopy: acid-fast bacilli and positive culture for Mycobacterium tuberculosis . Parenteral nutrition, surgery and antituberculous drug treatment resulted in a complete recovery of the patient. FEMS Immunol Med Microbiol, 1993 Aug, 7(2), 197 - 204 Heat-stable opsonins in tuberculosis and leprosy; Blair AL et al.; We have examined heat-stable opsonins to 4 species of gamma-irradiated mycobacteria (M . tuberculosis (H37Rv), M . avium (28A), M . scrofulaceum and M . leprae (cd 103)) in complement-depleted sera collected from Indonesian subjects with tuberculosis (106 patients),-leprosy (24 patients) and controls (40 hospital workers and 41 factory workers) indirectly by microtitre plate chemiluminescence (CL) assay and compared the results with antibody levels . The results indicate that there is a wide range of opsonic capacity for mycobacteria in complement-depleted sera . There was a poor correlation between the opsonic capacity as measured by CL and the anti-mycobacterial antibody content of sera measured by ELISA, suggesting that anti-mycobacterial antibody has little influence on the uptake of mycobacteria . However, a non-specific heat-stable opsonin appears to be present in some sera . Conversely, some sera from tuberculosis or leprosy patients suppress the production of reactive oxygen species from normal phagocytes in vitro when stimulated with M . tuberculosis . The relevance of this inhibition and the presence of heat-stable opsonins to the pathogenesis of tuberculosis have yet to be determined, but it is possible that the presence of opsonins may inhibit dissemination of tubercle bacilli to other organs. Kekkaku, 1993 Aug, 68(8), 533 - 8 {Characteristics of tuberculosis in Japan compared with those in other developed countries}; Aoki M; To clarify the characteristics of the tuberculosis situation in Japan, it was analysed in comparison with those in other developed countries . The results are summarized as follows: 1 . The tuberculosis epidemic peaked at the end of 1910s in Eastern Japan, and in the 1940s in Western Japan . It is estimated that the annual risk of tuberculosis infection was 4% or more until the end of the World War II . Tuberculosis has spread much later and was much more prevalent up through the 1940s in Japan than in other developed countries . 2 . A modern tuberculosis control programme including active case-finding, isolation of infectious cases, charge free medication and BCG vaccination was launched in 1951, and in 1961 an effective case-holding system was established . Tuberculosis incidence decreased rapidly thereafter . As the rate of decrease was almost the same as that of the Inuit (Eskimo) (Fig . 1), one might say that Japan is one of the countries where tuberculosis incidence decreased most rapidly . 3 . Incidence of tuberculosis in children is 2.1 per 100,000 in 1991 which is lower than that of the U.S.A . (3.1 per 100,000) . 4 . Incidence of tuberculosis among the aged is much higher than that of other developed countries as shown in Fig . 3 . Of course, this is mainly caused by the fact that a higher percentage of Japanese aged 55 years or more was infected with tubercle bacilli in the past.(ABSTRACT TRUNCATED AT 250 WORDS) Kekkaku, 1993 Aug, 68(8), 527 - 31 {Nontuberculous Mycobacterium pulmonary infection with pleural effusion caused by Mycobacterium kansasii}; Igari H et al.; A 28 year-old man was admitted to our hospital because of fever, cough and chest pain . A chest X-ray film taken on admission showed infiltrate in the left upper lung field with ipsilateral pleural effusion . Microscopical examinations of stained specimens of sputa and pleural effusions disclosed no acid-fast bacilli . The level of adenosine deaminase (ADA) in pleural effusion was 46.4 IU/l . A tuberculin skin test was moderately positive . The most probable diagnosis was pulmonary tuberculosis with pleural effusion . Isoniazid (INH) and rifampicin (RFP) were administered on the 5th hospital day and continued to lower the fever and reduce the pleural effusion . The cultured specimens of sputa and pleural effusions yielded Mycobacterium kansasii . After six months of treatment, chest X-ray film showed improvement and the administration of INH, RFP was discontinued without recurrence. J Clin Microbiol, 1993 Aug, 31(8), 2049 - 56 Large-scale use of polymerase chain reaction for detection of Mycobacterium tuberculosis in a routine mycobacteriology laboratory; Clarridge JE 3rd et al.; We investigated the use of DNA amplification by the polymerase chain reaction reaction (PCR) for detection of Mycobacterium tuberculosis from clinical specimens . Two-thirds of each sample was processed for smear and culture by standard methods, and one-third was submitted for DNA extraction, amplification of a 317-bp segment within the insertion element IS6110, and detection by agarose gel electrophoresis, hybridization, or both . DNA was prepared from over 5,000 samples, with 623 samples being culture positive for acid-fast bacilli . Of 218 specimens that were identified as M . tuberculosis, 181 (85%) were positive by PCR . In the M . tuberculosis culture-positive group, PCR was positive for 136 of 145 (94%) and 45 of 73 (62%) of the fluorochrome smear-positive and -negative specimens, respectively . Of 948 specimens that were either culture positive for mycobacteria other than M . tuberculosis or culture negative, 937 specimens were negative by PCR and 11 (1%) specimens initially appeared to be false positive for M . tuberculosis . The reason for discrepant results varied; some errors were traced to the presence of an inhibitor in the specimen (7.3% in unselected specimens), nucleic acid contamination, low numbers of organisms in the specimen antituberculosis therapy, and possible low-level nonspecific hybridization . In comparison with culture, the sensitivity, specificity, and positive predictive value were 83.5, 99.0, and 94.2%, respectively, for PCR . When PCR was corrected for DNA contamination, the presence of inhibitor, and culture-negative disease, the values became 86.1, 99.7, and 98.4%, respectively . If the results for multiple specimens submitted from the same patient are considered, no patient who had three of more sputum specimens tested would have been misdiagnosed. Am Rev Respir Dis, 1993 Aug, 148(2), 352 - 7 Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation; Torres A et al.; We studied the interrelations between gastric, pharyngeal, proximal, and distal airway bacterial flora in ventilator-associated pneumonia (VAP) on 36 patients with nosocomial pneumonia acquired during mechanical ventilation (MV) and 27 mechanically ventilated control subjects without pulmonary infection . Gastric, pharyngeal, and endotracheal (EA) sampling for quantitative cultures were performed upon all patients, as well as fiberoptic bronchoscopy with protected specimen brush (PSB) sampling . Mean bacterial and fungi colony counts were significantly increased in pharyngeal, EA, and PSB samples in patients with VAP compared with control subjects . The overall increase in colonization was due to gram-positive cocci in all samples . In addition, gram-negative bacilli and fungi mean counts increased significantly in PSB pneumonia samples versus control samples . However, mean gastric colonization was similar in both patients with VAP and control subjects . In the former group there was an increase in coincident microorganisms isolated from gastric, pharyngeal, and EA samples in relation to PSB samples compared with control samples . Among the different quantitative cultures analyzed, only those obtained from EA significantly correlated with PSB cultures in patients with pneumonia (r = 0.67, p = 0.001) . In summary, the present study shows that the coincidence between microorganisms isolated in PSB cultures and those from gastric and oropharynx increase in MV patients with pneumonia, indicating that both reservoirs play a key role in the pathogenesis of pneumonia . Conceivably, preventing both gastric and pharyngeal colonization may reduce the incidence of ventilator-associated pneumonia . From all the noninvasive samples studied only endotracheal aspirate cultures were useful for inferring the etiology of some VAP pneumonias. Diagn Microbiol Infect Dis, 1993 Aug-Sep, 17(2), 119 - 27 Improved detection of mycobacterial antigens in clinical specimens by combined enzyme-linked immunosorbent assay; Araj GF et al.; Three types of antibodies against cellular and secretory-excretory protein antigens were simultaneously used for the direct detection of mycobacterial antigens in sputum and cerebrospinal fluid (CSF) specimens, using enzyme-linked immunosorbent assay (ELISA) . The antibodies consisted of in-house raised and prepared anti-whole-cell, heat-killed, and sonicated Mycobacterium tuberculosis, anti-secretory-excretory protein extract of bacilli Calmette-Guerin (BCG) strain, and commercially available anti-BCG . Sputum specimens comprised 24 smear positive, culture positive, and 47 smear-negative, culture positive (SNCP), from patients with pulmonary tuberculosis, as well as 45 smear-negative, culture-negative (SNCN) control samples . The CSF specimens included 18 SNCPs from patients with tuberculous meningitis and 18 SNCN controls . The sensitivity of the individual tests for sputum and CSF specimens ranged from 70% to 79% and 72% to 89%, respectively, whereas in the combined tests it reached 86%-96% for sputum specimens and 100% for CSF specimens . The specificity of ELISAs for sputum specimens was lower in the combined (73%-87%) than in the individual (87%-98%) tests, whereas for CSF specimens it was 100% in all tests . Thus, the combined ELISA approach for mycobacterial antigen detection provides a rapid and reliable laboratory adjunct in the diagnosis of patients with tuberculosis. Postgrad Med J, 1993 Aug, 69(814), 621 - 3 Atypical presentations of pulmonary tuberculosis diagnosed by fibreoptic bronchoscopy; Jayasundera CI et al.; A total of 356 patients were subjected to fibreoptic bronchoscopy from September 1989 to June 1991 to exclude bronchial carcinoma . Bronchial biopsy, bronchial brush smears and bronchial wash were obtained . Bronchial wash was examined for acid fast bacilli (AFB) compatible with Mycobacterium tuberculosis . The total number diagnosed as pulmonary tuberculosis by fibreoptic bronchoscopy was 21(5.8%) . The sputum smears were negative for AFB in all these patients . Previous studies have shown the importance of fibreoptic bronchoscopy in suspected cases of tuberculosis where the sputum smear is negative . This study is further evidence of the importance of routine examination of bronchial wash for AFB in all cases undergoing fibreoptic bronchoscopy to detect atypical cases of pulmonary tuberculosis. J Antimicrob Chemother, 1993 Aug, 32(2), 223 - 31 Susceptibility of 539 gram-positive and gram-negative anaerobes to new agents, including RP59500, biapenem, trospectomycin and piperacillin/tazobactam; Appelbaum PC et al.; Susceptibilities of 539 Gram-positive and Gram-negative anaerobes were tested by agar dilution against 15 new and existing antimicrobial agents . Organisms included 218 Bacteroides fragilis group strains, 15 non-fragilis group Bacteroides, 130 Porphyromonas/Prevotella, 49 fusobacteria, 50 peptostreptococci, 53 clostridia and 24 Gram-positive non-sporeforming bacilli . Of 412 Gram-negative bacilli, 89% were beta-lactamase-positive, while only two of the Gram-positive strains (both clostridia) produced this enzyme . Using established and preliminary breakpoints, all strains were susceptible to biapenem and imipenem (MIC90s 1 mg/L) and chloramphenicol (MIC90 8 mg/L) . Only one of all the strains tested (a Cl . innocuum) was resistant (MIC > 4 mg/L) to RP59500; the latter had MIC90 2 mg/L, while 98% of strains were susceptible to trospectomycin (MIC90 16 mg/L) . Ninety-nine per cent of strains were susceptible to piperacillin/tazobactam (MIC90 8 mg/L) compared to 86% to piperacillin (MIC90 > 64 mg/L) . Corresponding data for ticarcillin/clavulanate versus ticarcillin were 97% susceptible (MIC90 8 mg/L) compared to 83% (MIC90 > 64 mg/L) . Enhancement of the beta-lactam by the inhibitors was only seen in beta-lactamase-producing strains . Amoxycillin and cefoperazone were less often active (36% susceptible, MIC90 > 256 mg/L and 66% susceptible, MIC90 64 mg/L, respectively) . Cefoxitin had greater activity than cefotetan (90% susceptible, MIC90 32 mg/L, compared to 72% susceptible, MIC90 > 64 mg/L) . Metronidazole was active against 94% of strains (MIC90 4 mg/L) . All metronidazole-resistant strains were Gram-positive (75% of non-sporeforming bacilli, 9% of clostridia and 6% of peptostreptococci) . Ninety per cent of strains were susceptible to clindamycin (MIC90 4 mg/L). Tuber Lung Dis, 1993 Aug, 74(4), 240 - 3 DNA fingerprints of Mycobacterium tuberculosis do not change during the development of rifampicin resistance; Godfrey-Faussett P et al.; Drug-resistant tuberculosis has become a major public health problem . Resistance to rifampicin probably arises through mutations in the mycobacterial RNA polymerase . Patients may acquire rifampicin resistant tuberculosis by three mechanisms: (1) infection with a resistant organism, (2) selection of a sub-population of resistant organisms that remain contained whilst the more virulent wild type is present, (3) mutations within the population of bacilli causing the original infection . Sequential isolates of Mycobacterium tuberculosis were collected from 2 patients who developed rifampicin resistance whilst on treatment . One patient was immunosuppressed with HIV-infection; in the other patient the original isolate was also resistant to isoniazid . DNA fingerprinting techniques were used to type the isolates . No differences were found between the fingerprints of isolates from before and after the development of resistance . These data suggest that the third of the mechanisms listed above was responsible for the acquisition of rifampicin resistance in these 2 patients. Infect Immun, 1993 Jul, 61(7), 2763 - 73 Pathogenesis of tuberculosis: interaction of Mycobacterium tuberculosis with macrophages; McDonough KA et al.; Central to understanding the pathogenesis of tuberculosis is the interaction between the pathogen and mononuclear phagocytes . A key question about that interaction is whether Mycobacterium tuberculosis exerts an effect on phagolysosome fusion . We have reexamined the dynamics of phagolysosome fusion and its effect on intracellular bacterial replication in M . tuberculosis-infected macrophages by performing an extensive study at the electron microscopic level . Thoria-labelled murine and human macrophages were infected with a virulent (H37Rv) or avirulent (H37Ra) strain of M . tuberculosis or with Mycobacterium bovis BCG vaccine for times ranging from 2 h to 7 days . In all cases, by 2 h postinfection, approximately 85% of the bacteria clearly resided in fused vacuoles . However, at 4 days postinfection, fusion levels for viable H37Rv and H37Ra were reduced by half, whereas the fusion profiles of BCG and of heat-killed H37Rv and H37Ra were unchanged . A comparison of the numbers of bacteria per fused and nonfused vacuoles suggests both a net transfer of bacteria out of fused vacuoles and preferential bacterial multiplication in nonfused vacuoles . H37Rv and H37Ra appeared to bud from the phagolysosomes into tightly apposed membrane vesicles that did not fuse with secondary lysosomes . In some cases, no such membrane was seen and the bacteria appeared to be free in the cytoplasm . Only viable H37Rv showed a significant increase in bacterial counts during the course of infection . Thus, both of the attenuated strains we examined differed from the virulent strain H37Rv in their abilities to replicate successfully within macrophages, but each diverged from H37Rv at a different point in the process . Viable tubercle bacilli H37Rv and H37Ra had the capacity to escape from fused vesicles as the infection progressed; BCG did not . After extrusion from the phagolysosome, H37Rv, but not H37Ra, was able to multiply . These results suggest a novel mechanism by which virulent M . tuberculosis eludes the microbicidal mechanisms of macrophages by escaping from fused phagolysosomes into nonfused vesicles or the cytoplasm. J Gastroenterol Hepatol, 1993 Jul-Aug, 8(4), 370 - 4 Antimicrobial therapy and prevention of spontaneous bacterial peritonitis; Holland DJ et al.; Spontaneous bacterial peritonitis is a frequent and serious infection in cirrhotic patients with ascites . A high index of suspicion is required for early diagnosis and rapid institution of treatment . The common micro-organisms involved in SBP are the aerobic Gram-negative bacilli and Gram-positive cocci that inhabit the intestine . Empiric antibiotic therapy active against these organisms should be instituted as soon as possible to improve survival . Third generation cephalosporins are very effective and safe as the initial empiric antibiotic regimen . Alternatives include beta-lactam-clavulanic acid combinations and other broad-spectrum antibiotics, although cost benefit considerations are important in selection . If cultures and susceptibility tests allow, antibiotic therapy should be altered to provide optimum narrow-spectrum and cost-effective treatment . Recent evidence suggests that (at least in the case of cefotaxime), 5-day treatment is equally effective as 10-day treatment . Except in patients awaiting liver transplantation, antibiotic prophylaxis of SBP is not recommended at present, as the few trials performed have not been able to demonstrate superior results for survival, hospital admissions or cost-effectiveness, over prompt diagnosis and therapy of individual episodes of SBP. Kekkaku, 1993 Jul, 68(7), 487 - 93 {A survey of the initial course of tuberculosis chemotherapy under compulsory hospitalization on the basis of the revised Tuberculosis Prevention Law--report of the 32nd C series of controlled trials of chemotherapy--Cooperative Study Unit of Chemotherapy of Tuberculosis of the National Sanatoria in Japan}; Sato K et al.; We studied 2247 patients with pulmonary tuberculosis who were hospitalized for the initial course of chemotherapy under the provision of the revised Tuberculosis Prevention Law issued by Japanese Ministry of Welfare . The results were as follows . 1) There were more males than females with a ratio of 2.6: 1 . 2) There were two peaks in their ages, 20s and 60s . 3) The average admission periods were 5.2 +/- 2.7 months for men and 5.1 +/- 2.8 months for women . 4) The average compulsory admission periods were 6.8 +/- 2.5 months for men and 6.4 +/- 2.3 months for women, so that the actual admission periods were shorter in the majority of the patients . 5) The sputum cultures were converted negative in three months in about 80 percent of the patients who were smear and/or culture positive on admission . 6) The appearance rate of INH-resistant and RFP-resistant strains were 2% and 1.4% respectively . 7) Most of the death from tuberculosis was observed in the early stages of admission . 8) With regards to the cost, there seemed to be no difference whether treated under the new or the old provisions . 9) The newly approved extension of the admission periods for those who had complications such as diabetes mellitus or pneumoconiosis and those who had INH and/or RFP positive bacilli seemed to be appropriate. AIDS, 1993 Jul, 7(7), 981 - 7 The impact of HIV on infectiousness of pulmonary tuberculosis: a community study in Zambia; Elliott AM et al.; OBJECTIVE: To examine the impact of HIV on infectiousness of pulmonary tuberculosis (TB) . DESIGN: A cross-sectional tuberculin survey carried out among household contacts of HIV-1-positive and negative patients with bacteriologically confirmed pulmonary TB . Contacts were also examined for active TB . SETTING: Index cases were recruited from patients attending the University Teaching Hospital in Lusaka, Zambia and household contacts were examined during visits to their homes within Lusaka . PATIENTS, PARTICIPANTS: A total of 207 contacts of 43 HIV-positive patients, and 141 contacts of 28 HIV-negative patients with pulmonary TB were examined . MAIN OUTCOME MEASURES: Proportion of contacts of HIV-positive and negative index cases with a positive tuberculin response (diameter of induration > or = 5 mm to a dose of 2 tuberculin units) . RESULTS: Fifty-two per cent of contacts of HIV-positive pulmonary TB patients had a positive tuberculin response compared with 71% of contacts of HIV-negative patients (odds ratio, 0.43; 95% CI, 0.26-0.72; P < 0.001) . This difference persisted after allowing for between-household variations in the tuberculin response . Tuberculin response in the contact was related to age of contact, intimacy with the index case and crowding in the household . However, the effect of HIV status of the index case was not confounded by these variables . Tuberculin response in the contact was also related to the number of bacilli seen in the sputum smear of the index case which partially explained the effect of HIV status of the index case . Active TB was diagnosed in 4% of contacts of HIV-positive and 3% of contacts of HIV-negative cases, respectively (P = 0.8) . CONCLUSIONS: HIV-positive patients with pulmonary TB may be less infectious than their HIV-negative counterparts and this may partly be explained by lower bacillary load in the sputumPIP: Between April and December 1989, the chest clinic of the University Teaching Hospital in Lusaka, Zambia, confirmed pulmonary tuberculosis (TB) in 141 adults, 95 (67%) of whom were HIV-1 seropositive . Health workers made home visits to 71 of the index cases (43 HIV-1 positive and 28 HIV-1 negative) to learn whether the 348 household members would also develop TB, thus allowing researchers to determine the effect of HIV on infectiousness of TB . Contacts of HIV-1 positive patients developed TB at a lower rate than did those of HIV-1 negative patients (52% vs . 71%; odds ratio {OR} = 0.43; p .001) . This difference continued even after controlling for between-household variations, indicating that confounding variables did not account for the difference . Age of contact, intimacy with the index case, and crowding in the household were associated with the tuberculin response in the contact, but they did not confound the effect of HIV status . Tuberculin response in the contact was associated with the number of bacilli in the sputum smear (crude OR = 3.13; p = .013, and adjusted OR =1.84; p = .28), suggesting that the number of bacilli somewhat explained the difference in infectiousness between HIV-1 positive and HIV-1 negative patients . 12 contacts (8 of HIV-positive cases and 4 of HIV-negative cases) developed active TB after the TB diagnosis in the index case . These findings clearly demonstrated that infection with Mycobacterium tuberculosis was less likely in household members of HIV-1 positive cases than in those of HIV-1 negative cases . The lower bacillary load in the sputum in HIV- 1 cases may have accounted somewhat for the lower infectiousness of pulmonary TB . Am J Clin Pathol, 1993 Jul, 100(1), 52 - 6 Disseminated bacillus Calmette-Guérin infections in patients with primary immunodeficiencies; Abramowsky C et al.; The pathologic findings from biopsy or autopsy material in four patients, who were vaccinated with bacillus Calmette-Guerin (BCG) at birth in Chile, are presented . Two patients had severe combined immunodeficiency, and two had more restricted cellular (T-cell) immunodeficiency with no evidence of human immunodeficiency virus infection . The patients had distinct skin nodules and nodular lesions in systemic organs and bone marrow . Three patients had regional BCG lymphadenitis . One patient with severe combined immunodeficiency, however, had disseminated BCG without any local reaction . In all cases BCG strains of Mycobacterium were identified in a reference mycobacteriology laboratory . The histologic lesions in most patients usually consisted of diffuse histiocytic infiltrates with poorly formed granulomas and variable or no necrosis . Histiocytes were plump and engorged with numerous acid-fast bacilli (AFB) . In some areas the massive histiocytosis resembled a spindle cell neoplasm . Other histologic findings supported the underlying immunodeficiency . The pattern of histiocytic response and degree of microbial killing depend on the host's immunocompetence . In the later stages of disease or in severe immunodeficiency, there is a lack of granuloma formation and unimpeded proliferation of AFB . These findings are reminiscent of nontuberculous mycobacterial infections in AIDS patients . Bacillus Calmette-Guerin dissemination has to be considered in immunocompromised individuals when the patient comes from other countries in which such vaccinations are practiced. Chest, 1993 Jul, 104(1), 307 - 9 Disseminated infection after intravesical BCG immunotherapy . Detection of organisms in pulmonary tissue; Palayew M et al.; A 57-year-old man undergoing intravesical immunotherapy with BCG for transitional cell bladder carcinoma presented with dyspnea, fever, hypoxemia, and a diffuse micronodular pattern on chest radiograph . Transbronchial biopsy specimen revealed widespread noncaseating granulomas, and acid-fast bacilli were identified in sputum as well as in the biopsy tissue . The patient's condition responded promptly to antituberculous antibiotics given in conjunction with corticosteroids . Although no growth was evident on TB culture of the specimens, the presence of organisms indicates a probable infectious cause of the pulmonary disease process. Am J Gastroenterol, 1993 Jul, 88(7), 989 - 99 Tuberculosis of the gastrointestinal tract and peritoneum; Marshall JB; Gastrointestinal and peritoneal tuberculosis remain common problems in impoverished areas of the world, but is relatively infrequent in the United States . A resurgence of tuberculosis in America since the mid-1980s means that clinicians will continue to see cases . Immigrants and AIDS patients are two population groups at particular risk for abdominal tuberculosis in this country; the urban poor, the elderly, and Indians on reservations are others . The symptoms and signs of GI and peritoneal tuberculosis are nonspecific, and unless a high index of suspicion is maintained, the diagnosis can be missed or delayed resulting in increased morbidity and mortality . Only 15-20% of patients have concomitant active pulmonary tuberculosis . Tuberculous peritonitis needs to be considered in all cases of unexplained exudative ascites . Laparoscopy with directed biopsy currently is the best way to make a rapid specific diagnosis . The measurement of ascites adenosine deaminase levels represents a major diagnostic advance in tuberculous peritonitis, particularly in underdeveloped areas where the affliction is common and laparoscopy may not be available . With greater experience, this testing procedure could also supersede invasive studies in western countries, particularly in high-risk patient groups . The commonest sites of tuberculous involvement of the GI tract are the ileocecal area, the ileum and the colon, although any area of the gut can be involved . If the area of affected gut is within reach of the flexible endoscope, rapid diagnosis may be possible with biopsy (if acid-fast bacilli or caseating granulomas are seen) . Not infrequently, the disease is not considered until it is diagnosed at the time of surgery . In countries with a high prevalence of intestinal tuberculosis, a therapeutic trial of antituberculous drugs may be reasonable if the clinical picture is compatible . The diagnosis of tuberculous enteritis can be taken as highly probable if the patient responds to treatment and this is followed by no recurrence . Serologic tests for diagnosing tuberculosis are being improved and evaluated in intestinal tuberculosis . Gastrointestinal and peritoneal tuberculosis are treated with antituberculous drugs . Surgery is reserved for complications or uncertainty in diagnosis . Six-, 9-, and 18- to 24-month regimens are all effective for extrapulmonary tuberculosis . Standard therapy of at least 9 months duration is also effective in most AIDS patients who are started on appropriate treatment in a timely fashion and who are compliant . The potential for multidrug resistance needs to be kept in mind and accounted for. Am J Gastroenterol, 1993 Jul, 88(7), 1112 - 5 Mycobacteremia and granulomatous hepatitis following initial intravesical bacillus Calmette-Guerin instillation for bladder carcinoma; Proctor DD et al.; We describe the first case of mycobacteremia and granulomatous hepatitis occurring after the initial intravesical instillation of bacillus Calmette-Guerin (BCG) for bladder cancer . Eight days after BCG instillation, a liver biopsy revealed well-defined granulomas and acid-fast bacilli . A blood culture drawn 8 h after BCG instillation grew Mycobacterium bovis . We summarize the reported complications of BCG intravesical immunotherapy, the associated risk factors, and discuss options for treatment . Although rare, mycobacteremia and granulomatous hepatitis are important systemic side effects of intravesical instillation of BCG for bladder cancer, and should be considered in any patient who presents with persistent fever and abnormal liver function tests after instillation of BCG. Indian J Lepr, 1993 Jul-Sep, 65(3), 289 - 95 Sample survey of leprosy after three years of MDT in Bhavani taluk of Periyar District, Tamilnadu; Narayan NP et al.; A sample survey of Bhavani taluk was undertaken in March 1992 three years after the introduction of MDT . Ten percent of the population was taken for the sample . A population of 45,781 was enumerated and 41,554 was examined . The three sectors were stratified according to the prevalence rate and classifying the villages by the size of the population . Villages were selected by random sampling . The sample survey detected 288 new cases of leprosy of which 16 (5.55%) were bacteriologically positive for acid-fast bacilli . The child rate was 13.54% among new cases . According to the sample survey the current prevalence rate per 1000 population was 9.07 (with a new case detection rate of 6.93/1000 population), much higher than that derived from programme data (prevalence rate 3.45) and the expected ten fold reduction of prevalence under MDT . Independent sample surveys of NLEP units after three to five years of implementation of MDT will help to assess deficiencies in the programme and enable us to take remedial measures. Indian J Lepr, 1993 Jul-Sep, 65(3), 283 - 8 Bacillaemia and Mycobacterium leprae cell wall antigen in paucibacillary leprosy; Kaur I et al.; A study was undertaken to estimate bacillaemia and M . leprae antigen detection in 54 paucibacillary leprosy patients (TT, BT) . Acid-fast bacilli were detected in the blood of 14.8% patients of borderline tuberculoid (BT) leprosy . M . leprae antigen was demonstrated in 48.2% patients of BT leprosy . Slit-skin smears were negative in all these patients . At the end of treatment (6 months of WHO-MDT) all the follow-up blood samples were negative for both bacillaemia and M . leprae antigen in the serum. Indian J Lepr, 1993 Jul-Sep, 65(3), 271 - 82 In vivo effect of delipidified cell component of Mycobacterium leprae in relation to infection with leprosy bacteria in mice; Damle A et al.; The delipidified cell component (DCC) of Mycobacterium leprae was used as an immunomodulatory agent in Swiss white mice . The peritoneal macrophages of these mice were activated to produce increased amount of reactive oxygen intermediates like hydrogen peroxide (H2O2) and superoxide . These macrophages also attained the ability to kill M . Leprae in vitro as shown by several assay systems including the conventional mouse foot-pad technique . The increased levels of superoxide seem to be responsible for the killing of M . leprae as addition of the enzyme superoxide dismutase, which breaks down O2, resulted in survival of these bacilli inside the macrophages . The increased production of H2O2 does not seem to be responsible for killing M . leprae . The results indicate that the DCC of M . leprae acts as an effective immunomodulator in mice leading to the activation of macrophages with increased production of H2O2 and superoxide as well as enabling them to kill M . leprae via the action of superoxide anions. Pathology, 1993 Jul, 25(3), 313 - 5 Rapid identification of mycobacteria by the Gen-Probe Accuprobe system; Lumb R et al.; Chemiluminescent acridinium ester-labelled (AE)-DNA probes (Gen-Probe, Inc., San Diego, Calif.) for the identification of Mycobacterium tuberculosis complex (MTBC) and the M . avium-M . intracellulare complex (MAC) were evaluated using 184 mycobacterial isolates cultured in BACTEC 12B vials (Becton Dickinson and Co., Towson, Md.) . A 1.5 mL aliquot from BACTEC 12B vials containing acid-fast bacilli and a Growth Index of > 200 was concentrated 15-fold using a centrifugation step prior to performing the test procedure . When 184 mycobacterial isolates were tested (42MTBC/142 nontuberculous mycobacteria) using the AE-MTBC probe, there was 100% sensitivity and specificity when compared with conventional identification procedures . Criteria for using the AE-MAC probe were defined to optimize results whilst minimizing laboratory costs . Ninety-one (64%) of AE-MTBC probe negative isolates failed to meet selection criteria and were not tested . When 51 (36%) of the AE-MTBC-probe negative mycobacterial isolates were tested, the AE-MAC probe was found to be 88% sensitive and 100% specific . The non-isotopic Gen-Probe test is a rapid and practical alternative to current procedures for differentiation of mycobacteria. Avian Dis, 1993 Jul-Sep, 37(3), 891 - 4 Tyzzer's disease in a neonatal cockatiel; Saunders GK et al.; A 4-day-old cockatiel that died suddenly had a pale, mottled liver at necropsy . Extensive necrosis and numerous bacilli were present microscopically in the liver . The organism was identified as Bacillus piliformis, the causative agent of Tyzzer's disease, by special staining and electron microscopy . This is the first report of Tyzzer's disease in an avian species. Ann Acad Med Singapore, 1993 Jul, 22(4), 580 - 2 Tuberculosis of the thyroid gland--a review; Tan KK; A review of the literature reveals that tuberculosis of the thyroid gland is a very rare condition . Only one case was notified in Singapore over the last ten years . It can occur either as part of a miliary spread or as a primary lesion in the thyroid . It is difficult to diagnose clinically and the thyroid enlargement is often mistaken for carcinoma, suppurative abscess or a haemorrhage into a thyroid cyst . Signs and symptoms are variable, and are mostly related to enlargement of the gland . Thyroid dysfunction is rare . Diagnosis is made by histological examination and demonstration of the tubercle bacilli from biopsy or aspiration specimen. Stomatologiia (Mosk), 1993 Jul-Sep, 72(3), 66 - 9 {Wound infection in the surgical treatment of children with congenital cleft palate}; Frolova LE et al.; Clinico-microbiologic examinations of 153 children with cleft palate aged 2 to 9 were carried out . Two groups of patients with different pattern of operative wound healing after uranoplasty were singled out: 110 ones with primary healing and 13 ones with infectious inflammations of the wound . The incidence of S . aureus carriership on the palatal mucosa before surgery was higher among patients who developed postoperative inflammations . On day 3 after the operation gram-negative bacilli were isolated from the majority of patients with postoperative wound inflammations coursing in the presence of marked dysbacteriosis as against patients in whom the wounds healed by primary intention . The authors suggest a method for wound infection prevention in uranoplasty, consisting in irrigation of the operative wound with acilact (a biopreparation) suspension and shortening of antibiotic prevention course to just 48-72 h; the efficacy of this method was confirmed by a reduction of the incidence of postoperative complications . Normal microflora representatives predominated in the microbiocenosis of the operative wound on days 3 and 10-12 after uranoplasty. Stomatologiia (Mosk), 1993 Jul-Sep, 72(3), 16 - 8 {The morphology of the microorganisms from the contents of a periodontal pocket in relation to the severity of the periodontitis}; Khazanova VV et al.; Ninety-five patients with periodontitis of slight and medium severity were examined, 21 of them without concomitant diseases, 44 with essential hypertension, and 30 with diabetes mellitus . Besides clinical signs of periodontal abnormalities, the examinations revealed using phase-contrast microscopy four groups of microorganisms in the periodontal pouch contents: cocci, immovable and movable bacilli, and tortuous forms . Multidimensional analysis of clinico-laboratory data revealed a relationship between the counts of some microorganisms and severity of periodontal pathology. Rev Invest Clin, 1993 Jul-Aug, 45(4), 339 - 43 {Surveillance of therapy with aminoglycosides at a specialized hospital}; Macias-Hernandez AE et al.; Aminoglycosides (AG) are excellent antibiotics against gram-negative bacilli infections, but their use implies potential ototoxicity and nephrotoxicity if an excessive dosage is prescribed . In this study we evaluated 105 episodes of AG treatment in 104 patients hospitalized in a specialty hospital in the city of Leon, Mexico . In each case a basal serum creatinine, weight and age were recorded . A single serum AG assay per episode of treatment was done . Either amikacin or gentamicin were one the AG prescribed . Prior to AG administration only 54 treatment episodes (51%) had a before treatment creatinine assay . The initial creatinine clearance showed normal values in 43% (23/54 episodes) and it was altered (below 80 mL/min) in 31 (57%) of the episodes . In the 31 cases with an altered renal function only 15 (48%) underwent dosage adjustment . In summary the AG were prescribed in excess in 54% (29/54) of the episodes . The serum AG levels within toxic range were observed in 11 episodes . These results suggest that in our hospital AG treatment is not adequately done and monitored. Epidemiol Infect, 1993 Jun, 110(3), 609 - 19 A bacteriological survey of tuberculosis due to the human tubercle bacillus (Mycobacterium tuberculosis) in south-east England: 1984-91; Yates MD et al.; The occurrence and nature of bacteriologically confirmed tuberculosis due to Mycobacterium tuberculosis in South-East England in the period 1984-91 is reported and compared with the results of a study for 1977-83 . Registered new cases reached a low of 1028 in 1988 but increased to 1252 in 1991 . This appeared to be due to a halt in the previous decline in new cases of European patients, a small increase in the number of Indian subcontinent (ISC) patients and an increase in patients from Africa . A total of 122 patients, mostly of European ethnic origin, were known to be HIV positive . As in the 1977-83 study, disease in the ISC group affected younger patients than in the European group, tubercle bacilli were more frequently isolated from a non-pulmonary site in the ISC group (45%) than in the European group (19%) and there was a higher incidence of the South Indian variant of M . tuberculosis in the former group (17%) than in the latter (9%) . The overall incidence of drug resistance has not altered significantly since the 1977-83 study but 46 strains resistant to 3 or more drugs were isolated from 4099 ISC patients, compared with 3 of 4594 strains from European patients . Six of the 122 isolates from HIV positive patients were drug-resistant but none was multi-drug resistant . The slight rise in registered bacteriologically proven cases of tuberculosis, the presence of multi-drug resistant strains, the occurrence of HIV-related tuberculosis and reports of the emergence of multi-drug-resistant HIV-related tuberculosis in other countries strongly indicate the need for continued careful surveillance. Clin Exp Immunol, 1993 Jun, 92(3), 466 - 72 Adjuvant treatment increases the resistance to Mycobacterium avium infection of mycobacteria-susceptible BALB/c mice; Castro AP et al.; We have investigated the effect of inflammation on host resistance against infection by Mycobacterium avium, an atypical mycobacteria species that is responsible for life-threatening opportunistic infections in AIDS patients . Inflammation was induced in BALB/c mice by two intraperitoneal injections of mineral oil (Freund's incomplete adjuvant, FIA) . The BALB/c strain was chosen because it is naturally susceptible to Myco . avium infection . One week after the second FIA injection, the BALB/c mice were infected intravenously with 2.6 x 10(6) Myco . avium bacilli; at this time, the mice showed systemic granulocytosis because of the FIA injections . The kinetics of the murine infection was determined during 3 months by quantification of Myco . avium loads in the major target organs (liver and spleen) of the mycobacteria . The FIA treatment resulted in a significant decrease in the growth of Myco . avium in the infected BALB/c mice . This enhancement in host resistance to Myco . avium infection lasted for 2-3 months . In contrast with BALB/c animals, C3H mice (naturally resistant to Myco . avium infection) did not show an increased anti-Myco . avium action in association with the FIA treatment . The antimycobacterial effect of the FIA injections in BALB/c mice was compared with that produced by the injection of mycobacterial antigens (heat-killed Myco . tuberculosis) added to the mineral oil (i.e . Freund's complete adjuvant, FCA) . The FCA treatment resulted in strong and sustained enhancements in the microbicidal capacities of BALB/c, and also of C3H mice . Data obtained with mutant athymic BALB/c mice revealed that the anti-Myco . avium effect of the FCA treatment was T cell-dependent . Our results indicate that: (i) non-immune inflammatory stimulation (FIA) of Myco . avium-susceptible hosts is able to cause a significant, albeit transient, increase in the resistance to Myco . avium infection; (ii) this protective effect is enhanced if heat-killed mycobacteria are added to the phlogistic agent (FCA), i.e . if a T cell-dependent response is induced; and (iii) systemic increase in the number of circulating granulocytes may help host defence against Myco . avium infection. South Med J, 1993 Jun, 86(6), 638 - 40 Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS; Jacob CN et al.; Infections due to nontuberculous mycobacteria (NTM) are especially common in patients with AIDS . Meningitis due to NTM, however, is rare . A search for CSF cultures positive for NTM over the past 11 years at our hospital yielded 16 cases . Of these, 15 were caused by Mycobacterium avium-intracellular (MAI), and one was caused by M fortuitum . All patients with MAI infection had widespread dissemination and at least one risk factor for AIDS . Clinical features included weight loss, altered mentation, and seizures . Analysis of cerebrospinal fluid revealed a mildly elevated leukocyte count with lymphocyte predominance and normal protein and glucose values . All direct smears were negative for acid-fast bacilli . In-hospital mortality was 67% . The patient with infection due to M fortuitum had a preexisting diagnosis of AIDS and had a right upper lobe pneumonia and headaches . Cranial CT showed an enlarged infundibulum of the pituitary gland . Results of CSF analysis were essentially normal, and direct smears were negative . He left the hospital against medical advice . Our study indicates that the finding of MAI in the CSF in patients with AIDS is associated with an in-house mortality of 67% indicating a very poor prognosis. J Am Geriatr Soc, 1993 Jun, 41(6), 629 - 32 Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population; Patel YR et al.; OBJECTIVE: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population . DESIGN: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years) . Natural sputum smears and cultures positive for M . tuberculosis (M . TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures . Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance . SETTING AND PATIENTS: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B . For 1990, 525 cases were reported, 269 in Group A and 256 in Group B . All cases met CDC-approved criteria for diagnosis of tuberculosis . MEASUREMENTS: The number of positive AFB smears and M . TB cultures were compared in each group . In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only . MAIN RESULTS: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures . In Group B, 77 (24.4%) were diagnosed by FOB . Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone . In 1990, 269 cases of TB were reported in Group A . Of these, 38 (14.1%) were diagnosed by FOB . There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB . Of these 83 cases, 60 (23.4%) were diagnosed by FOB only . While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05) . CONCLUSIONS: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB . While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly. J Infect Dis, 1993 Jun, 167(6), 1481 - 97 T cell response to Mycobacterium tuberculosis; Orme IM et al.; The T cell-mediated acquired immune response to infection with Mycobacterium tuberculosis, both in humans and in experimental models in the mouse, is a complex event believed to involve a variety of T cell subsets that manifest themselves in numerous functions, including protection, delayed-type hypersensitivity, cytolysis, and the establishment of a state of memory immunity . These functions in turn involve the secretion of an array of cytokines, several of which direct cells of the monocyte/macrophage axis to contain and destroy the invading bacilli . This article reviews the development of these ideas, both from clinical experience and from basic research in animal models . In addition, the newly emerging hypothesis that the secreted or export proteins of M . tuberculosis are the key protective antigens leading to the initial expression of acquired specific resistance to this organism is examined. Chest, 1993 Jun, 103(6), 1837 - 41 The course of nosocomial oropharyngeal colonization in patients recovering from acute respiratory failure; Ketai LH et al.; We sought to determine the duration of nosocomially acquired Gram-negative bacilli (GNB) oropharyngeal colonization following hospitalization for acute respiratory failure (ARF) . We selected 24 inpatients recovering from ARF who had positive oropharyngeal cultures for GNB . Follow-up cultures were obtained at the time of hospital discharge, and 2 and 4 weeks afterwards . The prevalence of GNB colonization in these patients was 14/21 (67 percent) at the time of hospital discharge and 14/23 (60 percent) 2 weeks afterwards . Both rates were greater than the control population's 7/30 (23 percent, p < 0.02 and < 0.05, respectively) . Four weeks after hospital discharge, the prevalence of colonization had fallen to 7/19 (37 percent) which was not significantly different from that of controls . Five of 24 subjects were rehospitalized during the follow-up period . Pneumonia was diagnosed in only two of the five and both proved to be due to pathogens other than GNB . We conclude that the prevalence of GNB oropharyngeal colonization following ARF approaches control levels within four weeks of hospital discharge . We speculate that a post-ARF patient's risk for GNB pneumonia similarly declines. Int J Lepr Other Mycobact Dis, 1993 Jun, 61(2), 270 - 82 Extent, origin, and implications of observer variation in the histopathological diagnosis of suspected leprosy; Fine PE et al.; Identical slides from 100 biopsies obtained from individuals suspected of having leprosy, ascertained in a total population survey in Malawi, were examined twice, independently, by three histopathologists . Results were reported in a standard protocol, and were compared among themselves and with a standardized clinical assessment of each "suspect." The proportion of biopsies considered to show definite evidence of leprosy ranged from 29 to 55 among the six evaluations (twice by each of three histopathologists) . Comparisons of variations within and between histopathologists revealed three different patterns . Two of the pathologists were very consistent as individuals, but differed markedly between themselves in that one was the least inclined and the other the most inclined to report definite evidence of leprosy . The third pathologist was less consistent, reporting appreciably more definite leprosy on the first than on the second examination of the same biopsies . Although acid-fast bacilli (AFB) were reported on at least 1 examination in 40 of the biopsies, they were observed in all six examinations of only six of the biopsies . There was greater agreement regarding classification than regarding diagnosis, except with reference to the indeterminate category which was employed more frequently by one histopathologist than by the other two . A workshop of participants at the end of the investigation highlighted several reasons for the variations observed . The fact that AFB were reported in only nine biopsies by one histopathologist but in 33 by another reveals the importance of the examination method and time in arriving at a diagnosis of leprosy . The differences in the interpretation of cellular evidence of inflammation revealed the need for further studies of nerve-related pathology in nonleprosy conditions to serve as a reference against which to judge possible evidence of leprosy per se. Int J Lepr Other Mycobact Dis, 1993 Jun, 61(2), 255 - 8 In vivo antileprosy activity of the newly synthesized benzoxazinorifamycin, KRM-1648; Tomioka H et al.; The in vivo anti-Mycobacterium leprae activity of the newly synthesized benzoxazinorifamycin, KRM-1648, was studied . KRM-1648 was given orally to athymic nude mice, infected subcutaneously with M . leprae in the hindfoot pad, at doses between 0.001 and 0.01 mg of the drug/mouse/day six times per week, from day 31 to day 80 . KRM-1648 administration markedly suppressed bacterial growth in the foot pads for 360 days . KRM-1648 given daily at the dose of 0.01 mg/mouse elicited a 2-4-log decrease in the number of acid-fast bacilli . The therapeutic effects of KRM-1648 were significantly higher than that of rifampin when both drugs were given in the same dosage . Moreover, when mice were fed a KRM-1648-containing diet (0.00004%-0.0004%), the drug displayed an even higher efficacy against M . leprae infection, causing an almost 4-log decrease in the number of leprosy bacilli in the infected foot pad compared to untreated controls. Int J Lepr Other Mycobact Dis, 1993 Jun, 61(2), 227 - 35 Molecular cloning and characterization of contiguously located repetitive and single copy DNA sequences of Mycobacterium tuberculosis: development of PCR-based diagnostic assay; Reddi PP et al.; Screening of a lambda gt11 genomic library has been used as an approach for molecular cloning of the Mycobacterium tuberculosis repetitive DNA shown to be present on a previously described 5.6-kb Alu I genomic fragment . The recombinant clone R18.8.2, which strongly hybridized with the radiolabeled 5.7-kb Alu fragment, carried two Eco RI inserts of 2 kb and 1.4 kb in size . Southern hybridization of each of these fragments to restriction endonuclease-cleaved M . tuberculosis DNA clearly demonstrated the 2 kb to contain the repetitive DNA sequence, while the 1.4 kb is represented in a single copy . When replica plaque lifts from the genomic library were probed, the 5.6-kb genomic fragment and the cloned 2-kb repetitive insert hybridized to an identical number of plaques, indicating the similarity and the high copy number of the repeating unit shared by the two fragments . Restriction mapping and Southern hybridization patterns indicated that the 2-kb repetitive and the 1.4-kb single-copy DNA sequences originated from a contiguous piece of genomic DNA . Both fragments were found to be unique to members of the M . tuberculosis complex, except that the 2-kb insert exhibited a weak hybridization with M . kansasii DNA . Finally, a 169-bp region from one end of the single-copy sequence has been amplified by polymerase chain reaction (PCR) in a manner specific to members of the M . tuberculosis complex . The sensitivity of the PCR was such that as few as 9-10 bacilli could be detected. Int J Lepr Other Mycobact Dis, 1993 Jun, 61(2), 218 - 26 Correlation between TNF production, increase of plasma C-reactive protein level and suppression of T lymphocyte response to concanavalin A during erythema nodosum leprosum; Foss NT et al.; The complex symptoms observed in lepromatous leprosy patients with reactive episodes of the erythema nodosum leprosum (ENL) type are associated with different serum components actively participating in the acute inflammatory reaction . Among them are the tumor necrosis factor (TNF) and the acute-phase protein C-reactive protein (CRP) . TNF and CRP were found at significantly more elevated concentrations in the serum of patients with ENL, with a positive correlation of about 95% when compared with patients with nonreactive lepromatous leprosy (L) or tuberculoid leprosy (T) or with control individuals . Furthermore, in another series of experiments CRP had a specific and significant suppressive action on concanavalin A (ConA)-induced lymphoproliferation in cultures from patients and controls, the reduction being more marked (75%) in patients with ENL . By extrapolation from its known actions, production of TNF may have a number of potential consequences for the immunobiology of ENL . Thus, TNF may cause direct injury to compromised cells, facilitating mononuclear cell activation and production of cytokines such as interleukin-1 and interleukin-6, and upregulating hepatocyte expression of CRP . Both CRP and TNF in high serum concentrations have the ability to enhance the acute inflammatory process in ENL, favoring increased macrophage activation and phagoctyosis, and contributing to the elimination of damaged cells and bacilli, as well as in the reduction of T-suppressor cells, with a consequent improvement in the immunologic response of ENL patients. Tuber Lung Dis, 1993 Jun, 74(3), 180 - 6 Critical assessment of smear-positive pulmonary tuberculosis patients after chemotherapy under the district tuberculosis programme; Datta M et al.; This is a status report of a retrospectively assembled cohort of 3357 smear-positive patients initiated on anti-tuberculosis chemotherapy in the North Arcot district between April 1986 and March 1988 . The patients were contacted once at their homes between November 1988 and June 1989 (6 and 36 months after start of treatment), and information on their status, including death, could be obtained from 76% of them . Regimens were selected by the patients . 2306 (69%) had accepted short course regimens (SCC) and 1051 (31%) had been started on standard chemotherapy (non-SCC), 43% and 35% in SCC and non-SCC respectively had completed 80% or more of their treatment . Overall mortality was 28% . Of those remaining, 31% had active disease and were excreting bacilli, among which 65% of the cultures were resistant to isoniazid and 12% to rifampicin . Combined resistance to isoniazid and rifampicin was seen in 4% and to isoniazid and streptomycin was seen in 19% . A significant finding was that even among those who had taken less than 50% of their treatment, 56% were bacteriologically negative . However, inadequate or irregular chemotherapy resulted in over four times the mortality and about twice the rate of smear positivity as compared with those taking adequate chemotherapy . No comparisons are made between patients on short-course and standard regimens as the patients selected their treatment and the groups are not comparable. J Antimicrob Chemother, 1993 Jun, 31(6), 813 - 29 Selective decontamination of the digestive tract and its role in antimicrobial prophylaxis; Donnelly JP; Selective decontamination of the digestive tract (SDD) is an established form of infection prevention which relies upon local antibiotic action to afford suppression of potential pathogens while preserving 'colonization resistance' (CR) . However, CR has never been shown conclusively to play a decisive role in either achieving or maintaining effective prophylaxis in patients and by employing absorbable antimicrobials or parenteral antibiotics, prophylaxis is actually achieved by both local and systemic action . The role of prophylaxis in neutropenic patients is also far from clear since morbidity and mortality remain the same whether or not prophylactic antibacterials are given and most patients still require empirical therapy for fever . In addition, the Gram-positive cocci, rather than Gram-negative bacilli presently predominate as pathogens . There is also an increasing trend towards including fungal and viral infection as targets for prophylaxis . Moreover, current anti-infective strategies are more akin to 'pre-emptive therapy' (PET) since the antimicrobials are available systemically and given at optimum therapeutic doses and there is little to distinguish treatment given to prevent colonization from progressing to infection from that used to arrest incipient infection or effect a cure of established infection . In contrast, SDD as originally conceived may well prove cost-effective for the prevention of infection in intensive care although neither the optimum regimen nor the patient group who would gain most benefit have been defined . None the less, by affording protection against Gram-negative sepsis, both SDD and PET would reduce the pressure on the clinicians to treat empirically and shift the emphasis once more on appropriate investigations which would involve the microbiologist more directly and immediately in patient care . Any savings from lowering the drug usage could then be diverted to improving diagnosis and providing the regular monitoring that is essential to the success of both PET and SDD. Med J Malaysia, 1993 Jun, 48(2), 113 - 6 A study of primary drug resistance in pulmonary tuberculosis in west Malaysia 1984-1987; Jalleh RD et al.; Eight hundred and fifty-six strains of Mycobacterium tuberculosis from previously untreated patients with pulmonary tuberculosis from various states in West Malaysia were studied during the period 1984 to 1987 . All the strains were tested for in vitro susceptibility to the anti-tuberculosis drugs isoniazid (INH), streptomycin (SM), rifampicin (RMP) and ethambutol (ETB) . One hundred and twenty-one of the isolates (14.18%) were resistant to 1 drug while 17 (1.97%) were resistant to 2 drugs . No strain was found to be resistant to more than 2 drugs . The prevalence of primary resistance to INH was 4.20%, SM was 7.59%, RMP was 0.95% and ETB was 1.44% . In 1.86% of isolates, resistance was noted to both INH and SM, while 0.11% were resistant to both RMP and ETB . There was no significant difference in distribution of resistant bacilli between the sexes (p > 0.01). Isr J Med Sci, 1993 Jun-Jul, 29(6-7), 381 - 2 Mycobacterium bovis lymphadenitis complicating BCG immunization in an infant with symptomatic HIV-1 infection; Marks K et al.; A 3-month-old infant with HIV-1 infection who recently immigrated from Ethiopia developed regional lymphadenitis and systemic symptoms subsequent to BCG immunization . She was suffering from axillary lymphadenitis ipsilateral to the BCG vaccination site, failure to thrive, unresolving fever and hepatosplenomegaly . Acid-fast bacilli were seen on staining and Mycobacterium bovis was isolated from the regional lymph node . The infant responded promptly to triple antituberculous therapy but died 2 months later from overwhelming pneumonia and respiratory failure . This case emphasizes the iatrogenic hazards of BCG immunization in HIV-1 infected infants . With the increasing prevalence of pediatric HIV-1 infection, indiscriminate BCG immunization programs should be reconsidered . While infants with asymptomatic HIV-1 infection at risk for tuberculosis should be immunized, BCG immunization should be withheld in those with symptomatic disease. Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Jun, 31(6), 780 - 4 {A case of adenocarcinoma presenting as a cavitary lesion with niveau formation}; Matsuba T et al.; Primary pulmonary adenocarcinoma rarely shows cavitation with a fluid level on chest roentgenograms . Herein we describe such a case misdiagnosed as pulmonary tuberculosis . The patient was a 63-year-old, female who had never smoked . Chest roentgenograms revealed a cavitary lesion in the left lower lobe, possessing a prominent fluid level . Fiberoptic bronchoscopic aspirate was positive for acid-fast bacilli on stains . Since there was no improvement with antituberculous chemotherapy, a left lower lobectomy was performed . The present case is of interest in the light of cavity formation in pulmonary carcinoma . The diagnosis and roentgenographic features are discussed. Infect Dis Clin North Am, 1993 Jun, 7(2), 411 - 24 Problems with detection of beta-lactam resistance among nonfastidious gram-negative bacilli; Sanders CC et al.; The single most important aspect of any susceptibility test is the accurate detection of resistance, because resistance carries a strong prediction of therapeutic failure . However, the accurate detection of resistance has been difficult in tests performed with gram-negative organisms producing certain beta-lactamases and in tests with the new beta-lactam drug/beta-lactamase inhibitor combinations . These problems are due to limitations in the design of studies performed to establish test parameters, and these problems can be avoided if a new predictor panel approach is used . This, coupled with the use of special tests to detect resistance mechanisms, could optimize the accurate identification of beta-lactam resistance in gram-negative bacteria. Lepr Rev, 1993 Jun, 64(2), 128 - 35 Survey for secondary dapsone and rifampicin resistance in Cuba; Gonzalez AB et al.; A total of 1211 Cuban multibacillary leprosy patients treated for at least 5 years were clinically and bacteriologically examined . They were being treated according to a 2-phase monotherapy regimen with RMP first and DADDS afterwards . On skin-smear examination 50 patients were found positive, of which 9 showed a BI of 3+ or higher at any site . With regard to the clinical status the only cases found with clinical signs of relapse were 5 out of 7 long-standing patients with BI of 4+ and 5+ . A 6th patient of this high BI group who showed a good clinical condition, except for a heavy infiltration of both earlobes, was receiving a second RMP course when examined and biopsied for this research . These 9 patients were biopsied and susceptibility tests to RMP and DDS performed . The results showed that in 1 case the Mycobacterium leprae were resistant to both drugs; the organisms from 2 other patients were susceptible to RMP but low-grade resistant to DDS . Those from another patient were susceptible to RMP and fully resistant to DDS . In 3 other cases the bacilli did not multiply in any of the mice but 1 of these strains was from the patient taking a second RMP course, therefore this strain might also be susceptible to RMP and resistant to DDS . In the last 2 cases multiplication was only observed in 2 of the controls and in 1 of the 0.0001% DDS treated mice; therefore, these experiments were not conclusive, and the AFB recovered were inoculated into fresh mice to repeat the tests but these failed to multiply. Eur Respir J, 1993 Jun, 6(6), 811 - 5 Immunoprotective behaviour of liposome entrapped cell wall subunit of Mycobacterium tuberculosis against experimental tuberculous infection in mice; Chugh IB et al.; We wanted to determine the immunoprotective behaviour of cell wall protein peptidoglycan complex (CW-PPC) of Mycobacterium tuberculosis H37Ra, using liposomes as adjuvant, in an experimental animal model . Immunization of mice with CW-PPC entrapped in liposomes induced both humoral response, as measured by enzyme-linked immunosorbent assay (ELISA), and cell-mediated immune responses, as seen by delayed type hypersensitivity (DTH) and leucocyte migration inhibition (LMI) techniques . Ten days after complete immunization, the animals were challenged with median lethal dose (LD50) of M . tuberculosis H37Rv . The animals exhibited significant protection, as evident by 72% survival after 30 days of infection, compared to 38% survival in control animals . Protective effect of immunization with liposome entrapped CW-PPC was further substantiated by significant decrease in the number of viable bacilli in lungs, liver and spleen of immunized animals, as compared to control animals . These results indicate that immunization with liposome-entrapped mycobacterial cell wall protein peptidoglycan complex induces protection against experimental tuberculosis. Antimicrob Agents Chemother, 1993 Jun, 37(6), 1348 - 52 A rapid method for screening antimicrobial agents for activities against a strain of Mycobacterium tuberculosis expressing firefly luciferase; Cooksey RC et al.; We developed a rapid method to screen the efficacy of antimicrobial agents against Mycobacterium tuberculosis . A restriction fragment carrying a promoterless firefly luciferase gene was cloned into a 4,488-bp shuttle vector, pMV261, and luciferase was expressed under the control of a mycobacterial heat shock promoter . The resulting plasmid, pLUC10, was introduced by electroporation into the avirulent strain M . tuberculosis H37Ra . Luciferase assays of sonic lysates of Triton X-100-treated cells of M . tuberculosis H37Ra(pLUC10) yielded bioluminescence in excess of 1,000 relative light units/approximately 10(9) tubercle bacilli, compared with 0.0025 for the same number of parental cells . A 48-h microdilution antimicrobial agent-screening assay using this strain was developed. Clin Infect Dis, 1993 Jun, 16 Suppl 4, S371 - 6 Susceptibility of anaerobic bacteria to beta-lactam antibiotics in the United States; Johnson CC; beta-Lactam antibiotics are critical agents in the treatment of anaerobic infections . Susceptibility to these agents, however, varies widely, depending on the specific drug and organism; has not been constant over time; and differs in various geographic locations within the United States for many species . For the organisms in the Bacteroides fragilis group, the beta-lactam antibiotics with the most consistent activity are imipenem and combinations of a beta-lactam drug plus a beta-lactamase inhibitor, such as ticarcillin/clavulanate and ampicillin/sulbactam . Antibiotics with less activity include cefoxitin, piperacillin, cefotetan, and ceftizoxime . In other species of anaerobic gram-negative bacilli, beta-lactamase production is seen with increasing frequency . In vitro susceptibility of these strains is now similar to that of the B . fragilis group, with imipenem, ticarcillin/clavulanate, ampicillin/sulbactam, and cefoxitin being the most active drugs . The anaerobic gram-positive cocci and bacilli remain, for the most part, highly susceptible to penicillins and imipenem. Gastroenterol Nurs, 1993 Jun, 15(6), 247 - 50 Helicobacter pylori: a cause of chronic abdominal pain in children; Young R et al.; Approximately one in ten children are seen by a health care professional for a complaint of chronic recurrent abdominal pain . In most cases these complaints are non-organic . Organic causes of abdominal pain may include gastroesophageal reflux, peptic ulcer disease, gallbladder, pancreatic or kidney disease . In addition, infection of the gastric antrum with Helicobacter pylori is now included in the differential diagnosis of chronic abdominal pain in children . H . pylori are "S" or "C" shaped, gram negative bacilli with a smooth outer coat and two to four unipolar flagella . There is no known natural reservoir for H . pylori in the environment . The mode of transmission is also unknown . Multiple drug therapy is necessary to maintain long-term eradication of the organism . Until epidemiologic data are determined, universal precautions should be employed in cases of suspected H . pylori infection. Mikrobiol Z, 1993 Jun-Aug, 55(4), 92 - 112 {The current concepts of the mechanisms of the therapeutic-prophylactic action of probiotics from bacteria in the genus Bacillus}; Smirnov VV et al.; Data from literature as well as the authors' experimental data on the mechanism of the effect of probiotics from aerobic sporeforming bacteria have been first generalized . The authors made a conclusion that the effect of biopreparations from bacilli is the multifactor process, when bacilli get to the gastrointestinal tract they begin producing biologically active substances which make the immediate effect on pathogenic and conditionally pathogenic microorganisms as well as activate specific and nonspecific systems of the macroorganism protection . The unknown before phenomenon of bacteria translocation is analyzed in detail as one of the most important factors of activation of non-specific resistance of the macroorganisms . Aerobic sporeforming bacteria produce a number of enzymes, amino acids, antibiotic substances and other biologically active substrates which add to the complex treatment-prophylactic effect of biopreparations from these bacteria . Prospects of the use of probiotics based on aerobic sporeforming bacteria in medicine and veterinary are considered . It is emphasized, in particular, that the potential multifactor character of the treatment-prophylactic efficiency of biological preparations from Bacillus is of positive value, since no negative effects are evoked by the known mechanisms of specific effect of aerobic sporeforming bacteria . This opens wide potentialities for improving the schemes and methods of application of probiotics from bacilli, creation of new forms of drugs on their base as well as to combine them with other preparations. J Clin Pathol, 1993 Jun, 46(6), 559 - 60 Safer staining method for acid fast bacilli; Ellis RC et al.; To develop a method for staining acid fast bacilli which excluded highly toxic phenol from the staining solution . A lipophilic agent, a liquid organic detergent, LOC High Studs, distributed by Amway, was substituted . The acid fast bacilli stained red; nuclei, cytoplasm, and cytoplasmic elements stained blue on a clear background . These results compare very favourably with acid fast bacilli stained by the traditional method . Detergents are efficient lipophilic agents and safer to handle than phenol . The method described here stains acid fast bacilli as efficiently as traditional carbol fuchsin methods . LOC High Suds is considerably cheaper than phenol. Pediatr Pathol, 1993 May-Jun, 13(3), 299 - 304 Neonatal tuberculosis; Gogus S et al.; We present an autopsy case of neonatal miliary tuberculosis in a 36-day-old baby that was born to a mother who had no symptoms . Histopathological examination of lungs revealed necrosis and numerous acid-fast bacilli . Mycobacterium tuberculosis hominis was isolated by guinea pig inoculation with lung tissue . Three months after dietary the mother was admitted with pleural effusion and endometrial biopsy showed a granulomatous inflammation compatible with tuberculosis . Intrauterine infection was considered and that was supported by retrospective findings of the endometrial biopsy . We also want to emphasize the importance of searching for genital tuberculosis even if the mother has no symptoms. J Infect, 1993 May, 26(3), 253 - 6 The treatment of neonatal meningitis due to gram-negative bacilli with ciprofloxacin: evidence of satisfactory penetration into the cerebrospinal fluid; Green SD et al.; We describe two cases of neonatal meningitis due to Gram-negative bacilli treated successfully with ciprofloxacin . Examination of serial samples of cerebrospinal fluid indicated the effect of meningeal inflammation on penetration of this drug into the CSF. Acta Cytol, 1993 May-Jun, 37(3), 329 - 32 Cytodiagnosis of tuberculous lymphadenitis . A correlative study with microbiologic examination; Gupta SK et al.; One hundred two of 272 cases of cytodiagnosis of tuberculous lymphadenitis were subjected to mycobacterial examination by Ziehl-Neelsen staining on direct and concentration smears and by culture . Cytomorphologically the cases were categorized into four types: 1, predominantly necrotic material; 2, typical caseating epithelioid cell granulomas and giant cell formation; 3, only noncaseating epithelioid cell granulomas with or without giant cells; and 4, doubtful presence of epithelioid cells . Ziehl-Neelsen staining for acid-fast bacilli (AFB) was positive in 25% in direct smears, 26.5% in concentration smears and 29.5% in both combined . The cultures for mycobacteria were positive in 49%; combined smear and culture positivity was found in 56.9% . Maximum culture positivity was seen in cases with type 1 smears (56.9%) followed by types 2 (44%) and 3 (40%) . The percentage of AFB positivity was similar in type 1 and type 2 smears (32.2% and 30%, respectively); however, AFB were present in large numbers in type 1 smears as compared to type 2 and 3 smears . In type 3 smears AFB positivity was found in 20% of cases . Cases with type 4 smears were negative for AFB in smears and culture . In eight cases (7.8%) the smears were positive for AFB, whereas the cultures were negative, indicating that negative culture examination still does not exclude the possibility of tuberculosis . However, culture is essential to a characterization and determination of drug sensitivity. J Antimicrob Chemother, 1993 May, 31(5), 749 - 54 Five-day treatment of non-severe, community-acquired pneumonia with josamycin; Mensa J et al.; This study assessed the efficacy of oral josamycin 1 g bd for five days as treatment for non-severe, community-acquired pneumonia in patients less than 60 years of age who were not at obvious risk of developing respiratory tract infection caused by aerobic Gram-negative bacilli . Of the 84 patients (43 male, 41 female) with a mean age of 33 years who were enrolled during a 14-month period, the clinical outcome was invariably favourable . All patients became afebrile within three days of starting therapy; the mean duration of fever after initiating treatment was 1.7 days . Therefore, according to the study protocol, josamycin therapy was discontinued on day five . A chest X-ray performed four to six weeks after completing treatment was normal in every case and no relapses were observed during a six-week follow-up period . We conclude that a five-day course of josamycin is effective monotherapy for community-acquired pneumonia in patients without the clinical features of severe infection. Kekkaku, 1993 May, 68(5), 361 - 5 {Effect of atypical mycobacterial infection on the cell-mediated immunity induced by Mycobacterium bovis BCG in mice . II . Suppression of protective immunity}; Nakamura RM; The protective immunity against virulent mycobacteria is induced by Mycobacterium bovis BCG in mice . It was found that a preceding infection with a strain of atypical mycobacteria, M . avium Mino, suppresses the BCG-induced protective immunity . In the present study, protective immunity was judged by the extended survival time after the challenge with virulent mycobacteria, M . bovis Ravenel . C57BL/10 mice receiving BCG vaccination with 10(7) live bacilli sc showed prolonged survival after 10(6) injection with M . bovis Ravenel iv . Infection of these mice with M . avium Mino, 10(6) iv, 2 weeks before BCG vaccination shortened the survival time significantly . This suppression of protective immunity was caused by CD8+ T cells . CD4+ T cells also had a weak suppressive effect on the protective immunity, but was not the main population of suppressor T cells . Thus, it was confirmed that atypical mycobacterial infection produces CD8+ suppressor T cells which inhibit both protective immunity and delayed-type hypersensitivity induced by BCG. Kekkaku, 1993 May, 68(5), 351 - 60 {Tuberculin sensitivity to purified protein derivatives from Mycobacterium other than tuberculosis (PPD-B, PPD-Y, PPD-F and PPD-C) and PPDs among patients with mycobacteriosis--cooperative study of the Research Committee for the Mycobacteriosis in Japan}; Shigeto E et al.; Purified protein derivatives (PPDs) prepared from M . intracellulare (PPD-B), M . kansasii (PPD-Y), M . fortuitum (PPD-F), M . chelonei subsp . abscessus (PPD-C) and M . tuberculosis (PPDs) were simultaneously used in skin tests on patients diagnosed as having tuberculosis or atypical mycobacteriosis to reveal their specificity, clinical usefulness and immunological status of the patients . The mean diameter of reaction (redness) for patients with M . tuberculosis positive sputum (TB group, n = 71; age, 20-90 yrs) was PPDs, 20.4 mm; PPD-B, 7.9 mm; PPD-Y, 11.7 mm; PPD-F, 0.8 mm; and PPD-C, 0.3 mm . For M . avium complex positive patients (MAC group, n = 100; age, 31-89 yrs), the results were PPDs, 10.9; PPD-B, 16.9 mm; PPD-Y, 10.7 mm; PPD-F, 1.6 mm; and PPD-C, 0.3 mm . The M . kansasii positive patients (K group; n = 8) showed results of PPDs, 12.6 mm; PPD-B, 10.7 mm; PPD-Y, 20.8 mm; PPD-F, 0.5 mm; PPD-C, 0.0 mm . The M . fortuitum positive patients (F group; n = 5) had measurements of PPDs, 5.8 mm; PPD-B, 4.4 mm; PPD-Y, 9.8 mm; PPD-F, 17.8 mm; and PPD-C, 16.0 mm . The patients who were previously M . tbc . positive but presently negative patients (pre . TB group; n = 50) showed the following results: PPDs, 16.6 mm; PPD-B, 7.4 mm; and PPD-Y, 10.9 mm . For the patients who were previously M . avium complex positive (previous MAC group; n = 19), the results were PPDs, 10.4 mm; PPD-B, 9.9 mm; and PPD-Y, 7.7 mm . Also considering their frequency distribution curve, with exception of the previous MAC group, the patient groups showed specificity to the PPD of the bacilli detected . The previous MAC group recorded no significant difference in response to PPDs and PPD-B . Strong cross reactions were observed between PPD-F and PPD-C, and moderate reactions between PPDs, PPD-B and PPD-Y . Cross reactions were scarce between PPDs, PPD-B or PPD-Y and PPD-F or PPD-C . Though it is difficult to distinguish cross-reaction and multiple infections, majority of the patients (72-85%) showed greatest response to the PPD that corresponds with the species of bacilli detected . In conclusion, two or more PPDs applied simultaneously can be of aid in diagnosing mycobacteriosis especially in the early stages of the disease . Also, cross-reactions between atypical mycobacteria and PPDs should be taken into consideration when diagnosing infection caused by M . tuberculosis. J Clin Pharmacol, 1993 May, 33(5), 470 - 4 Pharmacokinetics of aztreonam in healthy elderly and young adult volunteers; Meyers BR et al.; Aztreonam is a monobactam exhibiting an antibacterial spectrum similar to that of the aminoglycosides, with activity against aerobic gram-negative bacilli, and is the only related drug that may be given to patients hypersensitive to beta-lactams . The pharmacokinetics of aztreonam were compared in two groups of healthy volunteers . The young group comprised 10 adults between the ages of 18 and 30 years, and the elderly group included 10 adults older than 65 years of age . The two groups each received two doses (1 and 2 g) aztreonam, separated by 1 week . Although the mean peak serum concentrations of aztreonam for the two groups were similar, there were differences in other pharmacokinetic parameters . For example, for the 2-g dose the mean half-life (1.8 +/- .51 versus 3.1 +/- .9 hour), and area under the curve (AUC) (294.42 +/- 64.08 versus 469.01 +/- 144.02 micrograms x hour/mL per 1.73 m2) were less for the younger group compared with the elderly group . The mean total body clearance of aztreonam was greater for the younger than the elderly group . The results were similar to the pharmacokinetic parameters derived from the 1-g dose . These results mirror the lower creatinine clearances and higher serum creatinine levels found in the elderly group . The data suggest that lower doses of aztreonam given at less frequent intervals may be appropriate in the elderly population. Kansenshogaku Zasshi, 1993 May, 67(5), 482 - 6 {Pneumonia due to respiratory syncytial virus diagnosed by transtracheal aspiration in an adult}; Konishi M et al.; A healthy-looking 44-year-old female was admitted to our hospital complaining of fever and hemosputum . The chest roentgenogram on admission showed patchy infiltrates of the segment 3 and 8 of the right lung . Laboratory studies showed a leukocyte count of 9700/microliters, erythrocytes sedimentation rate of 55 mm/hour and C reactive protein of 8.7 mg/dl . The arterial PO2 was 71.9 torr while the patient was breathing room air . Transtracheal aspiration was performed on admission, and strains and culture for bacteria, acid fast bacilli, fungi and mycoplasma were negative . Respiratory syncytial virus was isolated from transtracheal aspirates . The RSV complement fixing antibody titers rose from 1:40 to 1:16 . She became afebrile on the fourth day after admission and her chest roentgenogram improved gradually . RSV infection should be considered in the differential diagnosis of atypical adult pneumonias. Kansenshogaku Zasshi, 1993 May, 67(5), 421 - 8 {Detection and identification of mycobacterial DNA with sputa and AIDS samples by nested-polymerase chain reaction (nested-PCR)}; Uematsu K et al.; We have demonstrated the nested-polymerase chain reaction (nested-PCR) assay detected from 14 mycobacterial species . We have further demonstrated the species specific restriction sites within amplified dnaJ gene, which allowed us to differentiate the mycobacterial DNA by combination of the PCR with the restriction fragment length polymorphism (PCR-RFLP) . Nested-PCR-RFLP was used to detect and identified mycobacterial DNA in the sputa samples and HIV related samples . The target DNA was a 196-base pair segment of dnaJ gene . Of 68 sputum samples tested, 7 were smear positive for acid-fast bacilli and culture . The 7 samples were also identified with Mycobacterium tuberculosis by PCR-RFLP . We tested 69 HIV related samples (19 frozen samples, 22 paraffin embedded samples and 28 lymphocyte from HIV infected people) . Of 38 samples were positive for nested-PCR, 8 M . tuberculosis complex, 7 M . avium, 8 M . intracellulare, and 16 others were detected by PCR-RFLP . The PCR method is useful for the rapid diagnosis of mycobacterial infection. J Oral Pathol Med, 1993 May, 22(5), 235 - 9 Oral mucosal bacillary epithelioid angiomatosis in a patient with AIDS associated with rapid alveolar bone loss: case report; Glick M et al.; Oral manifestations of bacillary epithelioid angiomatosis have been described in the literature, but without histopathologic evidence confirming the presence of the etiologic bacilli . The clinical and histopathologic similarities between bacillary epithelioid angiomatosis and Kaposi's sarcoma may have contributed to confusion in diagnosis and treatment of the latter . Furthermore, inclusion of bacillary epithelioid angiomatosis in the differential diagnosis of proliferative vascular lesions may help to clarify the etiology, pathology and epidemiology of these lesions . This article is the first report of the intraoral manifestation of bacillary epithelioid angiomatosis with histopathologic documentation of the causative pathogen. East Afr Med J, 1993 May, 70(5), 263 - 6 A comparative study on the reliability of the fluorescence microscopy and Ziehl-Neelsen method in the diagnosis of pulmonary tuberculosis; Githui W et al.; Pulmonary tuberculosis (PTB) is the most common presentation of tuberculosis (TB) in Kenya . For the diagnosis of PTB the sputum smear is used because it is technically simple, non-invasive and cheap . The reliability of direct smear examination for the diagnosis of TB has however frequently been questioned . To address this problem, a study comparing the reliability of fluorescence microscopy (FM) and Ziehl-Neelsen (ZN) staining method for examination of direct smear in the diagnosis of PTB was carried out at the Respiratory Disease Research Unit Laboratory, Nairobi, Kenya . A total of 1480 sputum specimens collected from patients with suspected PTB were analyzed . Two direct smears were prepared from each specimen, one stained using FM and the other using the ZN method . Culture results were used as the gold standard for assessment . Specificity was 97% and 96% for FM and ZN methods, respectively . The sensitivity of the FM method was 80% and that of the ZN method 65% (p < 0.001) . Overall agreement was 86.8% . Positive smears which were missed on the ZN stained smears (15%) contained low density bacilli on both FM stained smears and on culture . The use of FM greatly improves the diagnostic value of the sputum smear especially in patients with a low density of bacilli who are likely to be missed on ZN stained smears . The method is economical in both time and expense and is recommended for laboratories handling large numbers of sputum specimens. New Horiz, 1993 May, 1(2), 181 - 6 Cephalosporin therapeutics for intensive care infections; Salacata A et al.; Third generation cephalosporins are valuable agents in the ICU setting because of their broad spectrum of activity, in vitro potency against the Gram-negative bacilli commonly isolated in the ICU, and excellent penetration into most body sites . Multiresistant organisms may emerge as a result of widespread injudicious use of these agents, and this possibility is of special concern since these organisms may be associated with higher mortality rates . Combination therapy may be superior to monotherapy in severely ill patients with Gram-negative bacteremia . Double-beta lactam therapy has been efficacious in selected patients, although this regimen has several theoretical disadvantages . When third-generation cephalosporins are used for Gram-negative rod bacteremia in the ICU, combination therapy with an aminoglycoside should be considered. Infect Immun, 1993 May, 61(5), 1835 - 45 The mycobacterial secreted antigen 85 complex possesses epitopes that are differentially expressed in human leprosy lesions and Mycobacterium leprae-infected armadillo tissues; Rambukkana A et al.; The granulomatous skin lesions in leprosy are thought to be initiated by the immune response to certain antigens of the causative agent, Mycobacterium leprae . The antigen 85 complex is one of the major targets in the immune response to M . leprae infection . In the present study, a panel of previously characterized monoclonal antibodies (MAbs) (3A8, Rb2, A4g4, A2h11, Pe12, and A3c12) reacting with different epitopes of the 85 complex proteins of Mycobacterium tuberculosis and M . leprae was employed in a comparative immunohistological analysis to demonstrate the in situ expression of 85 complex antigenic epitopes in leprosy lesions across the clinical spectrum and in M . leprae-infected armadillo liver tissues . These MAbs showed a heterogeneous staining pattern in a given leprosy lesion . In highly bacilliferous borderline and lepromatous leprosy lesions, MAbs Rb2, A4g4, A2h11, and Pe12 stained clear rod-shaped M . leprae bacilli within macrophages, and the degree of staining correlated with the bacillary index of the lesion . On the other hand, MAbs 3A8 and A3c12 staining was mostly seen as a diffuse staining pattern within interstitial spaces and on the membranes of the infiltrated cells but not the bacilli . In paucibacillary borderline and tuberculoid leprosy lesions, only 3A8, Rb2, and A3c12 showed distinct staining in association with infiltrates in the granuloma . None of these MAbs showed any detectable reaction with control nonleprosy skin lesions, while MAb A3c12 positively stained the granulomas of both leprosy and control specimens . In situ reactivity of these MAbs with M . leprae-infected armadillo liver tissues also showed a heterogeneous staining pattern . Interestingly, a clear difference in expression of these epitopes was observed between armadillo tissues and human leprosy lesions . By immunogold ultracytochemistry, we further showed the differential localization of these MAb-reactive epitopes on the cell surface, in the cytosol, and at the vicinity of M . leprae within Kupffer cells of armadillo liver tissues . Our results indicate that these antigenic epitopes of the antigen 85 complex are differentially expressed in leprosy lesions and infected armadillo tissues and that they could be target determinants in the immunopathological responses during M . leprae infection. Lancet, 1993 Apr 10, 341(8850), 911 - 3 Gastroduodenal dysfunction and bacterial colonisation of the ventilated lung; Inglis TJ et al.; The source of ventilator-associated pneumonia (gastric or oropharyngeal flora) remains controversial . We investigated the source of bacterial colonisation of the ventilated lung in 100 consecutive intensive-care patients . Gram-negative bacilli were isolated from the lower respiratory tract in 19 patients . Bacteria isolated from the stomach contents either previously or at the same time were identical to lower respiratory isolates in 11 patients . No gram-negative oropharyngeal isolate was identical to a lower respiratory tract isolate . Gastric bacterial overgrowth with gram-negative bacilli was associated with the presence of bilirubin in the stomach contents . Detectable bilirubin was also associated with subsequent acquisition of gram-negative bacilli in the lower respiratory tract . Only 5 gastric aspirate specimens with pH < 3.5 contained gram-negative bacilli . These results establish a relation between duodenal reflux and subsequent bacterial colonisation of the lower respiratory tract . Restoration of normal gastroduodenal motility might help prevent pneumonia in intensive-care patients. Clin Infect Dis, 1993 Apr, 16(4), 555 - 7 A cutaneous lesion in a patient with AIDS: an unusual presentation of infection due to Mycobacterium avium complex; Clark JA et al.; A patient with AIDS developed a purplish, necrotic skin lesion followed by fevers, constitutional symptoms, and watery diarrhea . Stains of samples from the skin lesion and of stool and bone marrow revealed acid-fast bacilli, and Mycobacterium avium was isolated from cultures of these specimens and blood . With the initiation of multiagent oral antimycobacterial therapy, the patient's symptoms abated and the cutaneous lesion reepithelialized . We believe this lesion to be a manifestation of disseminated infection due to Mycobacterium avium complex (MAC) . As the population of patients with AIDS who have CD4 cell counts of < 100/mm3 increases, new and unusual manifestations of disseminated MAC infection can be expected . New oral agents with increased activity against MAC may make early recognition and treatment of MAC infections more rewarding. Kekkaku, 1993 Apr, 68(4), 319 - 23 {A case of streptomycin-induced lupus}; Toyoshima M et al.; A case of streptomycin-induced lupus occurring in a 48-year-old female is presented . She was admitted to our hospital in July 1990, complaining of productive cough and general fatigue . A chest roentgenogram showed cavitary lesions and infiltrative shadows in the bilateral upper and middle lung fields and a sputum smear tested positive for acid-fast bacilli . She was diagnosed as lung tuberculosis and antituberculous therapy with isoniazid, rifampicin and streptomycin was started . Ten days after starting the treatment, she began to complain of high fever and erythema on her face and forearms . Blood cell count revealed leucopenia . The antinuclear antibody and antihistone antibody were positive . The improvement of clinical findings and the lowering of antinuclear antibody titer seen after stopping streptomycin confirmed the diagnosis as streptomycin-induced lupus . Streptomycin-induced lupus is very rare. Br J Surg, 1993 Apr, 80(4), 512 - 6 Colonic bacteria and bacterial translocation in experimental colitis; Gardiner KR et al.; The indigenous intestinal flora and an intact mucosa are vital components of body defences against luminal pathogenic bacteria . Disruption of these defences in inflammatory bowel disease may permit bacterial translocation and contribute to disease severity . Support for this hypothesis comes from this study of a hapten-induced rat model of colitis . Induction of colitis was associated with a significantly increased colonic Gram-negative aerobic bacilli count . The results, expressed as log10 {colony-forming units per gram tissue} were: colitic 6.97-8.86 versus control 4.90-6.69 (P < 0.05) . Colitis was also associated with a decreased Gram-positive cocci count at 4.00-8.04 versus control 6.45-8.30 (P < 0.05) . Bacteria translocated to the mesenteric lymph nodes in five of eight colitic rats (P = 0.01), to the spleen in four (P = 0.04) and to the liver in five (P = 0.01) but to these organs in none of the eight control animals . There was a positive correlation between the severity of colonic inflammation and extent of bacterial translocation in colitic animals (rs = 0.86, P = 0.007). J Clin Microbiol, 1993 Apr, 31(4), 990 - 3 Mycobacteriosis due to Mycobacterium genavense in six pet birds; Hoop RK et al.; Six cases of mycobacteriosis due to Mycobacterium genavense in three budgerigars (Melopsittacus undulatus), one orange-winged amazon (Amazona amazonica), one flycatcher (Cyanoptila cyanomelana), and one zebra finch (Taeniopygia guttata) are discussed . Gross lesions associated with the infection included a high degree of muscular wasting (five cases), hepatomegaly (four cases), and thickening of the wall of the small intestine (four cases) . Granulomas were found in the lung (one case) and the subcutis (one case) . Acid-fast bacilli were detected in the liver of all six birds . Only the use of acidic BACTEC mediums consistently led to growth, whereas the egg-based medium failed . These findings point to a possible role of the environment as a reservoir for M . genavense. J Clin Microbiol, 1993 Apr, 31(4), 895 - 9 Evaluation of polymerase chain reaction amplification of Mycobacterium leprae-specific repetitive sequence in biopsy specimens from leprosy patients; Yoon KH et al.; Biopsy specimens were obtained from 102 leprosy patients before chemotherapy and examined by polymerase chain reaction (PCR) using the primers amplifying the 372-bp DNA of a repetitive sequence of Mycobacterium leprae . The PCR results were then compared with bacterial indices (BI) of slit-skin smears and biopsy specimens . The intensities of DNA bands were in general correlated with the numbers of acid-fast bacilli, and even a sample with only one organism gave a PCR positive result . Ten 5-micron sections from each frozen tissue sample were pooled and processed for DNA preparation . PCR was positive for 11 (73.3%) of 15 biopsy specimens with BI of 0 determined for the paraffin sections from the same biopsy samples . PCR also gave positive results for 84 (96.6%) of 87 BI positive biopsy samples . Although the difference in overall results between the two methods was not statistically significant, PCR seemed to have an advantage over microscopic examination in detecting M . leprae in biopsy specimens negative for acid-fast bacilli . Further evaluation of PCR using more specimens from leprosy patients who are bacteriologically negative is warranted to ensure PCR's advantage over the conventional microscopic examination for the diagnosis of leprosy. J Clin Microbiol, 1993 Apr, 31(4), 771 - 5 Current practices in mycobacteriology: results of a survey of state public health laboratories; Huebner RE et al.; Fifty-six state and territorial public health laboratories were surveyed to determine whether currently available rapid methods for the identification and drug susceptibility testing of Mycobacterium tuberculosis were being performed . Forty (71%) laboratories use fluorochrome rather than conventional basic fuchsin stains for screening clinical specimens for acid-fast bacilli . Of the 55 laboratories that routinely culture for mycobacteria, 16 (29%) use the more rapid radiometric methods . Species identification of isolates is done by biochemical tests in 13 (23%) laboratories; 40 (72%) use nucleic acid probes, high-performance liquid chromatography, or the BACTEC p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test (rapid tests); 3 laboratories do not perform species identification . Drug susceptibility testing is performed with solid media by 36 of 45 (80%) laboratories, while the more rapid radiometric methods are used by 9 (20%) laboratories . Compared with the laboratories that use conventional methods, laboratories that use rapid methods report results more quickly: for species identification, 43 days (conventional) versus 22 days (rapid); for drug susceptibility testing, 44 days (conventional) versus 31 days (rapid) from specimen processing . Rapid technologies for microscopy and species identification are being used by many, but not all, state and territorial public health laboratories; however, most laboratories do not use the more rapid radiometric methods for r