Bacillus

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 routine culture or drug susceptibility testing of mycobacteria . Implementation of such rapid technologies can shorten turnaround times for the laboratory diagnosis of tuberculosis and recognition of drug resistance.

J Vet Med Sci, 1993 Apr, 55(2), 337 - 9
Tyzzer's disease complicated with distemper in a puppy; Iwanaka M et al.; A Pomeranian puppy which died from diarrhea and nasal discharge showed catarrhal pneumonia, acute enteritis and focal liver necrosis . Slender bacilli were detected within ileal enterocytes and hepatocytes . A double infection with a distemper virus and Tyzzer's organism at a cellular level was seen within the ileal enterocytes.

Avian Dis, 1993 Apr-Jun, 37(2), 612 - 5
Isolation of Mycobacterium avium from ringneck pheasants (Phasianus colchicus); Singbeil BA et al.; Tuberculous lesions were observed at necropsy in the liver, spleen, and intestine of five 10-month-old ringneck pheasants (Phasianus colchicus) from a flock of birds raised in captivity for breeding . Histological examination of the tissues revealed granulomas with associated acid-fast bacilli . The history and lesions are unusual in that very few bacteria were found in any given lesion, the birds were all in good flesh when necropsied, and five birds from this same group at 6 months of age were observed to have acid-fast bacteria in the small intestine . Mycobacterium avium was isolated and serotyping was attempted, but the colonies were too dry to serotype.

Indian J Lepr, 1993 Apr-Jun, 65(2), 163 - 71
Observations on attempted leprosy cultures in two media; Bhatia VN et al.; Suspensions of skin tissue material collected from lepromatous leprosy patients and material from mouse foot-pad harvests were inoculated into two media, viz., a biphasic medium and a minimal basal medium . The cultures were incubated at 37 degrees C and 15 degrees C . Small oval (or round) cells appeared in these cultures around the tenth day along with a few cystic structures; and they increased in number later, reaching the maximum around six-seven weeks . The above cells appeared acid-fast in some cultures and some of them appeared to split into pairs of acid-fast bacilli . The cells were most often seen in the biphasic medium at 37 degrees C . The identity of these structures is not known at this stage.

J Dermatol, 1993 Apr, 20(4), 226 - 30
Two sisters with leprosy; Ishii N et al.; Leprosy is a rare entity in Japan, but remains quite common in developing countries . We report two sisters with leprosy from Brazil but currently working in Japan who presented to our clinic . The younger sister was infected with the BB type with HLA-A2, A24, B51, Bw52, DR2, DRw8, DRw52, DQw1, and DQw3 . The elder sister had the TT type with HLA-A2, A31, B51, Cw3, DRw6, DRw8, DRw52, DQw1, and DQw3 . Immunohistochemical findings revealed that CD4+, 4B4+ helper/inducer T-cells were dominant in the granulomas of both cases . Bacilli were not detectable in the biopsy specimens . However, Mycobacterium leprae-specific DNA fragments were found in their peripheral blood and biopsy specimens by polymerase chain reaction.

J Assoc Physicians India, 1993 Apr, 41(4), 193 - 4
Bacteriology of spirometer tubing and evaluation of methodology to prevent transmission of infection; Singh V et al.; Transmission of respiratory infection by a spirometer is a definite risk in countries like India where a majority of respiratory diseases are infective in nature . To assess this problem, scrapings and washing from a spirometer tube in regular use were taken for microbiological studies . Significant bacterial growth on culture included Aspergillus and acid fast bacilli . In order to check contamination, a segregation chamber was attached to the spirometer . Twenty-three patients used the spirometer with or without segregation chamber and a good correlation was shown between the two methods in forced expiratory volume in one second (r = 0.94), forced vital capacity (r = 0.92) and mid maximum expiratory flow rate (r = 0.90) . It can be concluded that a spirometer may have significant growth of pathogenic bacteria and a segregation chamber may be used routinely with the spirometer in order to prevent its contamination.

Presse Med, 1993 Mar 27, 22(11), 532 - 4
{Rochalimaea henselae infection . Febrile pancytopenia and hepatic peliosis in a patient with HIV infection}; Quint L et al.; A case of Rochalimaea henselae infection in an AIDS patient is reported . The R . henselae infection was revealed by febrile pancytopenia associated with liver and spleen enlargement . The diagnosis was made on the finding at histology of hepatic peliosis lesions . Within these lesions Warthin Starry staining displayed bacilli that were identified as R . henselae . This case shows that all HIV-infected patients with these symptoms might be infected with this organism.

Schweiz Med Wochenschr, 1993 Mar 6, 123(9), 391 - 7
{Suspected adult-onset Still's disease: unexpected manifestation of leprosy}; Weber M et al.; A 23-year old male from Sri Lanka was admitted to hospital with symmetrical inflammatory peripheral polyarthritis, fever of 39 degrees C and poly-lymphadenopathy . At first we suspected adult onset Still's disease . The histological findings from axillary lymph node biopsy strongly suggested the diagnosis of leprosy, for which we had had little evidence thus far . Typical skin lesions were absent, skin smears were negative and neurological symptoms only became obvious much later when fever and arthritis had subsided under anti-inflammatory treatment . At this time a right ulnar palsy developed, with atrophy of the interosseous muscles and thickening of the ulnar nerves at both medial epicondyles . Fite-stains of a sural nerve biopsy confirmed the diagnosis when mycobacteria were detected . Leprosy displays a clinico-pathological spectrum caused by variations in host resistance . A widely accepted classification is the five group system of Ridley and Jopling . At one extreme of this spectrum are patients with lepromatous or low resistance leprosy with numerous bacilli, and at the other those with high resistance or tuberculous leprosy where few or no bacilli are found . The numerous bacilli in the sural nerve biopsy classified the disease as lepromatous in our case . Of the various manifestations of the lepra reaction occurring in lepromatous leprosy, one is acute arthritis, but a more common one is erythema nodosum leprosum . Our patient's clinical presentation was interpreted to be a rheumatic manifestation of a type-2 reaction . This form of immunological response in leprosy is an immune complex syndrome and may mimic different rheumatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Immunol Med Microbiol, 1993 Mar, 6(2-3), 121 - 4
Classification of black-pigmented anaerobes by pyrolysis mass spectrometry (PMS) and conventional tests (CTs); Duerden BI et al.; Clinical (66: dental 53; vaginal 4; wound 9) and reference (5*) strains of pigmented Gram-negative anaerobic bacilli were examined in pyrolysis mass spectrometry (PMS) and conventional tests (CTs) . The strains were identified in CTs as: Prevotella intermedia (48*); Pr . melaninogenica (1); Pr . corporis (7); Porphyromonas asaccharolytica (12*); P . endodontalis (1*) and P . gingivalis (2*) . Numerical classification based on CTs resolved five clusters comprising strains identified as (I) Pr . corporis, (II) Pr . melaninogenica, (III) Pr . intermedia, (IV) P . gingivalis and (V) P . asaccharolytica and P . endodontalis . Numerical classification based on PMS showed a similar division, with decreasing homogeneity in the order Pr . intermedia, Pr . corporis, P . asaccharolytica, in agreement with the ordering of homogeneity for these species in CTs . PMS clusters corresponding the Porphyromonas spp . were clearly distinct from those of Prevotella spp . PMS and CT classifications disagreed on cluster membership for only six of the strains . PMS identification from blind challenge sets agreed with conventional identification for 64 of 67 strains.

Trop Med Parasitol, 1993 Mar, 44(1), 37 - 9
Comparative analysis of the clinicopathological features in cutaneous leishmaniasis and lupus vulgaris in Turkey; Paksoy N et al.; Cutaneous leishmaniasis (LC) and lupus vulgaris (LV) are commonly encountered in the Mediterranean region of Turkey . Differential diagnosis is rather difficult and unreliable purely on clinical grounds; thus histopathological examination is required . Microscopical findings of both lesions may also present some similarities . 12 LC and 16 LV cases were analysed comparatively regarding the clinicopathological features . In the early stage of LC, macrophage granulomas containing numerous leishmania parasites was the key microscopic finding . In the late stage of LC, granulomas consisted of epithelioid histiocytes with scanty organisms were present . LV biopsies showed tuberculoid granulomas with Langhans type giant cells in all cases, and acid fast bacilli were detected only in two cases.

Jpn J Antibiot, 1993 Mar, 46(3), 269 - 73
Bacterial flora detected in the uterine endometrial cavity of normal puerperae on the puerperal first day and on the puerperal fifth day after incidental use of cefpodoxime proxetil; Mikamo H et al.; In Japan, oral antimicrobial agents are prophylactically used with oxytocics after normal delivery to prevent puerperal infections . The present study was designed to investigate bacterial floras in the endometrial cavity immediately after normal delivery and the effect of prophylactic use of anti-microbial agents on those floras . Sixty-six puerperae who underwent uneventful courses of pregnancy and delivery were subjected for this study . Intrauterine contents were collected on the first day and the fifth day of the puerperium and submitted to microbiological examinations . Cefpodoxime proxetil (CPDX-PR) was orally given to the puerperae for prophylaxis for 5 days after the initial sampling . On the puerperal first day, a total of 98 strains (71 strains of aerobic bacteria, 27 strains of anaerobic bacteria) was detected in the uteri of the 66 subjects . The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 59.2%, 12.2%, 27.6% of the 98 strains, respectively . On the puerperal fifth day, a total of 82 strains (51 strains of aerobic bacteria and 31 strains of anaerobic bacteria) were detected in the uteri of the 66 subjects . The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 52.5%, 8.6% and 37.7% of 82 strains, respectively.

Mikrobiol Zh, 1993 Mar-Apr, 55(2), 88 - 94
{The use of the neustonic forms of bacilli for purifying and decontaminating reservoirs}; Stabnikova EV et al.; It is shown possible to select the bacterial strains which are neuston ones, i.e., concentrating on the water-atmosphere interface . The preparation based on the neuston form of Bacillus megaterium is more efficient for purification of water polluted with oil hydrocarbons than the preparation based on the planktonic form of the same culture . Preparation based on the neuston form of the aerobic spore-forming bacteria is effective for biological decontamination of sewage treated using conventional methods . Application of neuston bacterial forms permits intensifying the microbiological processes in the thin (15-40 microM) surface layer of water bodies.

Infection, 1993 Mar-Apr, 21(2), 89 - 92
CSF shunt infections in children; Kontny U et al.; The incidence of shunt infections and possible risk factors was investigated by chart analysis . From 1986 to 1989 350 shunt procedures were performed including 273 ventriculoperitoneal shunts and 75 ventriculoatrial shunts . Twenty-eight infectious episodes (8%) occurred in 25 patients during a median follow-up time of 20 months . For 204 patients the follow-up time could be prolonged until September 1992 . In these patients no infectious episodes occurred in the extended observation period . In 24 cases (85.7%) a causative organism could be isolated . The infecting organisms were gram-positive cocci in 22 cases (78.6%) and gram-negative bacilli in two cases . The main signs and symptoms were fever, shunt malfunction and meningeal irritation, and with VP-shunts only, abdominal pain . Twenty-four infectious episodes were treated with antibiotics and immediate removal of the shunt . The remaining were managed with antibiotics only . The risk for shunt infection did not correlate with age or sex of patients, nor with the etiology of hydrocephalus, type of shunt implanted or perioperative antibiotic prophylaxis . However, a trend showing a higher risk for shunt infections with prolonged operation time was noticed . The infection rate was 13.6% for an operation lasting more than 90 minutes versus 5.2% for procedures of less than 30 minutes duration.

Rinsho Ketsueki, 1993 Mar, 34(3), 243 - 50
{Complications and management of hematopoietic malignancy therapy}; Horiuchi A; Infection and refractoriness to platelet transfusion, as complications in hematopoietic malignancy therapy, were investigated . The Hanshin Study Group of Hematopoietic Disorders and Infection treated with 3,346 cases of bacterial infection (7.8% sepsis, 71% sepsis suspected, 13.7% respiratory infection) during the past 13 years . A total of 688 strains were detected as causative organisms, 59.2% being gram-negative bacilli and 40.3% gram-positive bacteria . Comparison of the detection rates obtained 10 years ago and those obtained in the last three years showed a decrease from 73.8% to 46.8% for gram-negative bacilli and an increase from 25.1% to 53.2% for gram-positive bacteria . Twenty-eight antibiotics administered singly and nine combinations of two drugs administered concomitantly were assessed . Efficacy rates were 43.9% to 67.2% for single-drug administration and 35.2% to 64.2% for concomitant administration . Notably, some combinations were less effective than single-drug administration . Of 153 cases of fungal infection seen in the last three years, 80% were caused by the genus Candida . Two antifungal drugs were used, with efficacy rates ranging from 45.5% to 70.0% . In 150 patients undergoing frequent transfusion, anti-HLA alloantibody was measured . The positive rate was 32.9% . In 76 subjects receiving leukocyte-depleted platelet transfusion using a polyester filter, a decreased alloantibody positive rate of 17.1% was obtained.

Microbiol Rev, 1993 Mar, 57(1), 109 - 37
Protein secretion in Bacillus species; Simonen M et al.; Bacilli secrete numerous proteins into the environment . Many of the secretory proteins, their export signals, and their processing steps during secretion have been characterized in detail . In contrast, the molecular mechanisms of protein secretion have been relatively poorly characterized . However, several components of the protein secretion machinery have been identified and cloned recently, which is likely to lead to rapid expansion of the knowledge of the protein secretion mechanism in Bacillus species . Comparison of the presently known export components of Bacillus species with those of Escherichia coli suggests that the mechanism of protein translocation across the cytoplasmic membrane is conserved among gram-negative and gram-positive bacteria differences are found in steps preceding and following the translocation process . Many of the secretory proteins of bacilli are produced industrially, but several problems have been encountered in the production of Bacillus heterologous secretory proteins . In the final section we discuss these problems and point out some possibilities to overcome them.

Contraception, 1993 Mar, 47(3), 303 - 6
Intravasal application of BCG (Bacille Calmette Guerin) is not an effective method for control of fertility in the male: a preliminary report; Singh SK et al.; Bacille Calmette Guerin (BCG) was applied intravasally in male rats with the hope of developing a method for control of fertility in the male . Our results, however, suggest that this approach is not feasible for control of male fertilityPIP: Some researchers had proposed earlier that Bacille Calmette Guerin (BCG) injected intratesticularly would cause an autoimmune response against haploid spermatogenic cells, thereby bringing about azoospermia . Yet, research showed that the injection caused transient scrotal swelling and pain . So urologists from Salzburg, Austria, General Hospital conducted laboratory research to determine the feasibility of intravasal administration of BCG in controlling male fertility . They used a catheter to administer BCG (1 million bacilli) into the lumen of the vas deferens of 12 adult male rats (220-240 gm) . The spermatozoa removed from the affected vas deferens had normal morphology and their motility was normal . This technique did not cause any granuloma formation . The histological features of the testis, epididymis, and vas deferens on the side where BCG was administered were identical to the normal features of the same organs on the other side . None of the organs exhibited any inflammatory reactions . These results indicated that BCG cannot control male fertility .

J Clin Microbiol, 1993 Mar, 31(3), 665 - 70
Simple colorimetric microtiter plate hybridization assay for detection of amplified Mycobacterium leprae DNA; van der Vliet GM et al.; The detection of amplified products resulting from polymerase chain reactions (PCRs) remains a complicated process . To simplify the detection procedures, we developed a colorimetric microtiter plate hybridization assay for the specific detection of 5'-biotinylated PCR fragments of Mycobacterium leprae DNA . For this assay, an M . leprae DNA capture probe was made and immobilized on the wells of a microtiter plate . Hybridization of the biotin-labeled PCR fragments was detected through enzymatic color development . The resulting optical densities showed a logarithm-linear relationship with the amount of template DNA and corresponded to the intensity of the bands obtained through gel analysis and Southern blotting of the PCR products . The sensitivity of the assay was found to be 125 fg of genomic M . leprae DNA, or 20 lysed bacilli, revealing a detection limit similar to that of agarose gel analysis . The efficient coamplification of human DNA was used as a positive control for the presence of inhibitory substances in clinical material . For detection of human PCR products, a human DNA capture probe was also constructed for the colorimetric assay . This dual setup for hybridization, which thus detected both M . leprae and human DNA PCR products, was useful for ascertaining the presence of inhibiting substances in clinical specimens . All biopsy specimens (n = 10) from untreated patients with leprosy were positive . Apparently, this assay is more sensitive than microscopy, because biopsy specimens from half of the patients were negative upon histopathological examination . Biopsy specimens from three treated patients were negative, as were those from the three patients who did not have leprosy . We conclude that this colorimetric assay can replace agarose gel analysis and Southern hybridization, because it is as sensitive as those methods . Its advantages over conventional gel analysis and Southern hybridization are that it is less cumbersome and more rapid.

Dis Colon Rectum, 1993 Mar, 36(3), 240 - 6
Is aggressive management of perianal ulcers in homosexual HIV-seropositive men justified?
Schmitt SL, Wexner SD, Nogueras JJ, Jagelman DG.
A study was undertaken to assess the etiology, optimal diagnostic method, and incidence of healing of perianal ulcers in HIV-seropositive men . Between March 1990 and December 1991, 26 HIV-seropositive homosexual or bisexual males were referred with perianal ulcerations . According to CDC criteria, three (12 percent) were Class II, six (23 percent) were Class III, and 17 (65 percent) were Class IV . Eighteen patients had one ulcer, five had two ulcers, and two had three ulcers . In one patient the ulcer was circumanal . Patients with superficial erosions were not included . Biopsies were obtained in 23 patients for routine microscopy, HIV, cytomegalovirus, herpes simplex virus, and acid-fast bacilli . Biopsy revealed an immunoblastic lymphoma in one patient . A comparison of microscopy and culture results revealed culture to be more helpful in determining the etiology of these ulcers . Medical treatment included reverse transcriptase inhibitors (zidovudine, dideoxyinosine, and dideoxycytosine), oral and topical Zovirax (Burroughs Wellcome, Research Triangle Park, NC), ganciclovir, and oral broad-spectrum antibiotics . Surgical treatment included lateral internal sphincterotomy in three patients and seton placement in one patient . Follow-up for at least four weeks was obtained in 22 patients . Overall, healing occurred in 15 patients (68 percent): three (20 percent) were Class II, four (27 percent) were Class III, and eight (53 percent) were Class IV . Healing occurred in all four patients who underwent surgical treatment . In conclusion, aggressive diagnostic maneuvers allow the use of both medical and conservative surgical measures to successfully treat the majority of perianal ulcers in this patient population.

Infect Immun, 1993 Mar, 61(3), 844 - 51
Specificity of a protective memory immune response against Mycobacterium tuberculosis; Andersen P et al.; We have investigated the memory T-cell immune response to Mycobacterium tuberculosis infection . C57BL/6J mice infected with M . tuberculosis were found to generate long-lived memory immunity which provided a heightened state of acquired resistance to a secondary infection . The T-cell response of memory immune mice was directed to all parts of the bacilli, i.e., both secreted and somatic proteins . Major parts of the memory T-cell repertoire were maintained in a highly responsive state by cross-reactive restimulation with antigens present in the normal microbiological environment of the animals . A resting non-cross-reactive part of the memory repertoire was restimulated early during a secondary infection to expand and produce large amounts of gamma interferon . The molecular target of these T cells was identified as a secreted mycobacterial protein with a molecular mass of 3 to 9 kDa.

Radiology, 1993 Mar, 186(3), 653 - 60
Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy; Im JG et al.; To evaluate findings of active pulmonary tuberculosis on computed tomographic (CT) scans and their sequential changes before and after antituberculous chemotherapy, 29 patients with newly diagnosed pulmonary tuberculosis and 12 patients with recent reactivation were studied prospectively . The diagnosis of active pulmonary tuberculosis was based on positive acid-fast bacilli in sputum (n = 29) and changes on serial radiographs obtained during treatment (n = 12) . Twenty-six patients were followed up with CT during treatment for 1-20 months . Lungs from the cadavers of nine other patients, who died of pulmonary tuberculosis, were studied to provide a pathologic basis for diagnosis . At examination with CT, centrilobular lesions (nodules or branching linear structures 2-4 mm in diameter) were most commonly seen (n = 39 {95%}); in the 26 patients with follow-up, most of these lesions disappeared within 5 months after the start of treatment . In 11 of 12 patients with recent reactivation, CT clearly differentiated old fibrotic lesions from new active lesions . Lesions in and around the small airways appear to be the most characteristic CT feature of early active tuberculosis and may be a reliable criterion for disease activity.

Southeast Asian J Trop Med Public Health, 1993 Mar, 24(1), 3 - 10
Leprosy trends in northern Thailand: 1951-1990; Smith TC et al.; Data of new, previously untreated leprosy patients from 6 northern provinces of Thailand, diagnosed at McKean Rehabilitation Center, Chiang Mai and associated clinics between 1951 and 1990 were analysed . The following trends were found: 1) Decreasing numbers of new, previously untreated patients . 2) Increasing average age of patients at onset and presentation of disease . 3) Decreasing duration between onset and presentation . 4) Increasing percentage of patients presenting within the first year of symptoms . 5) Increasing percentage of paucibacillary cases . 6) Decreasing percentage of patients presenting with deformity . These trends are a reflection of those seen for the whole of Thailand and indicate that leprosy control is being effective . Patients are presenting at an earlier stage than before, with consequent reduction in disability and infectivity . Better usage of chemotherapy since 1976 has helped to reduce the transmission of bacilli from person to person, combined with effective health education activities which have dispelled some wrong ideas about leprosy and encouraged patients to seek help early in the course of the disease . Additional factors related to public health and living standards have also contributed.

Int J Artif Organs, 1993 Mar, 16(3), 132 - 4
Disseminated tuberculosis in a renal transplant recipient presenting as a non-healing skin ulcer . A case report; Ghosh AK et al.; Cutaneous tuberculosis in renal allograft recipients is rare . A 33 year old recipient of a second renal allograft developed a painless ulcer on the left foot two months after surgery, followed by the appearance of a cold abscess in the left inguinal region . Smear from the pus aspirated from this abscess revealed acid fast bacilli, and biopsy from the edge of the ulcer showed an epithelioid cell granuloma with Langhans type of giant cells . X-ray of the chest revealed miliary mottling in both lung fields . Antitubercular therapy lead to a complete resolution of the tuberculous lesions.

J Med Assoc Thai, 1993 Mar, 76(3), 129 - 37
Community- and hospital-acquired pneumonia in medical intensive care unit; Limthongkul S et al.; Seventy-four cases of pneumonia admitted to the Medical Intensive Care Unit of Chulalongkorn Hospital from January 1986 to December 1988 were analyzed . There were 52 males and 22 females with 46, 26 and 2 cases of community-, hospital- and combined-acquired pneumonia, respectively; the average age on admission was 58 +/- 18.1 years . The majority of the patients had abnormal host or underlying pulmonary diseases . Most of the cases with community-acquired pneumonia were admitted to the ICU because of respiratory failure (85%) and most of the cases with hospital-acquired pneumonia had ventilator-associated pneumonia (71.4%) . The dominating pathogens in community- and hospital-acquired pneumonia were Gram-positive and Gram-negative organisms, respectively . There were no significant differences in initial clinical manifestations, laboratory data, complications, between the two groups . However, the duration on antibiotic, respirator, leukocytosis and stay in hospital were significantly longer in hospital acquired than community acquired pneumonias . Overall mortality was 63.5 per cent, the causes of which were progressive or uncontrolled pneumonia and mechanical ventilation complications in 37.8 and 25.7 per cent of the cases, respectively . High-risk factors of the non-surviving groups included pneumonia on assisted ventilation, mechanical ventilation complications, shock and the presence of Gram-negative bacilli . Our study indicates that the patients required assisted ventilation because of the severity of the underlying pulmonary conditions rather than the extent of the pneumonia itself . Gram-negative pneumonia predisposed the patients requiring mechanical ventilation to develop complications . The duration on mechanical ventilation, ICU admission and hospitalization were 13.84, 13.21 and 29.08 days, respectively.

Nippon Rai Gakkai Zasshi, 1993 Mar, 62(1), 13 - 20
Immunopathological stain of lipoarabinomannan-B (LAM-B) for diagnosis of leprosy; Butt KI et al.; We developed an immunopathological staining of LAM-B antigen in formalin-fixed paraffin-embedded tissues, and compared it with, PGL-I immunostaining, Fite Faraco's stain and periodic acid carbol pararosaniline (PACPR) stain . Out of the total 28 leprosy cases, 27 were positive to LAM-B immunostaining while 23 were positive to PGL-I stain . Fite's stain was positive in 21 cases while PACPR stain was positive in 24 cases . In scrofuloderma, LAM-B antigen was observed only in the granuloma while no other positive findings were noted with other stains . Normal skin did not give any positive findings with any of the stains . Other dermatoses showed no positive findings to any of the stains tested . LAM-B staining was observed in the nerve even in the absence of bacilli in leprosy tissues . Presence of LAM-B in the cutaneous nerves is helpful in discriminating leprosy from other mycobacterioses . Considering the high sensitivity of LAM-B and the predilection of M . leprae for the nerves, we concluded that LAM-B staining can be a useful new tool in the prompt diagnosis of leprosy, especially in suspected or early cases.

Cell Immunol, 1993 Mar, 147(1), 222 - 9
Evidence for a defective accumulation of protective T cells in old mice infected with Mycobacterium tuberculosis; Orme IM et al.; Mice infected with virulent Mycobacterium tuberculosis exhibit an age-related increase in susceptibility to disease . The basis of this susceptibility has previously been shown to reflect an inability of the aged host to generate protective CD4 T cells during the early course of the infection . The results of the present study, however, indicate that the emergence of interferon-gamma secreting protective CD4 T cells in such mice is not absent, but merely delayed . Furthermore, flow cytometric analysis of such cells accumulating in the spleens of intravenously infected 24-month-old animals revealed that a large percentage of CD4 cells initially had poor or negative expression of the cell surface markers L-selectin and CD11a, molecules that may be important in the movement of T cells across inflamed endothelial blood vessel surfaces . During the course of the tuberculosis infection the numbers of CD4 cells in the spleens of old mice expressing high levels of these molecules rose to levels similar to those observed in young mice, but by that time the numbers of bacilli in target organs had reached close to fatal levels . These data suggest that the capacity of CD4 cells to cross inflamed endothelial surfaces and home into sites of mycobacterial infection may be deficient in old mice, and hence support the hypothesis that the ensuing delay in accumulating such cells within infected lesions contributes to the increased susceptibility of these animals to disease.

N Engl J Med, 1993 Feb 25, 328(8), 527 - 32
Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin; Goble M et al.; BACKGROUND AND METHODS . The frequency of infection with multidrug-resistant Mycobacterium tuberculosis is increasing . We reviewed the clinical courses of 171 patients with pulmonary disease due to M . tuberculosis resistant to rifampin and isoniazid who were referred to our hospital between 1973 and 1983 . The patients' records were analyzed retrospectively . Their regimens were selected individually and preferably included three medications that they had not been given previously and to which the strain was fully susceptible . RESULTS . The 171 patients (median age, 46 years) had previously received a median of six drugs and shed bacilli that were resistant to a median of six drugs . Thus, their regimens were frequently not optimal . Of 134 patients with sufficient follow-up data, 87 (65 percent) responded to chemotherapy (as indicated by negative sputum cultures for at least three consecutive months); 47 patients (35 percent) had no response, as shown by continually positive cultures . The median stay in the hospital was more than seven months . In a multivariate analysis, an unfavorable response was significantly associated with a greater number of drugs received before the current course of therapy (odds ratio, 4.0; 95 percent confidence interval, 1.6 to 9.9; P < 0.001) and with male sex (odds ratio, 2.5; 95 percent confidence interval, 1.1 to 6.2; P < 0.03) . Twelve of the patients with responses subsequently had relapses . The overall response rate was 56 percent over a mean period of 51 months . Of the 171 patients, 63 (37 percent) died, and 37 of these deaths were attributed to tuberculosis . CONCLUSIONS . For patients with pulmonary tuberculosis that is resistant to rifampin and isoniazid, even the best available treatment is often unsuccessful . Only about half of such patients eventually have negative sputum cultures despite carefully selected regimens administered for extended periods . Failure to control this resistant infection is associated with high mortality and ominous implications for the public health.

Eur J Clin Microbiol Infect Dis, 1993 Feb, 12(2), 114 - 8
A cluster of four cases of Mycobacterium haemophilum infection; Kiehn TE et al.; Four cases of infection with Mycobacterium haemophilum occurred at a single hospital in a seven-month period . Only 22 cases have been reported since 1976 . All four patients were immunocompromised; two had AIDS and two were the first known recipients of allogeneic bone marrow transplants (BMT) to develop the infection . One BMT recipient died of Mycobacterium haemophilum pneumonia . The organism requires hemin or ferric ammonium citrate and incubation of media at 30 degrees C for optimum growth . Clinicians and microbiologists should consider infection with Mycobacterium haemophilum, particularly when specimens are from immunocompromised patients with unexplained illness and/or when acid-fast bacilli are seen on smear.

Tuber Lung Dis, 1993 Feb, 74(1), 59 - 61
Congenital tuberculosis; Foo AL et al.; A neonate presented with poor feeding, jaundice and hepatosplenomegaly . He was in liver failure with disseminated coagulopathy . Post-mortem liver biopsy revealed discrete granulomas with central necrosis and acid-fast bacilli on Ziehl-Nielsen's stain . The mother had active tuberculosis at delivery . The principal characteristics of congenital tuberculosis are reemphasized in this observation.

Tuber Lung Dis, 1993 Feb, 74(1), 23 - 7
Bacteriological investigations for short-course chemotherapy under the tuberculosis programme in two districts of India; Paramasivan CN et al.; To examine the bacteriological profile and the prevalence of drug resistance among patients attending the health facilities where the District Tuberculosis Programme (DTP) was in operation with short-course chemotherapy (SCC) regimens, sputum specimens were collected on admission and the end of treatment in North Arcot district and Pondicherry region . In North Arcot district, rifampicin, isoniazid and pyrazinamide were given twice weekly for the first 2 months followed by rifampicin and isoniazid twice a week for the next 4 months under fully supervised administration . In Pondicherry, rifampicin, isoniazid and pyrazinamide were given daily for the first 2 months followed by rifampicin and isoniazid twice weekly for the next 4 months . Of the patients who had received 80% or more of the drugs, 80% from North Arcot and 92% from Pondicherry were rendered culture-negative for Mycobacterium tuberculosis at the end of treatment . Even among patients with initially resistant bacilli, a high proportion had a favourable response . Before start of treatment, of the 2779 patients from North Arcot, 25% had resistance to one or more drugs including 2% with resistance to rifampicin . In Pondicherry, 13% of the patients had initial resistance to one or more drugs . Initial resistance to rifampicin was observed in 0.9% . None of the initially drug-sensitive patients had acquired resistance to rifampicin at the end of treatment.

Thorax, 1993 Feb, 48(2), 167 - 70
Ultrasound guided aspiration biopsy for pulmonary tuberculosis with unusual radiographic appearances; Yuan A et al.; BACKGROUND: Pulmonary tuberculosis can produce unusual radiographic appearances and negative results of sputum and bronchoscopic examinations are common . This study assessed the value of ultrasound guided aspiration biopsy in the diagnosis of pulmonary tuberculosis with unusual radiographic appearances . METHODS: Thirteen patients, ultimately diagnosed as having tuberculosis, underwent a chest ultrasonographic examination between June 1984 and August 1991 . All had sputum available for examination and nine were also examined by bronchoscopy . Ten patients who had a negative sputum smear and negative bronchoscopic brushing smears underwent ultrasound guided aspiration or biopsy . Percutaneous aspiration was performed with a 22 gauge needle . If the smear did not reveal acid fast bacilli, a biopsy sample was taken with a 16 gauge Tru-cut needle to obtain a histological diagnosis . RESULTS: The ultrasonographic examination delineated the more complex nature of the lesions better than the chest radiograph . Ultrasound guided aspiration biopsy provided the diagnosis in nine of 10 patients, while the sputum smear and culture provided diagnosis in five of 13, and bronchoscopy in four of nine . In terms of rapid diagnosis, ultrasound guided aspiration biopsy gave the diagnosis in eight of 10 cases . No patient developed a major complication . CONCLUSION: Ultrasonography can direct the needle to the most suitable part of a lesion to obtain the relevant specimens . The diagnostic yield is high and the procedure is relatively safe . It is especially helpful in patients with negative results of sputum and bronchoscopic examinations.

Nippon Eiseigaku Zasshi, 1993 Feb, 47(6), 994 - 1000
{An epidemiological study of tuberculosis in the former coal-mining area of Chikuho . I . An analysis of newly registered tuberculosis patients in Iizuka Health Center District}; Une H et al.; To clarify risk factors and groups at high risk of tuberculosis, a study on tuberculosis was conducted in the former coalmining area of Chikuho, where the death rate from tuberculosis was high . The authors analysed 701 newly registered tuberculosis patients during the 5 years from 1982 through 1986 in Iizuka Health Center District in the Chikuho area, studied the geographical distribution of tuberculosis incidence in Fukuoka Prefecture, and compared the trends of tuberculosis incidence in Iizuka Health Center District, all Japan and Fukuoka Prefecture . The results were as follows: 1) The incidence of tuberculosis in Iizuka Health Center District was higher than those both in all Japan and in Fukuoka Prefecture . The incidence in Iizuka Health Center District has not decreased since 1981 . Therefore, the difference in tuberculosis incidence between Iizuka Health Center District, and all Japan and Fukuoka Prefecture has gradually become greater . The incidence of tuberculosis in 1986 was 81.6 (per 100,000) in Iizuka Health Center District, 58.1 in Fukuoka Prefecture, 46.6 in all Japan . 2) A specific pattern was observed in the geographical distribution of tuberculosis incidence in Fukuoka Prefecture . A high incidence was concentrated in the former coalmining area of Chikuho . 3) The positive rate of tubercle bacilli (38.8%) was the same as that in all Japan . However, the positive rate was higher in age groups 10-49 than that in all Japan . 4) A total of 83.5% of tuberculosis cases were detected when visiting doctors, mainly with complaints of cough, fever and sputum . Only 6.9% of the patients were detected by screening examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

J Vet Med Sci, 1993 Feb, 55(1), 141 - 3
A case of neonatal calf with meningitis associated with Klebsiella oxytoca infection; Seimiya Y et al.; A 16-days-old calf exhibited pyrexia, difficulty to stand and walk, cloudiness of the ocular aqueous humor, and swelling of the shoulder joints . The primary pathological lesion was fibrinopurulent meningitis with Gram-negative small bacilli, and which was concurrently accompanied with endophthalmitis, polyarthritis, and purulent inflammation in several visceral organs . Klebsiella oxytoca was isolated from the brain and spinal cord . These results suggest that this is a rare case of meningitis with septicemic K . oxytoca infection in neonatal calf.

Alcohol Clin Exp Res, 1993 Feb, 17(1), 75 - 85
Ethanol ingestion increases susceptibility of mice to Listeria monocytogenes; Saad AJ et al.; Excessive consumption of alcohol is associated with an increase in the frequency and severity of infectious diseases . Ethanol adversely affects specific and nonspecific aspects of the immune response . We used a murine model to determine whether ethanol ingestion impairs host mechanisms of resistance to Listeria monocytogenes . Naive mice and mice immune to L . monocytogenes were pair-fed either a Leiber-DeCarli liquid diet containing 7% (v/v) ethanol or an isocaloric control diet for 7 days . Then, nonimmune mice were given a sublethal dose of L . monocytogenes and studied 2 and 5 days after infection, and immune mice were challenged with a lethal dose of L . monocytogenes and studied 5 days after infection . Multifocal liver abscesses developed in nonimmune ethanol-treated and control mice 2 days after infection . Bacterial colony counts in the spleens were similar between the two groups; however, counts in the livers were slightly higher in ethanol-treated mice as compared with those in control mice . Five days after infection the nonimmune ethanol-treated mice had large necrotizing liver granulomas and organ bacterial colony counts 100 to 1000 times higher than those in control mice . Immune ethanol-treated mice had large areas of liver necrosis and inflammation containing numerous Gram-positive bacilli, whereas immune control mice had small, well-formed granulomas and much less necrosis . Organ bacterial colony counts were about 100 times higher in immune ethanol-treated mice as compared with those in immune control mice . Liver enzyme levels and mortality were significantly higher in ethanol-treated immune and nonimmune mice as compared with those in immune and nonimmune control mice . Data support the suggestion that ethanol consumption impairs the development and expression of T cell-mediated immunity of mice to L . monocytogenes, resulting in increased susceptibility to infection with this organism.

Am J Surg, 1993 Feb, 165(2A Suppl), 82S - 88S
Combination antibiotic therapy in the management of intra-abdominal infection; DiPiro JT et al.; Combination antimicrobial regimens consisting of an agent with activity against gram-negative bacilli (an aminoglycoside) plus an agent with anaerobic activity (usually clindamycin or metronidazole) have traditionally been accepted as the standards for the treatment of intra-abdominal infection . Because of the problems of nephrotoxicity and ototoxicity in patients treated with aminoglycosides, clinical trials have been conducted using alternative combination therapy (e.g., aztreonam plus clindamycin) or single beta-lactam antimicrobial agents . Most clinical trials of intra-abdominal infections have been conducted in relatively small patient populations with a variety of low- and high-risk patients . The newer regimens have demonstrated efficacy equivalent to traditional combination therapy in selected patient populations . When selecting an antimicrobial regimen for treatment of intra-abdominal infection, multiple issues should be considered, including demonstrated efficacy in clinical trials, potential for adverse effects, and cost.

J Am Acad Dermatol, 1993 Feb, 28(2 Pt 2), 352 - 5
Cutaneous nodules of Mycobacterium chelonae in an immunosuppressed patient with preexisting pulmonary colonization; Swetter SM et al.; A 30-year-old immunocompromised man with known pulmonary Mycobacterium chelonae colonization developed a systemic infection with cutaneous manifestations . The eruption consisted of multiple, nontender, subcutaneous nodules on the extremities . A diagnosis of disseminated M . chelonae was made on the basis of recovery of M . chelonae subspecies abscessus from blood and bronchoalveolar lavage fluid and histologic evidence of acid-fast bacilli in a skin biopsy specimen . We believe this is the first reported case of disseminated M . chelonae infection in an immunocompromised host in whom a primary source of the infection was identified.

J Trop Med Hyg, 1993 Feb, 96(1), 1 - 11
The impact of human immunodeficiency virus on presentation and diagnosis of tuberculosis in a cohort study in Zambia; Elliott AM et al.; Two hundred and forty-nine patients with tuberculosis were recruited to a cohort study to investigate the interaction between tuberculosis and HIV in Lusaka, Zambia; findings at presentation are presented here . One hundred and eighty-two (73%; 95% confidence interval 67-79%) of the cases were HIV-1 antibody positive . The diagnosis of tuberculosis was confirmed by microscopy for acid-alcohol fast bacilli, culture of Mycobacterium tuberculosis, or histology in 74% of all cases . HIV negative and positive cases differed in site of disease: among HIV negative patients 72% had pulmonary disease alone, 16% extrapulmonary disease alone and 12% had both, whereas among HIV positive patients 40% had pulmonary disease alone, 34% extrapulmonary disease alone and 26% both (P < 0.001) . HIV negative and positive cases were compared with regard to outcome of diagnostic procedures: 55% of HIV negative cases could be diagnosed at enrollment by sputum smear, but only 35% of HIV positive cases (P < 0.01) . Among pulmonary cases confirmed by sputum culture, 76% of HIV negative patients had a positive sputum smear, compared with 57% of HIV positive patients (P = 0.09) . Pleural and pericardial disease were difficult to confirm, but culture of pleural fluid was positive in 12/46 HIV positive patients, compared with 0/11 HIV negative patients . Lymph node disease was readily confirmed by biopsy . The tuberculin test was positive in only 30/110 (27%) of HIV positive cases, but in 21/38 (55%) of HIV negative cases (P < 0.01) . Mycobacterium tuberculosis was cultured in 57% of HIV negative cases and 54% of HIV positive cases; no atypical mycobacteria were isolated . Initial resistance to isoniazid was present in isolates from 5% of cases with a positive culture.

Mol Microbiol, 1993 Feb, 7(4), 489 - 96
The two faces of Bacillus thuringiensis: insecticidal proteins and post-exponential survival; Aronson AI; Post-exponential Bacillus thuringiensis cells produce both an endospore and a variety of intracellular inclusions . The latter are comprised of protoxins, each being specific for the larvae of certain species from at least three orders of insects . Following ingestion of spores and inclusions, toxicity results in the spores gaining access to haemolymph, a source of nutrients suitable for germination and growth . Most B . thuringiensis subspecies contain multiple, plasmid-encoded protoxin genes, often with several on the same plasmid . These genes have been manipulated in order to understand the basis of toxicity and specificity, information which is important to the use of these toxins as biological control agents . Some protoxin genes are in operons, and others are in close proximity, perhaps to enhance the chances of recombination, and some are on unstable plasmids . The arrangement of these genes is probably important for flexibility in the variety of protoxins packaged into inclusions by a particular subspecies and thus the capacity to adapt to changing populations of insects . Protoxins accumulate over a prolonged period during sporulation because of the sequential transcription from two promoters, each being dependent upon a specific sporulation sigma factor, the relative stability of the messenger RNA, and the synthesis of proteins which stabilize protoxins and perhaps facilitate inclusion assembly . During the post-exponential phase, spore and inclusion formation must be balanced so as to ensure that both are available to contribute to the survival of these bacilli.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 1993 Feb, 15(1), 17 - 23
{Study on subclinical infection with M . leprae--a follow-up}; Shu H; In this article, we reported the results of studies on the rates of subclinical infection (SI) among leprosy contacts and a follow-up using PGL-I-ELISA . The results indicated that: (1) the rates of SI were higher in household contacts than those in around population; (2) factors such as type of leprosy, degree of contact affected the development of SI; (3) among 97 followed-up contacts, one person developed clinical leprosy in the second year; (4) acid-fast bacilli (AFB) were seen in the skin or peripheral blood of some subjects, some factors affecting SI, and the significance of AFB in skin and blood are discussed in detail.

Zhonghua Jie He He Hu Xi Za Zhi, 1993 Feb, 16(2), 69 - 72, 122
{A study on the relapse and its potential causes in pulmonary tuberculosis}; Liu XR; A retrospective cohort study was conducted to acquire the general picture of relapse in pulmonary tuberculosis in China and to clarify the relationship between potential causes and relapse rate . All data were collected from 4,797 initial sputum-positive cases . Results showed: (1) Bacteriological relapse rate within two years after chemotherapy was 4.6% . (2) Cumulative relapse rates within half a year and a year only accounted for respectively 28% and 43% of that within two years after chemotherapy . (3) Patients over 60 years old, with drug-resistant bacilli, with long excretion of bacilli, or with residual cavity(ies) or bacterial-negative conversion of less than 3 months at the end of treatment, were the high risk population of relapse.

Kekkaku, 1993 Feb, 68(2), 113 - 29
The impact of new technology on the laboratory's contribution to the diagnosis and management of mycobacterial disease; Wayne LG; From the time of the discovery of the tubercle bacillus in the late nineteenth century until the introduction of chemotherapy in the mid-twentieth, the role of the laboratory in the management of tuberculosis was limited because the treatment of the disease was nonspecific . The advent of specific chemotherapy and the recognition of human diseases caused by a number of mycobacterial species other than M . tuberculosis increased the scope and importance of the clinical laboratory in guiding the diagnosis and management of mycobacterial disease . This included the isolation of mycobacteria, the identification of the isolates, the determination of their susceptibilities to chemotherapeutic agents and their subtyping for epidemiologic purposes . In spite of the enhanced role it has played in the past forty years, the laboratory's contribution has been impeded by the slow growth of mycobacteria, which causes delays of weeks or months between submission of a specimen and the availability of a definitive report . In the meantime both the urgency and the complexity of diagnosis and management of mycobacterial disease have increased with the emergence of epidemics of these diseases associated with the acquired immunodeficiency syndrome (AIDS) . This development has also increased the need for recognition of tubercle bacilli in such specimens as blood and stools, which were only infrequently studied in past years . Recent developments in microchemical and immunologic technology, and especially molecular biology, are greatly reducing the time needed to get information that contributes to diagnosis and management of mycobacterial disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Contracept Fertil Sex, 1993 Feb, 21(2), 149 - 52
{Genital bacterial infections associated with papillomavirus: value of screening and basis for treatment}; Aynaud O et al.; Genital bacterial and viral infections may be responsible of couple infertility and may be potentially oncogenic for genital lesions . Genital bacterial infection is associated with human papillomavirus infection in as much as 48% for men and 64% for women . The bacterias most frequently found are intracellular species (29%) and Gram-negative bacilli (14%) . Treatment with specific antibiotics can reduce the frequency of infertility in both men and women . This treatment can also prevent therapeutic complications during treatment for papillomavirus infection.

J Indian Med Assoc, 1993 Feb, 91(2), 30 - 3
Demonstration of acid-fast bacilli in tissues and evaluation of atypical tuberculous lesions; Chakraborty S et al.; A study was conducted with tissue sections of 60 different suspected tuberculous lesions, obtained by biopsy from 60 patients of different age groups . The tissue sections were fixed with formol saline and stained with haematoxylin and eosin and Ziehl-Neelsen stain . Histological picture of tuberculosis and presence of acid-fast bacilli were studied . Out of 60, 39 sections showed typical tuberculous lesions . Remaining 21 sections presented atypical lesions . Of those 39 typical lesions 17(43%) showed presence of acid-fast bacilli . Among atypical lesions 10(47%) showed presence of acid-fast bacilli . Thus it may be stated that diagnosis of tuberculosis is not confirmed unless acid-fast bacilli is demonstrated in the lesions . Tuberculosis in substantial number of cases produces non-granulomatous atypical lesions, so non-specific inflammation and granulation tissue in histology need Ziehl-Neelsen staining and careful search for acid-fast bacilli should be made to exclude tuberculosis where the disease is common.

Kekkaku, 1993 Feb, 68(2), 109 - 11
Evaluation of sensitivity and specificity of cold stain vis-a-vis Ziehl Neelsen stain on culture results; Pathan AJ et al.; Various cold stain techniques have been tried with varying success since early part of the century . Dr . S . Kudoh of Japan and Dr . A . J . Pathan of Pakistan discussed to evolve a simple process for cold method (see the foot note) which is a simple procedure for staining tubercle bacilli in sputum specimen . And the cold method was found as sensitive, as specific and almost as reliable as Ziehl Neelsen on direct comparison of two techniques . In this paper, the cold method was further evaluated on culture results with Ziehl Neelsen stain during 1987-90 in our institute.

Hosp Pract (Off Ed), 1993 Jan 15, 28(1), 51 - 8
Immunopathogenesis of pulmonary tuberculosis; Dannenberg AM Jr; Antimicrobial therapy quickly eradicates susceptible bacilli, but the fight against drug-resistant disease must be waged entirely by host defenses . Knowledge of the two main types of immune response against tuberculosis and of how to manipulate those mechanisms--leading to precisely designed recombinant BCG vaccines--is essential to mounting an effective attack on the current epidemic.

East Afr Med J, 1993 Jan, 70(1), 61 - 2
Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report; Amayo EO et al.; A 27 year old female with AIDS and disseminated histoplasmosis is presented . The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor . The initial working diagnosis was pulmonary tuberculosis . The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination . Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosisPIP: A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991 . She presented with a 4-week history of productive cough, fever, weight loss, and night sweats . She acknowledged a history of contact with a patient known to have pulmonary tuberculosis . She has never received a blood transfusion . She was single and para 3 + 0 . Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush . There was no finger clubbing, lymphadenopathy, or pedal edema . Chest examination revealed bilateral basal pneumonia . The spleen was palpable 4 cm below the costal margin; the liver was not enlarged . The rest of the examination was normal . On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal . The anemia was normocytic, normochromic, and no malaria parasites were seen . Urea and electrolytes and liver function tests were normal . Sputum showed no acid fast bacilli on Ziel-Neelson Stain . HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot . Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum . Chest X-ray showed bilateral basal pneumonia . She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission . Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out .

Acta Neuropathol (Berl), 1993, 85(5), 533 - 41
A morphological study of nerve biopsies from cases of multibacillary leprosy given multidrug therapy; Jacobs JM et al.; Nerve biopsies were examined from 17 cases of lepromatous leprosy given WHO-recommended multidrug therapy (MDT) for 2 years . The pathological changes were assessed qualitatively and quantitatively to judge the effectiveness of MTD . The nerves varied very considerably in the severity of their lesions . Some regenerating fibres were seen in most of the nerves . In a few cases, the nerves were almost entirely populated by regenerated fibres, confirming that MTD was effective in halting the disease process within the nerve . Mycobacterium leprae showed morphological features of degenerate bacilli . Some pathological features of the lepromatous lesion are described.

Indian J Med Res, 1993 Jan, 97, 18 - 24
Antigenic similarity of a cultivable acid fast bacterium to Mycobacterium leprae; Joshi S et al.; A cultivable acid fast stainable bacterium obtained from leprosy nodule showed similarity to M . leprae in antigenicity to serum antibodies of lepromatous leprosy patients . The antigenic similarity has been seen more clearly in the delipidified cell components of both these bacteria . An antigen of 35-38 kDa has been seen as a common antigen between M . leprae and the cultivable bacilli with binding ability to sera from leprosy patients . This cultivable bacterial component could be used for serodiagnosis of lepromatous leprosy.

Crit Rev Microbiol, 1993, 19(1), 1 - 16
Tuberculosis: the return of an old enemy; Collins FM; Tuberculosis is an ancient human scourge that continues to be an important public health problem worldwide . The increasing number of multidrug-resistant (MDR) M . tuberculosis isolates from both AIDS and non-AIDS patients is an ominous trend that threatens tuberculosis eradication programs both in the U.S . and overseas . New antituberculosis vaccines with therapeutic properties are urgently needed for human immunodeficiency virus-infected individuals, as well as health care professionals likely to be exposed to MDR tubercle bacilli . Recombinant DNA vaccines bearing protective genes from virulent M . tuberculosis are being developed using shuttle phasmids to transfer genetic material from one mycobacterial species to another . Improved assay procedures are needed to measure the protection afforded by these new vaccines under experimental and field test conditions . Tuberculosis vaccine development should be given a high priority in current medical research goals.

J Pak Med Assoc, 1993 Jan, 43(1), 8 - 10
Bioburden and theoretical sterility dose calculation for radiation sterilization of surgical cotton and bandages; Khurshid SJ; The initial bioburden, count of colony forming unit (CFU) was determined on the locally manufactured non-sterilized surgical cotton and bandages . In all 489 tests were conducted on 163 cotton samples and 246 tests on 82 bandage samples . The surgical cotton showed an average of 198 microbes with a maxima of 287 and minima 94 whereas bandages showed an average of 179 microbes with a maxima of 268 and minima of 89 . In the 20% samples subjected to identification no anaerobic microorganism was isolated while the aerobic microorganisms isolated were all bacilli . The sterilization dose (SD) for sterility assurance level (SAL) of 10(-6) was 2.23 Mrads and 2.21 Mrads, whereas the device verification dose (DVD) was 0.6 and 0.59 Mrads for cotton and bandages respectively as calculated by the method proposed by the Sterilization Standard Committee, Association of Advancement of Medical Instrumentation (AAMI).

Eur J Clin Microbiol Infect Dis, 1993 Jan, 12(1), 37 - 43
Invasive infection with Mycobacterium genavense in three children with the acquired immunodeficiency syndrome; Nadal D et al.; Three children with human immunodeficiency virus infection and invasive infection with Mycobacterium genavense are reported . Fever spikes, abdominal cramps and distension, diarrhea or ileus, and anemia were the predominant symptoms in the severely immunodeficient patients (CD4 lymphocytes < 0.04 x 10(9)/l) . Numerous acid-fast bacilli were readily detectable by microscopy in stool samples and in lymph node biopsies, but cultures for mycobacteria remained negative . Mycobacterium genavense should be sought when invasive non-tuberculous mycobacteriosis is suspected and mycobacterial cultures from blood or other sites show limited growth . Multiple-drug regimens including amikacin, ethambutol, rifampin, and clarithromycin may be of benefit in controlling the infection, as observed in two patients.

Nephron, 1993, 63(4), 404 - 8
Serial changes of interleukin-6 and interleukin-8 levels in drain dialysate of uremic patients with continuous ambulatory peritoneal dialysis during peritonitis; Lin CY et al.; In this study, we investigated whether peritoneal dialysate interleukin-6 (IL-6) and IL-8 levels were elevated during peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, with special reference to the high peritonitis occurrence (HPO) group . Serial measurements of IL-6 and IL-8 levels in dialysate before, during and after resolution of peritonitis were done in 13 CAPD patients with 15 episodes of peritonitis . Based on the peritonitis occurrence, 7 patients were assigned to the low peritonitis occurrence (LPO) and 6 patients to the HPO group . Marked elevation of IL-6 and IL-8 in drain dialysate occurred in the early period of peritonitis especially on the first 2 days in both groups . However, there were no significant differences between the groups in the levels of IL-6 and IL-8 in drain dialysate on the first day of peritonitis . However, the disappearance of peritoneal dialysate IL-8 level was faster in the LPO than in the HPO group . The decrease in IL-8 levels during peritonitis was faster than that of IL-6 . Marked elevation of IL-6 and IL-8 in drain dialysate was found in the patient with peritonitis caused by Staphylococcus epidermidis and mixed gram-negative bacilli . Therefore, we hypothesize that when peritonitis occurs too frequently in a short period in the HPO group, more IL-6 and IL-8 have been produced in the peritoneum contributing to the ongoing peritoneal injury and/or fibrosis.

J Antimicrob Chemother, 1993 Jan, 31 Suppl A, 67 - 78
Treatment of intra-abdominal infections; Gorbach SL; Intra-abdominal infections are caused by a mixture of aerobic, anaerobic and facultatively anaerobic bacteria . Experimental studies in animals and clinical trials indicate that antimicrobial therapy should provide adequate coverage for the whole range of isolates . Penicillins and cephalosporins with relatively limited activity against anaerobes have been associated with clinical failures in treating various types of mixed infections . Aminoglycosides are often used in combination with other drugs in the treatment of intra-abdominal infections . Recent studies have cast doubt on this practice because of increased resistance of Gram-negative bacilli to aminoglycosides and high rates of renal toxicity . Regimens that do not include an aminoglycoside have given good results in treatment of appendicitis, penetrating abdominal trauma, and peritonitis . Enterococci are frequently isolated from intra-abdominal infections, but evidence suggests that it is not necessary to direct treatment at this organism initially.

Clin Infect Dis, 1993 Jan, 16(1), 75 - 81
Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli; Wingard E et al.; A prospective study of 67 patients in a nursing home and a subpopulation of 31 patients who were stratified according to functional level--a general measure of the amount of nursing care required by the patients--was performed . The goals of this study were (1) to determine whether antibiotic selection of resistant variants from within endogenous flora of hosts or horizontal transmission is more important in the development of colonization with trimethoprim-resistant gram-negative bacilli (TRGNB) in a nursing home; (2) to identify the mode(s) of transmission if horizontal transmission is more important; and (3) to identify risk factors for colonization and cross-colonization with TRGNB . Although a number of variables were associated with colonization, only a decreased functional level appeared to be independently associated with colonization . Isolates from the subpopulation were subtyped by restriction endonuclease digestion of cellular DNA, as were isolates from personnel of the nursing home . Results revealed that 16 of 21 staff members had 48 positive cultures for TRGNB . Of 25 typeable isolates, 12 from seven of the 21 staff members were identical to patient strains . Analysis of acquisition of new strains of TRGNB by members of the subpopulation showed that 67.5% were the result of cross-colonization . Our data are consistent with, but do not prove, the hypothesis that nurses' hands are the primary mode of transmission of TRGNB in this nursing home and suggest that most colonization could be prevented by interdicting horizontal transmission.

Vet Pathol, 1993 Jan, 30(1), 55 - 63
Epizootic gastritis associated with gastric spiral bacilli in cheetahs (Acinonyx jubatus); Eaton KA et al.; An outbreak of vomiting in a group of captive cheetahs (Acinonyx jubatus) was investigated, and histologic examination revealed chronic gastritis characterized by infiltration of lymphocytes and numerous plasma cells and epithelial erosions . Lymphoid follicles, globule leukocytes, scattered neutrophils, and (in one animal) abscessed gastric glands were inconsistent findings . In addition, necropsy of three cheetahs revealed gastric mucosal hyperplasia . Two kinds of bacteria were identified in the stomachs of infected cheetahs . Numerous long, tightly coiled motile Gastrospirillum-like organisms were seen in gastric mucus and in Warthin-Starry-stained sections of mucosa . These bacteria could not be cultured but were transmitted to conventional mice in homogenates of gastric mucosa from infected cheetahs . Ultrastructural examination revealed helical filaments on some of these bacteria . In addition, a smaller Helicobacter sp . was isolated . This organism could be cultured in vitro under microaerophilic conditions . One or both of these bacterial species was probably responsible for the gastritis in these cheetahs.

Vet Pathol, 1993 Jan, 30(1), 12 - 9
Two types of bacteria adherent to bovine respiratory tract ciliated epithelium; Hastie AT et al.; Two hundred sixty tracheas were obtained from a Philadelphia abattoir under permit from the Department of Agriculture; the tracheas were excised from predominantly Holstein calves of both sexes that weighed approximately 250 kg . Tracheas were transported in normal saline to the laboratory at Thomas Jefferson University, Philadelphia, Pennsylvania . Evidence of bacteria adherent to the tracheal epithelium was found in specimens from 20/24 of these tracheas . The epithelium from each of five tracheas was placed in glutaraldehyde fixative for transmission electron microscopic examination . Epithelium from each of 12 other tracheas was placed in formaldehyde fixative for light microscopic examination . Microscopically, 13 of these 17 bovine tracheal epithelia were observed to contain bacteria located longitudinally parallel to and between cilia and microvilli of ciliated cells . Preparations of ciliary axonemes isolated from the epithelium of seven additional bovine tracheas also contained these bacteria in sections viewed by a transmission electron microscope . These bacteria had two different ultrastructural morphologies: filamentous with a trilaminar-structured cell wall and short with a thick, homogeneously stained cell wall beneath a regularly arrayed surface layer . The short bacillus had surface carbohydrates, including mannose, galactose, and N-acetylgalactosamine, identified by lectin binding . The filamentous bacillus was apparently externally deficient in these carbohydrates . Immunogold staining revealed that the filamentous bacillus was antigenically related to cilia-associated respiratory (CAR) bacillus, which has been identified in rabbit and rodent species . Significantly decreased numbers of cilia were obtained from tracheal epithelium heavily colonized by the filamentous bacilli, suggesting a pathologic change in ciliated cells.

Diagn Microbiol Infect Dis, 1993 Jan, 16(1), 67 - 71
Tuberculous fasciitis and tenosynovitis . An unusual presentation of miliary tuberculosis; Kabani AM et al.; A case of miliary tuberculosis presenting initially as pyogenic fasciitis and tenosynovitis is described . The unusual presenting clinical features suggestive of a noninfectious inflammatory condition resulted in delayed diagnosis . Tuberculous fasciitis and tenosynovitis were diagnosed by the presence of acid-fast bacilli in histopathologic sections and confirmed by the growth of Mycobacterium tuberculosis from cultures of tissue specimens.

FASEB J, 1993 Jan, 7(1), 232 - 6
Bacterial diversity in a soil sample from a subtropical Australian environment as determined by 16S rDNA analysis; Stackebrandt E et al.; In order to investigate the genetic diversity of streptomycetes in an acid forested soil sample from Mt . Coot-tha, Brisbane, Australia, cells were mechanically lysed within the soil matrix and genomic DNA was isolated and purified . 16S ribosomal (r)DNA was amplified by the polymerase chain reaction (PCR) method using one primer conserved for members of the domain Bacteria and a second designed specifically for streptomycetes and related taxa . PCR amplification products were cloned into phage vector M13 mp19 and the diversity of 16S rDNA genes was determined by sequence analysis and oligonucleotide probing of the resultant clone library . Comparison of partial 16S rDNA sequences with published sequences revealed that few sequences originated from streptomycetes . The majority of sequences belonged to members of the alpha subclass of Proteobacteria . Other clones were related to planctomycetes, actinomycetes, or represented novel lines of descent . Bacteria that are customarily isolated from soil of pH 4-7 such as thiobacilli, bacilli, spore- and nonsporeforming actinomycetes, and pseudomonads are represented in the clone library in small numbers or were not detected at all . Parameters influencing the recovery, amplification, quantification, and interpretation of genetic information from natural sites are discussed.

Am J Clin Pathol, 1993 Jan, 99(1), 24 - 7
Focal enterocyte vacuolization . A new microscopic finding in the acquired immune deficiency wasting syndrome; Patterson BK et al.; Vacuolization of duodenal enterocytes was found by light microscopic examination in five patients meeting the Centers for Disease Control criteria for the acquired immunodeficiency wasting syndrome . Four of these patients had chronic diarrhea and malabsorption as documented by an abnormal D-xylose test, whereas one patient had no diarrhea or malabsorption . Enterocyte vacuolization was patchy in distribution, although affected cells were most notable on villous tips . Staining with period acid-Schiff, acid-fast bacilli, periodic acid-Schiff following diastase treatment, Congo red, and alcian blue were negative, suggesting that vacuolization is due to lipid accumulation . Immunoperoxidase staining for the human immunodeficiency virus envelope protein gp41 was positive in lamina propria mononuclear cells in all five patients . The authors hypothesize that lipid accumulation represents an enterocyte response to injury, possibly by an indirect effect of the human immunodeficiency virus.

Am J Gastroenterol, 1993 Jan, 88(1), 75 - 9
Abdominal tuberculosis in Saudi Arabia: a clinicopathological study of 65 cases; al-Quorain AA et al.; The clinical and pathological features of 65 patients with abdominal tuberculosis obtained during a 7-yr period were analyzed and the diagnostic procedures critically evaluated . The diagnosis was histologically confirmed in 59 patients . In two more patients, the diagnosis was based solely on a positive ascitic fluid culture for tubercle bacilli . The remaining four patients responded dramatically to anti-tuberculous chemotherapy given on suspected laparoscopic findings in cases in which no biopsy was taken . Laparoscopy was found to be safer and superior to laparatomy and is recommended as an initial investigation in the diagnostic work-up of patients in whom tuberculous peritonitis is suspected . Furthermore, the finding of granulomatous inflammation in peritoneal biopsy is a justification for immediate therapy in such patients . This is particularly valid in endemic areas if one considers the risks of delaying treatment of these patients.

Proc Natl Acad Sci U S A, 1993 Jan 1, 90(1), 188 - 92
Selection of T lymphocytes bearing limited T-cell receptor beta chains in the response to a human pathogen; Wang XH et al.; Delayed-type hypersensitivity (DTH) is a classic measure of T-cell responsiveness to foreign antigen . To estimate the extent of the T-cell repertoire in the DTH response to a human pathogen, we measured T-cell receptor (TCR) beta-chain variable-region (V beta) gene usage in reversal reactions in leprosy . Reversal reactions represent naturally occurring DTH responses in leprosy, in which augmentation of T-cell responses to Mycobacterium leprae is concomitant with clearance of bacilli from lesions . T cells using the V beta 6-, V beta 12-, V beta 14-, and V beta 19-encoded TCRs were strikingly overrepresented in the lesions of patients as compared to blood and pre-DTH lesions from the same individuals . Furthermore, these data indicate a possible association between the predominant expression of a V beta gene segment in lesions and the major histocompatibility complex class II haplotype of the individual . V beta 6 was prominent in the lesions of four patients who were DR15, a marker of resistance in leprosy infection . Sequence analysis of V beta 6 TCRs showed frequent use of V beta 6.1 and J beta 2.7 gene segments and a conserved amino acid motif in the V-J junction in a reversal-reaction lesion, but not in blood from the same patient . The limited TCR repertoire expressed by the infiltrating T cells suggests that a limited set of antigens is recognized in the DTH response to a human pathogen . We suggest that the mechanism by which major histocompatibility complex haplotype influences DTH in this disease involves the presentation of specific peptides, with subsequent selection of specific TCRs followed by local oligoclonal expansion.

J Antimicrob Chemother, 1993 Jan, 31 Suppl A, 29 - 38
Comparative susceptibility profile of piperacillin/tazobactam against anaerobic bacteria; Appelbaum PC; Current data are summarized on the comparative susceptibility of Gram-positive and Gram-negative anaerobic bacteria to piperacillin/tazobactam and other anti-anaerobe agents . For beta-lactamase-positive organisms, tazobactam, in fixed concentration or fixed ratio, lowered the MIC of piperacillin at least four-fold to susceptible levels in almost all cases; beta-lactamase-negative strains were all susceptible to piperacillin alone . Susceptibility rates and MIC90 values for piperacillin/tazobactam were comparable to those of other anti-anaerobe agents, including other combinations of beta-lactam agents with beta-lactamase inhibitors, such as amoxycillin/clavulanate, ticarcillin/clavulanate, ampicillin/sulbactam and cefoperazone/sulbactam . Kinetic studies revealed IC50 and Ki values for tazobactam that were in most cases lower than those of clavulanate and sulbactam against beta-lactamase-positive Gram-negative anaerobic bacilli.

Rev Med Interne, 1993 Jan, 14(1), 14 - 20
{Pulmonary tuberculosis and HIV seropositivity at the Principal Hospital of Dakar (Senegal)}; Brucker-Davis F et al.; In a prospective survey conducted in 1990 in the Principal Hospital of Dakar, pulmonary tuberculosis was 2.3 times more frequent in HIV seropositive patients (12.5%) than in HIV seronegative patients . We studied 22 cases of pulmonary tuberculosis in HIV+ patients and compared them with a control group of HIV- patients admitted for pulmonary tuberculosis . Tuberculosis occurred in 6 out of 22 asymptomatic HIV+ patients, in 15 out of 22 patients with clinical AIDS and in 1 patient with ARC syndrome . Clinical signs were the same as in controls, except for patients with advanced AIDS who developed cardinal signs . TB intra-dermal reactions were more often negative in HIV+ patients, notably those with HDV1, expressing immunodepression . Radiological images were typical in 81% of patients and in 86% of controls . However, concomitant infections were common in both groups, with atypical radiology and hyperleukocytosis . At light microscopy, there was no difference in the frequency of acid and alcohol fast bacilli between the two groups . The mortality rate was increased in HIV+ patients, but this was not due to tuberculosis . Relapses were frequent in both groups, due to poor compliance with treatment.

Pneumonol Alergol Pol, 1993, 61(5-6), 268 - 74
{Tuberculosis as a cause of death in patients treated in the institute of tuberculosis in 1976-1991}; Remiszewski P et al.; This study aimed at assessing the reasons why tuberculosis-which can be successfully treated today-is still the cause of death in some patients treated at the Institute of Tuberculosis in the last 15 years . The material consisted of clinical documentation and the results of autopsy of 30 patients who died of tuberculosis between 1976-1991 . It was found that 19 out of 30 patients were not treated with antituberculous drugs or were treated only during few days because tuberculosis was diagnosed too late (in 15 patients after death) . In 6 patients the treatment failed due to side effects of drugs and in 5 immunosuppressed patients, disease progressed despite the treatment . Difficulties in tuberculosis diagnosis were caused by atypical appearance of the disease in the chest X-ray (localization in the middle and lower lobes in 15 cases, absence of cavities in 22 cases) and in the extrapulmonary regions (11 cases) . The main obstacle was the failure to cultivate tubercle bacilli from numerous specimens of the sputum in 10 out of 23 patients in whom the cultures were done.

Am J Nephrol, 1993, 13(2), 164 - 6
Steroid-responsive renal insufficiency due to idiopathic granulomatous tubulointerstitial nephritis; Okada H et al.; A 26-year-old male was admitted to our hospital having suffered from subfever, sterile pyuria and renal insufficiency for 1 year . There had been no apparent hematuria/proteinuria, and evidence of infection, allergy or intoxication was not demonstrated . Open renal biopsy revealed severe tubulointerstitial changes with granuloma accompanied by neither caseous necrosis nor giant cells . Infiltrating cells mostly consisted of CD4 and CD8 T cells, and some proximal tubular cells presented MHC class II antigen . Following the negative culture of biopsied specimen for acid-fast bacilli, diagnosis of idiopathic granulomatous tubulointerstitial nephritis was made, and steroid therapy was started . Two months later, pyuria disappeared and renal function improved significantly, proving the effectiveness of steroid on idiopathic granulomatous tubulointerstitial nephritis.

Med Parazitol (Mosk), 1993 Jan-Feb, (1), 16 - 8
{The efficacy of entomopathogenic bacilli against ancylostomide larvae--Nippostrongylus braziliensis Travassons, 1914}; Fedianina LV et al.; Effects of seven bioinsecticides, containing Bacillus thuringiensis and B . sphaericus toxins, against N . braziliensis larvae were studied in vitro . Bitoxibacillin, astur-3, astur-4, gomelin, lepidocide, dendrobacillin, thuringin and sphaerix were found highly effective larvicides . Protein endotoxin was the principal component responsible for the larvicidal effect, the spores were of no importance.

Ann Pathol, 1993, 13(5), 341 - 5
{Bacillary peliosis in AIDS . Anatomo-clinical study of 2 cases}; Mainguene C et al.; The authors report two cases of peliosis hepatis, occurring in patients with AIDS, who presented a persistent fever and an hepatomegaly . The liver biopsies showed areas of peliosis, where bacilli were observed by Warthin-Starry stain . In one case, techniques of molecular biology allowed the identification of Rochalimaea henselae, pathogen involved in bacillary angiomatosis . This rickettsia has been newly recognized in the United-States, where 17 cases of bacillary peliosis have been published in immunocompromised hosts and mainly in patients with AIDS . These observations illustrate the clinical and histological features of this new opportunistic infection, as it is described in the literature . The clinical signs include an unexplained fever, an hepatomegaly, and in 75% of the cases, a splenomegaly . The cutaneous lesions of bacillary angiomatosis are associated in 40% of the cases . An antibiotic treatment by erythromycin ensures a complete recovery.

Acta Microbiol Hung, 1993, 40(1), 47 - 58
Water soluble complex of palmitic acid in media for cultivation of leprosy-derived psychrophilic mycobacteria from Mycobacterium leprae infected tissues; Kato L et al.; Palmitic acid and palmitates were transformed into water soluble complexes with crystalline heptakis-2,6-di-0-methyl-beta-cyclodextrin . This formulation was incorporated into liquid and solid chemically well-defined media . The fatty acid served as C and energy source, ammonium thioglycolate as the sole source of N with the SH group as further source of energy . Minute amount of dimethyl-sulfoxide added was used for its known effect on cell membrane permeability . The media were inoculated with host grown Mycobacterium leprae cells isolated from human, armadillo and Nu mice foot pad lepromata . No growth occurred in the liquid medium at 22 or 32 degrees C, but cultures and subcultures of acid fast rods were grown at 10 degrees C . Bacilli in the cultures were solid, strongly acid fast rods, growing in clumps like globi . Growth on the semisolid media was visible as smooth round colonies, of white to ivory in colour, slowly expanding flatly at the periphery of the colony on the agar surface . Colonies developed within 2-3 weeks and reached maximum size at 50-80 days depending on the size of inoculum . Subcultures grow faster and more abundantly with adaptation to the media . No growth was seen without the water soluble complexes of palmitic acid or palmitates in the media . The free fatty acid or its salts had an equal growth supporting effect . Identical psychrophilic cultures were obtained from 7 out of 9 armadillo, 12 out of 12 Nu mice and 1 out of 2 human lepromata . None of the cultures grow on Loewenstein, Dubos or 7H9 media at 10 degrees C, 20 degrees C or 32 degrees C, respectively . The tested 4th to 7th subcultures of the strains were strongly positive for phenolic glycolipid-1 . Heat killed suspensions of up to 7th subcultures gave negative late skin reaction in all of 16 LL cases . In 19 I, B and T cases the late skin reactions were all similar to that obtained with authentic human lepromin.

Acta Gastroenterol Latinoam, 1993, 23(3), 135 - 42
{Infections during the hospitalization of patients with liver cirrhosis}; Kremer A et al.; We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related . Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions . In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group . The main incidence of infection was among the female group . The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP) . On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections . The most frequent infections were respiratory and BSP . We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E . coli), with high relative frequency of neumoccocus . The most frequent complications were related to hepatic insufficiency . Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C . We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia . Survival rates were 42% for 2 years and 18% for 5 years . In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.

Probl Tuberk, 1993, (5), 44 - 7
{Effect of Mycobacterium tuberculosis on activity of lysosomal enzymes in mouse peritoneal macrophages}; Sozinov VA et al.; The studies of the effects produced by M . tuberculosis various strains on the activity of lysosomal enzymes in peritoneal mouse macrophages demonstrated multidirectional influence of the bacilli . Non-sedimentary activity rose in matrical enzymes indicating lysosomal membranes instability due to M . tuberculosis infection followed by hydrolase activation and hydrolases escape into the cytosol . An inhibiting action of pathogenic mycobacteria on lysosomal proteases is suggested.

Probl Tuberk, 1993, (5), 14 - 6
{Clinical aspects and outcome of recurrent pulmonary tuberculosis}; Krasnov VA et al.; Recurrent tuberculosis was treated in hospital in 86 patients, 82.7% of whom had destructive disease, while 84.0% disseminated the bacteria . Combined chemotherapy included 4 tuberculostatic drugs: 10% isoniazid (7 mg/kg iv drip), streptomycin (0.5 g intramuscularly), rifadin (0.6 g orally) and tisamid (25-30 mg/kg orally) . The drugs were given twice a week under the intermittent regimen in combination with 10% isoniazid (7 mg/kg) and streptomycin (0.5 g) inhalations . During a mean hospital stay of 6.5 months disappearance of destruction and discontinuation of the bacilli dissemination were achieved in 91.1% and 93.9% of patients, respectively, suffering from infiltrative and disseminated tuberculosis.

Rev Stomatol Chir Maxillofac, 1993, 94(6), 375 - 8
{Bacillary angiomatosis of the oral cavity in AIDS . A differential diagnosis of mucosal Kaposi's sarcoma}; Hofman P et al.; The diagnosis of bacillary angiomatosis (BA) was performed on a biopsy of a reddish nodular lesion of the gingival mucosa, in a patient seropositive for the H.I.V . It was based on the histopathological features, and by the demonstration of bacilli both on the Warthin-Starry stain and the electron microscopic study . A treatment by erythromycin was quickly effective . BA is an opportunistic infection seen essentially in patients with A.I.D.S., most often causing cutaneous involvement . The causative pathogen is Rochalimaea henselae . BA of the oral cavity is very rare . This infection can be mistaken with Kaposi sarcoma on its clinical appearance.

Microbios, 1993, 75(304), 171 - 9
Investigations into the growth of Mycobacterium leprae in a medium with palmitic acid under different gaseous environments; Ishaque M et al.; Low oxygen tension has often been considered important for the growth of Mycobacterium leprae . Palmitic acid has been suggested as the oxidizable substrate for the in vitro cultivation of leprosy bacilli . The combined effects of palmitic acid and various known gas mixtures on the in vitro growth of M . leprae were investigated . When palmitic acid was included in the medium an optimal growth in both liquid and solid media was obtained between 16 to 20 weeks of incubation under gas mixtures containing 2.5 or 5% O2 and 5 or 10% CO2 as well as air . The use of different gas mixtures is tedious, time consuming and laborious . Since the cultures incubated under air gave the same cell yield as obtained when incubated under optimal gas mixtures, air alone can be used for the in vitro cultivation trials of M . leprae when palmitic acid is included in the culture medium.

Cancer Invest, 1993, 11(6), 660 - 6
Inhibition of murine sarcoma cell adherence to polystyrene substrata by bacillus Calmette-Guérin: evidence for fibronectin-mediated direct antitumor activity of BCG; Klegerman ME et al.; Bacillus Calmette-Guerin (BCG) inhibited adherence of S180 mouse sarcoma cells and WI38 human diploid fibroblasts to the polystyrene substratum of 24-well cluster dishes in a dose-dependent manner . This property was retained by washed or heat-killed bacilli, but not by the vaccine filtrate or by the spent bacterial culture medium . Adhesion of bacilli to nonadherent S180 cells was demonstrated by light and scanning electron microscopy, but was not seen after trypsinization of adherent cells, indicating that bacilli bind to cell-surface adhesins . Preincubation of bacilli with human fibronectin abolished their ability to inhibit S180 adherence, suggesting that the phenomenon may be mediated by interaction of bacilli with cell-surface fibronectin . Fibronectin pretreatment of the bacteria also decreased their inhibition of S180 tumor growth in vivo, indicating that this mechanism may be at least partly responsible for BCG vaccine's observed antineoplastic activity.

Acta Leprol, 1993, 8(3), 133 - 5
Attempts to cultivate Mycobacterium leprae in fat tissue; Godard CM; The behaviour of M . leprae in fat tissue was studied . Preadipocyte cells were infected with M . leprae and injected intradermally (I.D.) into nude mice . Adipose nodules obtained by in vivo differentiation of infected cells were maintained in vivo for 3 months and subsequently incubated in vitro for 3 months . Counts of bacilli showed no increase over this 6 months period . It is concluded that undifferentiated preadipocyte and mature fat cells are not permissive for M . leprae . The morphological changes observed following passage of M . leprae into adipose nodules might be related to the process of adipose cell differentiation.

Rev Med Interne, 1993, 14(7), 715 - 22
{Tuberculosis and HIV}; Rogeaux O et al.; With the increased number of HIV infected patients, tuberculosis has become more frequent in Europe, USA and particularly in Africa . Impaired immunity, poor life conditions and high prevalence of tuberculosis in the general population facilitate the transmission of the disease . Tuberculosis is often seen early in the course of HIV infection and sometimes reveals the underlying immunodeficiency . Most of these cases are due to reactivation of earlier primo-infection when tuberculosis occurs later in the HIV disease, it may be secondary to a recent contagion . The infection may be localized in the lungs or in extrathoracic sites such as lymph nodes, liver, spleen, blood or meninges . The diagnosis is based on direct visualization of acid fast bacilli in gastric aspirate or BAL, on positive blood cultures or in histological findings which often show atypical granulomatous reaction without marked caseation . The role of the intracutaneous tuberculin test remain questionable as it often proves negative . A positive skin reaction can be useful for the diagnosis of tuberculosis, however, this is rarely observed . An early diagnosis is important in order to improve the prognosis and this justifies the frequent instauration of empiric treatment . The usual quadritherapy is efficacious and when started early permits in most cases a favorable outcome . The duration of treatment is poorly standardized but approaches 9-12 months in most instances . The drugs are not always well tolerated . A life-long maintenance therapy seems to have become necessary and primary prophylaxis might be of interest . The increased occurrence of drug resistant stains adds to the interest of preventing transmission, particularly in the hospital.

Pediatrie, 1993, 48(7-8), 543 - 6
{Congenital tuberculosis . Apropos of a case disclosed after necrotizing enterocolitis}; Lagier P et al.; The authors report on the observation of a premature infant (gestational age 31 weeks, birth weight 1440 g) who experienced a necrotizing enterocolitis and a congenital tuberculosis . Congenital tuberculosis is a rare infection; transmission of Koch's bacilli is achieved through hematogenous route or more frequently through inhalation or ingestion of infected amniotic fluid . The diagnosis was done when miliary patterns were found on the mother's chest X-ray . At the same time, the newborn presented with a chronic lung disease, a poor clinical status with biological signs of inflammation . Usual antibiotics were unsuccessful . A rapid improvement was obtained with a specific antituberculous treatment.

Pneumoftiziologia, 1993 Jan-Jun, 42(1-2), 23 - 7
{Tuberculosis in the elderly: sociomedical aspects}; Anastasatu C et al.; A study on a group of 100 tb patients aged over 60 years registered between 1987-1991 in the district 4 of Bucharest has been carried out aiming at the evaluation of medical and social aspects . In order to increase the relevance of the obtained data, these were compared with a group of young tb patients aged 20-39 years, in the same territory and period of time . The results show: the case-finding predominantly passive, extrarespiratory forms in 25%, high contamination risk (63% acid fast bacilli eliminators on microscopy) non-compliance to treatment in 1/5 of cases . These aspects could be explained by psychic particular features in aged persons, associated diseases a.s.o., leading to treatment failures . The analysis of social and epidemiological aspects of tb in aged subjects evidences some lack of good results in this important public health problem of people.

Folia Microbiol (Praha), 1993, 38(4), 345 - 8
Host response to Mycobacterial cell wall subunit during experimental tuberculosis in mice; Chugh IB et al.; The cell-wall protein-peptidoglycan complex (CW-PPC) of Mycobacterium tuberculosis, an immunologically potent component, was used to study the correlation between immune response and in vivo bacterial multiplication in the course of experimental tuberculosis infection in mice . Antibodies to CW-PPC were detected only after seven weeks of infection with M . tuberculosis H37Rv and afterwards no significant change was seen throughout the experiment . Delayed type hypersensitivity (DTH) to CW-PPC showed a gradual increase from the fifth week onward with a maximum during the 12th week after infection (p.in.) which did not change significantly afterward . The increased immune response in the course of infection correlated well with the multiplication rate of bacilli in the lungs . These results indicate a role of CW-PPC in antituberculous immunity.

Cancer Treat Res, 1993, 62, 101 - 7
Liposome-encapsulated muramyl tripeptide: a new biologic response modifier for the treatment of osteosarcoma; Kleinerman ES et al.; We have demonstrated that monocytes from osteosarcoma patients can be rendered tumor cytotoxic by both in vitro incubation with liposomal MTP-PE and i.v . administration of this agent . Chemotherapy did not interfere with this activation process . We have further demonstrated in phase I and phase II trials that liposomal MTP-PE can be given safely i.v . to both adults and children with minimal side effects . The findings of peripheral fibrosis with neovascularization and infiltration of the tumor with chronic inflammatory cells after liposomal MTP-PE therapy are unlike any observed following chemotherapy or surgery . Subsequent to chemotherapy, osteosarcoma lung metastases usually exhibit a zone of central necrosis, with viable tumor cells growing at the periphery of the lesion . However, in our patients following liposomal MTP-PE viable tumor cells were observed in the center of the lesion, with necrosis and fibrosis at the periphery . These changes were thus interpreted as a specific response to liposomal MTP-PE . The peripheral fibrosis observed in these tumors is reminiscent of the appearance of pulmonary tuberculosis lesions . Initially, the lesion is walled off and slow necrosis proceeds from the outside so that the lesion is replaced by fibrous tissue . Eradication of tuberculosis by chronic inflammation is a slow process . Viable bacilli can persist for months . Thus, our choice of a 3-month treatment course may have been insufficient . We have now extended our protocol to allow 6 months of therapy . Osteosarcoma appears to be an ideal disease in which to employ liposomal MTP-PE as an additional adjuvant to present chemotherapy regimens.(ABSTRACT TRUNCATED AT 250 WORDS)

J Hosp Infect, 1993 Jan, 23(1), 35 - 41
Impact of ampicillin and cefuroxime on bacterial colonization and infection in patients on a neonatal intensive care unit; Kalenic S et al.; The impact of ampicillin and cefuroxime on the bacterial flora of neonates was examined in a neonatal intensive care unit (NICU) . For the first period of study (January-September 1989), ampicillin plus gentamicin were used as empirical therapy of infection . During this time, 92.6% of all Gram-negative bacilli (GNB) were resistant to ampicillin and 56.6% to cefuroxime . These percentages decreased significantly (P < 0.05) to 60.0% and 16.2% respectively, over the next period of study (October 1989-October 1990) when cefuroxime+gentamicin were used . A decrease in the number of cases of GNB from bacteraemia and meningitis was also significant (from 21.2% to 11.2%), and this correlated with a decline in the occurrence of Klebsiella pneumoniae . However, the number of enterococcal isolates and cases of enterococcal bacteraemia increased . These observations underline the important effect of ampicillin and cefuroxime in modulating the bacterial flora and its antibiotic resistance in patients on a NICU.

Kekkaku, 1993 Jan, 68(1), 13 - 21
{Studies on the significance of CD4+ T lymphocytes in the development of tuberculosis}; Yamamoto S et al.; Numerous studies on the natural history of HIV-infection have revealed that the number of CD4+ T lymphocytes in peripheral blood was the most important determining factor for the occurrence of various opportunistic infections and the most reliable prognosis indicator for the progression of HIV-infection to AIDS . It is also generally accepted that CD4+ T lymphocytes are the key cells in protective immunity in tuberculosis . Basing on these knowledges, we tried to analyze the significance of the number of CD4+ T lymphocyte in the development of clinical tuberculosis from latent infection with tubercle bacilli . Of 84 tuberculosis patients, younger than 70 years old, who had been analyzed lymphocyte subsets by flow cytometry (FACS), six patients (one female, five males) had remarkably reduced number of CD4+ T lymphocytes (< or = 250 cells/mm3) by their first FACS analysis after diagnosis . Any obvious risk behavior and/or habit was noticed in none of the six patients, three of whom were in the twenties . FACS analyses of these six cases revealed that: 1) The proportion of total lymphocytes to total leukocytes was remarkably lower than that of tuberculosis patients as a whole as well as than that of healthy control group . 2) The numbers of total lymphocytes, T lymphocytes and CD4+ T lymphocytes were all far below the normal range . (mean +/- 2 x SD of the control group) . 3) The proportion of CD8+ T lymphocytes to total lymphocytes was higher in five of these six cases, but the number of CD8+ T lymphocytes was lower in all six than the respective mean value of the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Probl Tuberk, 1993, (2), 20 - 4
{Characteristics of thanatogenesis and pathomorphology of tuberculosis in the Gomel region in relation to the Chernobyl AES accident}; Surkova LK et al.; On the basis of 750 autopsy records fatal outcomes were studied in Gomel and Gomel region for the period of 5 years after the Chernobyl accident and for the same period in Minsk and Minsk region . A stereomorphometric method was used for studying thymus morphostructure in 20 fatal cases of tuberculosis among the population of Gomel . Certain specific features of tuberculous thanatogenesis and pathomorphology have been revealed which were most pronounced on the monitored territories of the Gomel region and which manifested themselves in the more remote terms (4-5 years) after the Chernobyl accident . Mortality from fibrocavernous pulmonary tuberculosis with massive destructive components and copious bacilli excretion increased to 63.2% and that from disseminated forms of tuberculosis to 22.5% . In regions under the strict control the frequency of tuberculosis progress among the principal causes of death with the development of caseous pneumonia has grown to 55.5% as against 31.8% on the less contaminated territories (to 1 Ci/km2) . The thymus underwent deep reorganization which was inadequate to the severity of the principal disease and age . The evidence of this was overstrain of adaptational-compensatory mechanisms of the immune system that finally led to the development of T-immunodeficiency in 55.3% of the patients.

Probl Tuberk, 1993, (2), 15 - 7
{Tuberculosis in cooperative workers}; Kononenko VG et al.; Out of 67 cooperators with tuberculosis treated at the city antituberculosis dispensary the advanced disease was found in 68.5% of the cases . Of them 67.7% discharged tubercle bacilli, 38.4% had multiple caverns . Among the reasons for a severe specific process in the lungs are intensive labour, late working hours, lack of social and health protection.

Diagn Cytopathol, 1993, 9(3), 325 - 8
Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with acquired immunodeficiency syndrome (AIDS): report of a case and a review of the literature; Ang GA et al.; Negative images of acid-fast bacilli were observed in Diff-Quik-stained smears of lymph node aspirates from a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Mycobacterium avium-intracellulare infection . The significance of this finding in relation to the diagnosis and treatment of this infection is discussed and the literature pertaining to this observation is reviewed.

Acta Clin Belg, 1993, 48(1), 20 - 9
Passive immunotherapy of gram-negative bacteremia, sepsis and septic shock; Spapen HD et al.; Despite the use of increasingly potent antibiotics and aggressive cardiovascular monitoring and support, Gram-negative bacteremia and ensuing sepsis and septic shock remain a leading cause of morbidity and mortality after surgery and in critically ill patients . In previous years several new agents and techniques have been developed to improve management and outcome of severe Gram-negative infections . A recently introduced treatment is passive immunotherapy by administration of poly- or monoclonal anti-endotoxin antibodies . The current view--sustained by experimental and human studies--on the mechanism of protection afforded by immunotherapy is that the harmful effects of endotoxin are neutralized by cross-reactive antibodies to the core glycolipid structure of rough mutant Gram-negative bacilli . Two recent large clinical trials reported impressive results achieved through the use of monoclonal anti-endotoxin antibodies in certain subgroups of patients with Gram-negative sepsis . However, this treatment is empirical, expensive and it does not affect overall sepsis mortality . Cytokines such as tumor necrosis factor alpha and interleukin-1 play a pivotal role in sepsis . Experimental studies suggest that specific antagonism of these mediators might offer great perspectives for the treatment of Gram-negative sepsis . An early multi-pharmacological approach aimed at interruption of multiple steps underlying the inflammatory septic cascade will probably constitute the most promising future treatment of severe Gram-negative infectious disease.

J Infect Dis, 1993 Jan, 167(1), 237 - 40
Cervical lymphadenitis in a child caused by a previously unknown mycobacterium; Haas WH et al.; Acid-fast bacilli were isolated from lymph nodes of an immunocompetent child presenting with unilateral cervical lymphadenitis . The slowly growing mycobacterium could not be identified by traditional methods . Direct sequencing of the enzymatically amplified 16S rRNA gene revealed a unique sequence belonging to a previously unrecognized mycobacterium . Direct 16S rDNA sequencing enables definitive identification of mycobacterial isolates . The method is useful for rapid recognition of previously unrecognized pathogens.

Lancet, 1992 Dec 19-26, 340(8834-8835), 1504 - 5
Fine-needle extrathoracic lymph-node aspiration in HIV-associated sputum-negative tuberculosis; Pithie AD et al.; HIV-associated tuberculosis is increasingly seen in Zimbabwe and other developing countries . The clinical and radiological features are often atypical, and diagnostic confusion may arise when sputum smears are negative . Patients with suspected intrathoracic tuberculosis frequently have palpable extrathoracic lymph nodes . In this study, Ziehl-Neelsen staining of aspirates from extrathoracic lymph nodes revealed acid-fast bacilli in 20 (71%) of 28 patients with suspected tuberculosis, and 20 (87%) of 23 patients in whom a final diagnosis of tuberculosis was made Aspiration is simple, rapid, and cheap and may be of value in the diagnosis of tuberculosis, especially in developing countries with limited diagnostic and therapeutic resourcesPIP: Between December 1991 and May 1992 physicians included all patients who come to Parirenyatwa Hospital or Harare Central Hospital in Zimbabwe with suspected pulmonary, pleural, or pericardial tuberculosis (TB) in their study to determine the utility of fine-needle aspiration of extrathoracic lymph nodes in suspected intrathoracic TB in identifying HIV-related pulmonary, pleural, or pericardial TB . They conducted fine-needle aspiration in 28 patients with suspected TB . Microscopy revealed acid-fast bacilli in 20 patients (71%) . 48 hours after hospital admission, 3 of these patients died even though they received anti-TB chemotherapy . The other 17 responded well to anti-TB chemotherapy . 3 of the 8 patients who had negative lymph-node aspirates for acid-fast bacilli responded to anti-TB therapy, indicating that they probably did indeed have TB . Therefore, fine needle extrathoracic lymph node aspiration followed by staining detected TB in 87% of patients actually ill with TB (20/23) . Since the study did not include sputum-positive patients, those with penicillin-responsive fever, and those with obvious palatal or cutaneous Kaposi's sarcoma, the study was somewhat biased . Nevertheless, these results indicated that HIV-associated intrathoracic TB was often associated with extrathoracic tuberculous lymphadenitis . Since fine-needle aspiration is simple, rural hospitals and clinics in developing countries could use it to detect sputum-negative TB and then to determine appropriate therapy . Infection with atypical mycobacteria rarely occurs in Zimbabwe and other African countries, so physicians in Africa should use anti-TB chemotherapy to treat patients with a positive aspirate .

Proc Natl Acad Sci U S A, 1992 Dec 15, 89(24), 12013 - 7
Major histocompatibility complex class I-restricted T cells are required for resistance to Mycobacterium tuberculosis infection; Flynn JL et al.; Mice with a targeted disruption in the beta 2-microglobulin (beta 2m) gene, which lack major histocompatibility complex class I molecules and consequently fail to develop functional CD8 T cells, provided a useful model for assessing the role of class I-restricted T cells in resistance to infection with virulent Mycobacterium tuberculosis . Of mutant beta 2m-/-mice infected with virulent 10(6) M . tuberculosis, 70% were dead or moribund after 6 weeks, while all control mice expressing the beta 2m gene remained alive for > 20 weeks . Granuloma formation occurred in mutant and control mice, but far greater numbers of tubercle bacilli were present in the lungs of mutant mice than in controls, and caseating necrosis was seen only in beta 2m-/-lungs . In contrast, no differences were seen in the course of infection of mutant and control mice with an avirulent vaccine strain, bacille Calmette-Guerin (BCG) . Immunization with BCG vaccine prolonged survival of beta 2m-/-mice after challenge with M . tuberculosis for 4 weeks but did not protect them from death . These data indicate that functional CD8 T cells, and possibly T cells bearing gamma delta antigen receptor, are a necessary component of a protective immune response to M . tuberculosis in mice.

J Laryngol Otol, 1992 Dec, 106(12), 1094 - 5
Diffuse tuberculous parotitis; Rowe-Jones JM et al.; Parenchymatous parotid tuberculosis diffusely affecting the entire gland is very rare . We present a case, associated with a primary pulmonary focus, that was confirmed after positive identification of alcohol and acid-fast bacilli in gastric washings . Both sites of infection resolved with quadruple anti-tuberculous chemotherapy.

Lepr Rev, 1992 Dec, 63(4), 329 - 36
Persistence of Mycobacterium leprae in the peripheral nerve as compared to the skin of multidrug-treated leprosy patients; Shetty VP et al.; Skin and nerve biopsies obtained from 18 multibacillary (MB) and 16 paucibacillary (PB) cases of leprosy who had been fully treated by the WHO regimen were assessed for bacterial load using different staining techniques . In addition skin and nerve homogenates of 10 MB cases were tested for 'persistor' Mycobacterium leprae using immunosuppressed mice . While significant amounts of integral bacilli and BCG cross-reactive antigen of M . leprae were detected both in skin and nerve tissues of all the MB cases (100%), 56% of skin and 62% of nerve biopsies of PB cases also showed the presence of BCG cross-reactive antigen . Detection of 'persistor' M . leprae in 2/10 skin biopsies (20%) and 3/10 nerve biopsies (30%) of MB cases was thought to be unexpectedly high after 2 years of MDT.

Lepr Rev, 1992 Dec, 63(4), 319 - 28
Bactericidal action at low doses of a new rifamycin derivative, 3'-hydroxy-5'-(4-isobutyl-1-piperazinyl) benzoxazinorifamycin (KRM-1648) on Mycobacterium leprae inoculated into footpads of nude mice; Gidoh M et al.; Among a series of newly-synthesized benzoxazinorifamycins, 2 of the 3'-hydroxy-5'-(4-alkyl-1-piperazinyl) derivatives, named KRM-1648 and KRM-2312, whose respective alkyl residues are isobutyl and isopropyl, were examined for efficacy against nude mouse-model leprosy . KRM-1648 completely inhibited the growth of leprosy bacilli inoculated into nude mouse footpads, even 6 months after the medication had been stopped, when given orally at a daily dose of 0.6 mg/kg, 5 or 6 times weekly, during 3-5 months postinoculation . In comparison, the growth inhibition by KRM-2312 was incomplete under the same conditions, though it was still stronger than that by rifampicin . Complete growth inhibition by KRM-1648 was also observed when it was given orally at a dose of 1 or 3 mg/kg twice weekly during the same period . In contrast, the growth inhibition by rifampicin was only slight at 1 mg/kg and partial at 3 mg/kg under the same condition.

J Vet Med Sci, 1992 Dec, 54(6), 1205 - 7
Listeric septicemia with meningitis in a neonatal calf; Seimiya Y et al.; A 9-days-old calf which had exhibited depression and difficulty to stand and walk was examined pathologically and bacteriologically . The primary pathological changes consisted of multifocal necrosis in several visceral organs and fibrinopurulent meningitis . The necrotic lesions were most frequently found in the liver, and accompanied with mononuclear cell infiltration and Gram-positive small bacilli . The organisms were also present in the foci of mononuclear cells at the central gray matter of the mesencephalon . Listeria monocytogenes was isolated from the brain and other organs of the whole body.

Epidemiol Infect, 1992 Dec, 109(3), 337 - 47
Selective decontamination of the digestive tract in intensive care; Boom SJ et al.; Nosocomial infection in intensive care unit (ICU) practice is a common problem and is associated with abnormal carriage of Gram-negative aerobic bacilli in the gastrointestinal tract, resulting in endogenous infections . Selective decontamination of the digestive tract (SDD) is a regimen aimed at preventing or eradicating this abnormal carriage . A large number of trials examining SDD in ICU practice have been published, the vast majority showing a significant reduction in the incidence of nosocomial, Gram-negative infection . However, the impact on morbidity and mortality is much less certain . A recent meta-analysis has suggested a 10-20% reduction in mortality (3-6% absolute difference) with SDD . A discussion of these results is presented together with potential criticisms of SDD.

Scand J Immunol, 1992 Dec, 36(6), 823 - 31
Identification of immunodominant antigens during infection with Mycobacterium tuberculosis; Andersen P et al.; T lymphocytes isolated from mice infected with Mycobacterium tuberculosis response vigorously to proteins secreted by the bacilli and these antigens may be of importance in the generation of protective immunity against the disease . In this study, short-term culture filtrate (ST-CF), which constitutes a complex mixture of secreted proteins, was fractionated by a modified preparative SDS-PAGE technique . The ability of each fraction to be recognized by T cells isolated from infected mice was evaluated by quantifying proliferation and IFN-gamma production in cell cultures . Two molecular mass regions 4-11 and 26-35 kDa were found to possess marked stimulatory properties . Four potent single antigens were mapped within the stimulatory regions . These purified antigens stimulated T cells isolated from mice at the height of a tuberculous infection to produce large amounts of IFN-gamma . Two of these stimulatory antigens belonged to the antigen 85 complex.

Crit Care Med, 1992 Dec, 20(12), 1699 - 704
Selective decontamination of the digestive tract prevents secondary infection of the abdominal cavity, and endotoxemia and mortality in sterile peritonitis in laboratory rats; Rosman C et al.; BACKGROUND AND METHODS: This study was undertaken to find out whether translocation of bacteria to the abdominal cavity and endotoxemia in rats with sterile peritonitis could be prevented by selective decontamination of the digestive tract . Sterile peritonitis was caused by the intraperitoneal injection of either 100, 150, 200, or 300 mg of zymosan suspended in paraffin . RESULTS: The frequency of infection of the abdominal cavity depended on the dose of zymosan given, ranging from 20% in rats receiving 100 mg to 89% in rats receiving 300 mg of zymosan . In rats not receiving antibiotics for selective decontamination of the digestive tract (the control group) . Gram-negative bacilli were isolated from the digestive tract in all rats, and Gram-negative bacilli were isolated from the abdominal cavity in ten of 19 rats . In rats receiving antibiotics for selective decontamination of the digestive tract, Gram-negative bacilli were isolated from the digestive tract in none of the 14 rats, and likewise, Gram-negative bacilli were isolated from the abdominal cavity in none of the 14 rats (p < .005) . Moreover, in rats receiving antibiotics for selective decontamination of the digestive tract, endotoxin levels in feces and plasma were significantly lower, as compared with rats not receiving antibiotics for selective decontamination of the digestive tract . CONCLUSION: Selective decontamination of the digestive tract prevents translocation of Gram-negative bacilli to the abdominal cavity, and endotoxemia and mortality in rats with sterile peritonitis.

Am Rev Respir Dis, 1992 Dec, 146(6), 1448 - 51
The combined effect of rifampin and pyrazinamide within the human macrophage; Sbarbaro JA et al.; A recent study in the murine model suggested that a combination of rifampin and pyrazinamide used as preventive therapy might shorten the duration of treatment time . Clinical trials using this combination have been initiated, but significant results will not be available for many years . The ex vivo human macrophage model has been instructive in expanding our knowledge of the activity of chemotherapeutic agents against intracellular virulent tubercle bacilli . Prior studies have shown rifampin to have a bactericidal effect in this model while even at clinically unachievable levels, pyrazinamide had only a bacteriostatic impact . This study finds an enhanced bacteriostatic effect when low, nonbactericidal levels of rifampin are combined with clinically achievable levels of pyrazinamide but not with higher bactericidal levels of rifampin . Adding pyrazinamide 2 days after the introduction of rifampin clearly enhanced the combined killing effect . However, reversing the order and adding rifampin 2 days after the introduction of pyrazinamide produced a result weaker than introducing the agents simultaneously . Our findings do not support the use of these agents as a potentially effective preventive therapy combination, but they suggest that the timing of the administration of these chemotherapeutic agents could be an important factor in their effectiveness.

J Clin Microbiol, 1992 Dec, 30(12), 3095 - 8
Effects of fixation on polymerase chain reaction detection of Mycobacterium leprae; Fiallo P et al.; The effects of standard fixatives (10% neutral buffered formalin, ethanol and mercury based) on the detection of Mycobacterium leprae DNA by the polymerase chain reaction (PCR) were studied . Mercury-based fixatives (Zenker's and Carnoy-Lebrun's fluids) strongly inhibited PCR amplification of M . leprae DNA . Ten percent neutral buffered formalin was inhibitory, but significant inhibition was observed only when fixation times exceeded 24 h . Ethanol-based fixatives provided the best medium for holding specimens for subsequent PCR with both free bacilli and skin biopsy specimens containing M . leprae . The M . leprae-specific, 360-bp region of the 18-kDa protein gene could be amplified from paraffin-embedded sections of formalin-fixed skin biopsy specimens from patients with either multibacillary or paucibacillary infections when proper fixation conditions were used . Results of the study demonstrate that tissues properly fixed with two standard fixatives (10% neutral buffered formalin and 50 or 70% ethanol) can be analyzed by PCR for the presence of M . leprae with no loss in specificity and only minimal diminution in sensitivity compared with the specificities and sensitivities obtained by use of freshly prepared, unfixed specimens.

Chest, 1992 Dec, 102(6), 1746 - 7
Large pericardial effusions in the acquired immunodeficiency syndrome; Reynolds MM et al.; The increasing importance of the acquired immunodeficiency syndrome (AIDS) as a cause of large, clinically significant pericardial effusions has not been well documented . To determine the frequency and characteristics of large AIDS-associated pericardial effusions, we reviewed the records of 50 consecutive patients undergoing pericardiocentesis between 1985 and 1990; AIDS was the most common underlying illness and was present in 14 patients (28 percent) . The pericardial fluid was diagnostic in three (21 percent) of the 14 cases (one bacterial, one positive for acid-fast bacilli, and one lymphoma) . Of the 11 patients with nondiagnostic fluid, one underwent a pericardial biopsy which revealed granuloma consistent with mycobacterial disease, four had active pulmonary tuberculosis (TB), and two responded clinically to anti-TB therapy . Thus, in 8 (57 percent) of the 14 patients with AIDS, there was either definitive or suggestive evidence of mycobacterial disease . We conclude that AIDS is now a common underlying illness associated with large pericardial effusions and that mycobacterial disease may frequently be the etiology.

Zhonghua Jie He He Hu Xi Za Zhi, 1992 Dec, 15(6), 325 - 7, 378
{A study on the count of living BCG bacilli using BL and FS methods}; Zhang JG; Counting of living BCG bacilli is an important indicator for surveillance of BCG quality . Presently the method of CFU recommended by WHO is still widely used . This study employs rapid bioluminescent technique which measures ATP in the BCG and the fluorescent staining method which determines living bacilli rate in the BCG . CFU technique is used as control . Combining the results of OT tests in newborn children, we can evaluate the effects of BL and FS techniques used in surveillance of BCG quality . It is show that there is a significant correlation between BL and CFU techniques (r = 0.973, P < 0.005) . Coefficient of variation in BL test group (ev = 2.72%) is much smaller than that in CFU group (cv = 39.5%) . The results are also compatible with that of FS and OT reaction.

Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Dec, 30(12), 2128 - 33
{Adult T-cell leukemia with various pulmonary complications}; Fujita H et al.; A 59-year-old male, born in Wakayama prefecture, was admitted to our hospital because of cervical lymph node swelling, huge mass lesions in both liver and head of the pancreas, and multiple nodular shadows in the left lung . Lymph node biopsy revealed a necrotic lesion containing tuberculous bacilli with no epithelioid cells or giant cells . Adult T-cell leukemia (ATL) was diagnosed by the presence of atypical lymphocytes with a convoluted nucleus and positive anti-ATL antibody . During successful treatment of Mycobacterium tuberculosis with ethambutol, isoniazid and rifampicin, ATL transformed to the blastic phase . The new pulmonary infiltrates improved after treatment with both combination chemotherapy for ATL and antibiotics . However, new infiltrative shadows appeared in both lungs, and were resistant to treatment and the patient died of acute respiratory failure . Histological examination of the lung at autopsy showed interstitial fibrosis with infiltration of leukemic cells and cytomegalovirus infection.

Zentralbl Bakteriol, 1992 Dec, 277(4), 561 - 4
Isolation of Mycobacterium simiae from the environment; Schroder KH et al.; An examination of 18 sphagnum samples collected in two different biotopes of the coastal region of southeastern Madagascar revealed an unexpectedly high positivity for mycobacteria (83.3%) . The concentration of alcohol acid-fast bacilli reached a high level of 10(5) and 10(6)/g, respectively, compared with the sphagnum biotopes in moderate climates . Besides the habitat-specific mycobacterial species in sphagnum vegetation, like M . sphagni, M . gordonae and M . madagascariense, potentially pathogenic species, like M . avium, M . scrofulaceum and M . xenopi and M . marinum, were found . Furthermore, pathogenic M . simiae was found in sphagnum vegetation of Madagascar, first time isolated in the environment until now . It should be considered as a potential source of infection for human and animals.

Kekkaku, 1992 Dec, 67(12), 771 - 4
{Diagnostic role of fiberoptic bronchoscopy for mycobacterial diseases}; Kurashima A et al.; From 1981 to 1991, 5,572 patients underwent bronchoscopic examination, in this series 3,754 patient's samples were sent for determination of mycobacterial isolation . In the 506 samples, mycobacterial bacilli were detected with smear or culture . In the low tuberculous incidence area like northern part of America, many reporters supported the opinion that routine bronchial aspirate detection for tuberculosis was not cost-effective . Inversely, in the high tuberculous incidence area like Hong Kong, M . lp et al . claimed the usefulness of routine bronchial aspirate examination for mycobacterial bacilli . Japan was regarded as moderate tuberculous incidence area . We review a ten-year experience with fiberoptic bronchoscopy for mycobacterial isolation . Our results suggest that in an area with a moderate prevalence of tuberculosis, bronchoscopic examination for mycobacterial disease is useful in the selected hospitals for the selected cases . In Japan, the smear positive prevalence has been on the increase from 1982 . We estimate that the Japanese popularization of fiberoptic bronchoscopy may influence a part of the Japanese epidemic statistical analysis of mycobacteriosis.

Kansenshogaku Zasshi, 1992 Dec, 66(12), 1682 - 91
{Rapid and direct detection of Mycobacterium tuberculosis complex and mycobacteria in sputum by advanced method, PCR}; Kusunoki S et al.; We developed two PCR methods, which amplify bovine tuberculous MPB70 gene and mycobacterial 16S rRNA gene, for detection of tubercle bacilli and mycobacteria in sputum, respectively . Among 27 Mycobacterium species and 57 species of 30 genuses other than Mycobacterium, only M . tuberculosis (TB) complex, i.e., M . tuberculosis, M . bovis, M . africanum, M . microti showed DNA amplification by PCR for MPB70, and amplification of 16S rRNA gene were observed specific in Mycobacterium species . A combination of these PCR abilities were available to differentiate the TB complex and nontuberculous mycobacteria (NTM) . We investigated the correlation between these methods and conventional methods with 311 sputa that were suspected mycobacteriosis . The PCR method could detect 12 cases of TB complex and 4 cases of NTM in 17 specimens, which were positive by conventional methods, but could not for one specimen . Among 294 specimens that were negative with conventional methods, the PCR method detected 13 and 8 cases of TB complex and NTM, respectively . These results were confirmed by commercial tuberculous specific DNA probe or investigation of the clinical background of the patients . On the other hand, 273 specimens showed negative result either PCR nor conventional methods . The PCR method did not detect tuberculous DNA in normal 197 sputa, which were not suspected mycobacteriosis . These results indicate that each one of these PCR methods is highly specific to TB complex or Mycobacterium species . We concluded that these PCR methods are useful and advanced methods for rapid and direct detection of tuberculosis and mycobacteriosis.

Jpn J Antibiot, 1992 Nov, 45(11), 1474 - 88
{The influence of cefprozil on intestinal bacterial flora}; Iwata S et al.; Cefprozil (CFPZ, BMY-28100), a new oral cephalosporin antibiotic, was studied for its effect on the intestinal bacterial flora in pediatric patients . The subjects were children admitted for infections (2 males and 2 females, 9 months to 6 years 3 months old, weighed 4.3 to 19.0 kg) . CFPZ granule was orally administered at a dose between 10.0 to 11.6 mg/kg, 3 doses daily, over 4 to 14 days . The feces from these children were collected before, during and after administration, and bacteria were identified and counted . CFPZ concentration, beta-lactamase activity were also assayed . Bacterial flora in feces during CFPZ administration showed some variance, but no significant change was observed in main aerobes and anaerobes . And in no case, glucose nonfermentative Gram-negative bacilli or fungi were found dominant . beta-Lactamase activity was positive in the feces in all cases . CFPZ concentrations were not detectable in feces before, during and after administration . The above results suggest that CFPZ is a drug with little influence on the intestinal bacterial flora in children.

Jpn J Antibiot, 1992 Nov, 45(11), 1460 - 8
{Therapeutic effects of cefuzonam against severe infections in patients with hematopoietic disorders . Hanshin Infection Study Group}; Hasegawa H et al.; Cefuzonam (CZON) was used to treat severe infections in 151 patients with hematopoietic disorders, and its efficacy and safety were assessed . The drug was given in doses of 2.0 to 6.0 g a day, divided into 2 or 3, intravenously by injection or infusion . The clinical effects were excellent in 34 cases, good in 40 cases, fair in 5 cases, and poor in 57 cases . Therefore, the results were excellent or good in 54.4% of the patients treated . The efficacy rates were 43.8 and 35.9% for groups of patients whose neutrophil counts were 500/microliters or less and 100/microliters or less, respectively . It was excellent or good in 70.6% of patients in whom causative agents were identified, and in 66.7 and 80.0% of patients infected with Gram-negative and -positive bacilli, respectively . The efficacy rate for patients infected with unidentified agents was 52.1% . The rate for patients who had received other antibiotics previously was 41.5% . The rate for patients having received only one antibiotic for the preceding treatment was 50.0% . Six (3.9%) of the treated patients experienced adverse effects including changes in laboratory test results observed in 4.

Kekkaku, 1992 Nov, 67(11), 729 - 33
{A case of severe juvenile pulmonary tuberculosis associated with malnutrition in special reference to nutritional assessment}; Yoshida E et al.; We reported a case who had suffered from severe pulmonary tuberculosis in association with severe malnutrition . A 19-year-old man was admitted complaining of high fever, productive cough and body weight loss . Before admission, he worked as a cook for long hours a day and had meals irregularly . On admission, he was cachexic . Coarse crackles were auscultated on the both lung field, and the liver was enlarged . Chest X-ray revealed multiple ringed and mottled shadows mainly in bilateral upper and middle lung field . Laboratory examination revealed inflammatory reaction defined by an increase of white blood cells, accelerated erythrocyte sedimentation rate and positive CRP, impairment of liver function and cell-mediated immunity, hypoxemia and restrictive lung dysfunction . Ziehl-Neelsen stain of sputum showed a large number of acid fast bacilli . The assessment of his nutritional status showed decrease in anthropometric measurements, visceral proteins and the Fischer ratio, which suggested that he was in the status of protein-calorie malnutrition in association with amino acid imbalance . He was treated with nutritional therapy in addition to antituberculous drugs, which improved his clinical symptoms, laboratory data and nutritional assessment . These results suggested the importance of nutritional assessment and nutritional therapy based on it.

Kekkaku, 1992 Nov, 67(11), 721 - 8
{A case of pulmonary tuberculosis associated with severe respiratory failure, DIC and intractable bilateral pneumothoraces}; Tsubosaka S et al.; We had a sixty-five year old male patient who suddenly complained of dyspnea and fever with pulmonary tuberculosis, severe respiratory failure, disseminated intravascular coagulation (DIC) and intractable bilateral pneumothoraces . From the first hospital day severe hypoxemia which did not respond to conventional oxygen therapy developed with a diffuse ill-defined reticulo-nodular shadow in the plain chest x-ray film . On the 2nd hospital day mechanical ventilation with 2cmH2O PEEP was introduced . Antituberculous agents as well as corticosteroids were started suspecting acute interstitial pneumonia with pulmonary tuberculosis and adult respiratory distress syndrome (ARDS) . Medication was followed by the treatment of Gabexate mesilate and heparin against DIC on laboratory data . Though clinical findings and pulmonary infiltrate on chest x-ray film transiently improved, right pneumothorax occurred suddenly on the 6th day followed with left pneumothorax on the 36th day . Tube drainage of both pleural spaces and repeated instillation of thrombin-rich oxycel cotton via bronchofiberscope failed to stop air leakage . He ultimately expired on 49th hospital day . At postmortem lung had multiple bilateral bulla several of which ruptured to the pleural site and caseating necrotic area containing bacilli positively stained with Ziehl-Nielsen stain in the bilateral upper lobe . No typical caseating necrotic lesion, however, was found in the other lung tissue . Therefore, it seemed to show a chronic phase of diffuse alveolar damage (DAD).

J Hepatol, 1992 Nov, 16(3), 266 - 72
Gut-derived substances in activation of hepatic macrophages after partial hepatectomy in rats; Mochida S et al.; When liver perfusion with nitro blue tetrazolium and phorbol myristate acetate was performed in rats 24 h after two-thirds liver resection, there were marked deposits of formazan converted from nitro blue tetrazolium in hepatic macrophages throughout the liver, indicating macrophage activity . The extent of the deposits was significantly reduced when perfusion was performed following oral administration of polymyxin B sulfate, a non-absorbable bacteriocidal agent against gram-negative bacilli which can also bind endotoxin lipopolysaccharides . Polymyxin B sulfate administration also attenuated the derangements of SGPT and the histological liver injury provoked by endotoxin administration after partial hepatectomy . These results suggests that gut-derived substances sensitive to polymyxin B sulfate may contribute to activation of hepatic macrophages after partial hepatectomy in rats.

Am J Surg, 1992 Nov, 164(5), 412 - 5; discussion 415-6
Occult fever in surgical intensive care unit patients is seldom caused by sinusitis; Borman KR et al.; Febrile intensive care unit (ICU) patients were evaluated prospectively for sinusitis . Of 598 admissions, 26 patients with transnasal cannulas, ICU stays over 48 hours, and occult fevers were identified . These 26 underwent physical examinations and sinus computed tomographic (CT) scans . Maxillary centeses and cultures were done in patients with CT abnormalities . Patients with positive scans had nasal tubes removed and received decongestants . Scans were abnormal in 19 (73%) . All patients with major CT changes had positive maxillary taps . Most infections were polymicrobial; enteric bacilli were common . Fever resolved with nonoperative care in 18 (95%) patients; in only 1 patient was fever primarily from sinusitis . Sinus CT scans are often abnormal in ICU patients with occult fevers and transnasal cannulas . Pneumatic otoscopy can serve as a screening tool . Most patients respond to nonoperative management . Remote infections are often present . Although radiographic nosocomial ICU sinusitis is common, it is seldom the sole source of fever or the proximate cause of significant morbidity.

Int J Dermatol, 1992 Nov, 31(11), 813 - 7
Lepromatous leprosy treated with recombinant interferon gamma: cutaneous histologic changes; Bottasso O et al.; We report on the histologic changes occurring in single cutaneous lesions, from six active lepromatous patients, 1 week following the administration of three daily intradermal injections, 35 micrograms each, of recombinant interferon gamma (rIFN-gamma) . Except for a strong induration at the injection site, rIFN-gamma produced no adverse systemic reactions and was able to promote a remarkable influx of T-lymphocytes, mononuclear phagocytes with large nuclei, nonvacuolated cytoplasm, and reduced lysozyme reactivity . Furthermore, despite no clear-cut reduction of mycobacterial dermal burden, bacilli showed a clear increase in the granular appearance . Present findings provide a basis for further elucidation of rIFN-gamma as an additional tool for leprosy treatment.

Dig Dis Sci, 1992 Nov, 37(11), 1754 - 6
Hyperammoniemic coma in a patient with ureterosigmoidostomy and normal liver function; Van Laethem JL et al.; Hyperammoniemic encephalopathy has been reported after ureterosigmoidostomy . Its development is related to a problem of bacterial overgrowth and, most often, is favored by the presence of an underlying liver dysfunction . We report the case of a 43-year-old woman with a ureterosigmoidostomy done 28 years earlier who developed hyperammoniemic coma induced by an acute rectocolitis and in the absence of any detectable liver dysfunction . Neither administration of Lactilol and neomycin nor rectal tube drainage were effective; systemic antimicrobial therapy effective against the urease-producing gram-negative bacilli was required and led to a decrease in serum ammonia levels and a dramatic clinical improvement.

J Infect Dis, 1992 Nov, 166(5), 1177 - 80
Evaluation of polymerase chain reaction, tuberculostearic acid analysis, and direct microscopy for the detection of Mycobacterium tuberculosis in sputum; Savic B et al.; Tuberculosis remains a major global cause of morbidity and mortality . There is an urgent need for improved bacteriologic diagnosis of Mycobacterium tuberculosis infection . Three methods for rapid identification of M . tuberculosis in sputum samples (direct microscopy, gas chromatography-mass spectrometry {GC-MS}, and polymerase chain reaction {PCR}), were compared with culture on Lowenstein-Jensen medium . Growth of M . tuberculosis was observed in 38 of 145 sputum samples . Detection of acid-fast bacilli by direct microscopy gave a sensitivity of 66% and a specificity of 100% . Detection of tuberculostearic acid by GC-MS gave a sensitivity of 55% and a specificity of 87% . Amplification by PCR of a fragment of the insertion sequence IS6110 gave a sensitivity of 95% and a specificity of 93% compared with culture and a corrected specificity of 99% compared with both culture and clinical data . This study indicates that PCR can be adapted for clinical use and is the method of choice for rapid diagnosis of pulmonary tuberculosis.

Infect Immun, 1992 Nov, 60(11), 4781 - 92
Immunization with extracellular proteins of Mycobacterium tuberculosis induces cell-mediated immune responses and substantial protective immunity in a guinea pig model of pulmonary tuberculosis; Pal PG et al.; We have studied the capacity of a selected fraction of Mycobacterium tuberculosis extracellular proteins (EP) released into broth culture by mid-logarithmic-growth-phase organisms to induce cell-mediated immune responses and protective immunity in a guinea pig model of pulmonary tuberculosis . Guinea pigs infected with M . tuberculosis by aerosol but not uninfected control guinea pigs exhibit strong cell-mediated immune responses to EP, manifest by dose-dependent cutaneous delayed-type hypersensitivity and splenic lymphocyte proliferation . Guinea pigs immunized subcutaneously with EP but not sham-immunized control guinea pigs also develop strong cell-mediated immune responses to EP, manifest by dose-dependent cutaneous delayed-type hypersensitivity and splenic lymphocyte proliferation . EP is nonlethal and nontoxic to guinea pigs upon subcutaneous immunization . Guinea pigs immunized with EP and then challenged with aerosolized M . tuberculosis exhibit protective immunity . In five independent experiments, EP-immunized guinea pigs were consistently protected against clinical illness, including weight loss . Compared with EP-immunized guinea pigs, sham-immunized control guinea pigs lost 12.9 +/- 2.0% (mean +/- SE) of their total weight . EP-immunized guinea pigs also had a 10-fold reduction in viable M . tuberculosis bacilli in their lungs and spleens (P = 0.004 and 0.001, respectively) compared with sham-immunized control animals . In the two experiments in which some guinea pigs died after aerosol challenge, EP-immunized animals were protected from death . Whereas all 12 (100%) EP-immunized guinea pigs survived challenge with aerosolized M . tuberculosis, only 6 of 12 (50%) sham-immunized control guinea pigs survived challenge (P = 0.007, Fisher exact test) . This study demonstrates that actively growing M . tuberculosis cells release immunoprotective molecules extracellularly, that a subunit vaccine against tuberculosis is feasible, and that extracellular molecules of M . tuberculosis are potential candidates for a subunit vaccine.

Infect Immun, 1992 Nov, 60(11), 4762 - 7
Growth characteristics of recent sputum isolates of Mycobacterium tuberculosis in guinea pigs infected by the respiratory route; Balasubramanian V et al.; The consideration of virulence must distinguish between infectivity and the ability to cause progressive disease once the infection is established . Several investigators have reported the presence of naturally occurring isolates which differ in virulence for guinea pigs . Isolates from south India which differed with respect to gross disease and number of bacilli recovered from spleen after an intramuscular infection also differed in their efficiencies to initiate an infection, once inhaled and retained . Also, this difference was correlated with differences in the rate of multiplication at the site of implantation and rate of multiplication at sites of hematogenous seeding, as well as the extent of hematogenous seeding . The number of metastatic foci was identified as a quantitative measure of hematogenous seeding, which was not confounded by the rate of multiplication of bacilli . Even allowing for the fourfold-reduced efficiency of low-virulence tubercle bacilli to produce a lesion, this measure clearly revealed a significantly reduced ability of the low-virulence tubercle bacilli to disseminate via the bloodstream.

Infect Immun, 1992 Nov, 60(11), 4517 - 27
Identification and characterization of epitopes shared between the mycobacterial 65-kilodalton heat shock protein and the actively secreted antigen 85 complex: their in situ expression on the cell wall surface of Mycobacterium leprae; Rambukkana A et al.; Both mycobacterial hsp65 and the actively secreted antigen 85 complex of 30-kDa region proteins are considered to be major immune targets in mycobacterial diseases . In this study, by using a novel series of monoclonal antibodies (MAbs) directed to these antigens, we identified and partially characterized three unique epitopes (Rb2, Pe12, and A2h11) that are shared between mycobacterial hsp65 and the individual components of the antigen 85 complex . Dot blot assays with native purified proteins revealed that all three MAbs are strongly bound to hsp65 and antigens 85A (MPT44) and 85B (MPT59), while a weak reaction or no reaction was found with antigen 85C (MPT45) . Immunoblotting showed that MAb Rb2 reacted strongly with both hsp65 and the antigen 85 complex proteins, whereas MAbs Pe12 and A2h11 reacted strongly with the former but weakly with the latter . Moreover, these MAbs did not react with other closely related MPT51 and MPT64 secreted proteins . Further characterization of these epitopes was performed by using recombinant fusion and truncated proteins of Mycobacterium bovis BCG hsp65 (MbaA) and the M . leprae 30- and 31-kDa antigen 85 complex fusion proteins . In hsp65, Rb2-Pe12- and A2h11-reactive epitopes were found to reside in the C-terminal region of amino acid residues 479 to 540 and 303 to 424, respectively . In the M . leprae 30- and 31-kDa antigen 85 complex, all three epitopes were located in an N-terminal region of amino acid residues 55 to 266, one of the known fibronectin-binding sites of the M . leprae antigen 85 complex . Comparison of these MAb-reactive amino acid sequence regions between mycobacterial hsp65 and the components of the antigen 85 complex revealed that these regions show certain amino acid sequence identities . Furthermore, by immunoperoxidase and immunogold ultracytochemistry, we demonstrated that Rb2-, Pe12-, and A2h11-reactive epitopes are expressed both on the cell wall surface and in the cytosol of M . leprae bacilli within the lesions of lepromatous leprosy patients and in M . leprae-infected armadillo liver tissue.

AIDS, 1992 Nov, 6(11), 1327 - 30
HIV infection and primary resistance to antituberculosis drugs in Abidjan, Côte d'Ivoire; Braun MM et al.; OBJECTIVE: To determine the prevalence of Mycobacterium tuberculosis resistance to antituberculosis drugs, and to relate this resistance to HIV serologic status . DESIGN: Cross-sectional prevalence study . SETTING: The two major outpatient tuberculosis clinics in Abidjan, Cote d'Ivoire, West Africa . PATIENTS: Sixty individuals with newly diagnosed pulmonary tuberculosis and sputum smears positive for acid-fast bacilli . MAIN OUTCOME MEASURES: HIV serologic status and in vitro testing for susceptibility of M . tuberculosis isolates to antituberculosis drugs . RESULTS: M . tuberculosis was isolated from 82% (49 out of 60) of sputum specimens . Thirty-five per cent (17 out of 49) were obtained from HIV-seropositive and 65% (32 out of 49) from HIV-seronegative patients . There was no statistically significant difference in the proportion of resistant isolates from HIV-seropositive versus HIV-seronegative patients, although the relatively small sample size limited power . Of the total number of isolates, 17% were resistant to isoniazid; resistance was less to streptomycin (7%), rifampin (2%), pyrazinamide (0%), and ethambutol (0%) . Eighteen and 21% of mycobacterial isolates from HIV-seropositive and HIV-seronegative individuals, respectively, were resistant to one or more of these drugs . CONCLUSIONS: Surveys of this type are useful in planning and evaluating tuberculosis preventive therapy in individuals with dual infection.

Mikrobiologiia, 1992 Nov-Dec, 61(6), 1038 - 42
{Age specificity of the interaction of Bacillus cells with a liquid-gas interface}; Stabnikova EV et al.; The age specificity of the bacilli cells with liquid--gas interface was studied using flow cytofluorometry . This interactions is dependent on the position of the cell in the division cycle and not on the position of the cell in the DNA replication cycle.

Eur J Clin Microbiol Infect Dis, 1992 Nov, 11(11), 1081 - 93
beta-Lactamase production and susceptibility of US and European anaerobic gram-negative bacilli to beta-lactams and other agents; Jacobs MR et al.; The susceptibility of 1,476 US and European strains of anaerobic gram-negative bacilli to amoxicillin, amoxicillin/clavulanate, ticarcillin, ticarcillin/clavulanate, cefoxitin, imipenem and metronidazole was determined . All of the Bacteroides fragilis group and 51% of the non-Bacteroides fragilis group were beta-lactamase positive . Amongst the non-Bacteroides fragilis group, beta-lactamase positivity rates were higher for US strains (58%) than for European strains (39%) . All strains were susceptible to imipenem and metronidazole . MIC90s of amoxicillin and ticarcillin for all beta-lactamase negative strains were 0.5 and 2 micrograms/ml, respectively . The addition of clavulanate reduced the MIC90s of amoxicillin (> or = 256 micrograms/ml) and ticarcillin (> or = 64 micrograms/ml) to 16 and 8 micrograms/ml, respectively, for the Bacteroides fragilis group, and to 4 micrograms/ml for both agents for the non-Bacteroides fragilis beta-lactamase producing group . Twenty-nine cefoxitin-resistant strains were found, mainly in the Bacteroides fragilis group, while 95 beta-lactamase producing strains (predominantly Bacteroides fragilis group and fusobacteria) did not show synergy between beta-lactams and clavulanate . Of the newe agents tested, meropenem and piperacillin-tazobactam were the most active (100% of strains susceptible), followed by amoxicillin-BRL 42715 (99% of strains susceptible); 94 to 98% of the strains were susceptible to cefoperazone-sulbactam, tosufloxacin, temafloxacin and clindamycin . Only 73% of the strains were susceptible to cefotetan, compared to 91% to cefoxitin; 88% of the strains were susceptible to trospectomycin . Overall, all of the beta-lactam/beta-lactamase inhibitor combinations, imipenem, meropenem, cefoxitin, tosufloxacin, temafloxacin and clindamycin had good activity against beta-lactamase producing strains, while all agents tested had good activity against beta-lactamase negative strains.

Agents Actions, 1992 Nov, 37(3-4), 238 - 44
Effects of ketotifen on airway responses to allergen challenge in the actively sensitized brown Norway rat; Sapienza S et al.; The purpose of the study was to examine the effect of ketotifen on the airway responses and the recruitment of the inflammatory cells into the airways of sensitized rats after antigen challenge . Twenty-five Brown Norway rats, 7-9 weeks old, were actively sensitized to ovalbumin (OA) (1 mg s.c.) and Bordetella pertussis vaccine (10(9) bacilli i.p.) . At 14 days after sensitization rats were anesthetized with urethane (1.1 g/kg i.p.) and intubated endotracheally . Aerosols of OA (5% W/V in saline for 5 min) were administered to control rats (Group A; n = 9), to a low-dose ketotifen group (Group B; 1 mg/kg PO; n = 8) and a high-dose ketotifen group (Group C; 10 mg/kg; PO for 10 days; n = 9) . Pulmonary resistance (RL) was measured at baseline, and every 15 min for up to 8 h after OA . The magnitude of the early response was 241 +/- 51% in A (% baseline RL; mean +/- SE), and significantly less in B(119 +/- 7%) and C(131 +/- 16%) (p < 0.01) . The late response was significantly lower in C than A but not B . The total cell number in bronchoalveolar lavage at 8 h after OA challenge was significantly higher in A than B and C (p < 0.01) . The lymphocyte and eosinophil counts were reduced in B and C compared to A (p < 0.05) . A positive correlation was found between the late response and total number of cells recovered in the BAL (r = 0.78) (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Nippon Rai Gakkai Zasshi, 1992 Nov, 61(3), 175 - 81
{Modification of Harada's method for rapid staining of mycobacteria}; Kawatsu K et al.; Harada employed periodic acid-carbol pararosaniline and periodic acid-methenamine silver stain for demonstrating chromophobic bacilli which do not get stained with conventional carbol fuchsin or counter stain . This staining method takes considerable time for complete oxidation with periodic acid . We have succeeded in reducing the oxidation time by using hydrogen peroxide treatment prior to periodic acid and with the use of acidified sodium hydrogen sulfite treatment before carbol pararosaniline stain . We also found that in methenamine silver stain, combined use of semicarbazide and microwave treatment can shorten the whole staining time up to four hours without losing ito sensitivity.

Nippon Rai Gakkai Zasshi, 1992 Nov, 61(3), 153 - 6
{Specific odor component produced by Mycobacterium lepraemurium on Ogawa yolk medium}; Mori T et al.; When Mycobacterium lepraemurium is grown on the 1% Ogawa yolk medium, it produces a specific odor . This odor was not observed in other easily cultivable acid-fast bacilli . Therefore, identification of the components responsible for the specific odor produced by M . lepraemurium was attempted . The odor components were extracted for overnight with sterilized and distilled water from the Ogawa yolk medium on which M . lepraemurium had been cultivated for two months . The odor components in the extract was adsorbed on refined charcoal . After washing with distilled water for three times, the charcoal was dried . Then the odor components were eluted from the charcoal with ethanol and the eluate was condensed under nitrogen gas flow at 40 degrees C . The condensate was analyzed by Gas-Chromatography-Mass-Spectrum (GC-MS) . Phenylethanol and phenylacetic acid were identified as major odor components . A mixture of authentic phenylacetic acid, its methyl and ethyl esters, smelled similar to the odor of cultivated medium of M . lepraemurium . Thus, phenylacetic acid was identified as the key odor component produced by M . lepraemurium . When initial isolation culture of M . lepraemurium from murine leproma was cultivated on the Ogawa yolk medium by adding phenylacetic acid, growth inhibition was brought by the compound.

J Clin Microbiol, 1992 Nov, 30(11), 2934 - 7
Isolation of a fastidious Mycobacterium species from two AIDS patients; Jackson K et al.; Two strains of fastidious mycobacteria were isolated from two patients with AIDS and clinical disease suggestive of Mycobacterium avium complex infection . Acid-fast bacilli were isolated from blood and bone marrow of both patients in BACTEC 12B and/or 13A media . The acid-fast bacilli failed to grow on subculture to routine Lowenstein-Jensen medium containing pyruvate and egg yolk agar . After several attempts, the strain from one patient was finally cultured on Middlebrook 7H9 medium with agar, charcoal, and yeast extract 13 months after the initial specimens were received in the laboratory . The second patient's strain was cultured on the same medium 6 weeks postinoculation with fresh BACTEC fluid and 5 months after specimen collection . Routine biochemical and growth tests were performed on these isolates but failed to give definitive identifications . 16S rRNA gene sequencing suggested that the organisms share at least 98.9% homology with M . simiae . Even greater homology (99.86%) was found with the recently described species "M . genavense." Recognition of the fastidious nature of some mycobacteria that infect AIDS patients is important in the treatment of infections in these patients and in understanding the epidemiology of atypical mycobacterial infections . It is suggested that a liquid culture medium such as BACTEC be employed for primary isolation of mycobacteria from AIDS patients and that subculture to the charcoal medium described here be carried out for those organisms that fail to grow on subculture to routine media.

Presse Med, 1992 Oct 17, 21(34), 1616 - 8, 1623-4
{Bacillary epithelioid angiomatosis in AIDS . Two cases}; Bodokh I et al.; Bacillary angiomatosis is a newly recognized multisystem opportunistic infection seen in the human immunodeficiency virus infection . The disease is marked by papular and nodular vascular skin lesions that clinically resemble Kaposi's sarcoma . Histologically, the lesions are different and show clusters of bacteria showing the structure of Gram negative bacilli staining with Warthin-Starry stain . Transmission electron microscopy shows that the organisms (1 to 2 microns) have a trilamellar wall structure . Treatment with oral erythromycin (2 to 3 g a day) for 2 to 4 weeks rapidly leads to resolution.

Cell Immunol, 1992 Oct 15, 144(2), 258 - 68
Tumor necrosis factor alpha stimulates mycobactericidal/mycobacteriostatic activity in human macrophages by a protein kinase C-independent pathway; Bermudez LE et al.; Tumor necrosis factor (TNF) is a 17-kDa protein produced by endotoxin-stimulated macrophages . We have demonstrated that recombinant human TNF activates human macrophages to kill intracellular bacteria of the Mycobacterium avium complex (MAC) in a dose-related manner . TNF also primed macrophages to produce superoxide anion (O2-) following treatment with phorbol esther PMA (0.1 micrograms/ml) . To investigate the intracellular pathway involved in the TNF-mediated activation of mycobacteriostatic/mycobactericidal activity in macrophages, we used two different protein kinase C (PKC) inhibitors: H7 (10(-5)-10(7) M) and staurosporine (10(-7)-10(-9) M) . Mellitin (1 and 100 mM) was used as a calmodulin inhibitor . Human peripheral blood-derived macrophages cultured for 7 days were treated with H7, mellitin, or staurosporine for 1 hr prior to incubation with TNF (10(3) U/ml) . Twenty-four hours after treatment with TNF the O2- release was measured spectrophotometrically following exposure to PMA . Macrophages were infected with MAC and the viable intracellular bacilli were quantitated following 4 days of treatment with TNF . All PKC inhibitors suppressed O2- production after incubation with PMA . However, treatment with either PKC or calmodulin inhibitors did not influence the intracellular killing of M . avium by TNF-stimulated macrophages . Exposure of the macrophages to cGMP inhibitor but not to cAMP inhibitor significantly impaired the response to the stimulation with TNF . In contrast, incubation of macrophages with protein kinase A (PKA) had no effect on TNF-mediated mycobacteriostatic/mycobactericidal activity . These results suggest that the TNF-mediated mycobactericidal activity in cultured macrophages probably occurs by a PKC-independent mechanism.

Biochemistry, 1992 Oct 13, 31(40), 9832 - 7
Structural elucidation of a novel family of acyltrehaloses from Mycobacterium tuberculosis; Besra GS et al.; Analysis of the lipids of Mycobacterium tuberculosis H37Rv, by both normal- and reverse-phase thin-layer chromatography, revealed a series of novel glycolipids based on 2,3-di-O-acyltrehalose . The structures of these acylated trehaloses were elucidated by a combination of gas chromatography-mass spectrometry, 1H, 13C, two-dimensional 1H-1H, and 1H-13C nuclear magnetic resonance spectrometry . The fatty acyl substituents were mainly of three types: saturated straight-chain C16-C19 acids; C21-C25 "mycosanoic acids"; and C24-C28 "mycolipanolic acids." Analysis of one of the major 2,3-di-O-acyltrehaloses by two-dimensional 1H-chemical shift correlated and 1H-detected heteronuclear multiple-bond correlation spectroscopy established that the C18 saturated straight-chain acyl group was located at the 2 position and that the C24 mycosanoyl substituent was at the 3 position of the same "right-hand" glucosyl residue . At least six molecular species differing only in their fatty acid content comprised this family of di-O-acylated trehaloses . We regard these acyltrehaloses as elemental forms of the multiglycosylated acyltrehaloses (the lipooligosaccharides) perhaps due to an inability of the majority of isolates of virulent tubercle bacilli to glycosylate core acyltrehaloses . The acyltrehaloses are minor but consistent components of virulent M . tuberculosis and apparently the basis of the specific serological activity long associated with its lipid fractions.

Med Clin (Barc), 1992 Oct 3, 99(10), 368 - 70
{Treatment of gram negative bacilli bacteremia with intramuscular ceftriaxone in home care}; Hazas MJ et al.; BACKGROUND: Bacteremias by gram negative bacilli (BGNB) are serious diseases which normally require hospital admission . In accordance with the pharmacokinetic characteristics of ceftriaxone, the possibility of treating such processes with home care (HC) and the existence of advantages for both the patient and the hospital were evaluated . METHODS: Twenty patients were prospectively studied . Upon obtaining clinical stability in the hospital the possibility of following home care (HC) treatment was evaluated . Ceftriaxone was administrated at intramuscular doses of 1g/24 h . The clinical and bacteriologic response, patient satisfaction and treatment time were estimated . RESULTS: The origin of the bacteremia was varied as was the type of gram negative bacilli responsible . All the patients evolved favorably with no relevant secondary effects . The mean length of treatment was 12.75 days per patient . The antibiotic was mainly administered at home (83%), permitting a mean reduction of 10.5 hospital stays per patient . The social and psychologic advantages for the patients were evident . CONCLUSIONS: This study confirms the possibility of treating stable phase gram negative bacilli bacteremias at home efficiently with the supervision of home care teams leading to a substantial reduction in hospital expenses and patient satisfaction.

Ann Intern Med, 1992 Oct 1, 117(7), 545 - 53
Prevention of infection in critically ill patients by selective decontamination of the digestive tract; Cockerill FR 3rd et al.; OBJECTIVE: To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients . DESIGN: Randomized, controlled trial without blinding . SETTING: Surgical trauma and medical intensive care units in a tertiary referral hospital . PATIENTS: One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval, whose condition suggested a prolonged stay (greater than 3 days) . INTERVENTION: Patients were randomly allocated to an experimental group (n = 75) that received cefotaxime, 1 g intravenously every 8 hours for the first 3 days only, and oral, nonabsorbable antibiotics (gentamicin, polymyxin, and nystatin by oral paste and oral liquid) for the entire stay in the intensive care unit . Control patients (n = 75) received usual care . MEASUREMENTS: The number of infections, total hospital days, and deaths, as well as the number of days in intensive care unit, were recorded . RESULTS: Control patients experienced more infections (36 compared with 12, P = 0.04), including bacteremias (14 compared with 4, P = 0.05) and pulmonary infections (14 compared with 4, P = 0.03) . Although total hospital days, days in intensive care, and the overall death rate all were lower in the treatment group, these differences were not statistically significant . Clinically important complications of selective decontamination of the digestive tract were not encountered . CONCLUSIONS: Selective decontamination of the digestive tract decreases subsequent infection rates, especially by gram-negative bacilli, in selected patients during long-term stays in the intensive care unit.

Tuber Lung Dis, 1992 Oct, 73(5), 273 - 9
Studies on cell-wall deficient non-acid fast variants of Mycobacterium tuberculosis; Chandrasekhar S et al.; While the host-parasite relationship in tuberculosis still remains incompletely understood, there has been recent renewed interest in indications that tubercle bacilli are converted into metabolically inactive, non-acid fast (NAF) granular forms in the presence of host defence mechanisms and antituberculosis drugs . The present study investigates the mechanism of induction of these NAF variants in vitro and in vivo, and their ultimate pathogenicity . Evidence is provided that appears to clearly indicate that acid-fast mycobacteria are converted into NAF, cell wall deficient variants which remain dormant, only to revert to the parent, acid-fast bacilli in immune-compromised hosts, thence ultimately producing disease . It is then suggested that this may be one of the causes of the observed persistence of the bacilli in hosts in spite of chemotherapy . In a typical study in experimental animals in the present investigation, NAF variants were separated from lung lavage by differential centrifuging . When these were then injected into animals made immune-deficient with Freund's adjuvant or cyclophosphamide, they reverted to parent acid-fast forms . The presence of these NAF forms as variants of M . tuberculosis, and not merely contaminants, was clearly established by a number of methods . These included phase contrast and electron microscopy, immunological studies employing antiserum and comparison with the parent organisms, and gel electrophoresis of the proteins of the parent organisms . Other evidence is also offered confirming the hypothesis of reversion of NAF forms . It is also shown in this study that NAF forms can be induced in vitro by hydrolases.

Tuber Lung Dis, 1992 Oct, 73(5), 268 - 72
Virulence of Mycobacterium tuberculosis for guinea pigs: a quantitative modification of the assay developed by Mitchison; Balasubramanian V et al.; One of the more accepted methods of assay of virulence of tubercle bacilli is one developed by Mitchison in which guinea pigs were infected by the intramuscular route with 1.0 mg of tubercle bacilli freshly harvested from Lowenstein Jensen medium and in which virulence was based on a subjective score of the extent of gross disease in the animal 6 weeks after infection . Due to the practical difficulties involved in such an assay when routinely performed, the following modifications were made: frozen stocks of the culture were prepared prior to the date of infection, the inoculum was quantitated by means of colony forming units, and virulence was based on the number of tubercle bacilli recovered from the spleen of infected animals 6 weeks after infection . A significant correlation was obtained between the findings from the Mitchison assay of virulence and the modification . The latter assay is recommended for its quantitative and objective features.

Enferm Infecc Microbiol Clin, 1992 Oct, 10(8), 451 - 5
{Microbiology and conservative surgery of serious infections of the diabetic foot}; Diaz Colodrero G et al.; Between June of 1987 and August 1988 we evaluated 31 diabetic patients hospitalized for severe foot infections to determine the etiologic agents, the value of the bacteriologic samples obtained, the benefits of conservative surgery and variable predictors of a major amputation . Sixteen patients suffered from necrosis, 16 osteomyelitis, 14 ulcers, 5 cellulitis, and/or abscesses and 22 had vascular compromise . Samples were taken from these infections excluding necrotic material . We isolate 76 microorganisms (2.4/pt), 57% Gram-positive cocci (predominantly S . aureus and enterococci), and 43% Gram-negative bacilli . Anaerobes were not isolated probably secondary to the exclusion of necrotic samples . There was high incidence of skin and soft tissue sampling (79%) bone (13/16) and surgical curettage (11/11) . In 9 patients the correlation of soft tissue sampling and bone sampling was assessed with a positive correlation with respect to Gram-positive cocci . Twenty-one patients required conservative surgeries of the foot (9 underwent revascularization), 67% of which avoided a mayor amputation . However no significant variables predictive of a major amputation were detected in this study . In summary, the conservative surgery allowed to 2 out of 3 patients to preserve the foot.

J Vet Diagn Invest, 1992 Oct, 4(4), 428 - 33
Gross and microscopic lesions of naturally occurring tuberculosis in a captive herd of wapiti (Cervus elaphus nelsoni) in Colorado; Rhyan JC et al.; A Mycobacterium bovis-infected herd of captive wapiti (Cervus elaphus nelsoni) in Colorado was depopulated after lesions of bovine tuberculosis were confirmed in 8 of 10 tuberculin skin test reactors . Of the 43 animals > 1 year of age, 26 had gross lesions suggestive of tuberculosis, 24 had microscopic lesions of tuberculosis, and 23 had acid-fast bacilli associated with the lesions . Lungs and retropharyngeal lymph nodes were the most frequently affected sites . Most lesions grossly and microscopically resembled tuberculosis in cattle; however, some lesions resembled abscesses or ovine caseous lymphadenitis lesions . Special stains and immunohistochemical techniques labeled few to numerous mycobacteria associated with the lesions.

J Vet Diagn Invest, 1992 Oct, 4(4), 423 - 7
Mycobacterium bovis infection in North American elk (Cervus elaphus); Thoen CO et al.; A naturally occurring outbreak of Mycobacterium bovis infection in captive wild elk (wapiti) in Montana was confirmed by mycobacteriologic examination . Twenty-eight of 143 elk responded to M . bovis purified protein derivative (PPD) tuberculin injected intradermally in the cervical region (SCT) . The results of comparative cervical tuberculin skin tests conducted within 9 days of SCT revealed greater responses to M . bovis PPD tuberculin than to M . avium PPD tuberculin in 23 of 28 elk responding . At necropsy, several grossly visible tuberculous lesions were observed in the parenchyma of the lung, thoracic lymph nodes, and submandibular lymph nodes . Microscopic examination of appropriately stained tissue sections revealed the presence of granulomatous lesions containing acid-fast bacilli . An enzyme-linked immunosorbent assay (ELISA) was developed using a sarkosyl extract of M . bovis (antigen) and peroxidase-labeled protein G (conjugate); reactions were detected in the sera of 8 of 9 elk responding to M . bovis PPD tuberculin . Lymphocyte blastogenic assay responses were detected using M . bovis antigens in 7 of 9 elk positive on skin tests using M . bovis PPD.

Kekkaku, 1992 Oct, 67(10), 663 - 5
{Counting efficacies of the CFU-enumerating method and microscopic counting method for mycobacteria located in cultured macrophages}; Sato K; I compared counting efficacies of CFU-enumerating method for the number of mycobacteria (Mycobacterium intracellulare and M . fortuitum) locating in cultured macrophages with that of microscopic counting method . Zymosan A-induced macrophages from ddY mice were infected with either M . intracellulare or M . fortuitum by incubation in 10% FBS-RPMI 1640 medium containing the organisms for 1 hr, thereafter thoroughly washed to remove extracellular bacilli, and cultured for 3 to 5 days . At intervals, macrophages were thoroughly rinsed and subjected to either CFU-enumeration or microscopic counting, as follows . In the former method, macrophages were lysed with 0.2% Tween 80-distilled water by sonication using Handy Sonic and CFUs were counted on 7H11 agar plates . In the latter method, the number of acid-fast bacilli was counted by microscopy for macrophages after Ziehl-Toda's staining . The number of bacteria by the CFU-enumerating method was much greater than that by the microscopic counting method.

Antimicrob Agents Chemother, 1992 Oct, 36(10), 2125 - 30
Microbiological efficacy and pharmacokinetics of prophylactic antibiotics in liver transplant patients; Arnow PM et al.; The pharmacokinetics of perioperative systemic antibiotics and the microbiological effectiveness of oral nonabsorbable antibiotics started immediately prior to surgery were studied in 18 adult patients undergoing liver transplantation . All patients received cefotaxime, 2 g intravenously, at 6-h intervals during surgery and then at 8-h intervals thereafter for 48 h; eight patients also received ampicillin at the same dose and schedule . This regimen produced levels of antibiotics in blood that appeared appropriate for prophylaxis . The first dose peak (68 +/- 18 micrograms/ml) and trough (6.9 +/- 4.7 micrograms/ml) levels of cefotaxime in serum and the first dose peak (73 +/- 22 micrograms/ml) and trough (4.1 +/- 2.3 micrograms/ml) levels of ampicillin in serum, which were assayed by high-performance liquid chromatography, were similar to levels reported in normal volunteers, despite mean intraoperative blood loss of 3.3 liters and fluid replacement of 21 liters . On postoperative days 1 and 2, the levels of cefotaxime and ampicillin were maintained at or above 0.9 and 1.3 micrograms/ml, respectively, with little accumulation . By random assignment, 8 patients received systemic antibiotics alone and 10 patients received systemic antibiotics plus a 3-week regimen of oral nonabsorbable antibiotics (gentamicin, polymyxin E, and nystatin) beginning when a donor liver was procured . Pre- and postoperative cultures of rectum, throat, and gastric aspirate samples showed persistence of aerobic gram-negative bacilli for the first 2 postoperative weeks in about half of the patients in each group . Failure of the regimen of oral nonabsorbable antibiotics to supplement cefotaxime in eradicating aerobic gram-negative bacilli from stools probably results from impaired peristalsis during and after surgery and warrants earlier initiation of the regimen.

J Appl Bacteriol, 1992 Oct, 73(4), 342 - 8
Comparative study on the antimicrobial effects of Hexomedine and Betadine on the human skin flora; Chevalier J et al.; Studies were carried out to detect the modifications, if any, on the peri-umbilical flora of six healthy volunteers after two or three daily applications of Hexomedine solution (HEX) and Betadine solution (PVI) repeated for five consecutive days . A standardized scrubbing method was used for bacterial sampling . Surviving bacteria were selected with both selective and non-selective media, and then identified by gas chromatographic fatty acid analysis . Both antiseptics were highly effective, showing both immediate and residual antimicrobial activities . The use of HEX led to a slight increase in Gram-positive cocci and a small decrease in coryneforms, but PVI produced a marked increase in Gram-positive cocci and a sharp decrease in coryneforms . The two antiseptics, however, caused no major alteration in the cutaneous microbial population . Indeed, neither the overgrowth of Gram-negative bacilli nor the emergence of resistant species was observed.

An Med Interna, 1992 Oct, 9(10), 509 - 15
{Clinical and diagnostic characteristics of Aeromonas strains}; Gutierrez J et al.; We studied the taxonomic, clinic, microbiological diagnostic and therapeutic characteristics of Aeromonas strains . Eleven geno-species have been isolated in human . They can be enterotoxigenic or enteroinvasive . These bacteria can be easily confused with other Gram negative bacilli (the Aeromonas are oxidase positive) . They produce diarrhea but can only colonizer . In others localizations they are always diagnostic . Their detection in stools can be realized with the blood agar plus ampicillin or cefsulodin-novobiocin-irgasan agar . The treatment of extraintestinal infection is similar to the Gram negative infections . The Aeromonas are resistant to erythromycin, streptomycin and first generation cephalosporin . The beta-lactamic antimicrobials aren't the election treatment because the are positive beta lactamase . The diarrhea in children and immunocompromised or chronic patients will be treated with cotrimoxazole or fluorquinole.

Clin Infect Dis, 1992 Oct, 15(4), 601 - 5
Comparison of mycobacterial lymphadenitis among persons infected with human immunodeficiency virus and seronegative controls; Shriner KA et al.; Lymphadenitis is a common extrapulmonary manifestation of mycobacterial disease in persons with human immunodeficiency virus (HIV) infection . We compared the clinical, mycobacterial, and diagnostic characteristics of mycobacterial adenitis in 11 HIV-seropositive and 29 HIV-seronegative patients . Ninety-three percent of the HIV-seronegative patients and 54% of the HIV-seropositive patients were foreign-born . In contrast to the HIV-seronegative patients, seropositive patients were more likely to be febrile and have negative purified protein derivative skin tests and abnormal chest roentgenograms . Sputum samples were rarely diagnostic in either group . Mycobacterium tuberculosis was the most commonly isolated organism in both groups, although United States-born patients with HIV infection were more likely to be infected with nontuberculous mycobacteria . In contrast to results for seronegative patients, fine-needle aspiration was usually diagnostic in the HIV-seropositive population, especially in those at risk for M . tuberculosis infection . Similarly, the rate at which smears were positive for acid-fast bacilli was significantly higher in the HIV-seropositive group, a circumstance suggesting a higher burden of organisms in this population . Finally, although preceding opportunistic infections were uncommon in the HIV-seropositive group, both tuberculous and nontuberculous adenitis were associated with advanced immunosuppression.

J Autoimmun, 1992 Oct, 5(5), 641 - 51
Acquisition of autoimmunity genes by New Zealand mice is associated with natural resistance to infection by mycobacteria; Esaguy N et al.; New Zealand (NZ) mouse strains comprise both autoimmune and non-autoimmune animals: NZ black (NZB) mice and the F1 hybrid (NZB/W) of NZB and NZ white (NZW) mice show spontaneous autoimmune disease by 6 months of age and die before the first year of age from renal disease, while NZW mice do not show autoimmune disorders . We investigated whether the autoimmunity-prone NZ animals (NZB and NZB/W) differ from the non-autoimmune NZW mice in susceptibility/resistance to mycobacterial infection . The three groups of NZ mice were infected by intraperitoneal inoculation of 10(8) colony forming units (cfu) of Mycobacterium avium . The M . avium infection was induced in 3-month-old mice (i.e., before NZB and NZB/W mice develop autoimmune disease) and studied for 4 months . Infected NZB and NZB/W mice showed evidence of renal disease at 2 and 4 months of infection (but not at 1 month) . The non-autoimmune NZW mice were found to be susceptible to M . avium since they allowed massive proliferation (4-5 log growth) of the bacilli in liver and spleen . In contrast, both groups of autoimmunity-prone mice (NZB and NZB/W) were resistant to M . avium since their mycobacterial loads remained below the value of the initial inoculum . We conclude that in NZ mice the acquisition of autoimmunity genes is associated with expression of natural resistance to mycobacterial infection . This is consistent with the view that autoimmunity genes may have been evolutionarily selected because of their association with increased resistance of the host to infections by intracellular parasites.

Infect Immun, 1992 Oct, 60(10), 4074 - 9
Experimental infection of severe combined immunodeficient beige mice with Mycobacterium paratuberculosis of bovine origin; Mutwiri GK et al.; Severe combined immunodeficient beige mice were inoculated orally and intraperitoneally with a bovine strain of Mycobacterium paratuberculosis to explore their potential as laboratory animal models in the study of paratuberculosis (Johne's disease) . Control animals were similarly inoculated with heat-killed M . paratuberculosis . In the mice inoculated intraperitoneally, focal lesions and acid-fast bacilli were first detected in the livers (4 weeks postinfection) and later in the spleens and intestines of the test but not the control animals . No bacteria were seen in the hearts, kidneys, or lungs . At 12 weeks postinfection, all test mice had significant losses in body weight compared with those in controls (P less than 0.05), a characteristic sign of bovine paratuberculosis . Tumor necrosis factor alpha was not detected in the serum . Histologic lesions were seen in the intestines, livers, and spleens of the animals in the orally inoculated test group after 26 weeks of infection . Our results suggest that the severe combined immunodeficient beige mouse may be a useful model for the investigation of paratuberculosis and cachexia and the evaluation of antimycobacterial drugs.

Appl Microbiol Biotechnol, 1992 Oct, 38(1), 101 - 8
Molecular cloning, nucleotide sequence and expression of the structural gene for a thermostable alkaline protease from Bacillus sp . no . AH-101; Takami H et al.; Alkaliphilic Bacillus sp . no . AH-101 produces an extremely thermostable alkaline serine protease that has a high optimum pH (pH 12-13) and shows keratinolytic activity . The gene encoding this protease was cloned in Escherichia coli and expressed in B . subtilis . The cloned protease was identical to the AH-101 protease in its optimum pH and thermostability at high alkaline pH . An open reading frame of 1083 bases, identified as the protease gene, was preceded by a putative Shine-Dalgarno sequence (AAAGGAGG) with a spacing of 11 bases . The deduced amino acid sequence revealed a pre-pro-peptide of 93 residues followed by the mature protease comprising 268 residues . AH-101 protease showed slightly higher homology to alkaline proteases from alkaliphilic bacilli (61.2% and 65.3%) than to those from neutrophilic bacilli (54.9-56.7%) . Also AH-101 protease and other proteases from alkaliphilic bacilli shared common amino acid changes and a four amino acid deletion when compared to the proteases from neutrophilic bacilli . AH-101 protease, however, was distinct among the proteases from alkaliphilic bacilli in showing the lowest homology to the others.

Clin Pharm, 1992 Oct, 11(10), 865 - 75
The postantibiotic effect; Spivey JM; The factors that affect the presence and duration of the post-antibiotic effect (PAE) for different antimicrobial agents are described, and the clinical importance of the PAE is discussed . Proposed mechanisms by which the PAE occurs include both nonlethal damage induced by the antimicrobial agent and a limited persistence of the antimicrobial agent at the bacterial binding site . The specific microorganism-antimicrobial combination is the most important factor to influence the presence and duration of the PAE . Additional factors are antimicrobial combinations and experimental conditions, including the antimicrobial concentration and the length of the antimicrobial exposure . Most antimicrobial agents produce a PAE when tested against gram-positive cocci . However, against gram-negative bacilli, beta-lactam antibiotics (except for imipenem) have a minimal, or even a negative, PAE . Aminoglycosides, inhibitors of protein and nucleic acid synthesis, and fluoroquinolones have PAEs against gram-negative bacteria that range from one to four hours . In vivo PAEs are generally longer than in vitro PAEs for the same microorganism-antimicrobial combination . In human studies, aminoglycosides, which have an extended PAE against gram-negative bacilli, have been effective when given in once-daily dosing regimens that allow serum drug concentrations to fall below the minimum inhibitory concentration . Extending the dosing interval of an antimicrobial agent that has a PAE has several potential advantages, among them reduced cost, less toxicity, and better compliance among outpatients receiving antimicrobial therapy . Although data are limited, animal and human studies provide support for the clinical importance of the PAE . Further research into the impact of the PAE on antimicrobial dosing, efficacy, toxicity, and costs is warranted.

Otolaryngol Head Neck Surg, 1992 Sep, 107(3), 367 - 9
Indications for open cervical node biopsy in HIV-positive patients; Burton F et al.; Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available . Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy . Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated . A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989 . Twenty of the patients who underwent biopsy were HIV-positive . Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS) . Seventeen of these patients underwent FNA before biopsy . In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia . Five of these patients had antecedent FNA, none demonstrating any pathologic changes . Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one . In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing . In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease . We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Vojnosanit Pregl, 1992 Sep-Oct, 49(5), 466 - 9
{Tuberculous inflammation of the synovial membrane}; Stojiljkovic B et al.; Four patients with tuberculous synovitis of the large joints are reported in whom primary tuberculous process has not been confirmed as a possible foci of spreading of the acidoresistant bacilli . The authors, describing in details the histologic picture of tuberculous synovitis, point out the importance of an early biopsy of the synovial membrane and obligatory microbiological confirmation of the established diagnosis.

Int J Lepr Other Mycobact Dis, 1992 Sep, 60(3), 421 - 35
Relapses among leprosy patients treated with multidrug therapy: experience in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT) in Ethiopia; practical difficulties with diagnosing relapses; operational procedures and criteria for diagnosing relapses; Becx-Bleumink M; Multidrug therapy (MDT), according to the recommendations of a WHO Study Group of 1982, was introduced in the leprosy control program of the All African Leprosy and Rehabilitation Training Center (ALERT), Ethiopia, in January 1983 . Paucibacillary (PB) patients are treated with 6 months of MDT . Multibacillary (MB) patients are treated with at least 2 years of MDT and until skin-smear negativity . An analysis was made of the relapses which had been diagnosed among self-reporting patients in four rural districts and Addis Ababa . Among 3065 PB patients, 34 relapses (1.1%) were diagnosed during an average period of 6.1 years after stopping MDT (range 2 1/2 to 7 1/2 years) . Among 2379 MB patients, 24 relapses (1.0%) were diagnosed during an average period of 4.7 years after stopping MDT (range 2 1/2 to 6 years) . The estimated relapse rate per 1000 patient-years after release from MDT was 2.1 for PB patients and 2.4 for MB patients . From the analysis of the clinical, bacteriological, and histopathological findings, it was concluded that there was strong positive evidence for the diagnosis for 16 of the 34 relapses in the PB patients and for 0 of the 24 relapses in the MB patients . The main cause for overdiagnosis of MB relapses was that too much reliance had been put on skin-smear results, without a careful comparison of the results with those from before, during, and at completion of MDT; the diagnosis was based on the finding of positive smears in one set of smears only; insufficient attention was given to finding solid-staining bacilli; and findings in biopsies, if these were examined, did not confirm the diagnosis . The main cause of overdiagnosis of PB relapses was that too much reliance was put on histological findings, while these are often inconclusive for differentiating between a relapse and late reversal reaction . Recommendations are made on how to limit overdiagnosis of relapses . Operational procedures and criteria for making the diagnosis under conditions where facilities for back-up histological and mouse foot pad investigations are not available are proposed.

Int J Lepr Other Mycobact Dis, 1992 Sep, 60(3), 390 - 5
Maxillary antrum involvement in multibacillary leprosy: a radiologic, sinuscopic, and histologic assessment; Hauhnar CZ et al.; Thirty patients having lepromatous leprosy (22 males, 8 females) and showing radiological involvement of the maxillary antrum were subjected to sinuscopy, biopsy, and histopathological examination . Radiological observations showed diffuse opacity in 33.3% of the sinuses, localized mucosal thickening in 28.6%, and generalized thickened mucosa in 38.1% . Sinuscopy revealed inflamed mucosa as the most common finding (40%), followed by ulcerative (26.7%) and granulomatous (10%) lesions of the mucosal lining . The mucosal thickening (localized or generalized) evident on radiology was always associated with granuloma formation and acid-fast bacilli in the histology . The presence of an external nasal deformity indicated a statistically significant chance of encountering mucosal involvement on sinuscopy and histopathology (p < 0.05) . There was more chance of finding positive sinuscopic lesions in those patients with a bacterial index above 3+.

Mol Microbiol, 1992 Sep, 6(18), 2565 - 71
Septal membrane fusion--a pivotal event in bacterial spore formation?
Higgins ML, Piggot PJ.
Formation of the asymmetrically located septum divides sporulating bacilli into two distinct cells: the mother cell and the prespore . The rigidifying wall material in the septum is subsequently removed by autolysis . Examination of published electron micrographs indicates that the two septal membranes then fuse to form a single membrane . Membrane fusion would be expected to have profound consequences for subsequent development . For example, it is suggested that fusion activates processing of pro-sigma E to sigma E in the cytoplasm by exposing it to a membrane-bound processing enzyme . Asymmetry of the fused membrane could restrict processing to one face of the membrane and hence explain why sigma E is associated with transcription in the mother cell but not in the prespore . Asymmetry of the fused membrane might also provide a mechanism for restricting the activity of another factor, sigma F, to the prespore . Attachment of the flexible fused septal membrane to the condensing prespore nucleoid could help drive the engulfment of the prespore by the mother cell.

Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Sep, 30(9), 1770 - 6
{A case of pulmonary alveolar proteinosis and disseminated atypical mycobacteriosis complicating chronic myelogenous leukemia}; Miyake S et al.; A 47-year-old woman with chronic myelogenous leukemia was treated with daily busulfan (total dose approximately 500 mg) from December 1988 to January 1990 . The disease thereafter remained stable with no evidence of blastic transformation . In February 1990 she developed productive cough and abnormal acinar lung shadows appeared transiently on her chest X-ray . In October 1990, productive cough and linear and abnormal acinar lung shadows reappeared . Expectorated sputa contained acid-fast bacilli (Gaffky 6, 10) . Antituberculous therapy was started, which caused severe liver dysfunction . She was admitted to our hospital for evaluation of abnormal lung shadows . Transbronchial lung biopsy revealed pulmonary alveolar proteinosis with thickening of alveolar septa . The alveolar septal thickening was suspected to be a pathological change following pulmonary alveolar proteinosis . Cultures from sputum, cerebrospinal fluid, and bone marrow aspiration specimens revealed atypical mycobacterium (M . avium complex), and the diagnosis of disseminated atypical mycobacteriosis was established . The pathogenesis of the disseminated atypical mycobacteriosis was considered to be superinfection by mycobacteria.

Eur J Pharmacol, 1992 Sep 1, 228(2-3), 147 - 53
Pharmacological aspects of arthritis induced by a muramyl dipeptide analogue in rats; Sugawara T et al.; Fourteen consecutive daily subcutaneous injections of 4 mg/kg of the muramyl dipeptide analogue MDP-Lys(L18) into rats caused arthritis characterized by swelling of the tarsal joint, increases in lymphocytes and monocytes in the peripheral blood, and elevated serum immunoglobulin G (IgG) . The present study was performed to evaluate the effects of indomethacin, phenylbutazone, dexamethasone, D-penicillamine, aurothioglucose, cyclophosphamide and cyclosporin A on this arthritis . Administration of indomethacin, phenylbutazone or dexamethasone inhibited the development of the tarsal joint swelling, suggesting that prostaglandins may be involved in the pathogenesis of the arthritis . Cyclophosphamide reduced the arthritis, together with decreases in the lymphocyte count and the serum IgG level . Cyclosporin A worsened the arthritis in a dose-dependent manner and increased the neutrophil count without raising the serum IgG level, but inhibited the induction of adjuvant arthritis in rats with Mycobacterium bacilli . MDP-Lys(L18) may therefore induce arthritis differing in mechanism from adjuvant arthritis.

Obstet Gynecol Clin North Am, 1992 Sep, 19(3), 511 - 7
The aminoglycosides; Duff P; The three most commonly used aminoglycosides in obstetrics and gynecology are gentamicin, tobramycin, and amikacin . These drugs bind to subunits of the ribosome and inhibit bacterial protein synthesis . They are primarily active against aerobic gram-negative bacilli . Their principal adverse effects are nephrotoxicity, ototoxicity, and neuromuscular blockage . They may be administered intramuscularly or intravenously and usually are used in combination with other drugs for treatment of disorders such as pyelonephritis, chorioamnionitis, puerperal endometritis, and pelvic inflammatory disease.

Obstet Gynecol Clin North Am, 1992 Sep, 19(3), 461 - 74
Extended-spectrum (second- and third-generation) cephalosporins; Eriksen NL et al.; The extended-spectrum cephalosporins provide better activity against gram-negative bacilli and anaerobes than first-generation agents . Cefoxitin and cefotetan (second-generation) and ceftriaxone (third-generation) have excellent activity against B . fragilis and are useful in the treatment of postoperative infections and pelvic inflammatory disease . The extended-spectrum cephalosporins are as efficacious as first-generation agents for prophylaxis of cesarean section and hysterectomy . The first-generation drugs, such as cefazolin, are considerably less expensive than these newer compounds, however, making first-generation agents the drugs of choice when used for prophylaxis . The majority of the third-generation agents should be reserved for the treatment of meningitis and resistant nosocomial infections.

Kekkaku, 1992 Sep, 67(9), 613 - 9
{Mycobacterium fortuitum pulmonary infection in a healthy 17-year-old man}; Tanaka H et al.; A 17-year-old man was admitted with a 5-month history of intermittent dyspnea on exertion, 10 kg weight loss, cough, sputa and fever . He did not smoke, had no apparent underlying pulmonary disease, and was not immunocompromised . Mycobacterium fortuitum was cultured from sputa at admission . Chest radiograph showed many thin-walled cavities and infiltration in the bilateral middle and upper fields . Chest CT detected multiple cystic lesions that were not revealed in conventional X-ray . It was suggested that the formation of the cystic lesions was one of the predisposing factor of Mycobacterium fortuitum pulmonary infection in this patient . The pneumonic change improved after six-month treatment using isoniazid, rifampicin and streptomycin, despite in vitro resistance of the bacilli to all of these drugs.

Kansenshogaku Zasshi, 1992 Sep, 66(9), 1288 - 92
{A case of miliary tuberculosis presenting as fever and jaundice with hepatic failure looking like the course of fulminant hepatitis}; Hosokawa K et al.; A 79-year-old male was admitted to the Metropolitan Hiroo Hospital with chief complaints of icterus and fever . A few weeks prior to admission, he developed fever and swelling of right side of the neck and was seen at a local hospital where an anti-inflammatory agent was prescribed . The fever subsided in a few days, but recurred together with development of icterus a few weeks later, precipitating this hospitalization . After admission, hepatic failure progressed rapidly, indicating a fulminant hepatitis . Renal failure also developed and he died . Autopsy revealed diffuse caseous necrosis with demonstration of acid-fast bacilli in the liver, as did in the spleen, kidney and bone marrow . This case epitomizes a subset of miliary tuberculosis in which the hepatic failure predominates the clinical presentation while lacking the ante-mortem chest X-ray features suggestive of pulmonary tuberculosis and post-mortem macroscopic changes indicative of tuberculosis.

Gut, 1992 Sep, 33(9), 1209 - 13
Polymerase chain reaction detection of Mycobacterium paratuberculosis and Mycobacterium avium subsp silvaticum in long term cultures from Crohn's disease and control tissues; Moss MT et al.; Thirty one cultures were established in MG3 medium from the intestinal tissues of 29 patients, including 18 with Crohn's disease, five with ulcerative colitis, and six non-inflammatory bowel disease controls . All cultures grew either acid fast bacilli or uncharacterized spheroplasts . Pellets from these cultures were coded and assayed blind for M paratuberculosis and M avium subsp silvaticum using IS900- and IS902-PCR (polymerase chain reaction) assays, respectively . IS900 and IS902 are multicopy DNA insertion elements specific for these two organisms . Six Crohn's disease cultures and a single non-inflammatory bowel disease control were positive for M paratuberculosis . A further six cultures were positive for M avium subsp silvaticum, of which two each were from Crohn's disease, ulcerative colitis, and non-inflammatory bowel disease controls . The intensity of the IS900-PCR signals indicated very low numbers of M paratuberculosis organisms and bore no relation to visible spheroplastic or bacillary mycobacterial growth . The results suggest that M paratuberculosis isolated from man exists in a form which hardly replicates if at all when cultured in MG3 medium in vitro, and are consistent with the involvement of this known animal enteric pathogen in a proportion of chronic enteritis in man.

J Clin Microbiol, 1992 Sep, 30(9), 2427 - 31
Identification of Mycobacterium tuberculosis and Mycobacterium avium-M . intracellulare directly from primary BACTEC cultures by using acridinium-ester-labeled DNA probes; Evans KD et al.; Identification of members of the Mycobacterium tuberculosis complex and the M . avium-M . intracellulare complex (MAC) directly from primary BACTEC cultures was evaluated by using acridinium-ester-labeled DNA probes (AccuProbe; GenProbe, Inc., San Diego, Calif.) . In preliminary experiments, blood present in samples was found to interfere with the assay because of nonspecific chemiluminescence, which was measured in relative light units (RLUs) . There was a direct relationship between the age of the culture and the number of nonspecific RLUs . A protocol using 1% sodium dodecyl sulfate-5 mM EDTA to treat BACTEC broth cultures which, with specimens containing blood, gave on the average a ninefold reduction in nonspecific chemiluminescence was developed . By using this treatment protocol, 120 specimens were tested directly from BACTEC broth cultures with an AccuProbe for the M . tuberculosis complex and/or the MAC . In order to establish the background of the specimen, the patient sample was assayed without probe . The criteria for the inclusion of BACTEC cultures in the evaluation were a growth index of greater than or equal to 100 and a positive smear for acid-fast bacilli directly from the BACTEC broth . For the 120 cultures tested, if a hybridization result of greater than or equal to 30,000 RLUs was considered positive, the sensitivities for detecting the M . tuberculosis complex and the MAC were 47 and 90%, respectively, with a specificity of 100% for both . However, if a ratio of the RLUs obtained with the MAC or the M . tuberculosis complex probe to those obtained with the specimen background of >/= 20 was considered positive, this gave 77% sensitivity and 100% specificity for BACTEC cultures containing M . tuberculosis complex isolates and 96% sensitivity and 100% specificity for those growing MAC isolates.

J Clin Microbiol, 1992 Sep, 30(9), 2415 - 8
Detection of lipoarabinomannan as a diagnostic test for tuberculosis; Sada E et al.; A coagglutination technique was established for the detection of lipoarabinomannan of Mycobacterium tuberculosis in human serum samples and evaluated for its utility in the diagnosis of tuberculosis at the Instituto Nacional de Enfermedades Respiratorias in Mexico City . The test had a sensitivity of 88% in patients with sputum-smear-positive active pulmonary tuberculosis . The sensitivity in patients with active pulmonary tuberculosis negative for acid-fast bacilli in sputum was 67% . Less favorable results were obtained for patients with AIDS and tuberculosis, with a sensitivity of 57% . The specificity in control patients with lung diseases different from tuberculosis and in healthy subjects was 100% . The positive predictive value was 100%, and the negative predictive value for patients with sputum-positive active pulmonary tuberculosis was 97% . The results of this study suggest that the detection of lipoarabinomannan is an accurate test for the diagnosis of pulmonary tuberculosis.

Diagn Mol Pathol, 1992 Sep, 1(3), 185 - 91
Rapid detection and species identification of mycobacteria in paraffin-embedded tissues by polymerase chain reaction; Ghossein RA et al.; The sensitivity and specificity of the polymerase chain reaction (PCR) in the detection of mycobacteria in paraffin-embedded tissues and in crude lysates of mycobacterial cultures were assessed . Sections of formalin-fixed, paraffin-embedded tissues were deparaffinized and then subjected to a simple proteinase K and boiling lysis procedure . These preparations were used directly for PCR amplification of the 383 bp segment of the gene encoding the 65 kDa mycobacterial surface antigen . Crude lysates of mycobacteria were used as positive controls . The specificity of the PCR products was confirmed by Southern blot using a region-specific digoxigenin-labeled oligonucleotide probe and chemiluminescent detection . The 383 bp diagnostic fragment was visualized in 11 of 12 acid-fast bacilli (AFB) stain/culture-proven-positive blocks . Crude lysates of mycobacteria were detected to a sensitivity of approximately 80 organisms . Amplified fragments from paraffin-embedded tissues and mycobacterial cultures of M . tuberculosis, M . avium-intracellulare, and saprophytic mycobacteria were distinguished by digestion with Nar 1 restriction endonuclease . These results suggest that PCR amplification followed by restriction enzyme digestion of the PCR product is a rapid, specific, and highly sensitive technique for the detection and speciation of mycobacteria in paraffin-embedded tissues.

Mikrobiologiia, 1992 Sep-Oct, 61(5), 865 - 72
{Extracellular amino acids of aerobic spore-forming bacteria}; Smirnov VV et al.; An ability to synthesize and accumulate in the growth medium for extracellular amino acids of 108 strains of 13 aerobic sporeforming bacteria species at deep cultivation on the simple synthetic glucose-mineral liquid nutrient medium optimized for the representatives of this genus . Has been studied the bacillus strains studied in the present conditions synthesize 19 amino acids and 2 amino carbons in different quantities and combinations . Amino acids being synthesized the most and least by these microorganisms have been determined in quantitative expression . Extracellular amino acid accumulation was proved to be a strain property not of genus . In general, the genus studied was evaluated as active one in amino acid production . The most active strains may present an interest as initials for further selective obtaining of producers of separate amino acids . The outlook for aerobic bacilli strains having marked amino-synthesizing properties and complex of other biological activities is being discussed for construction of medicinal and prophylactic of live microbial culture preparations.

Diagn Mol Pathol, 1992 Sep, 1(3), 212 - 6
Localization of Mycobacterium avium-intracellulare within a skin lesion of bacillary angiomatosis in a patient with AIDS; Sagerman PM et al.; We report a 39-year-old man who had AIDS and who presented with an unusual cutaneous vascular lesion, which was clinically thought to be Kaposi's sarcoma . Histologically, the lesion was characterized by capillary proliferation and a mixed inflammatory infiltrate that included numerous histiocytes . The lesion was found to contain slender intracellular acid-fast bacilli, as well as plump extracellular Warthin-Starry-positive bacilli . The acid-fast bacilli were confirmed to be Mycobacterium avium-intracellulare by subsequent positive blood cultures for this organism . To further investigate the lesion, polymerase chain reaction DNA amplification and sequencing was performed, and the lesion was found to contain DNA sequences identical to those previously established for the agent of bacillary angiomatosis . The lesion is thought to represent a lesion of bacillary angiomatosis with secondary involvement by M . avium-intracellulare.

Schweiz Med Wochenschr, 1992 Aug 4, 122(31-32), 1168 - 72
{Bacillary angiomatosis: apropos of a case}; Kinloch-de Loes S et al.; We report a case of bacillary angiomatosis (BA), a recently described opportunistic infection, in a 30-year-old patient with Aids who was referred for a purplish vascular nodule on the forehead, of one-month duration, surrounded by similar smaller papules . For the previous 4 months he had suffered from progressive cachexia with fever, chills, night sweats, arthralgias and bone pain for which no infectious or malignant cause had been discovered after an extensive medical work-up . Histological examination of the skin lesions using Warthin-Starry staining revealed lobular vascular proliferation and protuberant endothelial cells with clumps of small bacilli . These findings were confirmed by electron microscopy . We believe that this is the first case of BA diagnosed in Switzerland and discuss the skin lesions, systemic symptoms and evolution under antibiotic treatment.

J Med Microbiol, 1992 Aug, 37(2), 83 - 90
Characterisation of non-pigmented species of the genus Prevotella by polyacrylamide gel electrophoresis; Yousefi-Mashouf R et al.; Gram-negative anaerobic bacilli previously known as the melaninogenicus-oralis group of Bacteroides have been assigned to a new genus, Prevotella . The non-pigmented members of this genus share several general characteristics and cannot be readily distinguished by routine tests . A polyacrylamide slab gel electrophoresis procedure, with visual analysis of protein patterns, was used to compare cellular protein patterns from clinical isolates with those from collection (reference) strains . Reference strains of P . oralis, P . veroralis, P . buccalis, P . oris, P . buccae, P . zoogleoformans, P . bivia, P . disiens, P . oulora, B . (P.) capillus and B . (P.) pentosaceus, and 91 non-pigmented isolates from patients with adult periodontal disease were examined by conventional biochemical tests, gas-liquid chromatography (GLC) and enzyme tests, and whole-cell protein profiles were obtained by SDS-PAGE . There was close correlation between patterns of results in biochemical and GLC tests and the SDS-PAGE profiles, and the species were readily distinguished in SDS-PAGE . The periodontal isolates were assigned to 10 groups by conventional test reaction patterns and nine groups by SDS-PAGE; the profiles of 79 isolates corresponded to those of seven species reference strains . By SDS-PAGE, clinical isolates of P . buccae (42 isolates) and P . oralis (eight isolates) showed good similarity with reference strains . However, for P . veroralis (15), P . oris (7), P . bivia (4), P . zoogleoformans (2) and P . buccalis (1), clinical isolates showed some minor variations from reference strains . Twelve isolates remained undesignated in SDS-PAGE analysis . Variant SDS-PAGE profiles divided clinical isolates of P . buccae into two subgroups and those of P . veroralis into five subgroups.

Ann Intern Med, 1992 Aug 1, 117(3), 184 - 90
Clinical presentation and outcome of patients with HIV infection and tuberculosis caused by multiple-drug-resistant bacilli; Fischl MA et al.; OBJECTIVE: To determine the clinical manifestations of patients with human immunodeficiency virus (HIV) infection and tuberculosis caused by multiple-drug-resistant bacilli compared with those with single-drug-resistant or susceptible bacilli . DESIGN: Descriptive, case-control, and cohort studies . SETTING: A large urban teaching hospital . PATIENTS: Sixty-two patients with tuberculosis caused by multiple-drug-resistant bacilli (cases) and 55 patients with tuberculosis caused by single-drug-resistant or susceptible bacilli (controls) . MEASUREMENTS: Characteristics of clinical presentation, radiographs, pathologic abnormalities, antituberculosis treatment, and clinical course . RESULTS: Twenty cases (32%) had concomitant pulmonary and extrapulmonary disease at presentation compared with 9 controls (16%; odds ratio, 2.4; 95% CI, 1.0 to 5.9) . More cases had alveolar infiltrates (76%; odds ratio, 3.6; CI, 1.2 to 11.4), interstitial infiltrates with a reticular pattern (67%; odds ratio, 7.8; CI, 1.0 to 83.5), and cavitations (18%; odds ratio, 6.6; CI, 0.8 to 315.3) on initial chest radiographs compared with controls (49%, 19%, and 3%, respectively) . Pathologic specimens from cases showed extensive necrosis, poor granuloma formation, marked inflammatory changes with a predominance of neutrophils, and abundant acid-fast bacilli . Twenty-five cases received two or more effective antituberculosis drugs for more than 2 months . Only 2 cases had three consecutive negative cultures for Mycobacterium tuberculosis; one patient died within 1 day of the last negative culture, and the other had positive cultures 496 days later . The remaining 23 cases had persistently or intermittently positive cultures despite therapy . The clinical course of these cases suggested overwhelming miliary tuberculosis with involvement of the lungs (77%), pleura (15%), stool (34%), meninges (13%), bone marrow (16%), blood (10%), lymph nodes (10%), and skin (8%) . The median survival time was 2.1 months for cases compared with 14.6 months for controls (P = 0.001, log-rank test) . CONCLUSIONS: Tuberculosis caused by multiple-drug-resistant bacilli in patients with HIV infection is associated with widely disseminated disease, poor treatment response with an inability to eradicate the organism, and substantial mortality.

Ann Intern Med, 1992 Aug 1, 117(3), 177 - 83
An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection; Fischl MA et al.; OBJECTIVE: To evaluate a nosocomial outbreak of tuberculosis caused by multiple-drug-resistant bacilli among patients with tuberculosis and HIV infection . DESIGN: A case-control study . PATIENTS: Patients with HIV infection and culture-proven tuberculosis . MEASUREMENTS: Patient characteristics, date of diagnoses of HIV infection and disease, date of diagnosis of tuberculosis, Mycobacterium tuberculosis susceptibility results, and medical center contact . RESULTS: Sixty-two patients who had tuberculosis caused by multiple-drug-resistant bacilli (cases) and 55 patients who had tuberculosis caused by susceptible or single-drug-resistant bacilli (controls) were identified . Controls were more likely to be black (odds ratio, 0.4; 95% CI, 0.2 to 0.9) or Haitian (odds ratio, 0.2; CI, 0.1 to 0.6) compared with cases, who were more likely to be homosexual men (odds ratio, 2.9; CI, 1.3 to 6.4) . Forty-four cases (71%) had previous contact with an HIV clinic compared with 15 controls (27%) (P less than 0.0001) . Cases were more likely to have had AIDS (odds ratio, 7.7; CI, 1.5 to 53.7), to have been hospitalized on an HIV ward (odds ratio, 8.3; CI, 2.3 to 29.7), to have been seen in an HIV clinic (odds ratio, 7.8; CI, 3.4 to 18.1), to have received intravenous therapy in an HIV clinic (odds ratio, 13.0; CI, 4.6 to 37.0), or to have received inhalation pentamidine in an HIV clinic before a diagnosis of tuberculosis was made . Multiple logistic regression analysis showed that a diagnosis of AIDS (odds ratio, 11.2; CI, 3.1 to 40.6) and HIV clinic visits (odds ratio, 13.0; CI, 2.7 to 63.7) before a diagnosis of tuberculosis were significantly associated with tuberculosis caused by multiple-drug-resistant bacilli . Using susceptibility patterns and appointment dates, we found that 22 cases had previous contact with a person who had tuberculosis caused by multiple-drug-resistant bacilli in the HIV clinic . CONCLUSIONS: Nosocomial transmission of M . tuberculosis from other HIV-infected patients with tuberculosis caused by multiple-drug-resistant bacilli can occur . These findings have serious public health implications and demand strict adherence to acid-fast bacilli isolation precautions.

Clin Infect Dis, 1992 Aug, 15(2), 330 - 45
Epidemiology and clinical significance of nontuberculous mycobacteria in patients negative for human immunodeficiency virus in Switzerland; Debrunner M et al.; Over the last decades, the rate of isolation of tubercle bacilli has declined in the developed countries, while the incidence of infection with nontuberculous mycobacteria (NTM) has increased . In a retrospective study, we analyzed all cases of patients negative for human immunodeficiency virus (HIV) and from whom NTM were isolated in the Zurich area of Switzerland from 1983 to 1988 . During the 6-year study period, 513 patients infected with NTM were identified, 34 of whom had clinically significant disease . The presentation of mycobacteriosis was found to be lung disease in 23 cases, soft-tissue disease in 10 cases, and disseminated disease in one case . The highest attack rate of pulmonary mycobacteriosis was 0.49% and was found in the group of patients 41-50 years old . During the 6-year period, the incidence of tuberculosis declined from 16.2 to 13.2 per 100,000 population, while the incidence of mycobacteriosis increased from 0.4 to 0.9 per 100,000 population . Clinically nonsignificant NTM isolates were found more frequently in patients with chronic lung diseases (P less than .01) and especially in patients with a history of tuberculosis (P less than .001).

Arch Pathol Lab Med, 1992 Aug, 116(8), 866 - 71
Abdominal visceral peliosis associated with bacillary angiomatosis . Ultrastructural evidence of endothelial destruction by bacilli; Leong SS et al.; Peliosis involving solid internal organs is a rare entity, and it has been reported in association with chronic debilitating diseases . Bacillary angiomatosis (BA), on the other hand, is a recently identified lesion found virtually only in individuals infected by the human immunodeficiency virus . We describe herein two cases of visceral BA and peliosis in human immunodeficiency virus-infected patients . Based on light and electron microscopic findings, we conclude that (1) BA bacilli present in the hepatic sinusoidal endothelial cells, in a suitable host milieu, may be the causative agents of peliosis hepatis; (2) BA bacilli can be found both intracellularly and extracellularly; and (3) peliosis is also identified in association with BA in abdominal lymph nodes.

J La State Med Soc, 1992 Aug, 144(8), 375 - 8
Tuberculosis in children in 1992; Smith MH; In children, as in adults, tuberculosis is much commoner among minority population groups, in Louisiana particularly among blacks . Since 1986 tuberculosis in some states has increased notably; in Louisiana the increase is only now, in 1992, becoming apparent . Eighteen new cases in children under 20 were reported in 1991 . Diagnosis in children still depends largely on history of contact and on the Mantoux tuberculin test . Treatment has changed markedly to a more intensive 6 month course including three or four drugs . Preventive treatment of tuberculin positive children is particularly emphasized because it will play an important role in achieving the stated public health goal of elimination of tuberculosis by the year 2010 . With the increasing number of children exposed to tuberculosis, the increasing number of HIV-positive children at risk, and the rising number of multiresistant tubercle bacilli, vaccination with BCG must be considered.

Allergy, 1992 Aug, 47(4 Pt 1), 327 - 30
Pulmonary tuberculosis in patients treated with inhaled beclomethasone; Shaikh WA; Inhaled beclomethasone dipropionate (BDP) has been used with few side-effects in the treatment of bronchial asthma for 2 decades . Until now the manifestation of tuberculosis (TB) in patients on inhaled BDP has not been reported . Eight patients with allergic asthma, of a total of 548 asthmatics (1.46%) seen over a 2-year period, developed active TB following the use of inhaled BDP . All were sputum-positive for acid-fast bacilli (AFB) on smear and/or culture, all responded well to a combination of anti-TB drugs, and none showed evidence of immunological or pituitary-adrenal suppression . Two patients agreed to a repeat administration of BDP; both developed TB again within 2 weeks and are again on anti-TB treatment.

Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Aug, 30(8), 1589 - 93
{Case report: chronic aggressive pulmonary sarcoidosis with bilateral cavitation}; Zaizen T et al.; A 34-year-old male patient was admitted to our hospital because of progressive exertional dyspnea and weight loss (8 kg in one year) . Twelve years previously, he had had an episode of uveitis accompanied with bilateral hilar lymphadenopathy . Scalene node biopsy at that time revealed non-caseating epithelioid granulomas . Four years later, a follow-up chest radiograph showed bilateral fine nodular lesions . The bilateral parenchymal lesions gradually increased in density, and eventually, formed a confluent air-space consolidation containing multi-ocular cavities . On physical examination, the patient was emaciated (Ht 165 cm, Wt 40 kg) . Nodular cutaneous lesions were present on his face and elbows . Hypoxemia with hypercapnea (PaO2 56 Torr, PaCO2 51 Torr) was noted . Repeated sputum cultures yielded negative results for acid-fast bacilli, fungi, and other pathological organisms . A transbronchial lung biopsy specimen obtained from near the cavitary lesion revealed non-caseating granulomas compatible with sarcoidosis . Skin lesion biopsy showed similar findings . The cavitation, was therefore considered to be due to ischemic necrosis of confluent sarcoid granulomas . Prednisolone (40 mg daily) was given with a prompt improvement of symptoms including dyspnea, as well as the radiographic abnormalities . We conclude that uncomplicated pulmonary sarcoidosis may rarely develop into an aggressive parenchymal disease with cavitation . It is of importance to differentiate such cases from infectious diseases (tuberculosis, mycosis etc.) because of the need for corticosteroid treatment.

Hepatogastroenterology, 1992 Aug, 39(4), 347 - 9
Surgery in cholangitis: bacteriology and choice of antibiotic; Lee WJ et al.; Owing the frequent occurrence of intrahepatic stones in orientals, cholangitis presents a real problem . Surgery and antimicrobial drug therapy are the main forms of treatment . A retrospective study of choledochotomy, including biliary tract surgery, performed between July 1987 and June 1990, was conducted . Cases with negative common duct exploration during cholecystectomy were excluded . Among 186 cases, 128 (68%) had positive bile growth, which was defined as cholangitis . Sepsis-related complications occurred in 51 patients (27.4%), including 3 surgical deaths, 30 wound infections, and 18 others . The complication rate was higher in the cholangitis group than in the negative group (37.5% vs . 5.2%) . However, if peri-operative antibiotics were effective against the cultured bacteria species, the complication rate was 16.9%; if not, the complication rate was 85.3% . For the different-generation cephalosporins used in the peri-operative period, the complication rates were 32.2%, 20.8%, and 27.6% each for 1st, 2nd, and 3rd generation cephalosporins, with no statistically significant differences . In microbiological study, polymicrobial infection was the rule . On average, 2.3 species were grown from each specimen . Enterococcus proved the most important species with a 54% culture rate . E . coli and Pseudomonas were important gram-negative bacilli, with culture rates of 46.1% and 39.1%, respectively . Anaerobic species were cultured in 12.3% of the patients . For good coverage of cholangitis prior to operation, the proper antibiotic should have potency against gram-positive Enterococcus, gram-negative bacilli, especially Pseudomonas and E . coli, and anaerobic species, especially Bacteroides.

Singapore Med J, 1992 Aug, 33(4), 409 - 10
A case of cavitating pneumonia in AIDS; Eng P et al.; Tuberculosis is a common cause of cavitating pneumonia in Singapore . In patients with the human immunodeficiency virus (HIV), cavitary pneumonias mimicking tuberculosis can mislead the clinician, delaying diagnosis, resulting in increased morbidity . We describe a HIV seropositive patient with cavitating pneumonia in whom the diagnosis of Pneumocystis carinii pneumonia (PCP) was ultimately established only on bronchoscopyPIP: In February 1991, a 30-year old single, Chinese male, who had not has sexual intercourse with another man but did have it with a woman while in another country 12 months earlier, sought medical care at Tan Tock Seng Hospital in Singapore . He had a productive cough for 3 months, lost 5 kg over 4 months, and had been gasping for breath for 3 days . Upon admission, he had a low grade fever and breathed very rapidly while resting . The apical segment of the right lower lobe of the lung had a 3 x 2 cm cavity which was filling with exudate . A sputum smear did not indicate acid fast bacilli in 2 of 3 samples and blood cultures did not yield aerobic or anaerobic bacteria . The Western blot test revealed HIV antibodies . The absolute CD4 lymphocyte count stood at 80/cu mm compared with more than 500/cm mm in healthy individuals . Physicians used a bronchoscope to do bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB), both of which disclosed cysts of Pneumocystis carinii . Treatment first consisted of trimethoprim/sulfamethoxazole for 7 days and antituberculosis chemotherapy for 2 weeks until the physicians realized he had Pneumocystis carinii . They switched the treatment to iv pentamidine isethionate because he still had a fever after 7 days . This treatment was successful . Physicians then administered Zidovudine (AZT) and aerosolized pentamidine each month . As of mid-1992 he was still healthy . In addition to the BAL/TBLB results indicating Pneumocystis carinii and excluding tuberculosis, other features excluding tuberculosis were a Mantoux reading of O, absence of hilar and/or mediastinal lymphadenopathy, response to pentamidine isethionate, and sputum and blood cultures that did not indicate Mycobacterium species .

Kekkaku, 1992 Aug, 67(8), 549 - 53
{A case of inflammatory bronchial polyp associated with pulmonary and bronchial tuberculosis}; Nagai H et al.; A 67-year-old man was admitted to our hospital because of cough and sputum . Chest X-ray revealed cavity and consolidation in the right upper lobe . Microscopical examination of stained specimens of sputum disclosed acid-fast bacilli (Mycobacterium tuberculosis) . Cough and sputum resolved and cultures of sputum did not yield M . tuberculosis a month after administration of antituberculosis agents . However, a mass shadow in the right upper lobe was found 3 months later . Bronchofiberscopy revealed a polyp with a stalk at the orifice of right upper bronchus, which was elastic, soft in consistency, smooth surfaced, and movable . The pathological findings of the polyp showed non-specific inflammatory granulation which suggested to be inflammatory bronchial polyp . It was appeared in the healing process of bronchial tuberculosis.

Acta Derm Venereol, 1992 Aug, 72(4), 310 - 1
Escherichia coli cellulitis: two cases; Castanet J et al.; We report two cases of cellulitis of the legs occurring in adults where Escherichia coli (E . coli) was, or probably was, the causative bacterial agent . E . coli and other gram-negative bacilli cellulitis are rarely reported . However, in cellulitis, the causative microorganism is rarely identified, and some cases of E . coli cellulitis could be unrecognized . Furthermore, classical risk factors for gram-negative sepsis are characterized by a state of leucocyte dysfunction which could explain the possibility of a severe, even lethal, course of gram-negative cellulitis . Therefore, the occurrence of cellulitis in patients with risk factors should prompt attempts at isolating the pathogenic microorganism, and a broad spectrum of antibiotic therapy should be initiated.

Ann Intern Med, 1992 Aug 1, 117(3), 191 - 6
Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis . A risk to patients and health care workers; Pearson ML et al.; OBJECTIVE: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission . DESIGN: A retrospective case-control study and tuberculin skin test survey . PATIENTS: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls) . Tuberculin skin test conversion rates were compared among health care workers assigned to wards where patients with tuberculosis were frequently or rarely admitted . SETTING: A large, teaching hospital in New York City . MEASUREMENTS: Mycobacterium tuberculosis isolates from case patients and controls were typed by restriction fragment length polymorphism analysis . RESULTS: Case patients were younger (median age, 34 compared with 42 years; P = 0.006), more likely to be seropositive for HIV (21 of 23 compared with 11 of 23 patients; odds ratio, 11.5; 95% CI, 1.9 to 117), and more likely to have had a previous hospital admission within 7 months before the onset of tuberculosis (19 of 23 compared with 5 of 23 patients; odds ratio, 17.1; CI, 3.3 to 97), particularly on one ward (12 of 23 compared with 0 of 23 patients; odds ratio, undefined; P = 0.002) . Health care workers assigned to wards housing case patients were more likely to have tuberculin skin test conversions than were health care workers assigned to other wards (11 of 32 compared with 1 of 47 health care workers; P less than 0.001) . Few (6 of 23) case patients were placed in acid-fast bacilli isolation, and no rooms tested had negative pressure . Of 16 available multidrug-resistant isolates obtained from case patients, 14 had identical banding patterns by restriction fragment length polymorphism analysis . In contrast, M . tuberculosis isolates from controls with drug-susceptible tuberculosis had patterns distinct from each other and from those of case patients . CONCLUSIONS: These data suggest nosocomial transmission of multidrug-resistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acid-fast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions.

Chest, 1992 Jul, 102(1), 70 - 5
Nontuberculous mycobacteria in adult patients with cystic fibrosis; Kilby JM et al.; Because patients with cystic fibrosis (CF) may be predisposed to airway infections with unusual microorganisms, we screened the sputum of adult CF patients for mycobacterial organisms . Acid-fast bacilli (AFB) smears and mycobacterial culture were performed on 297 sputum specimens from 87 patients . Cultures for mycobacteria were frequently overgrown with other bacteria; 22.6 percent of cultures were contaminated . Despite this limitation of mycobacterial culture, 17 patients had at least one positive culture for a Mycobacterium other than tuberculosis (MOTT) . Eleven patients were positive for Mycobacterium avium-intracellulare (MAI), two for MAI and M chelonei, three for M chelonei, and one for M fortuitum . None was positive for M tuberculosis . Patients with CF with MOTT were similar to patients with CF without MOTT; only a slightly different (older) age distribution was recognized . The clinical significance of MOTT was difficult to determine in any individual patient, but patients with positive AFB smears appeared more likely to suffer pathogenic effects . We conclude that MOTT is frequently recovered from adult CF patients in the southeastern United States . A specific risk factor for colonization and/or pathogenic infection in this patient group was not evident . The general prevalence and clinical pathogenesis in CF patients in the United States remains to be determinedPublication Types:

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