Acta Cytol, 1992 Jul-Aug, 36(4), 517 - 22 Fine needle aspiration cytology diagnosis of tuberculous thyroiditis . A report of eight cases; Das DK et al.; Among 1,283 cases of thyroid lesions subjected to fine needle aspiration cytology (FNAC) over a period of two years, 8 cases (0.6%) were found to be having cytologic features consistent with tuberculous thyroiditis . The ages of the patients ranged from 14 to 65 years, with a median of 30 . The male:female ratio was 4:4 . Six cases clinically presented with solitary nodules of the thyroid and two cases as abscesses in the thyroid region . Three patients had concomitant cervical lymphadenopathy, and only two patients were known cases of tuberculosis on treatment . Ultrasonography, done in seven cases, confirmed solitary nodules in four; in one case the differentiation between an extrathyroid nodule and cystic isthmic nodule was difficult, and in the remaining two cases the lesions were found to be extrathyroid . Fine needle aspirates from thyroid swellings showed epithelioid granuloma with necrosis in five cases and necrosis without epithelioid granuloma in three cases . The number of cases positive for acid-fast bacilli in these two groups were two and three, respectively . Lymph node aspiration, done in three cases, revealed necrotic material in two; both were positive for acid-fast bacilli, and the third case showed epithelioid granuloma without necrosis. J Med Microbiol, 1992 Jul, 37(1), 56 - 61 Classification of oral pigmented anaerobic bacilli by pyrolysis mass spectrometry and biochemical tests; Magee JT et al.; Clinical (66) and reference (5) strains of pigmented gram-negative anaerobic bacilli, identified as Prevotella intermedia (47), Pr . melaninogenica (1), Pr . corpora (8), Porphyromonas asaccharolyticus (12), P . endodontalis (1) and P . gingivalis (2), were examined by pyrolysis mass spectrometry (PMS) and in conventional tests . Numerical classification based on conventional test reaction patterns (CTRPs) resolved five clusters, four comprising strains identified as Pr . intermedia, Pr . corpora, Pr . melaninogenica, and P . gingivalis respectively, and one comprising strains identified as P . asaccharolyticus and P . endodontalis . Numerical classification based on PMS showed a similar division, with decreasing homogeneity of chemical composition in the order Pr . intermedia, Pr . corpora, P . asaccharolyticus, which agreed with the order of homogeneity in CTRPs . PMS clusters corresponding to the genus Porphyromonas were clearly distinct from those of the genus Prevotella . PMS and CTRP classification disagreed on cluster membership for six strains . PMS identification from blind challenge sets was in agreement with conventional identification for 64 of 67 strains. Chest, 1992 Jul, 102(1), 143 - 6 The role of bronchoscopy in the diagnosis of pulmonary tuberculosis in patients at risk for HIV infection; Salzman SH et al.; The present study was undertaken to clarify the role of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in the diagnosis of pulmonary tuberculosis in patients at risk for human immunodeficiency virus (HIV) infection . We retrospectively identified 31 patients at risk for HIV who proved to have Mycobacterium tuberculosis on culture of at least one pulmonary specimen . All had pulmonary symptoms but initial sputum smears negative for acid-fast bacilli (AFB) . All underwent fiberoptic bronchoscopy (FOB), including BAL and TBB; postbronchoscopy sputum was also collected in 19 patients . A specimen was considered to yield an immediate diagnosis when positive for AFB either on smear or histologic study; granulomas alone were considered positive when no other causes were identified . Overall, an immediate diagnosis was made by bronchoscopic specimens in 15 (48 percent) of 31 cases . TBB was the sole positive specimen in seven patients (23 percent) . For comparison, similar specimens from 40 patients in whom M avium complex (MAC) grew on culture were also evaluated . An immediate identification of AFB was made in only four patients (10 percent) . We conclude that the finding of AFB on staining of any pulmonary specimen is highly suggestive of tuberculosis, rather than MAC, and warrants institution of antituberculosis therapy . Of all bronchoscopic specimens, TBB provides the highest yield for an immediate diagnosis of tuberculosis. Clin Infect Dis, 1992 Jul, 15(1), 158 - 60 Cutaneous tuberculosis: a rare presentation of malignancy; Asnis DS et al.; An 88-year-old woman presented with fever, a neck ulcer, and multiple subcutaneous nodules on her upper extremities and thorax . Her condition was initially diagnosed as malignancy associated with metastatic disease to the skin . A subcutaneous nodule was aspirated . A gram stain of the aspirate revealed weakly gram-positive bacilli, and a stain for acid-fast bacilli was positive . Mycobacterium tuberculosis was isolated from a culture of a specimen of the skin lesion. Scand J Immunol, 1992 Jul, 36(1), 35 - 48 Association of the mycobacterial 30-kDa region proteins with the cutaneous infiltrates of leprosy lesions . Evidence for the involvement of the major mycobacterial secreted proteins in the local immune response of leprosy; Rambukkana A et al.; The granulomatous skin lesions of human leprosy are known to be due to the cutaneous immune reaction to various mycobacterial antigens . In the present study, by immunohistochemical analysis using a previously characterized monoclonal antibody (MoAb) 3A8 we have demonstrated a selective expression of the 3A8 epitope of mycobacterial 30-kDa proteins, the major secreted proteins of mycobacteria, in various forms of leprosy lesions across the clinical spectrum . The localization of MoAb 3A8 staining is confined to the areas of cellular infiltrates of the lesions . In tuberculoid lesions the intense 3A8 staining was seen mostly in association with the membrane of the dermal cellular infiltrates whereas in highly bacilliferous lepromatous lesions the staining seems to be diffused with granular appearance but not in the form of bacteria . In patients with reversal reaction the staining was specifically extended to cells infiltrating the epidermis . MoAb 3A8 did not show any reactivity with inflammatory skin lesions of patients other than those with leprosy . Since the 3A8 epitope of 30-kDa proteins has been shown to be present in all cellular compartments of the mycobacteria and in the actively secreted BCG 85 antigen complex, MoAb 3A8 reactive protein(s) in leprosy lesions may be derived either from degraded somatic mycobacterial products or from antigens actively secreted by live bacilli . The latter could be true in the cases of untreated lepromatous lesions with high bacterial load since live M . leprae has also been considered to secrete corresponding 30-kDa proteins similar to other closely related mycobacteria . By double immunoenzyme staining we clearly demonstrate the expression of 3A8 epitope on CD68+ macrophages in the granulomas of tuberculoid leprosy, whereas in highly bacilliferous lepromatous lesions most of the double staining was seen in a diffuse pattern within the interstitial space of the cellular infiltrate as well as in the cytoplasm of CD68+ macrophages . In lesions from reversal reaction the 3A8 epitope is more strongly expressed on CDla+ dendritic Langerhans cells (LC) both in the epidermis and in the dermis as compared with other types of leprosy . This provides evidence for the involvement of LC in handling of mycobacterial antigenic epitopes in leprosy lesions . Further, immunoenzyme double staining revealed that the expression of this mycobacterial 3A8 epitope on antigen presenting cells such as CD68+ macrophages and CDla+ LC is present in juxtaposition with CD3+ T cells including the alpha beta and gamma delta receptor-bearing T cells in the granuloma.(ABSTRACT TRUNCATED AT 400 WORDS) Infect Immun, 1992 Jul, 60(7), 2998 - 3001 Phosphate starvation enhances expression of the immunodominant 38-kilodalton protein antigen of Mycobacterium tuberculosis: demonstration by immunogold electron microscopy; Espitia C et al.; In this work, we grew Mycobacterium tuberculosis in an enriched Proskauer-Beck-Youmans culture medium in the presence and in the absence of phosphate salts . Immunoblot analysis of sonic extracts showed overexpression of the 38-kDa protein antigen by bacilli grown in the medium without phosphate . These observations were confirmed by immunogold electron microscopy, which showed that the number of gold particles was significantly higher in bacilli grown in medium without phosphate than in bacilli grown in medium with phosphate . The 38-kDa protein was located mainly in the wall and on the cell surface. Mol Biol (Mosk), 1992 Jul-Aug, 26(4), 891 - 6 {Design of hybrid metalloproteinases from Bacillus}; Piotukh KV et al.; Possibility of using recombination mechanisms for the construction of hybrids between relative proteins containing highly homologous regions has been demonstrated . In order to design hybrid neutral proteases (NPr) NPr B . amyloliquefaciens--NPr B . brevis genes encoding these enzymes have been cloned into the same plasmid in tandem orientation with subsequent recombination between them . With the help of sequential inactivation we have managed to ensure efficient selection at intermediate stages as well as at the completion stage of construction when the desirable hybrid forms exhibited proteolytic activity . Constructions containing expressed genes of the hybrid neutral proteases NPr B . amyloliquefaciens--NPr B . brevis were obtained . The presence of several regions of high homology between the genes of the two Bacilli neutral proteinases determines the possibility of obtaining of various variants of hybrid proteins with different properties. Indian J Lepr, 1992 Jul-Sep, 64(3), 341 - 7 Observations on the cultivation of M . leprae and M . tuberculosis in medium 'V' and 'V 1'; Herbert D et al.; Skin scrapings from five different active sites were collected from 14 leprosy patients and inoculated into medium V . Skin scrapings from three leprosy patients were inoculated into medium V 1 . All the cultures were incubated at 8-10 degrees C . M . tuberculosis H37Rv, pretreatment isolates and streptomycin resistant strains were inoculated into medium V, with and without antibiotics, and incubated at 8-10 degrees C as well as 37 degrees C . Smears were made from the M . leprae and M . tuberculosis cultures at 0 hours and at different time points . The number of bacilli in the smears were counted . There was no increase in the number of M . leprae or M . tuberculosis in any of the cultures. Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Jul, 30(7), 1303 - 7 {A case of chronic necrotizing pulmonary aspergillosis}; Kohmura K et al.; A 70-year-old woman with diabetes mellitus who was following a therapeutic diet showed an infiltrative shadow in the right upper lung field on chest roentgenogram in April, 1986 . She was diagnosed as having pneumonia and was treated for five months with several antibiotics, but the abnormal shadow on chest roentgenograms increased in size . Therefore, she was admitted to our hospital in October 1986 . Although tubercle bacilli were not isolated from her sputum or from materials obtained by bronchoscopic examination, we made an initial diagnosis of pulmonary tuberculosis based on the findings of chest roentgenograms, tomographs and CT scanning . In spite of treatment with antituberculous drugs, the infiltrative shadow with cavity on chest roentgenograms continued to increase in size, and the patient developed occasional hemoptysis . Percutaneous needle biopsy was performed in February 1987 to establish a definite diagnosis, and the presence of Aspergillus fumigatus was confirmed by microscopic examination and culture . After treatment with miconazole and 5-FC for 3 to 4 months, the abnormal shadow on the chest roentgenogram gradually disappeared and was almost undetectable one year later . The clinical course of this patient was considered to be strongly indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al . in 1982. Biochimie, 1992 Jul-Aug, 74(7-8), 723 - 33 A method for the determination of bacterial spore DNA content based on isotopic labelling, spore germination and diphenylamine assay; ploidy of spores of several Bacillus species; Hauser PM et al.; A reliable method for measuring the spore DNA content, based on radioactive DNA labelling, spore germination in absence of DNA replication and diphenylamine assay, was developed . The accuracy of the method, within 10-15%, is adequate for determining the number of chromosomes per spore, provided that the genome size is known . B subtilis spores were shown to be invariably monogenomic, while those of larger bacilli Bacillus megaterium, Bacillus cereus and Bacillus thuringiensis, often, if not invariably, contain two genomes . Attempts to modify the spore DNA content of B subtilis by altering the richness of the sporulation medium, the sporulation conditions (liquid or solid medium), or by mutation, were apparently unsuccessful . An increase of spore size with medium richness, not accompanied by an increase in DNA content, was observed . The implication of the apparently species-specific spore ploidy and the influence of the sporulation conditions on spore size and shape are discussed. Indian J Chest Dis Allied Sci, 1992 Jul-Sep, 34(3), 133 - 6 Adrenocortical insufficiency in smear positive pulmonary tuberculosis; Matah SC et al.; We studied 40 patients with pulmonary tuberculosis . All were positive for acid-fast bacilli (AFB) in the sputum . Their mean age was 30 yrs (range 10-50 yrs) and the duration of illness was 26.3 +/- 2.3 months . Radiologically minimal, moderately advanced and far advanced lesions were present in 7 (17.5%), 9 (22.5%) and 23 (57.5%) patients respectively . One patient with endobronchial lesion had no radiological evidence of pulmonary tuberculosis . Clinically, 14 patients (35%) had one or the other features of adrenocortical insufficiency . Postural hypotension was the commonest feature and was present in 11 patients (27.5%), followed by nausea and vomiting (20%), loss of axillary hair and libido (10%), skin and mucosal pigmentation in 7.5% of the cases . ACTH stimulation revealed incomplete adrenocortical insufficiency (partially responsive adrenal) in 5 patients (12.5%) and complete adrenocortical insufficiency (non-responsive adrenal) in 2 patients (5%) . Patients with features of adrenal insufficiency had significantly longer duration of illness (p < 0.001) but there was no correlation with extent or type of lesion. Rev Invest Clin, 1992 Jul-Sep, 44(3), 369 - 72 Follicular gastritis and its association with Helicobacter pylori infection; Arista-Nasr J et al.; Fifty endoscopic biopsies with follicular gastritis (FG) were reviewed to define the frequency of association of FG and Helicobacter pylori (H pylori) infection . All biopsies were studied in sections stained with hematoxylin and eosin and no special techniques were employed . In forty-two out of the fifty cases (84%) H pylori was documented and most of the gastritis showed activity . There was no correlation between the quantity of follicles and the number of bacilli; some biopsies with few follicles showed many microorganisms and others with many follicles showed only a few . There was also no correlation between the presence of the follicles and the distribution of Helicobacter: in some biopsies the microorganisms were found in the tissue fragments with hyperplastic follicles but in others, it was observed in fragments without lymphoid follicles . The high frequency of association between FG and H pylori suggests that this microorganism has some antigenic properties that condition lymphoid tissue hyperplasia in gastric mucosa . It is concluded that the diagnosis of follicular gastritis should be considered an important finding and its presence should lead to a careful search for H pylori . In most cases the microorganism can be identified in routine sections using only hematoxylin and eosin stain. Kekkaku, 1992 Jun, 67(6), 441 - 7 {Detection of mycobacteria by polymerase chain reaction}; Yamazaki T et al.; The polymerase chain reaction (PCR) was used to detect mycobacterial DNA sequences in the cultured or the clinical specimens . Four oligonucleotide primers derived from the sequence of a gene coding 65-kilodalton antigen of Mycobacterium tuberculosis amplified DNA samples of all the 11 species of mycobacteria tested . Serial dilution of M . bovis BCG showed that DNA extracted from only 12 bacilli was enough for the detection by PCR method . However, mycobacteria in sputum were detected by PCR when more than 10(3) bacilli were present . The PCR method may become a useful tool for the rapid diagnosis of mycobacterial infections. Kekkaku, 1992 Jun, 67(6), 433 - 9 {Study on familial attacks of pulmonary tuberculosis in Sapporo City}; Hamajima I; We studied familial attacks of pulmonary tuberculosis in Sapporo City from 1987 to 1990 . There were 146 sources of infection . Two hundred twenty three were infected secondly . Chemotherapy was given to the 75 out of 223 patients . Chemoprophylaxis was given to the total of 148 children . The average ages of the sources, those who were infected secondly and those who had given chemoprophylaxis were 44.8, 32.2 and 7.7 years of age respectively . The ratio of male vs female was 1:0.4 among the sources . The main routes of transmission of this disease were from husbands to wives, from fathers to children, and from grandfathers to grandchildren . The patients who did not have health examination in the preceding one year of their present diagnoses had more severe state of disease as well as higher Gaffky degrees and were treated for more than one year . The infectious patients accounted for more than 50% of the active pulmonary tuberculosis in Sapporo City in 1990 . Tuberculin skin test has been performed in almost cases of family examination and the period of chemoprophylaxis has been standardized along the guideline for the chemoprophylaxis by Japan Tuberculosis Association and the Ministry of Health and Welfare . Family and relatives of the patient who expectorates tuberculosis bacilli should take at least one examination annually . Younger people should take it more frequently and chemoprophylaxis should be given to the child whose reaction of Tuberculin skin test is strongly positive. Kekkaku, 1992 Jun, 67(6), 427 - 31 {Pulmonary tuberculosis in youth}; Yamagishi F et al.; The study of the group younger than 29 years of age with pulmonary tuberculosis was carried out . Thirty seven out of 287 tuberculosis patients who were discharged from National Chiba-Higashi Hospital in 1989 were enrolled . Only 5 patients (13.5%) were associated with complication . The smear and culture of sputum for acid-fast bacilli were positive in 30 cases (81.1%) and chest X-ray films revealed cavitary lesion in 31 cases (83.3%) . Many of them were moderately advanced cases . Twenty four of them were found symptomatically, 10 by mass survey and 3 under treatment of other diseases . The total delay of symptomatic patients was 8.5 weeks until 80% of them were definitely diagnosed . The days of hospital stay were 122 until half patients were discharged . Five of them (13.5%) were non-Japanese and all stayed in Japan illegally . Their condition was rather severe. J Clin Pathol, 1992 Jun, 45(6), 528 - 30 Fatal case of disseminated infection with the turtle bacillus Mycobacterium chelonae; Paul J et al.; An apparently immunocompetent 78 year old woman presented with confusion, subcutaneous abscesses, and lesions of the nasopharynx . Gram positive, acid fast bacilli were isolated from her blood after 10 days' incubation . She was treated with trimethoprim-sulphamethoxazole for presumed disseminated nocardiasis but deteriorated and died . A post mortem examination showed skin and pulmonary lesions and endomyocardial fibrous plaques . Organisms isolated from the skin and lung were indistinguishable from those cultured from the blood . The organism was subsequently identified as Mycobacterium chelonae . Primary pulmonary infection and disseminated disease are rarely caused by this organism and bacteraemia is seldom documented . The clinical presentation and bacteriological and histological findings are difficult to differentiate from those of disseminated nocardiasis . Isolation of the organism may fail without prolonged incubation of initial cultures and there is a danger of its being dismissed as medically unimportant . Diagnosis is further hampered because large pulmonary foci may be poorly revealed by conventional radiological examination of the chest. J Clin Microbiol, 1992 Jun, 30(6), 1568 - 71 Evaluation of the Autoscan Walkaway system for rapid identification and susceptibility testing of gram-negative bacilli; Kelly MT et al.; We evaluated the performance of the Autoscan Walkaway (W/A) system (MicroScan, Sacramento, Calif.) in conjunction with the fluorometric Neg Combo panels for rapid identification and susceptibility testing of gram-negative bacilli . Fermentative and nonfermentative gram-negative bacilli were tested in parallel with the W/A system and the Cathra Repliscan replicator (C/R) system (Cathra, St . Paul, Minn.) . Conventional biochemical testing and agar dilution testing were used to resolve the identification and susceptibility testing discrepancies . Of 495 clinical isolates tested, 445 (90%) were correctly identified by the W/A system and 483 (98%) were correctly identified by the C/R system . Repeat testing by using updated versions of the W/A system's computer identification software failed to demonstrate improved identification accuracy . For susceptibility testing, the W/A system demonstrated 5.6% total interpretative category errors, including only 0.9% major and very major errors . The comparative C/R system produced only 1% errors overall, including 0.2% major and very major errors . Although the W/A system is highly automated and is capable of producing results rapidly, our findings suggest that additional identification and susceptibility testing refinements are needed before the system will be suitable for routine use. Pediatr Infect Dis J, 1992 Jun, 11(6), 450 - 6 Usefulness of skin testing with mycobacterial antigens in children with cervical lymphadenopathy; Huebner RE et al.; One hundred twenty-three children with chronic cervical lymphadenopathy were skin-tested with purified protein derivative (PPD)-B (Mycobacterium intracellulare), PPD-Y (Mycobacterium kansasii), PPD-G (Mycobacterium scrofulaceum) (nontuberculous mycobacterial antigens (NTMags)) and PPD-T (Mycobacterium tuberculosis) . Children with culture-confirmed mycobacterial disease had significantly larger reactions to NTMags and were 6 times more likely to have PPD-B responses of greater than or equal to 10 mm than those with negative microscopy/culture results . Children with acid-fast bacilli present in clinical specimens but with negative culture results were 3 times more likely to have greater than or equal to 10 mm induration to PPD-B than those with negative microscopy/culture results . In all groups except those with culture-confirmed M . tuberculosis, responses to PPD-T were significantly smaller than those to the NTMags . We conclude that NTMags, particularly PPD-B, may be useful in diagnosing childhood mycobacterial cervical adenopathy; however, their usefulness in distinguishing disease caused by M . tuberculosis from that resulting from other mycobacteria is unknown. J Trop Med Hyg, 1992 Jun, 95(3), 186 - 91 Resistance to antituberculosis drugs in treated patients in Lagos, Nigeria; Idigbe EO et al.; The extent and pattern of drug resistance among previously treated tuberculosis patients was investigated . Ninety-six patients with a total treatment duration of between 6 and 18 months and still smear and culture positive were examined . Treatment was either continuous or in intermittent blocks . Drug susceptibility tests on strains of tubercle bacilli isolated from the patients were performed against isoniazid, streptomycin, p-aminosalicylic acid, ethambutol and rifampicin by the proportion method using LJ medium without potato starch . A total of 56% of the strains were resistant to one or more of the drugs tested . Resistance to isoniazid (38%) and streptomycin (29%) was most common . A significant finding in the study was the low level of resistance to rifampicin (2%) and ethambutol (3%) . A relationship between the incidence of drug resistance and the nature and duration of previous treatment appeared likely since susceptible strains were isolated more often from patients with continuous treatment than from patients on intermittent blocks of long-course regimens . It is therefore suggested that the introduction of better supervision of drug taking and the adoption of continuous short-course regimens on a nationwide level will contribute immensely towards the reduction of the drug resistance problems in Nigeria as well as in other developing countries. Am Rev Respir Dis, 1992 Jun, 145(6), 1429 - 32 Tuberculous pleural effusion: 6-month therapy with isoniazid and rifampin; Dutt AK et al.; We have shown that 6-month therapy with isoniazid (INH) and rifampin (RIF) is adequate for pulmonary tuberculosis when tubercle bacilli are less numerous, i.e., smear negative, culture positive . Tuberculous exudative pleural effusion contains small bacterial populations, as often demonstrated by negative smears and fewer positive cultures . Therefore, in 1980, we started treating tuberculous pleural effusion with a therapy protocol consisting of INH 300 mg plus RIF 600 mg daily for 1 month, followed by INH 900 mg plus RIF 600 mg twice weekly for another 5 months (total, 6 months) . From January 1980 to September 1990, 198 patients with an average age of 62.6 years were treated in this manner . Associated pulmonary infiltration was present in 92 patients, of whom 50% yielded positive sputum cultures . Other medical conditions as "risk factors" were present in 30% . Therapy was not completed in 36 patients because of death, relocation, noncompliance, and drug side effects . Treatment failed during therapy in only 1 patient . Side effects of the drugs occurred in 13 (6.6%) patients, but major side effects were encountered in only three (1.5%), two with toxic hepatitis and one with thrombocytopenia . The full 6-month therapy was completed by 161 patients . During follow-up from 2 to 133 months (median, 46 months), none of the 161 patients had relapse . An overall success rate of 99% was achieved in 162 patients with only 1 failure during therapy . Thus, 6-month therapy with INH plus RIF is adequate in tuberculous exudative pleural effusion, even when associated with smear-negative (3 specimens) culture-positive pulmonary tuberculosis. Ann Intern Med, 1992 Jun 1, 116(11), 937 - 41 Genetics and resistance to tuberculosis . Could resistance be enhanced by genetic engineering? Stead WW. Recent observations strongly suggest a significant role for genetic factors in innate resistance to infection by Mycobacterium tuberculosis . This relation was discovered in a study of tuberculosis in Arkansas nursing homes and was supported by data from three outbreaks of tuberculosis in two prisons . A person's resistance level was found to correlate with the region of his or her ancestry . Ancestors of person's in the more resistant group tended to derive from densely populated areas and cities rife with tuberculosis, whereas the ancestors of person's in the more susceptible group tended to derive from areas once free of tuberculosis . In accordance with current genetic theory, those persons who are less resistant to tuberculosis would be expected to be more resistant to infections endemic to the region once inhabited by their ancestors . Isolation of the gene previously shown to confer specific innate (nonimmune) resistance to tuberculosis should result in the creation of a more rational approach to increasing the capacity of human macrophages to kill tubercle bacilli without producing a positive tuberculin skin test. Int J Lepr Other Mycobact Dis, 1992 Jun, 60(2), 244 - 9 Isolation of cultivable mycobacteria from feces and lungs of armadillos infected with Mycobacterium leprae; Dhople AM et al.; In the past, no cultivable mycobacteria were isolated from armadillos captured in the state of Florida, U.S.A . But recent findings of acid-fast bacilli (AFB) in the lungs of armadillos infected with Mycobacterium leprae prompted us to undertake this study to determine the correlation between systemic leprosy infection and the occurrence of cultivable mycobacteria in the lungs and stools of these animals . No AFB could be isolated from noninfected animals . Seventy percent of the infected animals developed disseminated infection, but no cultivable mycobacteria were isolated from their livers and spleens . However, cultivable mycobacteria were isolated from the lungs and stools of a large number of armadillos showing disseminated infection . The most common among these were M . gordonae, M . fortuitum, and M . avium . There was a close correlation between the development of disseminated leprosy infection and the occurrence of cultivable mycobacteria in their lungs and stools, perhaps due to the decline in the immune system in these animals in the later stages of infection. Int J Lepr Other Mycobact Dis, 1992 Jun, 60(2), 161 - 72 Relapses in leprosy patients after release from dapsone monotherapy; experience in the leprosy control program of the all Africa Leprosy and Rehabilitation Training Center (ALERT) in Ethiopia; Becx-Bleumink M; Before implementation of multidrug therapy (MDT), leprosy patients who were clinically inactive, skin-smear negative and had been treated with dapsone monotherapy for at least 5 years (paucibacillary patients) or for at least 10 years (multibacillary patients) were released from treatment . An analysis was made of self-reporting relapses in 1081 paucibacillary (PB) patients and 1123 multibacillary (MB) patients who had been released in Addis Ababa and two rural districts of the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT) . During an average period of 6.6 years after stopping dapsone, 44 relapses were diagnosed among the PB patients and 148 relapses among the MB patients . The overall relapse rate was 4.1% or 7.2 per 1000 patient-years after release from treatment for PB patients and 13.2% and 24.8, respectively, for MB patients . The annual relapse rate in PB patients did not differ significantly from year to year . However the relapse rate for MB patients was significantly lower during the fifth to seventh years after stopping treatment compared with the first 4 years . Based on clinical findings there was a strong suspicion of relapse with dapsone-resistant bacilli in 40.4% of MB relapses . It is concluded that the relapse rate for PB patients is acceptable . However, the relapse rate for MB patients is considered too high . It is strongly recommended to administer to all MB patients, including those who have been on long-term treatment with dapsone and have become clinically and bacteriologically inactive, a 2-year course of MDT. Circ Shock, 1992 Jun, 37(2), 117 - 23 Intestinal bacterial flora, intestinal pathology, and lipopolysaccharide-induced translocation of intestinal bacteria; Wells CL et al.; The primary aim of this study was to clarify the mechanism and significance of lipopolysaccharide (LPS)-induced translocation of intestinal bacteria . Female Swiss Webster mice were purchased from two different animal suppliers . Twenty-four hours following parenteral LPS, mice from both suppliers had noticeable morbidity and mortality . However, intestinal pathology, gram-negative bacterial overgrowth, and increased bacterial translocation was noted in mice purchased from one supplier but not the other . Mice with increased translocation also had overgrowth of cecal gram-negative bacilli, i.e., 10(10) per gram of cecum following parenteral LPS; in contrast, mice without LPS-induced bacterial translocation had 1,000- to 10,000-fold fewer cecal gram-negative bacilli . Additional groups of mice with increased bacterial translocation were also sacrificed two and 6 hr after parenteral LPS; morbidity and intestinal pathology were evident without a corresponding increase in bacterial translocation . Separate groups of these mice were also injected with platelet activating factor, resulting in intestinal pathology similar to that noted with parenteral LPS, but no increase in bacterial translocation . Thus parenteral LPS was consistently associated with morbidity and mortality but not with intestinal pathology, enteric bacterial overgrowth, or increased bacterial translocation. Med Lab Sci, 1992 Jun, 49(2), 94 - 8 Counts of viable tubercle bacilli in sputum related to smear and culture gradings; Allen BW et al.; Pairs of sputum specimens obtained pre-treatment from 166 smear-positive patients with pulmonary tuberculosis were examined by direct smear, culture on Lowenstein-Jensen medium after decontamination by the Petroff method, and by quantitative colony counting on selective 7H11 medium after digestion with dithiothreitol . The selective medium counts ranged from no growth to 8.3 log10 cfu/ml with the largest numbers in the range 3.5-7.0 log10 cfu/ml . Although there was overlap in counts between specimens with negative and positive direct smears, a specimen with a count of 4.0 log10 cfu/ml or more was likely to have a positive smear while a negative smear was likely if the count was lower . This demarcation value should be increased to 4.5 log10 cfu/ml to account for under-estimation in the selective medium counts . The corresponding demarcation estimate for LJ cultures was 80 colonies . In distinguishing between patients in the bacterial contents of their sputum, the selective medium counts were better than the gradings of either LJ cultures or direct smears. Zhonghua Jie He He Hu Xi Za Zhi, 1992 Jun, 15(3), 163 - 4, 191-2 {The clinical significance of red cell immune adherence function in patients with pulmonary tuberculosis and silicotuberculosis}; Hu PC; In our study, we observed that (1) High RCIA were discovered in these two groups . (2) In the group of pulmonary tuberculosis, the C3b receptor activities remained no change after antituberculous therapy, but the amounts of immune complexes bearing on RBC decreased . In the patients with the high RCIA, CIC was discharged rapidly and the lesions of tissue produced by CIC were prevented . In the patients with silicotuberculosis, both silica and tuberculous bacilli may act as immune adjuvant and enhance the hypersensitivity . So the C3b receptor activities were higher in silicotuberculosis patients. Chin Med J (Engl), 1992 Jun, 105(6), 500 - 5 Comparison of serum bactericidal activity of 4 fluoroquinolones in healthy volunteers; Wang R et al.; In vitro antibacterial activities (MBCs) and serum bactericidal activities (SBAs) of fluoroquinolones were compared . The MBCs were measured by the agar disk dilution test . The 40 tested strains belonging to 8 species were isolated from hospitalized patients . Against Gram positive cocci, Ciprofloxacin (CPLX) and ofloxacin (OFLX) were the more active and nefloxacin (NFLX) was less potent than the others . Against Ps . aeruginosa, CPLX had the highest activity, enoxacin (ENX) as well as OFLX had powerful activity, whereas NFLX was less active . All the 4 agents showed high activity against Gram negative bacilli . In the self-controlled, randomized crossover study, 4 fluoroquinolones were given to 10 healthy volunteers and then SBAs were determined using microdilution method . The peak SBAs of CPLX and OFLX were significantly higher than NFLX, and those of ENX were comparatively low, but there was no difference between ENX and OFLX against most of the strains tested . The percentages of peak SBAs greater than 1:8 of the 4 fluoroquinolones suggest that in the treatment of serious infections, CPLX and OFLX are more effective and ENX can also achieve high cure rate . The trough SBAs of the 4 fluoroquinolones suggest that the time interval of administration of CPLX and OFLX should be more than 8 hours, but increase of the dosage or shortening of the time interval between the administrations is recommended for ENX and NFLX. Kansenshogaku Zasshi, 1992 Jun, 66(6), 729 - 36 {Study on the bacteriological examination of sputum and bronchoscopy specimens from 31 cases with pneumonia due to Chlamydia psittaci}; Hayashi Y et al.; We carried out the bacteriological examination of sputum and bronchoscopy specimens from 31 cases with pneumonia due to C . psittaci . The results obtained were as follows: 1 . The positive culture of sputum and bronchoscopy specimens were 38.7% (12/31) . 2 . The organisms detected from them were 13 strains of gram-negative bacilli, 2 of gram-positive cocci and one gram-positive bacillus . 3 . Significant differences were observed in the white blood cell count between the cases of positive culture and those of normal upper respiratory tract flora (p less than 0.05) . From the results we conclude that it would be better that we add the proper antimicrobial drugs to chlamydial antibiotics in the treatment of patients with leukocytosis. Tuber Lung Dis, 1992 Jun, 73(3), 167 - 9 Early diagnosis of tuberculosis by fibreoptic bronchoscopy; Fujii H et al.; We carried out a retrospective study of the methods used to achieve an early diagnosis of 67 patients with pulmonary tuberculosis treated at our institute between 1984 and 1989 . Sputum bacteriology was positive in 56 of the 67 patients, 22 were positive on microscopical examination of smears and on culture and 34 on culture alone . The 11 patients with negative sputum bacteriology were all diagnosed by fibreoptic bronchoscopy . In addition, 21 of the 34 smear-negative/culture-positive patients were examined by fibreoptic bronchoscopy and the initial diagnosis was made in 7 of these . Thus the initial diagnosis was made by sputum bacteriology in 49 cases and by fibreoptic bronchoscopy in 18 cases . The median number of days between obtaining a specimen and starting therapy was 7 days for sputum microscopy, 41 days for sputum culture, 7 days for microscopic examination of bronchoscopy specimens, 51 days for culture of the same and 19 days for biopsy . Fibreoptic bronchoscopy is therefore useful for the diagnosis of cases of tuberculosis in which tubercle bacilli are not detected in sputum and, in some instances, for an earlier diagnosis of smear-negative/culture-positive patients. Tuber Lung Dis, 1992 Jun, 73(3), 145 - 9 Proposal of an improved score method for the diagnosis of pulmonary tuberculosis in childhood in developing countries; Migliori GB et al.; 210 children aged less than 5 years, referred to the Arua Regional TB Centre (Uganda) for suspected pulmonary tuberculosis (PTB), were examined by anamnesis, clinical examination, Mantoux test, gastric washing, chest X-ray . The response to treatment criterion was applied to the patients treated . According to the score method suggested by Ghidey and Habte, 31 children were diagnosed as PTB patients . 30 of the 31 children with PTB tested positive for alcohol acid-fast bacilli (AAFB) in the aspirated juice . The Mantoux test and X-rays gave a minor contribution to diagnosis . The clinical results are commented . A statistical analysis was carried out to evaluate the role of gastric washing in the diagnosis of PTB in children under 5 years of age (sensitivity, 96.8%; specificity, 92.2%; positive predictive value, 68.2%; negative predictive value, 99.4%) . The response to treatment was also evaluated . A modified enlarged score method (based on gastric washing and including response to treatment) is proposed to be applied in developing countries where chest X-ray and other facilities are often lacking. Lepr Rev, 1992 Jun, 63(2), 108 - 16 Activity of sparfloxacin against Mycobacterium leprae inoculated into footpads of nude mice; Gidoh M et al.; The antileprosy activity of a new quinolone, sparfloxacin, was examined in the nude mouse footpad model . By serial dosing (once a day, 5 or 6 times per week, during the 3rd-5th months postinoculation), 10 mg/kg of sparfloxacin displayed bactericidal-type activity and bacteriostatic activity was present at daily doses of 5 and 2 mg/kg . By intermittent dosing (once a day, twice weekly at daily doses of 10 and 20 mg/kg or once weekly at a daily dose of 30 mg/kg, during the 3rd-5th months postinoculation), sparfloxacin markedly inhibited the growth of leprosy bacilli with slight remultiplication at later stages . Sparfloxacin seems to be worth studying clinically as a novel antileprosy drug. Eur Respir J, 1992 Jun, 5(6), 680 - 4 Combined chemotherapy including rifabutin for rifampicin and isoniazid resistant pulmonary tuberculosis . G.E.T.I.M . (Group for the Study and Treatment of Resistant Mycobacterial Infection); Pretet S et al.; A prospective multicentre open study has been conducted in France in order to assess the efficacy and tolerability of an antimycobacterial regimen including rifabutin in the treatment of patients with pulmonary tuberculosis due to rifampicin and isoniazid resistant bacilli . Patients were treated with daily rifabutin (450-600 mg), associated with companion drugs to which the organisms remained susceptible; in most cases the regimen included a fluoroquinolone . The duration of treatment was initially scheduled for a minimum period of 12 months after sputum culture conversion . Thirty nine patients were enrolled, 23 of whom were treated for at least 12 months . Culture conversion was obtained at the end of the twelfth month in 14 out of 23 patients . Twenty one out of 39 patients experienced adverse events . These were, however, serious enough to discontinue treatment in only four patients . These results suggest that an antimycobacterial combination including rifabutin might contribute to the treatment of multi-resistant pulmonary tuberculosis. J Clin Pathol, 1992 Jun, 45(6), 487 - 9 Rapid cytochemical demonstration of cytochrome oxidase activity in pathogenic bacteria; Barer MR et al.; AIMS: To develop and assess a cytochemical technique for the light microscopical detection of oxidase activity in pathogenic bacteria . METHODS: Live bacterial cells were deposited on to aminopropylsilane treated glass coverslips by centrifugation, dried, then reacted with either 1% (w:v) n,n,n',n'-tetramethyl-p-phenylene diamine (TPD) or 5 mM diaminobenzidine (DAB) at 37 degrees C . The preparations were mounted in 50% glycerol and assessed by brightfield microscopy . An optimised DAB procedure (5 minutes of drying at 37 degrees C and 10 minutes of reaction time) was applied to 44 strains of organisms commonly associated with infections in man and to two fresh positive blood culture containing Gram negative bacilli . RESULTS: TPD gave no discernible localised reaction product and was not investigated further . With DAB, oxidase positive cells (brown) were clearly differentiated from oxidase negative cells (colourless) even in mixed preparations . The DAB technique correctly assigned 18 oxidase positive isolates (seven genera), 26 oxidase negative isolates (eight genera), and the organisms present in the two freshly positive blood cultures to their appropriate oxidase reactivity as defined by the standard macroscopic TPD technique . CONCLUSIONS: The cytochemical reaction seems to be a reliable indicator of the macroscopic oxidase test . It permits determination of oxidase reactivity at an early stage in the assessment of clinical material when infecting organisms can be demonstrated by microscopy . Further development of this and related cytochemical techniques could permit the provision of microbiological information that would be relevant to patient management, well in advance of conventional techniques. Kekkaku, 1992 May, 67(5), 409 - 12 {A case of coexistent bronchogenic carcinoma with pulmonary tuberculosis}; Sakai T et al.; A 79-year-old housewife complaining of shortness of breath presented with a LUL mass lesion on chest roentgenogram . Bronchofiberscopic biopsy and curettage revealed adenocarcinoma as well as acid-fast bacilli of Gaffky-4 . Further investigations showed increased ESR, CRP levels and positive RF . PPD skin test was positive measuring 55 x 43 mm . A left upper lobectomy with mediastinal lymph node dissection was performed . The mass was in S1+2 and measured 2.7 x 2.5 x 1.5 cm . Histologically caseaous necroses and spotted granulomas of tuberculosis were surrounded by bronchioloalveolar cell carcinoma . Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a higher coexistence of both diseases . However, the coexistence of active tuberculosis with carcinoma in the same region, as in our case, is quite rare and suggests an etiological closer relationship between both diseases. Mol Microbiol, 1992 May, 6(9), 1115 - 9 The autocatalytic processing of the subtilisin Carlsberg pro-region is independent of the primary structure of the cleavage site; Egnell P et al.; Subtilisins are extracellular seryl-proteases produced by bacilli (Markland and Emil, 1971) . In addition to signal sequences, these proteases have N-terminal extensions (pro-regions) which have also been identified in several other proteases (Silen et al., 1988; Vasantha et al., 1984; Polhner et al., 1987; Henderson et al., 1987; Yanagida et al., 1986; Takagi et al., 1985) . The pro-region holds the pro-protease associated with the membrane and release of the protease takes place as a result of pro-region removal by autocatalytic processing (Egnell and Flock, 1991) . In this report we describe the construction of four deletion-mutations in the gene encoding subtilisin Carlsberg at the junction between the pro-region and mature subtilisin Carlsberg . We found that the introduction of different deletions abolished the ability of subtilisin to undergo autocatalytic cleavage of the pro-region in cis, whereas cleavage by exogenous subtilisin could still occur in trans . Point mutations were also introduced in positions -5 to +4 around the pro-region and native subtilisin cleavage site . Processing of pro-subtilisin with the point mutations showed that the autocatalytic cleavage and recognition of this junction of the subtilisin Carlsberg pro-region is independent of the amino acid sequence around the cleavage site. Am Rev Respir Dis, 1992 May, 145(5), 1223 - 5 Pyrazinamide sterilizing activity in vitro against semidormant Mycobacterium tuberculosis bacterial populations; Heifets L et al.; Previously, we reported that pyrazinamide has very poor bactericidal activity against M . tuberculosis growing in broth at pH 5.6 . In the present study, cultivation at pH 4.8 to 5.0 in 7H12 broth prevented an increase in the number of viable bacteria, but the cultures remained metabolically active . The presence of 50 micrograms/ml pyrazinamide in semidormant cultures led to a sharp decline in the number of viable bacteria, by more than 1,000-fold . This unfavorable environment probably made the bacilli especially vulnerable to pyrazinamide, whose mode of action remains unclear . To distinguish this effect of pyrazinamide on the semidormant bacteria from its mostly bacteriostatic activity against actively multiplying bacteria, we suggest interpreting the in vitro effect as "sterilizing." Chest, 1992 May, 101(5), 1245 - 9 Pseudoepidemic of nontuberculous mycobacteria due to a contaminated bronchoscope cleaning machine . Report of an outbreak and review of the literature; Gubler JG et al.; We describe a pseudoepidemic due to nontuberculous mycobacteria contaminating the water tank of a machine used to clean and disinfect fiberoptic endoscopes . Forty-six bronchoscopies performed on 41 patients during a six-month period yielded 16 specimens positive for acid-fast bacilli (AFB) . One specimen showed Mycobacterium avium complex from an AIDS patient and one, M tuberculosis from a patient with active cavitary tuberculosis . In four patients, only the smears showed AFB; subsequent cultures remained negative . Of the rest, seven contained M chelonae and three M gordonae, all in patients with no clinical signs of mycobacterial disease . Two of the three M gordonae isolates represented laboratory contamination from an antimicrobial solution in a culture medium . Four patients in the beginning of the pseudoepidemic were treated for presumed tuberculosis until negative culture results were available . Control of the "outbreak" was achieved by regular disinfection of the implicated water tank in the cleaning machine . Contamination of bronchoscopes with nontuberculous mycobacteria can lead to unnecessary diagnostic and therapeutic interventions. Chest, 1992 May, 101(5), 1211 - 4 The role of fiberoptic bronchoscopy for diagnosis of pulmonary tuberculosis in patients at risk for AIDS; Miro AM et al.; In patients with acquired immunodeficiency syndrome (AIDS)-associated pulmonary Mycobacterium tuberculosis (MTB) (group 1), we analyzed whether the addition of transbronchial biopsy (TBB) and bronchial brushings augmented the diagnostic MTB yield over nonbiopsy sampling . Positive acid-fast bacilli (AFB) smears from combined sputum, bronchoalveolar lavage (BAL), and washings were 30 percent compared with 37 percent when brushings and TBB were added (p = NS) . The addition of TBB increased culture yield from 96 percent to 100 percent (p = NS) . Similar results were seen in patients with pulmonary MTB without human immunodeficiency virus (HIV) risk factors (group 2) . Group 1 patients most commonly had a nonspecific inflammation on TBB histopathology and had a lower incidence of granuloma formation than group 2 (p less than 0.05) . Our results suggest that more invasive sampling with bronchial brushings and TBB does not contribute to the microscopic, bacteriologic, or histopathologic diagnosis of pulmonary MTB, independent of AIDS risk factors. Acta Cytol, 1992 May-Jun, 36(3), 440 - 4 Cytology of extrapulmonary Pneumocystis carinii infection in the acquired immunodeficiency syndrome; Abati AD et al.; Rare cases of extrapulmonary Pneumocystis carinii (EPPC) have been seen in patients with acquired immunodeficiency syndrome (AIDS) . We report seven such diagnoses of nonpulmonary P carinii (PC) from four AIDS patients between 1986 and 1989 . The specimens included fine needle aspirate of liver, spleen, periarticular tissue and pleura as well as ankle fluid, pleural fluid and ascites . In some, but not all, cases the patients had concurrent or previous episodes of PC pneumonia . In all cases the typical granular, eosinophilic aggregates of PC cysts were noted on routine Papanicolaou staining, leading to the definitive detection of PC cysts with Grocott silver stain . In most cases, evidence for granulomalike and neovascularized tissue reaction was present in cytologic material . One specimen demonstrated concurrent acid fast bacilli . In the setting of AIDS, cytology of effusions and masses should include an evaluation for EPPC. Acta Cytol, 1992 May-Jun, 36(3), 391 - 4 Critical appraisal of fine needle aspiration cytology in tuberculous lymphadenitis; Gupta AK et al.; A cytomorphologic diagnosis of tuberculous lymphadenitis by examination of needle aspirates was made in 560 of 1,471 cases of lymphadenopathy studied over two years . Cytologic features were categorized into four groups: epithelioid clusters with or without Langhans's giant cells without necrosis (32.14%), epithelioid clusters with or without Langhans's giant cells with necrosis (50.35%), occasional epithelioid cells without characteristic necrosis/giant cells (2.85%) and necrosis without epithelioid clusters or Langhans's giant cells (14.64%) . While a diagnosis of tuberculous lymphadenitis was offered with confidence in the first two groups, constituting about 82.49% cases, aspirates from the third- and fourth-group patients were subjected to Ziehl-Neelsen staining for acid-fast bacilli, which was positive in 12.5% and 75.6% of cases, respectively. Crit Care Med, 1992 May, 20(5), 691 - 703 Selective decontamination of the digestive tract in the intensive care unit: current status and future prospects; van Saene HK et al.; OBJECTIVE: To evaluate the available data on selective decontamination of the digestive tract . This therapy aims to prevent infection in critically ill patients admitted to ICUs . Microbial carriage in the oropharynx, stomach, and gut; infection; mortality rate; and antibiotic resistance are the outcome events that are being reviewed . DATA SOURCES: Published indices, abstract booklets, and conference proceedings up to the end of 1990 . STUDY SELECTION: Sixteen controlled trials of selective decontamination were identified . None of these trials was conducted as a randomized, placebo-controlled, double-blind trial . DATA EXTRACTION: Each of the three authors independently conducted a meta-analysis (thorough review) of the data from the 16 studies . DATA SYNTHESIS: Of the 16 trials, 15 show significant reduction of acquired infection among patients who received selective decontamination . Of the 14 studies that consider carriage of disease-causing microorganisms as an outcome event, 13 demonstrate a reduction in carriage of Gram-negative bacilli . Only ten studies consider mortality as an end-point, of which four demonstrate that the administration of selective decontamination is associated with decreased mortality rates in certain subgroups but not in the overall mortality rate . Of 11 studies that provide data about antibiotic resistance during selective decontamination, ten reported no increase in resistant microorganisms . Selective decontamination has been reported to be effective in controlling an outbreak of multi-resistant microorganisms . CONCLUSIONS: There is a general consensus about the efficacy of selective decontamination in diminishing microbial carriage and acquired infection rates, although conclusions about benefits related to mortality rates vary . Differences in mortality rate are found in the selective decontamination studies of patients with curable diseases, including multitrauma and cardiovascular patients . More data on resistance, collected over a longer period of time, are needed . Practical problems of blinding and the major ecological effect of selective decontamination may explain the lack of a randomized, placebo-controlled, double-blind trial. Obstet Gynecol, 1992 May, 79(5 ( Pt 2)), 818 - 9 Bacillary angiomatosis in a pregnant patient with acquired immunodeficiency syndrome; Riley LE et al.; Bacillary angiomatosis, a cutaneous lesion newly recognized to affect patients with AIDS, may resemble Kaposi sarcoma . It is presumed to be an infectious process caused by the gram-negative bacilli associated with cat-scratch fever . We present a case of bacillary angiomatosis in a pregnant AIDS patient. Intern Med, 1992 May, 31(5), 593 - 8 Diagnosis and management of endobronchial tuberculosis; Kurasawa T et al.; We examined the records of sixty-one patients (17 males and 44 females) with endobronchial tuberculosis (EBTB) . Smear tests of acid-fast bacilli were positive in 42 cases and cultures of tubercle bacilli (TB) were positive in 57 . The main findings of chest roentgenogram on admission were as follows: no abnormal findings in 8, atelectasis in 30, infiltration in 25, and cavitary lesions in 6 . The localization and cross-sectional extension of lesions confirmed bronchoscopically were as follows: trachea in 15, with 3 circular lesions (CLs) . Right (R-) main bronchus in 19 with 11 CLs, left (L-) main bronchus in 18 with 11 of CLs, R-truncus intermedius in 14 with 6 of CLs, R-upper lobar bronchus (UB) in 17 with 12 CLs, R-middle lobar bronchus in 14 with 11 of CLs, R-lower lobar bronchus (LB) in 6 with 2 CLs, L-UB in 10 with 7 CLs and L-LB in 3 with 2 CLs . All cases were treated by combination chemotherapy with isoniazid, rifampicin, streptomycin and/or ethambutol and the rate of negative conversion of TB was good, but most of circular lesions resulted in severe bronchial stenosis or complete obstruction during and after chemotherapy, and no improvement was seen in any of the atelectasis cases at the cessation of chemotherapy . We discuss the points of early diagnosis and management of EBTB. Antonie Van Leeuwenhoek, 1992 May, 61(4), 265 - 8 The occurrence of disporous Bacillus thuringiensis cells; Chapman GB et al.; Ultrathin sections of sporulating Bacillus thuringiensis were examined in a transmission electron microscope . Less than 1% of the about 2,000 approximately sagittal sections of the bacterial cells examined contained two endospores per cell . This finding clarifies the majority of textbook and research reports (which tend to be ambiguous), contradicts several of the most recent textbook reports, and confirms three unillustrated textbook reports, in relation to the occurrence of disporous bacilli . Electron microscopic evidence of the observation is presented, apparently for the first time. Enferm Infecc Microbiol Clin, 1992 May, 10(5), 267 - 71 {Serodiagnosis in pulmonary tuberculosis . Clinical evaluation}; Sanchez Monton T et al.; The IgA, IgG, IgM and IgG subsets antibodies levels were determined in 200 patients with pulmonary tuberculosis and compared to three control groups: 80 healthy individuals (50 with negative PPD skin test, 30 with positive PPD skin test), 30 leprosy patients and 20 patients with different pulmonary diseases . The technique used was an enzyme linked assay . As antigens, purified tuberculin and Ag60 from M . bovis were used . There were not statistically significant differences between antibody levels among all control groups studied, but when we compare the level in control groups with that observed in tuberculous patients, they showed higher levels of IgA, IgG, IgM, IgG2 (p less than 0.01) and IgG4 (p less than 0.05) . A definite diagnosis of tuberculosis of the lung should only be established if the patient showed to be positive to IgG plus IgA or IgM and in special cases to IgG1, reaching then a diagnostic efficacy of 90% in a patient population with a 68% of positive smears for acid-fast bacilli. Indian J Exp Biol, 1992 May, 30(5), 451 - 3 Adenosine triphosphate content of Mycobacterium leprae by percoll buoyant density centrifugation; Sharma VK et al.; Thirty nine untreated patients of bacilliferous leprosy with a mean bacteriological index of 4.8 and morphological index of 1.3% formed the study group . Adenosine triphosphate assay was carried out by (i) enzyme treatment method in 18 patients and (ii) percoll buoyant density gradient method in 21 patients . ATP content obtained by percoll buoyant density gradient method was significantly higher than that obtained by enzyme treatment method . Percoll buoyant density centrifugation for purification and isolation of bacilli from human leproma is simplier, quicker and can serve as an alternate method of enzyme treatment. J Clin Periodontol, 1992 May, 19(5), 348 - 56 Supragingival cleaning 3 times a week . The microbiological effects in moderately deep pockets; McNabb H et al.; It is generally believed that supragingival plaque control has little effect on the subgingival microflora of deep periodontal pockets . However, this may not be true for moderately deep pockets (4-5 mm), which may represent a pathological state between gingivitis and marginal periodontitis . In 6 patients with poor oral hygiene and severe gingival inflammation, 4 matched sites (1 in each quadrant), were chosen which demonstrated at least 20% spirochetes and 15% black-pigmented Gram-negative bacilli . During the first 12 weeks (phase 1), supragingival calculus was removed from the right half of the mouth and then the teeth were professionally cleaned three times a week . At the beginning of phase 2, supragingival calculus was also removed from the left quadrants and the entire mouth was subjected to the same protocol used in phase 1 . At no time did patients receive oral hygiene instructions . Clinical parameters were assessed and microbiological samples were taken at 3-week intervals . Samples were submitted to darkfield microscopy and anaerobic culturing . Analysis by multiple linear regression and the Wilcoxon signed-rank test revealed significant changes in the composition of the subgingival microbiota at cleaned sites . While Gram-positive organisms increased proportionally, a number of putative periodontal pathogens, such as P . gingivalis and spirochetes decreased. Antimicrob Agents Chemother, 1992 May, 36(5), 1140 - 3 Susceptibilities of 540 anaerobic gram-negative bacilli to amoxicillin, amoxicillin-BRL 42715, amoxicillin-clavulanate, temafloxacin, and clindamycin; Appelbaum PC et al.; Agar dilution MIC testing of amoxicillin, amoxicillin-BRL 42715, amoxicillin-clavulanate, temafloxacin, and clindamycin against 496 beta-lactamase-producing anaerobic gram-negative rods revealed MICs for 90% of the strains tested of 256.0 (amoxicillin), 2.0 (amoxicillin-BRL 42715 and amoxicillin-clavulanate), and 4.0 (temafloxacin and clindamycin) microgram/ml . Amoxicillin, temafloxacin, and clindamycin inhibited all 44 beta-lactamase-negative strains (MICs for 90% of the strains tested, less than or equal to 2.0 micrograms/ml) . BRL 42715 will not be developed, but temafloxacin merits clinical evaluation. Tuber Lung Dis, 1992 Apr, 73(2), 116 - 23 Activity of two long-acting rifamycins, rifapentine and FCE 22807, in experimental murine tuberculosis; Dhillon J et al.; The efficacy of the long-acting rifamycins, rifapentine (RPE) and FCE 22807 (FCE) in experimental murine tuberculosis was studied by counting viable bacilli in spleens . At 2 weeks after infection with Mycobacterium tuberculosis, strain H37Rv, treatment with isoniazid 25 mg/kg, rifampicin 10 mg/kg and pyrazinamide 150 mg/kg was given daily for 6 weeks . The mice were then divided into groups given RPE or FCE at intervals of 1, 2 or 3 weeks with spleen counts after 18 and 24 weeks of chemotherapy . The first experiment showed the great effect of the size of the dose of RPE, which, in once-weekly regimens, caused rapid sterilization at 16 mg/kg, less rapid sterilization at 10 mg/kg and incomplete activity at 6.25 mg/kg . Regimens of RPE given every 2 or 3 weeks were less effective, though 16 mg/kg fortnightly was as good as 6 mg/kg once-weekly . The second experiment compared RPE and FCE each given at 12 or 8 mg/kg . The results were similar though, at 8 mg/kg every 2 or 3 weeks, FCE was slightly more effective than RPE . Serum assays showed that the levels with 8 and 12 mg/kg FCE were lower than those produced even by 6.25 mg/kg RPE, suggesting that FCE would be a better drug than RPE if its bioavailability could be improved, and that the levels following 16 mg/kg RPE were similar to those found in man after 8 mg/kg RPE taken with a fat-rich meal, suggesting good prospects for effective once-fortnightly human treatment . The potential for long-acting rifamycins in the management of pulmonary tuberculosis is discussed. Neurosurg Clin N Am, 1992 Apr, 3(2), 435 - 42 Neurosurgical infections in the compromised host; Hall WA; Granulocytopenia, cellular and humoral mediated immune dysfunction are predisposing factors to the development of CNS infections in immunosuppressed patients . Brain abscess formation in the compromised host is most commonly caused by enteric bacilli, the bacterium N . asteroides, the fungus Aspergillus fumigatus, or the parasite T . gondii . Mucor and the JC virus cause invasive encephalitis in this patient population . CT and MR imaging have greatly aided in the diagnosis of intracranial lesions because of these agents . Stereotactic biopsy-aspiration for diagnosis and to relieve mass effect combined with systemic antimicrobial therapy is the treatment of choice for intracerebral abscess in the compromised host . Organ rejection and chronic immunosuppressive therapy can complicate surgical intervention in these patients . Only with a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy may we hope to alter the clinical course in this difficult group of patients. Intern Med, 1992 Apr, 31(4), 540 - 3 Superinfection of chronic necrotizing pulmonary aspergillosis by Mycobacterium tuberculosis; Kohno S et al.; A 63-year-old woman with chronic necrotizing pulmonary aspergillosis complicated by active pulmonary tuberculosis is reported . A small infiltrative shadow appeared, but no definite diagnosis was made . Six years later the shadow was found to have increased in size; chest CT revealed a fungus ball, while a transbronchial lung biopsy revealed aspergillus hyphae . The intrabronchial inoculation of amphotericin B proved ineffective, and a lobectomy was performed . Histopathologic findings showed necrotic granulomas containing aspergillus and some acid-fast bacilli . While the superinfection of healed tuberculous lesions by Mycobacteria or Aspergillus species is well documented, their coexistence is rare. Intern Med, 1992 Apr, 31(4), 489 - 92 Multiple osteomyelitis due to Mycobacterium avium with no pulmonary presentation in a patient of sarcoidosis; Sato Y et al.; A 31-year-old man with multiple osteomyelitis due to Mycobacterium avium is reported . The patient had been on prednisolone for systemic lymphadenopathy which was thought to be caused by sarcoidosis . In June 1990, he noticed high fever and general bone pain . He was found to have multiple lytic lesions in the bones which were biopsied showing acid-fast bacilli . This organism was revealed to be M . avium . The chest radiograph film revealed no abnormal pulmonary findings . Multiple bone lesions in the absence of pulmonary disease is reported to be rare for atypical mycobacterial infection. Nippon Ronen Igakkai Zasshi, 1992 Apr, 29(4), 305 - 11 {Isolated splenic tuberculosis}; Sato T et al.; A case of splenic tuberculosis is reported . The patient was a 79-year-old man who was admitted to the Tokyo Metropolitan Geriatric Hospital because of high fever and loss of body weight . Several finger-tip sized superficial lymph nodes were palpable in bilateral inguinal regions . The intermediate PPD skin test was positive . However, there was no evidences of active tuberculosis on the chest roentgenogram . The computed tomogram of the abdomen showed moderate enlargement of the spleen with multiple low density areas and several swollen lymph nodes in the para-aortic region . Although a lymph node of the inguinal region was resected for the pathologic examination, it showed no specific changes . In order to obtain a final diagnosis, laparotomy was performed . The spleen was markedly enlarged and nodular in appearance . No abnormal findings were observed in the other abdominal organs . Splenectomy was carried out . Numerous yellowish nodules, varying from 0.1 to 5 cm in diameter, were observed on the cut surface of the resected spleen (20 x 20 x 8 cm, 700 g) . The bacteriologic examination revealed acid-fast bacilli . The fever subsided after splenectomy and following antituberculous therapy . Recently, isolated tuberculosis of the spleen has become very rare . Since 1965, only six cases in five reports can be found in the English, French and German literature . The present case is considered to be one such very rare cases of tuberculosis . Although splenic tuberculosis is rare at the present time, splenic tuberculosis should be included in the differential diagnosis of fever of unknown origin with splenomegaly. Kekkaku, 1992 Apr, 67(4), 347 - 52 {So-called "open healing" of chronic calcified pleural empyema--a study on the etiological and clinical problems}; Hirata S et al.; Surgery performed on a 70 year-old male revealed a case of chronic calcified pleural empyema open healing that was induced through an effective bronchiolar drainage mechanism . The patient had previously received anti-tuberculosis medication, including INH and RFP, 7 years prior for positive sputum cultures and symptoms of fistulation observed in an x-ray finding of right lung pleural calcification . The four cardinal signs of chronic calcified pleural empyema open healing are as follows: 1 . Failure to isolate tubercle bacilli, 2 . Inability to locate necrotic coagulation or specific inflammatory granulation tissue on the cavitary wall, 3 . Calcified pleural plaque detached from the cavitary wall, and 4 . Microscopic recognition of many drainage bronchiolar openings to the empyema and the inner surface of the empyema covered with stratified squamous epithelium, which possibly penetrated via the entering bronchioles. Kekkaku, 1992 Apr, 67(4), 331 - 46 {Analysis of chronic excretors of Mycobacterium bacilli in Aichi Prefecture}; Katou M et al.; Among the patients diagnosed as having pulmonary tuberculosis who were newly admitted to six major tuberculosis centers in Aichi Prefecture during the period from January 1, 1982 to December 31, 1986, 73 patients were chronic excretors of Mycobacterium bacilli (chronics), whose sputum cultures tested positive at both 11 and 12 months after admission . In this study, those 73 patients were analyzed in March 1988 . If the patient was still hospitalized at that time, the patient was re-evaluated six months later . The life table method was used for analysis of clinical procedures . For the analysis of risk factors for chronics, 37 patients who were treated after 1971 when RFP was available for treatment were used . The results in this study are as follows: 1 . A total of 49.3% of the patients were determined chronics (those who had initial chemotherapy before 1970 when RFP was not available) . This result suggests that the use of RFP may contribute to the reduction of chronics . 2 . Patient delay in diagnosis, as well as irregular chemotherapy, was one of the factors for the development of chronics . 3 . In the chronics, many patients showed severe findings in their chest X-rays, high bacillary counts in the sputum, and low drug-sensitivity bacilli when treated with the major anti-tuberculosis drugs . 4 . The rate of chronics from newly admitted patients with positive sputum cultures following the initial chemotherapy treatment was 1.3% . This rate could increase following longer observation periods . 5 . Chronics were more prevalent in patients with Type I (extensive cavitary type) findings in the chest X-rays, and positive sputum smears for Mycobacterium bacilli in the clinical findings when compared with all newly registered active tuberculosis patients during the same period in Aichi Prefecture . 6 . Concerning the outcome, 55 patients were discharged (17 improved; 13 personally released; 25 deceased) while 18 remain hospitalized . Among those discharged patients, 17 patients were released as a result in improved health while 25 died . These results indicate poor prognosis . Using the life table method, the estimated mortality rate is 49.7%, and the negative sputum rate is 30.5% five years later . 7 . Using a multivariate analysis on the prognosis, the risk factor was greatest for poor prognosis for those patients who had Type I findings in their chest X-rays, initial chemotherapy before 1970, complications, and that were male . 8 . The patients with improved health, were more sensitive to the drugs applied when compared to the fatal patients . 9 . Careful chemotherapy during the first two years may contribute to the reduction of chronics. Scand J Clin Lab Invest, 1992 Apr, 52(2), 119 - 28 Oxidative metabolic status of blood monocytes and alveolar macrophages in the spectrum of human pulmonary tuberculosis; Jaswal S et al.; The oxidative metabolic status of blood monocytes (BM) and alveolar macrophages (AM) in patients with active pulmonary tuberculosis (TB) (n = 40) and in successfully treated patients (n = 40) was assessed and compared with that of healthy control subjects (n = 40) . Oxygen free radical (OFR) generation, measured by chemiluminescence (CL) and cytochrome c reduction assay and confirmed by using scavengers of different OFR, was suppressed in AM of the pulmonary TB group compared with healthy controls, whereas it was enhanced in BM . Successfully treated patients showed partial recovery of CL and cytochrome c reduction in AM . There was no significant change in BM of patients after having been treated . The overall capacity to generate OFR was markedly suppressed upon in vitro stimulation with latex in both BM and AM of TB patients . The observed suppressed oxidative metabolic activity in BM and AM was further elucidated by studying the molecular mechanism of respiratory burst . The activities of NADPH oxidase and enzymes of the hexose monophosphate (HMP) shunt were significantly (p less than 0.05) decreased in BM and AM of pulmonary TB patients compared with healthy controls . Patients who had been treated showed marked recovery of NADPH oxidase and HMP shunt activity . The present study suggests that tubercle bacilli escape the microbicidal action of macrophages as a result of suppressed OFR generation caused by decreased activity of HMP shunt, leading to decreased levels of NADPH, thereby preventing NADPH oxidase from working at its full capacity. Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Apr, 30(4), 719 - 23 {A case of sarcoidosis with primary acute pulmonary cavitation}; Yoshii C et al.; A 23-year-old man was admitted to our hospital on June 24, 1991, because of worsening chest X-ray findings of sarcoidosis . In August 1990, he was referred to our outpatient office, because of BHL and nodular lesions on chest X-ray film performed at his company 4 months earlier . At that time, serum ACE was elevated to 34.0 IU/l, and Ga scintigraphy showed abnormal uptake in bilateral lacrimal and salivary glands, mediastinal and hilar lymph nodes, and in the lung fields . TBLB specimen showed noncaseating epithelioid granuloma with giant cells and negative stains for acid-fast bacilli . Although it was planned to follow this patient without medication, he did not return to our outpatient department . In June 1991, because of worsening of lesions in the lung at annual checkup at his company, he was referred and admitted for steroid therapy . Chest X-ray film on admission showed BHL, multiple nodular lesions in both lung fields, and bullous change in the left upper lobe . Chest CT on admission showed three cavitating lesions within preexisting nodules . PPD skin test was negative, and sputum smears and cultures were repeatedly negative for pyogenic bacteria and acid-fast bacilli . Therapy was initiated with prednisolone 30 mg daily . Four months later, there was marked resolution of BHL and nodular lesions, and the cavitating lesions were no longer visible on chest X-ray film . From the clinical and radiological observations, it is concluded that the cavitating lesions in the present case were primary acute pulmonary cavitation in sarcoidosis, distinct from infection, bullae, or cystic bronchiectasis which are seen in the chronic and fibrotic stages of sarcoidosis. Zhonghua Jie He He Hu Xi Za Zhi, 1992 Apr, 15(2), 72 - 4, 125 {Application of enzyme linked immuno-electrophoresis for the diagnosis of tuberculosis}; Yang ZZ; The technique of Enzyme linked immuno-electrophoresis (ELIEP) was established to detect the specific antibody against tubercle bacilli . The results of 730 cases showed that the sensitivity of this method is 97.33%, and the specificity, 97.5% . Thus this method is more sensitive than the ELISA methods which had bean published . The manipulation of ELIEP is simple, convenient, and fast, reagent stable . This method may be used in diagnosis of tuberculosis with reliability and efficiency. Kekkaku, 1992 Apr, 67(4), 303 - 11 {The sequential changes of serum acute phase reactants in response to antituberculous chemotherapy}; Suzuki K et al.; In order to evaluate the clinical effectiveness of response to antituberculous chemotherapy, we measured the serum levels such of acute phase reactants as C-reactive protein (CRP), alpha-1-acid glycoprotein (alpha 1-AG), haptoglobin, alpha-1-antitrypsin (alpha 1-AT) and sialic acid in 24 patients with pulmonary tuberculosis . Furthermore the relationship between these parameters and other biochemical indicators, such as serum immunoglobulins (IgG, IgA and IgM) and blood erythrocyte sedimentation rate (ESR) were observed . In the case studies of the eighteen prognostically cured patients, the serum levels of alpha 1-AG, haptoglobin, alpha 1-AT and sialic acid were significantly higher than those of healthy controls (P less than 0.01), and were significantly decreased to normal levels within three to five weeks after negative results for tubercule bacilli were obtained in the sputum cultures, while CRP, immunoglobulin and ESR showed a tendency to be lower than the healthy controls . In conclusion, alpha 1-AG, haptoglobin, alpha 1-AT and sialic acid are considered to be the sensitive biochemical indicators capable of being used to predict and monitor the clinical response to antituberculous chemotherapy. Rev Saude Publica, 1992 Apr, 26(2), 96 - 107 {Risk estimates of tuberculosis infection in BCG-vaccinated populations}; Arantes GR et al.; The revaccination of schoolchildren can restore the residual allergy induced by vaccination in the first years of life but can not modify the allergy resulting from a natural infection . So revaccination in this population should indicate the group infected by the Koch bacilli . To assess the applicability of these assumptions in estimating the risk of tuberculosis infection in regions with high BCG coverage a study was undertaken on schoolchildren between 6 and 9 years of age who were attending the municipal schools in the east zone of S . Paulo City, in the course of the first semester of 1988 . Of 11,455 who were vaccinated only 7,470 were tested with PPD, revaccinated and retested ten weeks later; 3,314 of these were vaccinated in the first trimester of life with a half dose and 4,156 received a full dose at later ages (75% during the first year, 20% during the second and 5% during the third) . In comparing the results pre and post vaccination by correlation table, the calculation of infection was made according to the criteria of the original method and to the modifications made by the authors under separate cover for those vaccinated in the first trimester and those vaccinated later . The risk of infection was 0.35% and 0.37%, respectively, for the original model and 0.45% and 0.49% for the modified model . The referential was 0.55% . The difference between model and age or with the referential was not significant (p > 0.005) . Data suggest that the method is applicable to estimate the risk of tuberculosis infection in schoolchildren vaccinated with a full dose of BCG during the first year of life. Arq Gastroenterol, 1992 Apr-Jun, 29(2), 43 - 50 {Prevalence of the various types of gastritis in patients with upper dyspeptic symptoms}; de Mello ES et al.; Multiple site biopsy specimens from 153 patients were examined retrospectively for the presence of gastritis and Helicobacter-like organisms (HLO) . Chronic gastritis was classified as superficial gastritis, diffuse antral gastritis, postgastrectomy (reflux) gastritis, diffuse corporal atrophic gastritis, and multifocal atrophic gastritis . In some cases technical problems did not make possible to define the type of chronic gastritis and we introduce the terms unclassified gastritis and minimal inflammatory changes to name those cases . In our opinion they represent superficial biopsies from cases of diffuse antral gastritis . Diffuse antral gastritis was found in 60% of patients followed by multifocal atrophic gastritis found in 20% of patients . HLO was searched in histological sections stained by a modified Giemsa stain . The typical curved bacilli were seen in the gastric mucus or closely attached to the top of superficial or foveolar epithelial cells in 83% of patients . Although we have noted high correlation between activity of chronic gastritis and infection by HLO such correlation was not possible between the degree of activity and the degree of infection. Int J Lepr Other Mycobact Dis, 1992 Mar, 60(1), 18 - 27 Use of synthetic peptides corresponding to sequences of Mycobacterium leprae proteins to study delayed-type hypersensitivity response in sensitized guinea pigs; Estrada IC et al.; In this work we report the synthesis of 10 peptides (P1-P10) corresponding to one or several segments of the amino acid sequence of proteins from Mycobacterium leprae: 65 kDa, 28 kDa, 18 kDa, and 28 kDa superoxide dismutase, recently renamed antigens 2L, 9L, 12L, and 14L, respectively . They were assayed in the guinea pig model for the induction of a delayed-type hypersensitivity response in M . leprae and BCG-sensitized animals . To sensitize the animals two schemes were used: either a single dose of 5 x 10(9) irradiated or autoclaved whole bacilli, or four weekly intramuscular injections each containing 500 micrograms of soluble extract of M . leprae (MLSE) in incomplete Freund's adjuvant . Because the second scheme used far too much antigen, we decided to use the first scheme for the experiments we report here . DTH reactions of sensitized animals were induced after 30 days with intradermal injections of 5 micrograms of MLSE and with each of the 10 peptides at three different concentrations: 250 micrograms, 100 micrograms, and 0.05 micrograms . All M . leprae-sensitized guinea pigs gave indurations of 10 mm or more with MLSE, which indicates that the animals were sensitized . None of them gave DTH indurations with 250 micrograms or 100 micrograms, but some of them had positive DTH reactions with the 0.05 micrograms doses of the synthetic peptides . This is most likely due to the fact that we have used an outbred strain of guinea pigs . The peptides were also tested at 0.05 micrograms in animals sensitized with BCG . P7 and P10 seem to be nonspecific peptides; the remaining peptides only induced DTH in the M . leprae-sensitized guinea pigs . P3 (segments 65-85 of the 65-kDa protein) induced a positive DTH in 58% of the tested animals . In other experiments, guinea pigs were sensitized with a single injection (500 micrograms) of each of the synthetic peptides . All animals, except those sensitized with P4 and P8, had positive DTH responses when the homologous peptide was used . Those sensitized with P2, P4, P5, P7, and P8 were able to produce indurations when MLSE was used for the induction of the DTH reaction. J Am Mosq Control Assoc, 1992 Mar, 8(1), 86 - 8 Isolation of mosquito-toxic bacteria from mosquito-breeding sites in Kenya; Asimeng EJ et al.; A large number of source materials were collected for isolating entomopathogenic bacteria from larval mosquito habitats in Kirinyaga District, Kenya . Mosquito-toxic bacteria were included among the numerous types of microorganisms isolated from the habitats . The pathogenic isolates shared common structural characteristics; they were gram-positive, spore-forming bacilli that produced parasporal inclusions conferring broad-spectrum larvicidal activity against Anopheles, Culex and Aedes mosquitoes . Based on structural and growth characteristics, coupled with larvicidal activity, the pathogenic isolates were tentatively identified as variants of Bacillus thuringiensis . Although the collection consisted of a variety of items including soil, silt and mud, the most productive materials were larval bodies . Using healthy mosquito larvae held in a fully permeable plastic bottle, a baiting technique was developed as a means of recovering bacteria from the environment. Appl Environ Microbiol, 1992 Mar, 58(3), 905 - 10 Expression of the mosquitocidal toxins of Bacillus sphaericus and Bacillus thuringiensis subsp . israelensis by recombinant Caulobacter crescentus, a vehicle for biological control of aquatic insect larvae; Thanabalu T et al.; In the quest for effective control of mosquitoes, attention has turned increasingly to strains of the bacteria Bacillus sphaericus and Bacillus thuringiensis subsp . israelensis, which produce potent toxins with specific mosquitocidal activities . However, sedimentation of the bacterial spores limits the duration of effective control after field application of these bacilli . We describe here the cloning of genes encoding the 51.4- and 41.9-kDa toxins from B . sphaericus 2297, the 100-kDa toxin from B . sphaericus SSII-1, and the 130-kDa toxin from B . thuringiensis subsp . israelensis into the broad-host-range plasmid pRK248 and the transfer of these genes for expression in Caulobacter crescentus CB15 . The recombinant C . crescentus cells were shown to be toxic to mosquito larvae . Caulobacter species are ubiquitous microorganisms residing in the upper regions of aquatic environments and therefore provide the potential for prolonged control by maintaining mosquitocidal toxins in larval feeding zones. J Fla Med Assoc, 1992 Mar, 79(3), 175 - 6 Mycobacteria and AIDS; Blanchard DK; Mycobacteria are acid-fast, slow-growing microorganisms which have gained attention due to increasing prevalence in AIDS patients . Until the advent of AIDS, the only true pathogens of this group were Mycobacterium tuberculosis and M . leprae and the remaining mycobacteria were considered to be saprophytes or opportunistic pathogens . Infection with the MOTT (mycobacteria other than tuberculosis) bacilli was only seen in elderly or immunocompromised patients and was generally limited to caseating pulmonary granulomas, with rare extrapulmonary involvement . In AIDS patients, however, the incidence of mycobacterial infections ranges from 10 to 60% of HIV-positive persons, depending on location, method of identification, and patient population . Furthermore the pathogenesis of these mycobacterioses is distinct from that seen in non-AIDS patients because disseminated disease is the rule rather than the exception . Finally treatment of mycobacterial infections is increasingly difficult due to multiple drug resistances as well as the length of antimicrobial therapy required to cure the disease . Because of the prevalence and importance of these microorganisms, much research has been performed with the mycobacteria to develop new therapies and to understand their modes of pathogenesis. Clin Infect Dis, 1992 Mar, 14(3), 694 - 6 Systemic Bacillus species infection mimicking listeriosis of pregnancy; Workowski KA et al.; Bacillus species are increasingly recognized as agents of infection in humans . These organisms are ubiquitous in nature and can cause clinical illness ranging from transient bacteremia to serious systemic infection . We describe a pregnant intravenous drug abuser with fever, constitutional symptoms, and premature labor . Her blood cultures yielded gram-positive bacilli, and her clinical course was consistent with systemic listeriosis of pregnancy . Pathological examination of the placenta revealed acute villitis, and Bacillus species grew from cultures of both placenta and blood . Through biochemical testing the isolate was identified as Bacillus pumilis . To our knowledge, this is the first reported case of premature labor induced by Bacillus species infection. Clin Infect Dis, 1992 Mar, 14(3), 662 - 5 Mycobacterial brain abscess possibly due to bacille Calmette-Guérin in an immunocompromised child; Coppes MJ et al.; Disseminated infection with bacille Calmette-Guerin (BCG) is rare, even in immunocompromised patients who receive BCG injections as immunotherapy or immunization . When such infection occurs, it is usually in patients with decreased cellular immunity . A 6-year-old Caucasian girl who was receiving maintenance chemotherapy for acute lymphoblastic leukemia presented with symptoms of meningitis . A temporal-lobe biopsy revealed acid-fast bacilli that were identified as Mycobacterium bovis BCG . Neither the patient nor any family members had been immunized previously . Appropriate therapy resulted in a complete recovery. Br J Ophthalmol, 1992 Mar, 76(3), 175 - 6 Tuberculous keratoconjunctivitis; Aclimandos WA et al.; A 15-year-old West Indian boy had a left keratoconjunctivitis (KC) initially thought to be allergic in origin . He then developed a facial vesicular skin rash and a diagnosis of herpes simplex was suspected . Viral cultures were negative and there was a poor response to topical antiviral treatment . The KC progressed and became bilateral causing considerable reduction in the visual acuities . He complained of general fatigue and was pyrexial with generalised non-tender lymphadenopathy . There was a shadow in the upper lobe of the right lung . The bronchus was semioccluded by a non-caseating granuloma but no acid fast bacilli were found in the sputum or bronchial washings . In the presence of a strongly positive Heaf test, anti-tuberculous treatment was instituted which led to rapid resolution of all the systemic and ocular signs. Res Microbiol, 1992 Mar-Apr, 143(3), 271 - 80 Use of specific oligonucleotides for direct enumeration of Listeria monocytogenes in food samples by colony hybridization and rapid detection by PCR; Bohnert M et al.; Two 18-mer oligonucleotides derived from the sequence of hly, the gene coding for listeriolysin O, were shown to be specific for Listeria monocytogenes in the genus Listeria in colony hybridization tests . The oligonucleotides did not hybridize with any of the bacterial species found in food and co-isolated with Listeria on selective media . They were used in colony hybridization tests for enumeration of L . monocytogenes present in food samples after direct plating on selective media plates . In addition, two 24-mer oligonucleotides, each including the sequence of one of the 18-mers, were successfully used for the PCR-based detection of L . monocytogenes bacilli present in food samples after 48-h enrichment period . Using this technique, as little as 10(2) bacteria per ml of enrichment broth can be detected. Drugs, 1992 Mar, 43(3), 316 - 32 Pharmacotherapy of ascites associated with cirrhosis; Gines P et al.; Cirrhotic patients frequently develop ascites during the course of their disease . The appearance of ascites is the final consequence of profound disturbances in systemic and splanchnic haemodynamics, and in renal and hormonal function . The alterations in renal function consist of a decreased ability to excrete sodium and water, and in more severe cases, a reduction in renal blood flow and glomerular filtration rate . No effective drug therapy is yet available for water retention and renal failure in these patients . Sodium retention, however, may be treated by the administration of diuretics . The diuretics most commonly used in the treatment of cirrhotic patients with ascites are loop diuretics, particularly furosemide (frusemide), and distal, or 'potassium-sparing' diuretics such as spironolactone . Although furosemide has a much greater natriuretic potency than spironolactone in healthy individuals, studies in cirrhotic patients with ascites have shown that spironolactone is more effective than furosemide in the elimination of ascites . Nowadays, however, therapeutic paracentesis associated with plasma expanders has replaced diuretic therapy as the initial treatment for cirrhotic patients hospitalised with tense ascites since it is more effective and is associated with a lower rate of complications than diuretic therapy . Diuretics should be given after the elimination of ascites by paracentesis to avoid the reaccumulation of the abdominal fluid . Only cirrhotic patients with mild ascites should be treated initially with diuretics . Cirrhotic patients with ascites frequently develop a spontaneous infection of the ascitic fluid which is usually caused by Gram-negative bacilli from enteric origin and has a great tendency to recur after therapy . The antibiotics of choice for this infection are third-generation cephalosporins . Long term administration of norfloxacin, which causes a selective elimination of Gram-negative bacilli from the intestinal flora, is effective in preventing the recurrence of ascites infection in these patients . Finally, cirrhotic patients with ascites are prone to develop renal failure when treated with a variety of pharmacological agents, particularly aminoglycosides and nonsteroidal anti-inflammatory drugs . The administration of the latter drugs may also cause dilutional hyponatraemia and refractory ascites since they induce water retention and impair the renal response to diuretics. Am J Clin Pathol, 1992 Mar, 97(3), 318 - 21 Refractile mycobacteria in Romanowsky-stained bone marrow smears . A comparison of acid-fast-stained tissue sections and Romanowsky-stained smears; Torlakovic E et al.; The appearance of mycobacteria was studied in Wright-stained bone marrow preparations of human immunodeficiency virus-infected patients and compared with acid-fast-stained trephine biopsy sections and culture results . Mycobacterium avium complex in Romanowsky-stained preparations may be seen as extracellular and intracellular clear or red refractile beaded rods and nonrefractile "negative images." Refractile mycobacteria were seen in 17 of 20 culture-positive cases . Acid-fast stain of the trephine biopsy demonstrated organisms in only 11 of the 20 cases . Thus, six cases were culture positive and contained refractile rods but had no acid-fast organisms on the trephine biopsy . No false-positive results were seen with Romanowsky stain; the three false-negative results for refractility also were negative with acid-fast stain . Examination of Romanowsky-stained smears or imprints for refractile mycobacteria provides a reliable and sensitive method to identify mycobacteria in this population . Romanowsky-stained bone marrow aspirate and imprint smears should be examined for refractile bacilli when mycobacterial infection is suspected. N Engl J Med, 1992 Feb 27, 326(9), 594 - 9 A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics . The French Study Group on Selective Decontamination of the Digestive Tract; Gastinne H et al.; BACKGROUND . Selective decontamination of the digestive tract with topical nonabsorbable antibiotics has been reported to prevent nosocomial infections in patients receiving mechanical ventilation, and the procedure is used widely in Europe . However, it is unclear whether selective decontamination improves survival . METHODS . We conducted a randomized, double-blind multicenter study in which 445 patients receiving mechanical ventilation in 15 intensive care units were given either prophylactic nonabsorbable antibiotics (n = 220) or a placebo (n = 225) . Topical antibiotics (tobramycin, colistin sulfate, and amphotericin B) or a placebo was administered through a nasogastric tube and applied to the oropharynx throughout the period of ventilation . The main end points were the mortality rate in the intensive care unit and within 60 days of randomization . RESULTS . A total of 142 patients died in the intensive care unit; 75 (34 percent) in the treatment group and 67 (30 percent) in the placebo group (P = 0.37) . Mortality within 60 days of randomization was similar in the two groups (P = 0.40), even after adjustment for factors that were either unbalanced or individually predictive of survival in the two groups (P = 0.70) . Pneumonia developed in 59 patients (13 percent) in the intensive care unit within 30 days of enrollment in the study (33 in the placebo group and 26 in the treatment group, P = 0.42) . Pneumonia acquired in the intensive care unit and due to gram-negative bacilli was less frequent (P = 0.01) in the treatment group than in the placebo group . The total charges for antibiotics were 2.2 times higher in the treatment group . CONCLUSIONS . Selective decontamination of the digestive tract does not improve survival among patients receiving mechanical ventilation in the intensive care unit, although it substantially increases the cost of their care. Med J Aust, 1992 Feb 17, 156(4), 286 - 7 Mycobacterium bovis (BCG) vaccination . Progressive disease in a patient asymptomatically infected with the human immunodeficiency virus; Lumb R et al.; OBJECTIVE: To report a case of progressive disease caused by Mycobacterium bovis after BCG vaccination in a patient asymptomatically infected with the human immunodeficiency virus (HIV) . CLINICAL FEATURES: A 34-year-old white man about to commence employment as a developmental care worker had a BCG vaccination . Five months later, he had a positive result to a serological test for HIV antibody . Nine months after BCG vaccination, he presented with fever (38.7 degrees C), a large left axillary lymph node and a small left pleural effusion . The lymph node was biopsied and acid-fast bacilli observed in Ziehl-Neelsen stained smears . Culture grew Mycobacterium bovis (BCG) . TREATMENT AND OUTCOME: He was successfully treated with isoniazid, rifampicin and ethambutol for a period of nine months . CONCLUSION: BCG vaccination of asymptomatic HIV-positive patients is not recommended . The detection of those at risk for HIV infection before vaccination administration is essential . Self-exclusion based on information supplied to all potential recipients is likely to be the most effective method. Dis Colon Rectum, 1992 Feb, 35(2), 189 - 92 Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis; Chen WS et al.; From 1965 to 1989, 60 cases of large bowel tuberculosis among 116 cases of abdominal tuberculosis are reviewed and analyzed . Lesions located in the cecum or ileocecal region were found in 49 of the 60 cases . Most of the patients (50/60) received surgical intervention, but the definite diagnoses had never been proved until surgery . The diagnoses were proved by histopathologic examination in these 50 cases . Antituberculosis medications were given for at least nine months in all patients . Twenty-nine of the 50 patients who received operations had primary anastomosis during the operations, and no leakage occurred . Evidence of pulmonary tuberculous lesions could be found in 40 of the 60 cases . Positive findings of tubercle bacilli in sputum smear or culture were noted in 13 cases . The positive rate of sputum examinations decreased during 1980 to 1989; 25.6 percent (10/39) were positive from 1965 to 1979 and 14 percent (3/21) were positive from 1980 to 1989 . In the meantime, there was a steady decline in the cases of large bowel tuberculosis in the most recent few years . An antituberculosis program has been carried out in the past 40 years with remarkable effect in the Taiwan area, but the possibility of intestinal tuberculosis still exists . The authors suggest that surgeons keep tuberculosis in mind when they are dealing with patients who suffer from intestinal obstruction of unknown origin with the suspected findings of pulmonary tuberculosis in chest x-ray films. Chest, 1992 Feb, 101(2), 447 - 50 Four-stage tuberculin testing in elderly subjects induces age-dependent progressive boosting; Van den Brande P et al.; We administered four sequential tuberculin skin tests (5 TU, PPD) with intervals of one week to 223 subjects older than 65 years of age to evaluate whether elderly subjects demonstrated progressive boosting . Indurations of at least 10 mm with increases of at least 6 mm (over the previous test) were considered significant reactions, and these were found in 29 percent of the subjects after test 1, in 43 percent after test 2, in 53 percent after test 3, and in 57 percent after test 4 (p less than 0.05), ie, only about 50 percent of all the positives were detected after the first test . The percentage of positive reactors was inversely related to age (p less than 0.001), yet this age-dependent difference decreased with increasing number of tests . For the 65- to 74-year-old age group, 44 percent reacted positively after the first test and after three tests almost a plateau of 65 to 70 percent positive reactors was reached, suggesting that a minority only of about 30 to 35 percent of these geriatric patients might have outlived their bacilli or were never infected . For the 75- to 84-year-old age group, 24 percent reacted after the first test and 55 percent reacted after the fourth one . For the older than 85-year-old age group, 19 percent positive reactors were found after the first test and 46 percent were found after the fourth test, without clear-cut leveling off toward a plateau value, suggesting that additional tests would induce further boosting . Mean diameters of positive reactions were 15 to 24 mm, and were mostly at least 12 mm larger than in the previous tests . These data support the hypothesis that the negative tuberculin reaction, which is often found in elderly subjects, is mainly due to the failing immune response to tuberculin antigen that can be restored progressively by repeated administrations . These findings, furthermore, emphasize that especially in elderly, care should be taken not to interpret a boosting reaction as a conversion and especially that neither a two-step testing as recommended by the ATS and CDC (Am Rev Respir Dis 1990; 142:723-35) nor even a four-step testing may suffice to detect all positives in this type of population. Jpn J Med Sci Biol, 1992 Feb, 45(1), 19 - 34 Fatty acid-sensitive acid phosphatase activity of tubercle bacilli; Kondo E et al.; In a whole cell assay system with p-nitrophenyl phosphate as substrate, strains of Mycobacterium tuberculosis and M . bovis were identical in the pH-activity pattern of acid phosphatase . It was a one-peak curve with a pH optimum at 6.2 and sharp symmetrical slopes . The enzymatic activity did not reflect the virulence . When the cells were subjected to mechanical fractionation, the major part of the enzymatic activity was found in a particulate fraction and a minor portion in supernatant and cell walls, suggesting the location of the enzyme in the membrane . Exposure of the cells to free long-chain fatty acids, especially unsaturated ones, reduced the enzymatic activity in a dose-response manner with concomitant decrease in the viability . However, no causal relationship between these two effects was suggested from the collateral experiments. Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Feb, 30(2), 343 - 6 {Pulmonary infection caused by Mycobacterium gordonae (M . gordonae) in a healthy middle-aged male}; Hasegawa T et al.; A 51-year-old man was admitted to our hospital in July 1989 because of an abnormality in his chest radiograph . On his yearly health check-up, an abnormality of his chest radiography was first noted in June 1988 . At that time, examinations including bronchoscopy were performed but no specific diagnosis was made . On admission, his chest radiograph revealed new infiltrates at the apex of the right lung which were not present in June 1988 . Three out of 5 consecutive sputum specimens after admission produced a pure growth of 100 colonies to 1+ of acid-fast bacilli (AFB) . This AFB was scotochromogenic, and hydrolysis of Tween 80 at 5 days was positive . It did not reduce nitrate, and niacin test was negative . It was sensitive to ethambutol at a concentration of 5 micrograms/ml, and was not tolerant to 0.2% picric acid . We thus identified this AFB to be M . gordonae . The patient was treated with rifampicin (450 mg/day), isoniazid (400 mg/day), and ethambutol (1000 mg/day) for 9 months . After 2 months of treatment the sputum cultures became negative, and the chest radiograph showed improvement of the infiltrates . M . gordonae is considered to be one of the least pathogenic AFB to man . Most recent reports of M . gordonae infection have been in immunocompromized hosts or patients with a history of pulmonary tuberculosis . The present case is a very rare example of this organism affecting a healthy male, and thus yields new information on the pathogenesis of M . gordonae in man. Intern Med, 1992 Feb, 31(2), 185 - 8 Chest roentgenogram classification and clinical parameters in patients with active pulmonary tuberculosis; Murate T et al.; The relationship between the clinical parameters and chest film appearance was studied in patients with active pulmonary tuberculosis . Patients with extended disease were often malnourished and had weak tuberculin reaction accompanied by lymphopenia . They excreted a large amount of mycobacterial bacilli and a longer period was required for negative conversion of sputum culture . We confirmed that the criteria for chest roentgenogram classification established by the Japanese Society for Tuberculosis ("Gakkai Classification") is useful in the estimation of the risk of infection and the prognosis of tuberculosis patients. Postgrad Med J, 1992 Feb, 68(796), 110 - 5 Oesophageal tuberculosis: a review of eleven cases; Mokoena T et al.; Tuberculous infection of the oesophagus is rare . This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients . The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom . Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess) . All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two . The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients . In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1) . The diagnosis was established post-mortem in one patient . Treatment was primarily non-operative with standard anti-tuberculosis drug therapy . Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series . Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection . The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem . It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia . Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage. J Laryngol Otol, 1992 Feb, 106(2), 173 - 7 Prediagnostic malakoplakia presenting as a chronic inflammatory mass in the soft tissues of the neck; Douglas-Jones AG et al.; Malakoplakia presenting in the head and neck is very rare . We present a case of an inflammatory mass in the neck, clinically mimicking actinomycosis in a 67-year-old man . Repeated culture of E . coli and histological and electron microscopic examination of biopsy material showed an infiltration of granular macrophages and intracellular gram negative bacilli, but no classical Michaelis-Gutmann bodies . The clinical and pathological findings and criteria for the diagnosis of malakoplakia are discussed. Clin Otolaryngol, 1992 Feb, 17(1), 57 - 9 Tuberculosis of the nasopharynx: clinicopathological features; Waldron J et al.; The clinicopathological features of 10 adult patients with nasopharyngeal tuberculosis (TB) are presented . 9 patients had no evidence of chest or systemic disease . 7 patients presented with cervical lymphadenopathy, and only 4 had nasal symptoms . Examination of the nasopharynx showed no abnormality in 2 patients, lymphoid hyperplasia in 4 patients, and a tumour-like mass in 4 patients . These findings suggest that nasopharyngeal TB may occur more frequently as part of an isolated upper respiratory tract infection than as secondary to pulmonary infection . The nasopharynx may be a portal of entry for tubercle bacilli in patients who develop cervical lymphadenitis . Involvement of the nasopharynx by TB may be underdiagnosed because it does not produce obvious symptoms or physical signs in all cases. Kekkaku, 1992 Feb, 67(2), 127 - 31 {A suspected case of perforation of a lymph node into the bronchus during the treatment of adult hilar lymph node tuberculosis}; Suzuki K et al.; A 27-year old patient was diagnosed as having post-primary hilar lymph node tuberculosis . First being admitted to the hospital with a high fever, a chest x-ray examination revealed a swelling of the left hilar lymph nodes and a sputum smear tested positive for acid-fast bacilli . Neither regular clinical examination or investigation had reported abnormality . The acid-fast bacilli was successfully treated through treatment using INH RFP SM . However, after two months, swelling was observed in the right para-tracheal lymph nodes, Further, a bronchoscopic examination revealed polyp-like tumors at the left upper and lower bifurcation . The swelling of the para-tracheal lymph nodes was considerably reduced and the tumors non-existent after five months . These lymph node reactions could have likely been a part of the so called early exacerbation . The polyp-like tumors were not found during the bronchoscopy performed during admission to the hospital . It is therefore suspected that the cause was perforation of the hilar lymph node into the bronchus. J Clin Microbiol, 1992 Feb, 30(2), 275 - 80 Rochalimaea henselae sp . nov., a cause of septicemia, bacillary angiomatosis, and parenchymal bacillary peliosis; Welch DF et al.; Nine strains of Rochalimaea spp . that were isolated from patients over a period of 4.5 years were characterized for their enzyme activities, cellular fatty acid compositions, and DNA interrelatedness among Rochalimaea spp., Bartonella bacilliformis, and Afipia felis (cat scratch disease bacillus) . All except one isolate, which was Rochalimaea quintana, were determined to belong to a newly proposed species, Rochalimaea henselae sp . nov . After recovery from clinical material, colonies required 5 to 15 days of incubation to become apparent . Cells were small, gram-negative, curved bacilli and displayed twitching motility . Enzyme specificities for amino acid and carbohydrate substrates showed that R . henselae could be distinguished from Rochalimaea vinsonii by L-arginyl-L-arginine and L-lysyl-L-alanine peptidases, but not all strains could be distinguished from R . quintana on the basis of peptidases or carbohydrate utilization . R . henselae also closely resembled R . quintana in cellular fatty acid composition, with both consisting mainly of C18:1, C18:0, and C16:0 fatty acids . However, the strains of R . henselae all contained C18:0 in amounts averaging greater than or equal to 22%, in contrast to R . quintana, which contained this cellular fatty acid in amounts averaging 16 and 18% . DNA hybridization confirmed the identification of one clinical isolate as R . quintana and showed a close interrelatedness (9