Bacillus

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 (92 to 100%) among the other strains . Under optimal conditions for DNA reassociation, R . henselae showed approximately 70% relatedness to R . quintana and approximately 60% relatedness to R . vinsonii . Relatedness with DNA from B . baciliformis was 43% . R . henselae was unrelated to A . felis . R . henselae is the proposed species of a newly recognized member of the family Rickettsiaceae, which is a pathogen that may be encountered in immunocompromised or immunocompetent patients . Prolonged fever with bacteremia or vascular proliferative lesions are clinical manifestations of the agent.

Oral Microbiol Immunol, 1992 Feb, 7(1), 28 - 31
The early colonization of gram-negative anaerobic bacteria in edentulous infants; Kononen E et al.; The occurrence of oral gram-negative anaerobes was examined in 30 edentulous infants (mean age 3 months, range 1-7 months) . One pooled swab sample from mucosal surfaces (cheeks, palate, tongue) and one saliva sample was taken from each infant . The samples were cultured aerobically and anaerobically using non-selective and selective media . Prevotella (Bacteroides) melaninogenica was the most frequently isolated anaerobe, found in 70% of the infants . The other common anaerobes were Fusobacterium nucleatum, Veillonella spp . and nonpigmented Prevotella (Bacteroides) spp., found in 60%, 57% and 57% of the infants, respectively . Of corroding bacilli, Bacteroides gracilis was detected in 23% of the infants, Wolinella spp . and microaerophilic Eikenella corrodens in one infant (3% each) . Leptotrichia spp., microaerophilic Capnocytophaga spp., Prevotella (Bacteroides) loescheii and Prevotella (Bacteroides) intermedia were found in 17%, 13%, 13% and 7% of the infants, respectively . In addition to these 30 infants, 21 edentulous infants were investigated for the presence of Actinobacillus actinomycetemcomitans only . A . actinomycetemcomitans was not detected in any of the 51 edentulous infants . The number of different anaerobic bacterial species in the same mouth varied from 0 to 7 . No anaerobic bacteria were detected in 3 of 30 children (10%) . These data suggest that various anaerobic bacterial species readily colonize the edentulous mouth in infants.

East Afr Med J, 1992 Feb, 69(2), 97 - 100
Adult empyema in Zaria, Nigeria; Hassan I et al.; The clinical records of 41 adult patients who were treated for empyema thoracis at the ABU Hospital, Zaria from 1974 to 1986 have been reviewed . Twenty six (63%) of the patients were younger than 34 years . Bacterial pneumonia, pulmonary tuberculosis and chronic bronchitis were the underlying illnesses in 32 (78%) while advanced malignancies were present in two others . Gram-negative bacilli were as important as the gram-positive cocci as causative agents in the 16 patients whose pleural aspirates were culture-positive . Closed chest tube drainage was most often effective when combined with antibiotics . Overall, 5 patients died, 2 absconded, 34 were discharged home but the default rate from the follow up clinic was high.

Indian J Med Sci, 1992 Feb, 46(2), 43 - 5
Differential identification of Mycobacterium tuberculosis from various clinical specimens from Sassoon General Hospital, Pune; Dravid MN et al.; A total of 619 clinical specimens from cases of pulmonary and extrapulmonary tuberculosis were processed by smear, culture and biochemical tests . Acid fast bacilli could be demonstrated in 93 samples (15.02%) by Z.N . staining method . Culture yielded positive growth in 95 samples (15.35%) M . tuberculosis human type was the most predominient pathogen obtained from 82 cultures (13.40%) M tuberculosis bovine type was isolated from 2 cases of ascitic fluids (0.32%) . Atypical Mycobacteria were isolated from 11 samples (1.73%) . 5 turned out to be M . scrofulacium, 4 were M . Kansasii, 1 was M . phlei and 1 was M . smegmatis.

Mayo Clin Proc, 1992 Feb, 67(2), 179 - 87
Antituberculous agents; Van Scoy RE et al.; Antituberculous agents have radically improved the prognosis of patients with active tuberculosis . Generally, 6-month and 9-month antituberculous regimens have been successful, and surgical therapy is rarely needed . Extrapulmonary tuberculosis should be managed with the same drug regimens as pulmonary tuberculosis . The major cause of therapeutic failure is poor compliance of the patient in taking the prescribed medication regularly . A second cause of failure of treatment is resistance of tubercule bacilli to antimicrobial agents used . When failure of treatment is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated . A single drug should never be added to a failing regimen . Isoniazid administered prophylactically for 6 to 12 months is effective in most cases.

Tuber Lung Dis, 1992 Feb, 73(1), 59 - 67
A controlled study of rifabutin and an uncontrolled study of ofloxacin in the retreatment of patients with pulmonary tuberculosis resistant to isoniazid, streptomycin and rifampicin . Hong Kong Chest Service/British Medical Research Council; The early bactericidal activity of rifabutin measured by sputum viable counts in Hong Kong patients with pulmonary tuberculosis; Grantham Hospital, Aberdeen, Hong KongPreviously untreated patients with smear-positive pulmonary tuberculosis were randomly allocated to treatment with 600, 300, 150 or 75 mg doses of rifabutin (LM427, ansamycin), 600, 300 or 150 mg of rifampicin, 300 mg isoniazid or to no drug daily for 2 days . The fall in viable counts of Mycobacterium tuberculosis in sputum collections during the 2 days, termed the early bactericidal activity (EBA), was estimated from counts of colony-forming units (cfu) on selective 7H-11 agar medium . The EBA for rifabutin ranged from -0.039 (an increase in counts) to 0.049 log10 cfu/ml/day whereas the EBA increased from 0.071 for 150 mg rifampicin to 0.293 log10 cfu/ml/day for 600 mg rifampicin and was 0.43 log10 cfu/ml/day for 300 mg isoniazid . The difference between the EBAs for rifabutin and rifampicin just attained significance (P = 0.05) suggesting that rifabutin was inactive or less active than rifampicin against the extracellular bacilli in pulmonary cavities . Peak plasma concentrations of rifabutin after the initial doses were found to be proportional to dose size and were approximately 7 times lower than those after the same dose size of rifampicin . The lower EBA of rifabutin as compared to rifampicin is probably due to the low plasma concentrations which are not fully compensated for by slightly greater antituberculosis activity of rifabutin in vitro.

Acta Leprol, 1992, 8(2), 95 - 102
Treated-cured indeterminate leprosy: a search for predictive histopathological and immunohistochemical parameters in skin biopsies taken from patients at admission and at clinical discharge; Takahashi D et al.; In a previous study an index (sigma 3) resulting from the summation of three parameters, i.e., presence of bacilli, even in small numbers, in various dermal structures, multiple positive antigen sites as detected by anti-BCG antiserum and dermal nerve involvement, identified 72.22% of cases of indeterminate leprosy which progressed to multibacillary leprosy . The present study was undertaken to investigate possible parameters which might be indicative of indeterminate leprosy which would persist unchanged or be cured (treated cured patients) . Thirty treated cured indeterminate leprosy patients were selected from the files of the Sao Paulo Health Institute and studied by histopathological, immunohistochemical and statistical methods similar to those employed in the previous study . The sigma 3 index was 4.10 +/- 0.60, a finding that places this group of patients in a position close to that of patients changing to paucibacillary leprosy but statistically different from that of patients progressing to multibacillary leprosy . Moreover, it was found that patients belonging to this group have heterogeneous single parameters, some of them suggestive of multibacillary and others of paucibacillary leprosy . Immunologically based techniques mainly employing rabbit anti-BCG serum as the primary antibody have proved to be valuable to detect antigen sites in biopsies from indeterminate leprosy patients and should be used together with the bacillary index during the follow up and clinical discharge control of such patients . In the present study, we show that clinical discharge of these patients did not mean a complete clearance of bacillary antigens.

Mol Microbiol, 1992 Jan, 6(1), 35 - 46
spbA locus ensures the segregational stability of pTH1030, a novel type of gram-positive replicon; Lereclus D et al.; The replication region of the plasmid pHT1030 of Bacillus thuringiensis was previously mapped to a 2.9 kb DNA fragment . The DNA sequence was analysed and it was shown that the minimal replicon resides within a 1 kb fragment of DNA carrying no potential protein coding sequence . Moreover, no production of single-stranded DNA intermediates was detected in the plasmid-containing cells . pHT1030 therefore belongs to a class of replicons not previously described in Gram-positive bacteria . Examination of the segregational stability of deletion derivatives of pHT1030 in bacilli defined two stability regions . One is located within the minimal replicon of pHT1030, whereas the second (spbA) is not required for replication . spbA encodes a 15 kDa protein and ensures the segregational stability of the plasmid . This effect of spbA is particularly highlighted in sporulation . The absence of the spbA locus gives rise to plasmid-free spores at high frequency, whereas the spbA+ plasmids are stably maintained . The stability of the plasmids during sporulation seems to be correlated with an unequal division of the cell by the sporulation septum.

Am Rev Respir Dis, 1992 Jan, 145(1), 36 - 41
A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong . Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council; Gastric colonization by gram-negative bacilli and nosocomial pneumonia in the intensive care unit patient . Evidence for causation; Internal Medicine Program, McMaster University, Hamilton, CanadaThe purpose of this article is to assess critically the evidence for a causal relationship between gastric colonization by Gram-negative bacilli and nosocomial pneumonia in the intensive care unit . Articles were found using MEDLINE search and citations in relevant articles . Nine diagnostic tests of causation were applied and analysis showed that the major tests were satisfied . The strongest evidence comes from randomized controlled trials of selective gut decontamination and stress ulcer prophylaxis in intensive care units . These studies confirm that the incidence of nosocomial pneumonia correlates directly with the rate of gastric colonization by Gram-negative bacilli . Further support comes from other tests of causation such as strength and consistency of association, temporal relationship, and dose-response gradient . The data reviewed suggest that gastric colonization with Gram-negative bacilli plays a causal role in the development of nosocomial pneumonia in the intensive care unit patient . This relationship impacts on future studies of pathogenesis and prevention of this potentially lethal infection.

Intensive Care Med, 1992, 18 Suppl 1, S3 - 9
Nosocomial pneumonia: epidemiology and infection control; Craven DE et al.; Elderly, debilitated, or critically ill patients are at high risk for hospital acquired or nosocomial respiratory tract infection . Gram-negative bacilli, Staphyloccoccus aureus, and anaerobes colonizing the oropharynx are the most frequent etiologic agents . Colonization of the oropharynx may be related to the patient's age, underlying disease, nutritional status, prior exposure to antibiotics, supine position, and gastric colonization . Nosocomial pathogens may also be acquired from the hands of hospital personnel, contaminated equipment or fluids . The absence of sensitive and specific methods for accurate diagnosis remain a concern . Despite treatment with appropriate antimicrobial therapy, there is a high mortality and morbidity . Measures for the prevention of nosocomial pneumonia should include compliance with infection control principles, appropriate use of antibiotics, proper patient position, and removal of potential sources of cross colonization.

Ann Rech Vet, 1992, 23(2), 105 - 15
{Experimental paratuberculosis in sheep after intravenous or oral inoculation: pathogenicity and biologic diagnosis}; Thorel MF et al.; An experimental paratuberculosis study was performed in sheep . One group of 6 lambs was inoculated intravenously with the equivalent of 50 mg (wet weight) of live bacilli, another group of 6 lambs was inoculated orally by placing 500 mg (wet weight) of live organisms in milk feed and a group of 3 lambs was used as controls . The degree of cellular immunity was followed by examining delayed hypersensitivity using 3 allergens (bovine tuberculin PPD, avian tuberculin PPD and johnine PPD) and that of humoral immunity using complement fixation test, agar gel immunodiffusion test and ELISA . The elimination of bacilli in the faeces was examined simultaneously . After 2 years no macroscopic or microscopic lesion was observed in intravenously inoculated lambs and in those exposed orally to M paratuberculosis; cultures were negative . It appears that domestic sheep were able to control the infection . Nevertheless, most of them developed cellular and humoral immunity against paratuberculosis antigen . The best results were obtained in intravenously inoculated lambs.

J Med Assoc Thai, 1992 Jan, 75(1), 26 - 9
Nosocomial pneumonias-a comparison among normal and compromised hosts in Thailand; Saenghirunvattana S et al.; In order to compare the etiology, clinical manifestation, and prognosis of patients acquiring nosocomial pneumonia, we studied and compared twenty normal hosts who acquired nosocomial pneumonia from Jan 1, 1989 to Dec 31, 1989 (group 1) with fifty-four immunocompromised patients with nosocomial pneumonia who were admitted between 1984 and 1990 (group 2) . Both groups were similar in some patterns such as: gram-negative bacilli were common (75%, 60%), the chest roentgenogram showed initial localized lesions (75%, 73%), there was a history of prolonged hospitalization (27, 33 days) and a high mortality rate (60%, 50%) . The differing findings were that the first group acquired pneumonia more often during the first 7 days after admission; transbronchial aspiration was believed to be the route of entry and most of the patients had productive cough . Blood cultures rarely yielded the organisms (5%) . The second group had pneumonia at a mean of 33 days after admission, hematogenous spread to the lungs was common and blood cultures yielded the etiologic organisms more often (40.7%).

Microbios, 1992, 69(279), 105 - 11
Tuberculosis in apparently healthy milch cows; Okolo MI; Screening for mycobacteria was carried out on samples of normal milk, supramammary lymph nodes (SLNS) and udder tissue from apparently healthy milch cows, including the milk from those suspected of tuberculous mastitis . Milk samples from the slaughtered and live Fulani cows which were apparently healthy yielded 5% and 7% of tubercle bacilli, respectively, while suspected tuberculous milk from slaughtered cows and live cows yielded 8% and 10% of the bacilli, respectively . Tubercle bacilli were isolated both from SLNS with and without lesions . The udder tissue was positive for mycobacteria even though visible lesions were absent.

Antimicrob Agents Chemother, 1992 Jan, 36(1), 92 - 4
Fusidic acid is highly active against extracellular and intracellular Mycobacterium leprae; Franzblau SG et al.; The activity of fusidic acid against Mycobacterium leprae was studied in axenic medium and in bacilli residing within mouse peritoneal macrophages . Activity was assessed by subsequent quantitation of bacillary radiorespirometric activity . Significant inhibition in both systems was observed at 0.156 micrograms/ml, and an approximately 50% reduction in activity occurred after exposure to 1.25 to 2.5 micrograms/ml . The excellent human pharmacokinetics and in vitro activity of fusidic acid against the leprosy bacillus warrant a clinical trial of this drug for leprosy.

C R Acad Sci III, 1992, 314(3), 99 - 103
{Infection and elimination of Mycobacterium leprae in SCID C.B.-17 mice (severe combined immunodeficiency)}; Xabier MG et al.; Previous studies documented that T-cell deficient nude mice failed to control M . leprae infection . In the present investigation we monitored the growth of M . leprae for up to 15 months in the SCID C.B.-17 mouse, a host deficient in both T and B lymphocytes . At 8 months post-infection 10(8) organisms/foot-pad were recovered from SCID mice vs 5 x 10(6) in normal BALB/c mice . Thereafter the number of bacilli decreased rapidly in mice infected with high-dose inoculum (10(7)); however, at all doses SCID mice eventually cleared M . leprae . During infection both T and B cells as well as serum Ig remained as low as in uninfected mice; however, in the spleen MAC-1+ cells which include macrophages and NK cells were substantially increased . These results suggest that MAC-1+ cells are involved in the anti-mycobacteria-1 defence mechanisms adopted by SCID mice to compensate their deficiency in T and B cells.

Histol Histopathol, 1992 Jan, 7(1), 143 - 52
Bacillary angiomatosis . A "new" disease with a broadening clinicopathologic spectrum; Tsang WY et al.; Bacillary angiomatosis (BA) is a reactive vasoproliferative lesion occurring almost exclusively in immunocompromised individuals in response to infection by a bacillus closely related to Rochalimaea quintana . The commonest site of involvement is the skin, in the form of multiple erythematous nodules, but bacillary angiomatosis can also present in a wide variety of sites such as soft tissues, bone, lymph node, liver and spleen . Some patients may present with persistent fever and bacteraemia . Bacillary angiomatosis is characterized histologically by proliferation of blood vessels lined by plump endothelium, associated with an interstitial eosinophilic or amphophilic material formed by aggregated bacilli, best demonstrated by the Warthin-Starry stain . A heavy infiltrate of neutrophils is frequently, but not invariably, present . In the liver and spleen, there may be in addition features of peliosis . It is important to be able to diagnose bacillary angiomatosis correctly because prompt treatment with antibiotics is potentially life-saving.

Indian J Lepr, 1992 Jan-Mar, 64(1), 81 - 7
An ultrastructural study of Schwann cells in peripheral nerves of leprosy patients; Kumar V et al.; An ultrastructural study of peripheral nerves in leprosy patients was carried out of ascertain the changes in Schwann cells containing myelinated and nonmyelinated axons . Axonal multiplication was noticed in nonmyelinated axons in specimens from both tuberculoid and lepromatous leprosy . The Schwann cells in tuberculoid nerves were devoid of M . leprae in contrast to those in lepromatous nerves in which large number of bacilli were seen . These observations suggest that the Schwann cells containing nonmyelinated axons may be affected more frequently in either type of leprosy.

Eur J Epidemiol, 1992 Jan, 8(1), 128 - 31
Assessment of post-vaccination tuberculin sensitivity in Lagos-Nigeria; Odujinrin OM et al.; An increase in the number of cases of tuberculosis, especially in children, has been observed recently . Post-vaccination conversion rate in babies immunised with BCG was assessed . Sensitization was detected as early as 4 weeks after BCG inoculation . Although 84.2% had physical evidence of BCG inoculation only 69.8% had developed detectable sensitization to the tubercle bacilli as shown by the Mantoux test.

Clin Infect Dis, 1992 Jan, 14(1), 313 - 9
Protein antigens of mycobacteria studied by quantitative immunologic techniques; Harboe M et al.; Crossed immunoelectrophoresis has great resolving power in the demonstration of immunogenic constituents of mycobacteria . The pattern with multiple precipitate lines is highly reproducible and allows precise identification of components . After the isolation of individual proteins, immunologic specificity combined with molecular weight determination and N-terminal amino acid sequencing should be used to ensure consistent identification in different laboratories . Simultaneous quantification of individual proteins in sonicates of washed bacilli and culture fluids permits the determination of a localization index, which indicates whether the proteins are cytoplasmic constituents or actively secreted . Several "new," actively secreted proteins have recently been defined, and the role of these proteins in the interaction between the bacilli and the infected host is discussed.

Kekkaku, 1992 Jan, 67(1), 9 - 18
{Age-dependent alterations in clinical features of pulmonary tuberculosis}; Umeki S et al.; Age-related changes in clinical features of 182 patients diagnosed as having pulmonary tuberculosis from positive culture results of tubercle bacilli were extensively investigated . The percentage of cases detected using mass miniature radiophotography (MMR) was highest in the patients aged 30-39 years, and then decreased with increasing age . It was only 16-19% in those aged 60 years or older . Certain conditions, such as cardiovascular diseases, hypertension, diabetes mellitus, malignancy and other lung diseases, were common in the patients aged 60 years or older . Systemic symptoms, including weight loss and anorexia, and physical abnormalities, including fever and crackles, were common in these patients . Anemia tended to be predominant in the patients aged 60 years or older . The middle/lower lobes were involved more frequently in these patients, in whom the disease distribution was more than one lobe, or disseminated . Positive smear results and negative anergy were more frequently noted in the patients aged 60 years or older . The mortality from tuberculosis in these patients was 4% (7 cases) . Although gastrointestinal disorder due to antitubercular drugs was more common in the patients aged 80 years or older, eosinophilia was less frequently observed . Today, improved conditions, better sanitation and the development of new chemotherapeutic agents have contributed to the decline of tuberculosis among the general population . But more efficient procedures that allow the early detection or diagnosis of pulmonary tuberculosis in the elderly should be achieved as soon as possible.

Kekkaku, 1992 Jan, 67(1), 27 - 32
{A follow-up study by MRI and enhanced-MRI in a case of cerebral tuberculosis}; Niimi T et al.; We report a case of cerebral tuberculosis following miliary tuberculosis . A 54-year-old man was admitted to our hospital in October 1990 because of fever and general fatigue . Chest x-ray film on admission showed diffuse granular shadows in both lungs . Tubercle bacilli were seen in the sputum (Gaffky 5) by the Ziehl Neelsen's staining, and anti-tuberculous therapy was quickly started . But a few days after admission, the disturbance of consciousness, neck stiffness, and headache appeared . The examination of cerebrospinal fluid disclosed that leucocytes was increased in number, and that ADA was elevated to 14.6 IU/l . Tubercle bacilli were detected from cerebrospinal fluid by culture . Although CT scan of the brain was normal at first week of admission, brain CT at eighth week of admission showed several nodulus enhanced with contrast medium . The findings were confirmed by T2 weighted magnetic resonance images (MRI) as high intense areas . Although T1 weighted MRI showed isointensity of the gray matter, T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancement . At twenty-ninth week of admission CT showed no abnormality even by contrast enhancement, but enhanced T1 weighted MRI revealed a small lesion with enhancement which was not shown by CT . MRI enhanced by Gd-DTPA was more useful for evaluating cerebral tuberculosis than brain CT.

Kekkaku, 1992 Jan, 67(1), 19 - 26
{Evaluation of sputum smear examination--from the cases of Nepal, Yemen and the Philippines}; Fujiki A; Evaluation of sputum smear examination was carried out with smear slides stained by the Ziehl-Neelsen method, which were collected from Nepal, Yemen and the Philippines . The smear slides were checked macroscopically and microscopically according to the following points: 1) smear area size, 2) thickness of smear, 3) evenness of smear, 4) decolorizing condition by Ziehl-Neelsen stain, 5) smear cleanliness, 6) presence of cells in sputum and 7) smear reading accuracy by cross-checking . As the result of smear slide evaluation, it was concluded that proper sputum specimens have been smeared but smears were generally too thin and contaminated with too many dirt . Agreement rate of the slide reading in Nepal, Yemen and the Philippines were 73%, 90% and 88% respectively . Disagreement cases were concentrated in the subtle number of acid-fast bacilli or (+/-) and (+) results . The cause of disagreement might be attributed to contamination with debris, deposit etc., which hindered reading or were misread as acid-fast bacilli . Some improvement should be considered to eliminate the dirt , such as filtration of carbol fuchsin solution, preparation of proper quantity of carbol fuchsin solution to be consumed within three months, mixing the fuchsin stock solution and 5% carbol solution just before use, rinsing the mouth before sputum collection, usage of clean sputum container and slides, and smearing and drying of the slides within clean environment . However, in many developing countries there are many difficulties for facilities, equipments, system and management . Some of these difficulties may be solved by the efforts of laboratory side but some are beyond the limits of their efforts.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pathol, 1992 Jan, 166(1), 77 - 82
Morphometric analysis of Mycobacterium tuberculosis infection in mice suggests a genetic influence on the generation of the granulomatous inflammatory response; Orrell JM et al.; There is evidence in natural human disease and experimental infection in mice that host genetic factors influence susceptibility to infection with Mycobacterium tuberculosis and the progress of the disease . In mouse models, both H-2 and non-H-2 genes have been implicated . In this study, four inbred strains of mice (Balb/b, Balb/k, B10, B10.BR), selected for combinations of two different H-2 haplotypes on two different non-H-2 backgrounds, were inoculated with M . tuberculosis, strain H37Rv, by intraperitoneal injection . The histological features of the granulomatous inflammatory response in the liver and lungs were investigated during the first 18 weeks of the infection . Granuloma fraction, mean granuloma area, bacillary load, and the density of acid-fast bacilli within granulomata were measured . Animals of all four strains showed the same general pattern of infection with an early, and later self-limiting, infection of the liver and delayed onset, but progressive, infection of the lung . The non-H-2 related genetic background appears to influence the morphology of the granulomatous inflammatory response . In comparison, H-2 differences appeared to be small and inconsistent.

Probl Tuberk, 1992, (3-4), 49 - 51
{Characteristics of bacterial excretion in pulmonary tuberculosis patients residents of the Yakut region}; Chernogradskii IP et al.; The present state of bacilli excretion in the Yakut area and its certain social aspects are characterized, the detection rate of M . tuberculosis in pulmonary tuberculosis and the sex-age structure are subjected to analysis . Data on the primary and secondary drug resistance, type appertainance of the causative agent and the result of a disinfectant work in the infection foci have been studied in 511 patients having copious bacilli excretion.

Eur J Cancer, 1992, 28A(4-5), 867 - 70
Non-nephrotoxic empiric antimicrobial therapy in febrile neutropenic cancer patients; Kattan J et al.; We evaluated the efficacy of piperacillin-pefloxacin as a non-nephrotoxic antibiotic combination in febrile neutropenic cancer patients treated with nephrotoxic chemotherapy . 40 patients: 34 with solid tumours and 6 with non-Hodgkin lymphoma, were treated during 55 episodes with: piperacillin 4 g intravenously every 8 h and pefloxacin 400 mg intravenously every 12 h . If the patient remained febrile after 72 h, 1 g vancomycin intravenously was added every 12 h . The mean duration of neutropenia was 7 days (range 3-13) . Infection was microbiologically documented in 13 episodes (8 gram-positive cocci and 7 gram-negative bacilli) . Temperature became normal in 38 patients with piperacillin-pefloxacin and 12 further episodes were resolved by the addition of vancomycin . 2 patients had an early change of antibiotics because of clinical deterioration, there were 2 protocol violations and 1 patient's temperature became normal after the addition of amphotericin . Neither septic death nor toxicity were observed . We conclude that this empirical treatment is active and safe and warrants further comparative trials.

Arch Microbiol, 1992, 157(3), 272 - 8
Environmental regulation of alcohol metabolism in thermotolerant methylotrophic Bacillus strains; Arfman N et al.; The thermotolerant methylotroph Bacillus sp . C1 possesses a novel NAD-dependent methanol dehydrogenase (MDH), with distinct structural and mechanistic properties . During growth on methanol and ethanol, MDH was responsible for the oxidation of both these substrates . MDH activity in cells grown on methanol or glucose was inversely related to the growth rate . Highest activity levels were observed in cells grown on the C1-substrates methanol and formaldehyde . The affinity of MDH for alcohol substrates and NAD, as well as Vmax, are strongly increased in the presence of a Mr 50,000 activator protein plus Mg(2+)-ions {Arfman et al . (1991) J Biol Chem 266: 3955-3960} . Under all growth conditions tested the cells contained an approximately 18-fold molar excess of (decameric) MDH over (dimeric) activator protein . Expression of hexulose-6-phosphate synthase (HPS), the key enzyme of the RuMP cycle, was probably induced by the substrate formaldehyde . Cells with high MDH and low HPS activity levels immediately accumulated (toxic) formaldehyde when exposed to a transient increase in methanol concentration . Similarly, cells with high MDH and low CoA-linked NAD-dependent acetaldehyde dehydrogenase activity levels produced acetaldehyde when subjected to a rise in ethanol concentration . Problems frequently observed in establishing cultures of methylotrophic bacilli on methanol- or ethanol-containing media are (in part) assigned to these phenomena.

Biotechnology, 1992, 22, 251 - 310
Development of genetic engineering in Bacillus megaterium; Vary P; The opportunities for industrial genetic engineering in several species of Bacillus other than B . subtilis and B . thuringiensis are now becoming a reality . Many species have advantages for certain industrial applications, such as the lack of alkaline proteases, stable plasmid maintenance, and production of thermostable enzymes . It is now possible to increase production levels in many Bacillus strains that are already high producers of amylases, proteases, penicillinases, and penicillin amidases, by the introduction of such genes on high-copy-number plasmids . Possible problems in gene regulation, expression, limits on protein production, and secretion will be encountered, but recent reports on comparisons of expression of bacterial and eukaryotic genes in B . subtilis and B . megaterium (Shivakumar et al . 1989; Donovan et al . 1989a, 1989c; Ginsburgh et al . 1989) suggest that some species may prove to be better expression hosts for specific genes than others . What is needed is extensive comparative studies in promising species to better understand the parameters affecting cloning, gene expression, and protein secretion in the bacilli . In this chapter we have emphasized the development of genetic analysis and rDNA methods in B . megaterium . While the chromosomal map is still not a complete circle, many gene loci have been mapped, some with three-factor crosses, and have been characterized by enzyme assays (leu, trp, hem, cob, cbl) as well as complementation with B . subtilis genes (trp, dnaK, pur, met, ssp) E . coli genes (ATPase), hybridization (spoVG, abrB, sigK, ssp), and by growth on intermediates (trp, leu, thy, gua, ade, pur, pyr, his, arg) . A mapping kit of 12 strains is available, and can facilitate the mapping of new mutations rapidly . This is of great advantage in strain construction since genes can be transferred at will by cotransduction . A partial physical map generated by pulse gel electrophoresis is also available (Muse 1990) . It remains to be determined whether gene conversion occurs in B . megaterium as it does in B . subtilis . This is a powerful tool for rescuing genes and mutations of interest from the chromosome . There are now over 600 mutants available in our laboratory, over 100 in the laboratory of J.C . Vary, and several more that have been characterized in various laboratories throughout the world . Many of these are available in stock culture collections, although this source needs to be expanded . Mutants that should be useful for genetic engineering include recombination negative, protease negative, and plasmidless wild type, as well as Lac negative and several auxotrophs in the plasmidless background, and many sporulation negative mutants.

Biotechnology, 1992, 22, 189 - 217
Extracellular enzymes: gene regulation and structure function relationship studies; Jarnagin AS et al.; The first conclusion that one could make from the literature covered in this section is that most single mutations in subtilisin BPN'n do not cause major structural alterations . Even multiple mutations, though they may cause local minor perturbations at each of the altered sites, do not affect the overall structure to a large degree . Bott and Ultsch (1986) observed that the subtilisin BPN' structure is very tolerant of single mutations, and this tolerance may have been necessary for survival of the enzyme during the course of evolution . This structural tolerance is not all that surprising if one considers that the structure of subtilisin Carlsberg is very similar to that of subtilisin BPN' while the protein sequences differ by 31% . A superposition of the 274 alpha-carbon atoms of the two enzymes gives a root mean square (rms) deviation of 0.053 nm, a value indicating significant structural similarity (McPhalen and James 1988) . Furthermore, the fungal enzyme proteinase K, which is classified as part of the subtilisin family, has approximately 38-40% sequence homology with bacilli subtilisins, particularly in the catalytic site and substrate-binding regions (Betzel et al . 1988) . For these sequence-homology regions there is also a structural similarity indicated by a least squares superposition of alpha-carbons giving an rms deviation of 0.11 nm (Betzel et al . 1988) . Thermitase, also a member of the subtilisin family, has 47% sequence homology to subtilisin BPN' (Gros et al . 1989) . If the best 203 alpha-carbon atoms are superposed, then an rms deviation of 0.05 nm is obtained (Gros et al . 1989) . Apparently a significant amount of sequence variation still allows for overall structural similarities in the subtilisin family of enzymes . Though the overall structure of subtilisin is not easily perturbed by single or even multiple mutations, it is clear from the evidence reviewed here that single mutations can lead to very significant effects on the catalytic efficiency, substrate preference, and stability of the enzyme . Analyzing the structural alterations in subtilisin mutants will lead to an understanding of the molecular effects of the mutations at the atomic level . This understanding enables investigators to model and predict the effects of other substitutions, and allows them to focus their efforts on those mutants that are most likely to have the desired properties.(ABSTRACT TRUNCATED AT 400 WORDS)

Zhonghua Yan Ke Za Zhi, 1992 Jan, 28(1), 47 - 50
{Experimental autoimmune uveitis--a clinical and pathological study}; Ren PX; Experimental autoimmune uveitis (EAU) was induced in 95% of guinea pigs after immunization by a single intradermal injection of homologous retinal tissue in Freund's complete adjuvant and subcutaneous injection of dead pertussis bacilli . The clinical features were circumcorneal injection, cells and flare in the anterior chamber, vasodilation in the iris, and marked cellular exudate in the vitreous . The pathological changes were characterized by diffuse proliferative granulomatous panuveitis, consisting of lymphocytes, macrophages, and epithelioid cells . The outer layers of the retina were disrupted or missing in areas where the pigment epithelium was damaged.

Probl Tuberk, 1992, (7-8), 9 - 11
{Optimal methods for the detection of tuberculosis in not easily accessible regions of the Extreme North by bacteriological screening}; Tomashevskii AF; The results of bacteriological study of 2210 residents of the Extreme North are presented . The author's complex many factorial system of bacteriological screening is discussed, whose use will enable one to raise the detection parameter of bacilli excretors up to 2.93% in the preliminary detected population groups.

Cytobios, 1992, 71(284), 19 - 27
Palmitate oxidation by in vivo and in vitro grown Mycobacterium lepraemurium; Ishaque M; Oxidation of palmitate by Mycobacterium lepraemurium isolated from C3H mice lepromata (in vivo) and also grown on Ogawa egg-yolk medium (in vitro) was investigated . Palmitate was found to be oxidized, after a lag period of about 8 h, by both the in vivo and in vitro grown bacilli . Cell-free extracts prepared from in vivo and in vitro grown cells catalysed an active oxidation of palmitate after a lag period of 3-4 h . The amount of ATP increased, with the increase in time during oxidation of palmitate by the cell-free extracts . The generation of ATP was strongly inhibited by the inhibitors rotenone, antimycin A and cyanide as well as by the uncouplers 2,4-dinitrophenol and 2,6-dibromophenol . These results indicated that oxidation of palmitate by the in vivo and in vitro grown M . lepraemurium is mediated through the respiratory chain using oxygen as the terminal electron acceptor.

Bull Cancer, 1992, 79(7), 705 - 12
{Value of the combination of piperacillin and pefloxacin possibly followed by vancomycin in the treatment of febrile neutropenia in nephrotoxic chemotherapy}; Kattan J et al.; We evaluated the efficacy and safety of piperacillin-pefloxacin potentially associated to vancomycin as a non nephrotoxic antimicrobial therapy in febrile neutropenic cancer patients, treated with nephrotoxic chemotherapy . Fifty-seven patients: 49 with solid tumors and 8 non-Hodgkin lymphomas, were treated during 85 episodes with: piperacillin 4 g IV every 8 h pefloxacin 400 mg IV every 12 h . If the patient remained febrile after 72 h, 1 g of vancomycin IV was added every 12 h . The mean duration of neutropenia was 7 days (3-14 days) . In 44 episodes, the granulocyte nadir was < 100/mm3 . Infection was microbiologically documented in 17 episodes (20%) with ten Gram-positive cocci and 11 Gram-negative bacilli . There were 64 apyrexia with piperacillin-pefloxacin (75%) and further 14 were resolved by the addition of vancomycin (total success = 92%); three early changes because of clinical deterioration (two episodes) or germ resistance (one episode); three protocol violations, and one apyrexia by addition of amphotericin . Neither septic death nor toxicity were observed . We conclude that this empirical treatment is active and safe and avoids nephrotoxicity in cancer patients heavily treated with nephrotoxic chemotherapy.

Eur J Nucl Med, 1992, 19(12), 1011 - 5
Immunoscintigraphy in the detection of tuberculosis with radiolabelled antibody fragment against Mycobacterium bovis bacillus Calmette-Guérin: a preliminary study in a rabbit model; Lee JD et al.; Immunoscintigraphy with radiolabelled monoclonal antibodies is widely used to detect solid tumours, but only a few trials have been carried out concerning the specific in vivo localization of an inflammatory process . The purpose of this study was to investigate the detectability of tuberculous foci utilizing this method with radiolabelled bacillus Calmette-Guerin (BCG)-specific F(ab')2 in rabbits . All of the tuberculous lesions (n = 8) were clearly visualized on serial scintigraphy for up to 48 h after injection of the antibody . Immunohistochemical and Ziel-Neelson staining of the tuberculous lesions confirmed the presence of the tuberculous antigens and bacilli . It failed to demonstrate any sustained retention of the BCG-specific antibody fragment in the control group with syphilitic orchitis (n = 2) . Therefore, the specific in vivo localization of tuberculosis is feasible by immunoscintigraphy.

Soz Praventivmed, 1992, 37(5), 199 - 206
Tuberculosis and AIDS: European and worldwide perspectives; Leowski J et al.; To examine the possible influence of AIDS and HIV infection on the epidemiology of tuberculosis in Europe and worldwide in the coming decades an analysis of the available data on the two diseases and on the transmission of the two infections in relation to the demographic structure of the population was conducted, including projections for up to the year 2025 . Globally, the effects of the AIDS pandemic on the tuberculosis situation will probably be very serious, adding some 1.5 million new cases of tuberculosis annually by the year 2025 as a result of HIV infection . However, this effect for Europe in the year 2025 may be in the range of 15,000 additional cases only . The main factor determining the scale of aggravation of Tb is the age structure of the population infected, or at risk of being infected, with tubercle bacilli and HIV . Although the influence of HIV infection on tuberculosis in Europe may not be very high due to the fact that HIV infection involves mainly younger age groups it may, however, substantially postpone the elimination of tuberculosis from Europe . Therefore it seems necessary to monitor constantly all the changes in the epidemiological situation of both tuberculosis and AIDS/HIV.

Probl Tuberk, 1992, (9-10), 16 - 9
{Outpatient observation and treatment of patients with tuberculosis and massive bacterial excretion aggravated by negative social factors}; Nikolaev VP et al.; Social and epidemiologic features were studied in 1145 newly diagnosed tuberculosis patients in Yakutia who were on the dispensary record in the period between 1981 and 1990 . Among the negative social and hygienic factors which aggravated the course of tuberculosis were unsatisfactory living and domestic conditions, failure in family life, unskilled hard labour, idle life, stay in the penitentiary-labour establishments and chronic alcoholism . To improve the effectiveness of dispensary follow-up and treatment of this category of patients measures should be taken aimed at the centralized epidemiologic control . They include, registration of copious bacilli excretors as a special contingent of antituberculosis dispensaries, active measures directed against drug addiction and removal of the unfavourable psychologic factors as well as obligatory hospitalization of patients into specialized tuberculosis centres.

Indian J Pathol Microbiol, 1992 Jan, 35(1), 48 - 52
Serum adenosine deaminase activity in bacillary or paucibacillary pulmonary tuberculosis; Lakshmi V et al.; Serum Adenosine Deaminase (ADA) enzyme levels were estimated in 61 patients with symptoms and signs suggestive of Pulmonary Tuberculosis and correlated with "Gold standards" such as smear positivity of sputum for Acid Fast bacilli, Tuberculin skin testing and Radiological evidence . The mean ADA levels in smear and Tuberculin negative patients was 13.13 +/- 5.97 u/L, while in those with smear and/or strongly positive Tuberculin reaction, the mean levels of ADA were 33.52 +/- 15.22 u/L . The mean serum ADA levels in 25 healthy voluntary donors with no evidence of active or old Tuberculous lesion, were found to be 16.5 +/- 3.18 u/L . The specificity, sensitivity, positive predictive value and negative predictive value of the test was found to be 87%, 71%, 90% and 66.5% respectively . The results conclude that the serum ADA value is sufficiently useful in identifying those patients in whom the diagnosis of Pulmonary Tuberculosis should be actively considered.

Drugs Exp Clin Res, 1992, 18(4), 141 - 6
Comparison of norfloxacin and pefloxacin in the prophylaxis of bacterial infection in neutropenic cancer patients; D'Antonio D et al.; In this study the efficacy of norfloxacin and pefloxacin for the antibacterial prophylaxis of granulocytopenia was compared in cancer patients following cytostatic treatment . A total of 136 patients was randomly selected to receive either norfloxacin or pefloxacin . Nineteen patients remained afebrile in the norfloxacin group compared with thirty one in the pefloxacin group (p = 0.045) . Twenty four microbiologically documented infections (twelve with and twelve without bacteraemia) occurred in sixty seven patients taking norfloxacin, and twelve in sixty nine patients taking pefloxacin (five with and seven without bacteraemia) (p = 0.015) . Only one infection caused by Gram-negative bacilli was observed in the pefloxacin group compared with seven in the norfloxacin group (p = 0.019) . In conclusion, both microbiological and clinical results showed pefloxacin to be a better antibacterial agent than norfloxacin for these patients.

Intensive Care Med, 1992, 18(4), 218 - 21
Role of selective digestive decontamination (SDD) in the prevention of nosocomial pneumonia (NP): is gastric decontamination necessary?
Martinez-Pellus AE, Ruiz J, Garcia J, San Miguel MT, Seller G, Bru M, Palazon C.
In the course of a prospective selective digestive decontamination (SDD) trial to prevent nosocomial pneumonia (NP) during mechanical ventilation (MV), we carried out serial cultures of gastric aspirate to assess the importance of gastric colonization for potential respiratory pathogens and its relationship to the simultaneous gastric pH, to whether the patients were receiving Sucralfate or Ranitidine and to the nutritional biochemical parameters . If NP developed, a bronchial sample was taken by fibreoptic bronchoscopy to determine the causal organisms and its relationship to the previous gastric isolated . Results show: 1) Increase in aerobic Gram negative bacilli colonization during hospitalization . 2) Direct relationship between colonization level and gastric pH . 3) Greater pH in ranitidine vs sucralfate group . 4) Low incidence of NP (11%), the majority of these (66%) being early . 5) No bacteriological correlation between gastric colonization and aetiological agents of NP . 6) Close relationship between pharyngeal colonization and causative germs of pulmonary infection (40%).

Intensive Care Med, 1992, 18(4), 210 - 7
Uncertain relevance of gastric colonization in the seriously ill; Cade JF et al.; We have studied the temporal relationship for the same micro-organisms between gastric colonization and both nasopharyngeal colonization and major clinical infections in 100 consecutive, long-stay, intensive care patients . 67% of patients developed positive gastric cultures, mainly with aerobic Gram-negative bacilli and C . albicans; 33% developed positive nasopharyngeal cultures with similar organisms, but in only 8% was the same organism previously cultured from the stomach; 48% of patients developed infections, mainly respiratory, but commonly with different organisms . The presence of a positive gastric culture was not associated with gastric pH, bleeding, severity of illness, or mortality . The results fail to confirm that an ascending migration of organisms from the stomach is.frequent or that there is a relationship between gastric colonization and clinical infections . Firm therapeutic recommendation in these areas may be premature.

Eur Urol, 1992, 21 Suppl 2, 22 - 7
Prospects for improving the efficacy of BCG; Bohle A; Since 1976, when Morales, Eidinger and Bruce first published on the treatment of human urothelial bladder cancer, bacillus Calmette-Guerin has gained worldwide acceptance as a therapy against bladder carcinoma recurrences . However, there are many uncertainties with regard to patient selection, treatment protocol, reduction of side effects, mechanisms of action, and thus room enough for laboratory researchers and clinicians to contribute to the improvement of BCG therapy . Initiation of mycobacterial binding to urothelial cells may be promoted by methods which increase fibronectin exposure on target cells, reduce inhibitory factors in the instillate, or by identification of more avidly binding substrains of BCG . Quantification of the ensuing immune response focuses on the local rather than the systemic immune reaction of the host and may give the opportunity to predict a favourable response, or even the endpoint of therapy . For this purpose, assessment of local cytokine production seems to be a valuable tool . Ultimately, revealing the mode of action(s) of live BCG may render the use of potentially dangerous live bacilli unnecessary and lead to the application of derivatives with better results.

Diagn Cytopathol, 1992, 8(5), 451 - 5
Diagnosis of tuberculosis of bone and soft tissue by fine-needle aspiration biopsy; Masood S; Fine-needle aspiration biopsy is a well-established procedure in the detection of various neoplastic processes . However, there are only limited reports on the efficacy of this technique in nonneoplastic conditions . In this study, fine-needle aspiration cytology findings of bone and soft tissue lesions in 11 patients with tuberculosis are reported . Spine, scapula, chest wall, flank areas, tibia, ring, and index fingers were the sites of fine-needle aspiration biopsies . The age of the patients ranged from 21 to 65 years . Granulomatous reaction with or without caseation necrosis was seen in 73% . The aspirated material was acellular or predominantly composed of necrotic material and inflammatory infiltrates in 27% . Acid-fast bacilli (AFB) could be demonstrated in 64% . Culture for Mycobacterium tuberculosis was positive in 83% . This study supports previous suggestions that fine-needle aspiration biopsy is a simple alternative to open biopsy for the diagnosis of TB of bone and soft tissue lesions.

Indian J Pediatr, 1992 Jan-Feb, 59(1), 115 - 8
Cytologic diagnosis of tuberculous lymphadenitis in children by fine needle aspiration; Singh UR et al.; One hundred consecutively diagnosed cases of tuberculous lymphadenitis in children have been analysed retrospectively . All cases were stained by May Grunwald Giemsa for cytomorphology and Ziehl Neelsen stain for acidfast bacilli (AFB) . In 52 cases the material was sufficient and AFB cultures were possible . A diagnosis of tuberculosis was made when smears showed epithelioid cell granulomas or AFB on either smears or culture . M . tuberculosis and atypical mucobacteria were cultured in 26 and 3 cases respectively . In 6 cases the diagnosis of tuberculosis would have been missed but for culture studies, the cytologic smears were necrotic and stains for AFB negative.

Medicina (B Aires), 1992, 52(4), 291 - 5
{Tuberculosis in patients with lymphomas}; Melero M et al.; In a period of ten years (1980-1989) 6 patients, out of 506 cases of lymphoma, presented an active tuberculosis (1.18%) . Five of them had Hodgkin disease in an advanced stage, with predominance of the nodular sclerosis histologic subtype; one had a non Hodgkin lymphoma . Clinical presentation of TBC was mostly focal with a predominance of extra pulmonary involvement (cervical tuberculous lymphadenitis); disseminated disease only appeared in the non Hodgkin lymphoma patient . There was no difference in the severity of the infection when it appeared either before or after multiagent therapy of the hematologic malignancy . There was clinical suspicion of TBC in all of the pulmonary forms of the disease; lymph node tuberculosis, without drainage of caseous material, was a finding related to the routine culture of lymphatic tissue . In biopsy material, in which Mycobacterium tuberculosis was isolated, neither epithelioid cell granulomas with caseation necrosis nor acid-fast bacilli were histopathologically documented . No mortality due to tuberculous infection was registered in this group . TBC prevalence in these lymphoma patients was 1185.7 per 100,000; compared with the prevalence of this disease in the general population (52.3 per 100,000) a significant difference is demonstrated (p < 0.0001) and it is related to Hodgkin lymphoma.

Rev Mal Respir, 1992, 9 Suppl 1, R49 - 52
{Respiratory infection and bronchial cancer}; Brambilla C et al.; Respiratory infections are very frequent in the course of lung cancer . The diagnosis is often difficult because of the existence of a chronic inflammatory process and of radiologic abnormalities related to lung cancer . Clinical symptomatology is atypical: no clear distinction between fever due to inflammation or infection, productive cough linked with chronic bronchitis often associated... . Radiological abnormalities are difficult to interpret: infectious lobar infiltrate or atelectasis, nature of a pleural effusion... . Biological data bear little interest because of their lack of specificity . Depending on their evolution, respiratory infections have particular characteristics . Before treatment, the problem is more often related to a fever and/or a radiological abnormality . During the post-operative period, fever generally corresponds to infectious phenomena, not necessarily originating from the lung . Among patients treated by radiotherapy and/or chemotherapy, it is sometimes difficult to conclude among several diagnosis possibilities: infectious lung condition, secondary infectious sites, iatrogenic interventions . The various possibilities that can be encountered can be divided into three main categories: in the case of lung infection in a non-neutropenic patient the organisms are those of a common community-acquired respiratory infection and it is logical to suggest a treatment based on penicillin A possibly associated with an inhibitor of beta-lactamases . In the case of a localised lung infection in a neutropenic subject, it is essential to cover gram negative bacilli by adding a beta-lactam and an aminoside . Finally, in the case of interstitial lung involvement, opportunistic bacteria are likely and it is essential to propose an endoscopic examination before initiating a therapeutic scheme.(ABSTRACT TRUNCATED AT 250 WORDS)

Med Dosw Mikrobiol, 1992, 44(3-4), 219 - 29
{Investigation of activity of new quaternary imidazole-linear chlorides against selected bacterial strains . Synthesis of 2-alkyl-3-alkymethyl-1-ethylimidazolelinear and 2-alkyl-3-alkoxymethyl-1-ethylimidazolelinear chlorides}; Kuncewicz Z et al.; Synthesis and bacteriostatic properties of a new alkylthiomethylimidazole-linear and alkomethyly-limidazole-linear chlorides was described . It was found that these chlorides are active against bacilli, cocci and yeast-like fungi and express lower activity against rods . Highest activity was observed with 2-benzyl-3-decyloxymethyl-1--ethylimidazolinear and 1-ethyl-heptadecyl-3-undecyloxymethylimidazolelinear chlorides.

Med Dosw Mikrobiol, 1992, 44(3-4), 137 - 44
{Investigation of factors determining stability of BCG vaccine}; Janaszek W; This study was aimed at establishment of influence of a carrier-sodium glutamate and of changes introduced during the process of freeze-drying on survival of BCG bacilli during lyophilization, as well on thermostability and homogeneity of the vaccine and its immunogenicity . It was found that appropriate drying of the vaccine after freeze-drying performed in higher temperature influences favorably its thermostability . Concentration of the carrier is significantly influential for survival of bacilli during freeze-drying . Vaccine containing 1% of sodium glutamate was characterized by best thermostability, homogeneity and high survival of bacilli during freeze-drying . These parameters were keeping on a high level also one year after expiration date . It was shown that there exists a proportional dependence between immunogenicity of the vaccine measured indirectly by intensiveness of tuberculin allergization and number of live particles of BCG contained in vaccination dose.

Infection, 1992, 20 Suppl 4, S305 - 9
The influence of anaerobiosis on the activity of fosfomycin trometamol; Greenwood D et al.; MICs of fosfomycin trometamol were estimated for 40 strains of bacteria (20 gram-positive cocci, 20 gram-negative bacilli) by the agar incorporation method (Iso-Sensitest agar) in the presence of the potentiating agent, glucose-6-phosphate (25 mg/l) . Titrations were carried out in duplicate under aerobic and anaerobic conditions . For 22 strains (12 gram-negative bacilli), a fourfold or greater reduction in MIC was observed in tests conducted under anaerobic conditions . The effect was particularly marked with Klebsiella spp., four of five strains of which showed a 16- to 32-fold reduction in MIC in anaerobic conditions . To investigate the reasons for the effect of anaerobiosis, selected strains were examined in an opacity monitoring device in which cultures can be grown in aerobic or anaerobic atmosphere . Surprisingly, the effect of anaerobiosis observed by continuous turbidimetric monitoring was much less than that seen in agar incorporation MIC titrations: under anaerobic conditions, there was little or no reduction in the concentration of fosfomycin trometamol required to cause a lytic effect on dense bacterial cultures, and a small, but variable effect on the emergence of resistant variants.

Probl Tuberk, 1992, (11-12), 31 - 4
{The plastic repair of the residual axillary cavity following the open treatment of a cavern with the tissue from its wall and from the deep subcutaneous fat}; Kozhevnikov NN et al.; A variant of plastic surgery of the residual cavities after cavernotomy of armpit localization had been elaborated . Cicatricial tissue of the residual cavity wall is preserved and only the upper part of the residual cavity wall is used in combination with deeply-lying fatty tissue of the axillary fossa . Plastic closure of the residual armpit cavities after open treatment was successfully performed in 27 patients . The necessary condition for this operation performance is cessation of excretion of bacilli, sputum and discharge from the residual cavity on condition that the patient is in a satisfactory condition.

Probl Tuberk, 1992, (11-12), 26 - 8
{Risk factors in the development of pulmonary tuberculosis and the characteristics of its course in people over 50}; Koretskaia NM et al.; Study of the onset and course of pulmonary tuberculosis in 121 patients between the ages of 50 and 75 years showed that 31.4% of the patients belonged to a high risk group of tuberculosis . Study also revealed a high frequency of occurrence of disseminated and fibrocavernous tuberculosis, the predominance of disseminated processes, frequent destruction of lung tissue, massive bacilli excretion and marked clinical manifestations of the disease, which develops in more than half of the patients in the period between the established terms of prophylactic fluorographic examination.

Probl Tuberk, 1992, (11-12), 17 - 9
{The organization and efficacy of the hospital treatment of patients with newly detected pulmonary tuberculosis in Siberia}; Krasnov VA et al.; Analysis of the clinical observations of 2049 patients with newly diagnosed pulmonary tuberculosis has demonstrated that 54.3% of them had the destructive phase, 52.2% bacilli excretion, 20.7% the neglected forms, and 64.3% attendant diseases . The absence of bacilli was found in 82% of the patients with the destructive forms (in 5 months' period after hospitalization), and elimination of caverns in 74.5% . The most serious defects were found in the organization of a diagnostic and therapeutic process . The complex of measures has been suggested to promote heightening of treatment effectiveness in newly detected patients at the hospital stage.

Cytopathology, 1992, 3(5), 281 - 9
Inflammatory lesions of the breast: diagnosis by fine needle aspiration; Das DK et al.; Amongst 1061 breast lesions diagnosed by fine needle aspiration (FNA) over a period of 6 years (1985-1990), 128 were reported to be showing changes consistent with an inflammatory lesion . On review, the cytodiagnosis was found to be inaccurate in 31 cases . The cytological features of the 97 cases that were correctly reported are described in this report . The cytological diagnoses issued in these 97 cases were acute mastitis or breast abscess (57 cases) and tuberculous mastitis (30 cases) . Non-specific chronic mastitis and miscellaneous conditions accounted for four and six cases respectively . Acid fast bacilli (AFB) were demonstrated in 28.0% of tuberculous mastitis cases and 10.0% of those diagnosed as acute mastitis or breast abscess . FNA cytology was found to be useful for the diagnosis of inflammatory lesions of breast and their classification, as only five out of 57 cases of acute mastitis/breast abscess and one out of 30 tuberculous mastitis cases were suspected on clinical grounds.

J Intensive Care Med, 1992 Jan-Feb, 7(1), 24 - 35
Pneumonia in the intensive care unit setting; Gleeson K et al.; Nosocomial pneumonia is a common and serious occurrence in the ICU . It most often results from aspiration of oropharyngeal secretions that have become colonized with pathogenic enteric gram-negative bacilli . Colonization occurs in association with acute and chronic illness and particularly with therapy that includes nasogastric or endotracheal tubes, H 2 blocking antacid drugs, or antibiotics; aspiration is increased by anesthesia, sedative drugs, and upper airway instrumentation . The diagnosis of ICU-acquired pneumonia is complicated greatly by the nonspecificity of clinical and laboratory data, and the difficulty in distinguishing the organisms producing infection from those merely colonizing the airway when using routine culture techniques . Among specialized diagnostic techniques, quantitative culture of specimens obtained with the protected sampling brush offers the most promise in establishing a specific microbacteriologic diagnosis of nosocomial pneumonia . Empirical treatment with broad spectrum antibiotics is frequently necessary when a specific diagnosis cannot be made . The poor outcome associated with nosocomial pneumonia, regardless of treatment, suggests that methods to prevent dissemination and oropharyngeal colonization of the offending organisms should be emphasized.

Am J Gastroenterol, 1991 Dec, 86(12), 1820 - 2
Primary gastric tuberculosis presenting as pyloric outlet obstruction; Tromba JL et al.; A 38-yr-old Haitian male with a longstanding history of peptic ulcer disease presented with persistent vomiting and weight loss . Barium studies and upper endoscopy revealed gastric outlet obstruction with prepyloric ulcerations . Endoscopic biopsies were consistent with chronic gastritis . The patient did not respond to intensive medical management, including total parenteral nutrition, intravenous cimetidine, and nasogastric suctioning . At the time of surgery, large celiac lymph nodes were noted surrounding the pylorus and the first portion of the duodenum . Biopsies of the wall of the stomach and lymph nodes demonstrated necrotizing granulomas . Cultures for acid-fast bacilli subsequently grew Mycobacterium tuberculosis . A search for foci outside the gastrointestinal tract was negative . Primary gastric tuberculosis remains an extremely uncommon clinical entity; the definitive diagnosis is made by biopsy and positive culture for the organism.

Crit Care Med, 1991 Dec, 19(12), 1491 - 6
A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients; Eddleston JM et al.; OBJECTIVE: To compare the frequency of acute stress ulceration and secondary pneumonia caused by aerobic Gram-negative bacilli in ICU patients treated with either sucralfate or ranitidine . DESIGN: Prospective, randomized study . SETTING: ICU, university hospital . PATIENTS: Sixty adult patients who were mechanically ventilated and at risk of developing stress ulceration . INTERVENTION: The patients were randomized to receive either sucralfate (1 g every 6 hrs) via the nasogastric tube or iv ranitidine (50 mg every 6 hrs) . If the gastric pH was less than 3.5 in the latter group, 30 mL of 0.3M sodium citrate was given via the nasogastric tube . MEASUREMENTS AND MAIN RESULTS: On admission, the frequency rate of erosion/ulceration (assessed with the endoscope) was 13.5% . After 4 days, this rate had increased to 18% in sucralfate-treated patients and 36% in ranitidine-treated patients (NS) . Mean gastric pH was more alkaline in the ranitidine-treated patients (5.50) compared with the sucralfate-treated patients (4.26) (p less than .01) . This pH permitted a higher occurrence rate of gastric colonization by aerobic Gram-negative bacilli in ranitidine-treated patients (64.3%) compared with sucralfate-treated patients (23.8%) (p less than .01) . Retrograde bacterial colonization from the stomach to oropharynx and trachea occurred more frequently in ranitidine-treated patients compared with sucralfate-treated patients . Ultimately, the occurrence rate of pneumonia was greater in the ranitidine-treated (35.7%) than in the sucralfate-treated patients (10.3%) (p less than .05) . CONCLUSION: Based on our findings, we recommend the adoption of sucralfate for routine prophylaxis against stress ulceration.

Med J Malaysia, 1991 Dec, 46(4), 309 - 13
The role of diagnostic fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis; Zainudin BM et al.; The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli . Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them . The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them . Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination . Two of the cases had concomitant bronchogenic carcinoma . We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.

Kitasato Arch Exp Med, 1991 Dec, 64(4), 213 - 20
Intracellular fate of Mycobacterium leprae in cultured murine macrophages in 24-well trays; Osawa N; Mycobacterium leprae is an obligate intracellular parasite which grows within mononuclear phagocytes . In clinical cases, M . leprae reaches enormous numbers in the macrophage-rich granulomas of leprosy . Peritoneal macrophages from CBA mice were cultured in Waymouth medium containing fresh horse serum in Costar 3424 trays (24 wells, 16 mm in diameter) each containing 9 x 12 mm cover slips . This medium was supplemented with 0.5 micrograms/ml of cycloheximide . These cells were infected with M . leprae Thai-53 strain obtained by nude mice inoculation . Significant multiplication of the acid-fast bacilli in the macrophages was observed three weeks after inoculation . This experiment showed M . leprae mainly multiplied in cells and not by rephagocytization of M . leprae derived from destroyed cells.

J Antimicrob Chemother, 1991 Dec, 28(6), 855 - 67
Susceptibilities of anaerobic gram-negative bacilli to thirteen antimicrobials and beta-lactamase inhibitor combinations; Hill GB et al.; Thirteen antimicrobial agents and beta-lactamase inhibitor combinations were tested simultaneously for their in-vitro activity against a range of anaerobic Gram-negative bacilli with a standard reference agar dilution method . Overall, metronidazole, imipenem, ampicillin/sulbactam, ticarcillin/clavulanic acid and cefoperazone/sulbactam, followed by clindamycin, cefoxitin, and piperacillin, had the greatest activity . Cefotetan, ceftizoxime, and cefoperazone were moderately active, while ampicillin and penicillin were least active . Metronidazole was the only drug active against all strains, but only one strain was resistant to imipenem . Resistance was highest among certain members of the Bacteroides fragilis group, but was observed also among numerous other Bacteroides species . beta-Lactamase was produced by 94% of strains in the B . fragilis group, and by 64% of strains overall . The activities of clindamycin and cefoxitin were compared with those in previous surveys since 1982 at our institution . No clear evidence of increasing resistance was demonstrated, but the data emphasized the significant effects resulting from variations in susceptibility testing.

Protein Seq Data Anal, 1991 Dec, 4(6), 355 - 61
Sequence regions of Bacilli metalloproteinases that can affect enzyme thermostability; Strongin A et al.; By a computer analysis of the five Bacilli metalloprotease sequences it was found that mesophilic Bacillus amyloliquefaciens and B . subtilis proteases had lost two Ca(2+)-binding sites due to the substitutions Asp----Ser 57, Asp----Thr 59, Asp----Pro 200, in comparison with the thermostable B . thermoproteolyticus thermolysin and B . stearothermophilus protease, which conserved three Ca(2+)-binding sites, and B . cereus protease with the intermediate thermostability, which had presumably lost only one site (Ile----Lys 197 substitution) . The multiple substitutions within the sequence regions 91-101, 150-154, and 275-280 of the mesophilic enzymes also corresponded with the decrease in the proteinase thermostability value . On the known X-ray structure of thermolysin these sequence regions are spatially drawn together, being located near the central alpha-helix opposite the active site hole and providing the contact of the N- and C-terminal domains . It may be concluded that to increase the thermostability of the mesophilic Bacilli proteinases it is necessary to substitute the sequence regions 91-101, 150-154, 275-280 for the thermolysin ones and restore the Ca(2+)-binding sites of the enzymes.

Oral Surg Oral Med Oral Pathol, 1991 Dec, 72(6), 712 - 5
Primary tuberculosis of the oral cavity; Dimitrakopoulos I et al.; Two cases of primary tuberculosis of the mouth are reported . Painless ulceration of long duration and enlargement of the regional lymph nodes that did not respond to conservative and antibiotic therapy were the main manifestations of the disease in both cases . In the first case the tubercle ulcer was located in the lower buccogingival sulcus of a 17-year-old girl . In the second case the lesion occurred as a chronic periodontal inflammation around the gingiva of the left lower second molar tooth . When the tooth was extracted, a painless ulceration appeared around the socket, which was filled by granulation tissue . Histopathologic examination; bacteriologic, serologic, and blood tests; and chest x-ray film confirmed the diagnosis . Predisposing factors that might favor primary inoculation of tubercle bacilli into oral mucosa are also discussed . Finally we emphasize that in such cases it is essential to attempt to locate a possible primary site elsewhere in the body before oral tuberculosis is considered the primary disease.

Semin Respir Infect, 1991 Dec, 6(4), 254 - 60
Tuberculosis, poverty, and "compliance": lessons from rural Haiti; Farmer P et al.; Tuberculosis (TB) is the leading cause of death among rural Haitian adults, and TB control in Haiti is widely acknowledged to be a failure . The causes of both the endemicity of TB and the failure of attempts to address it are briefly reviewed before data from a study conducted in rural, central Haiti are presented . Members of one group of patients with active TB were given free medical care; members of a second group were given free care as well as financial aid, incentives to attend a monthly clinic, and aggressive home follow-up by trained village health workers . Comparing the two groups shows significant differences in mortality, sputum positivity after 6 months of treatment, persistent pulmonary symptoms after 1 year of treatment, average amount of weight gained, ability to return to work, and cure rate . The roles of human immunodeficiency virus and cultural factors are also examined . When adequate nutrition and access to free care were assured, drug-dependent and patient-dependent factors were shown to be of secondary importance in determining treatment outcome . Based on these data from a small, community-based TB-control project, the authors conclude that high cure rates can be achieved if the primacy of economic causes of TB is acknowledged and addressedPIP: Between February 1989 and June 1990, village health workers with the Proje Veye Sante community health program in the central plateau of Haiti enrolled 30 adults with tuberculosis (TB) living around the reservoir in the Peligre basin (sector 1) and 30 TB patients living in villages and towns next to sector 1 (sector 2) to compare 2 TB treatment approaches . The cases (sector 1 patients) received free medical care, home visits, US$30/month for the 1st 3 months (financial aid), nutritional supplements, monthly reminders to visit the clinic, and travel expenses . The controls (sector 2 patients) received only free medical care . 1 case (3.3%) and 2 controls (6.7%) tested positive for HIV . By June 1991, all 30 cases were cured of TB compared with only 56.7% of controls . None of the cases died but 10% of controls died . None of the cases exhibited sputum positivity for acid fast bacilli 6 months after diagnosis yet 13.3% of controls did . 1 year after treatment only 2 cases (6.7%) still had pulmonary symptoms compared with 13 (43.3%) controls . Cases gained more weight on average than controls (10.4 lbs . vs . 1.7 lbs) . All but 2 cases (93.3%) were able to return to work after 1 year of treatment while only 14 controls (46.7%) could . Cases made more trips to the clinic and experienced more home visits than the controls (11.4 vs . 5.8 and 37.9 vs . 1.1, respectively) . 25 cases (83.3%) and 26 controls (86.7%) did not deny that sorcery may have been responsible for their illness . The results demonstrated that high cure rates can occur under extremely impoverished conditions where hospitals do not exist . The top priority under these conditions should be identification and treatment of patients with active pulmonary TB . TB programs should address nutrition and providing TB patients easy access to drugs . Direct financial aid provides an incentive for TB patients to follow through with treatment which the free treatment alone does not do .

Q J Med, 1991 Dec, 81(296), 999 - 1004
Sputum examination in the screening and diagnosis of pulmonary tuberculosis in the elderly; Morris CD; Pulmonary tuberculosis is not uncommon in the elderly, particularly those in institutions, and is notoriously difficult to diagnose . Few bacilli are excreted by individuals with non-cavitating disease and positive cultures are usually required to confirm the diagnosis . Radiography is a poor screening method, and the role of the Mantoux test in this population controversial . The value of sputum culture as a screening procedure in elderly people with a productive cough was therefore investigated . In a prospective surveillance study over 26 months, all permanent residents in homes for the elderly were entered on the basis of a productive cough for 3 weeks or more irrespective of any known or presumed cause . Both smears and cultures were performed on sputum specimens, and Mantoux tests and chest radiographs were performed on those who were sputum positive . The 205 subjects investigated yielded 446 smears, seven of which were positive for acid-fast bacilli, and 433 cultures, 32 of which were positive for M . tuberculosis . From this 19 patients with pulmonary tuberculosis were identified, 18 of whom had non-cavitating disease on chest radiography . The numbers of bacilli in these patients were shown to be low and the excretion pattern haphazard . Smears were not sufficiently sensitive to diagnose non-cavitating tuberculosis in this population, and the sputum must be cultured in order to exclude the diagnosis . Four negative cultures are required in order to exclude the presence of pulmonary tuberculosis.

Acta Pathol Jpn, 1991 Dec, 41(12), 895 - 9
An autopsy case of purulent mycobacterial meningitis in AIDS; Shintaku M et al.; The patient was a 46-year-old male hemophiliac who died of acute mycobacterial meningitis associated with AIDS (acquired immune deficiency syndrome) . Autopsy revealed severe basal meningitis which was characterized by an infiltration of numerous polymorphonuclear leukocytes . Severe mural inflammation of the subarachnoid arteries was noted, and innumerable acid-fast bacilli were demonstrated . Epithelioid cell granulomas were not found in the meningeal lesion . The lungs, liver, spleen, and bone marrow contained many epithelioid cell granulomas with caseous necrosis . Massive proliferation of swollen histiocytes could not be identified in any organ . The absence of epithelioid cell granulomas in the meningeal lesion indicate a severe impairment of cell-mediated immunity in the patient; this anergic type of lesion is one of the characteristics of tuberculosis occurring in association with terminal AIDS.

Kekkaku, 1991 Dec, 66(12), 839 - 42
{A case report on tuberculosis with remittent fever after tonsillectomy in a patient under CAPD}; Kawai S et al.; This report pertains to a case of chronic renal failure with remittent fever after tonsillectomy . The patient was 45-year-old female who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for five years . She was admitted to our hospital after being diagnosed as having pyrexia with tonsillitis . A tonsillectomy was performed . Although several symptoms and signs, such as fever, positive CRP and accelerated ESR, improved transiently by the seventh postoperative day, remittent fever and cervical lymph node swelling suddenly recurred after the eighth postoperative day . In spite of the antibiotic therapy, the fever continued for two weeks thereafter . A culture to check for acid-fast bacilli was negative, but on epithelioid cell granuloma with a small central abscess was found in the biopsy specimen of the lymph node . INH was prescribed to her . After three days of INH administration, the patient became afebrile . Patients with long-term dialysis are known to be very susceptible to tuberculous diseases . However, to date, there has been no report of tuberculosis being accompanied by a fever after a tonsillectomy . As it might be difficult to make a tubercular diagnosis on such a febrile patient, early antituberculous chemotherapy is recommended for patients with antibiotic-refractory fever.

Kekkaku, 1991 Dec, 66(12), 819 - 28
{Estimating the year of eradication of tuberculosis in Japan}; Ohmori M; The time of eradication of tuberculosis has been discussed for several countries, and based on those results, a new strategic plan and goals have been elaborated . Considering such developments, and in order to make a new tuberculosis control strategy, it is important to determine the point at which eradication of tuberculosis would be achieved in Japan . Styblo proposed the two conventional definitions of eradication of tuberculosis, namely that the incidence of smear-positive tuberculosis has fallen below 1 per million population or that the prevalence of tuberculosis infection in the general population has fallen below 1% and continues to decrease . The bacteriological results of new cases have been reported since 1975 in Japan . However, those results are still of doubtful validity and reliability . Therefore, the author estimated the year of eradication of tuberculosis, according to the criterion that tuberculosis is eradicated when the proportion of the population infected with tubercle bacilli is less than 1% . If the risk of infection is changing at a regular rate, it is possible to estimate the risk of infection at any time in the past and in the future . Once the risk of infection is determined, it is also possible to calculate the age-specific prevalence of infection and the proportion of the population infected with tubercle bacilli at various times in the past and in the future . In Japan, the risk of infection before World War II was assumed to be around 4% and not to vary with calendar year . And based on the data from the prevalence surveys in Okinawa in 1968 and 1973, the risk of infection was estimated 0.3% in 1968 and has declined on average, by 10 to 11% annually . At that time, Okinawa was the only area free from BCG vaccination in Japan . The incidence rate in Japan also has declined, on average, by 10% annually . However, since late 1970s, the annual speed of decline of the incidence rate has been slowed down . Therefore, I assumed that the recent trend of the infection risk is the same as the trend of the recent incidence rate among the 0-29 year age-group . The size of the effect of age on the risk of infection has been discussed . The author also considered age-effects in the model . The weight applied to the risk of infection by age was determined by examining the age-specific positive rate in the 1930s before the era when BCG vaccination was widely used.(ABSTRACT TRUNCATED AT 400 WORDS)

Genitourin Med, 1991 Dec, 67(6), 441 - 52
The diagnosis and treatment of donovanosis (granuloma inguinale); Richens J; Donovanosis is a predominantly tropical cause of genital ulcer occurring chiefly in small endemic foci in all continents except Europe . Diagnosis requires the careful collection, staining and examination of smears or biopsies of characteristic genital and, occasionally, extragenital lesions for demonstration of the pathognomonic Donovan bodies (Calymmatobacterium granulomatis) within histiocytes . Successful isolation of C . granulomatis has rarely proved feasible, the last report being in 1962 . Donovanosis has a characteristic histopathological picture which occasionally simulates epithelioma . The antibiotics reported as showing good activity in donovanosis are those with good activity against gram negative bacilli and whose lipid solubility ensures good intracellular penetration . They include streptomycin, chloramphenicol, erythromycin, lincomycin, cotrimoxazole and the tetracyclines . More recently, good results have been reported with norfloxacin and thiamphenicol . The treatment of donovanosis in pregnant women and patients with AIDS poses special problems . Complications of donovanosis such as elephantiasis, stricture and pelvic abscess may require surgery . Contacts should be traced for examination but only treated if lesions are found.

Bull Int Union Tuberc Lung Dis, 1991 Dec, 66(4), 207 - 9
An emerging global programme against tuberculosis: agenda for research, including the impact of HIV infection; Murray JF; During the last 5 years, a worldwide resurgence of tuberculosis has been convincingly documented . Increased numbers of cases have been reported from several industrialized countries and there has been a veritable explosion of tuberculosis in the developing countries of sub-Saharan Africa . The fact that most of this increase is attributable to coexisting infection with the human immunodeficiency virus (HIV) should come as no surprise, because of the role played by cell-mediated immunity in protecting against tuberculosis and the depletion of this immunity by HIV infection . The World Health Organization estimates that there are more than 3 million persons in the world dually infected with HIV and tubercle bacilli . To combat this problem, there needs to be an expansion of programmes designed to identify and treat all patients with tuberculosis, whether HIV infected or not . In addition, the prospects for further advances in basic research, clinical research, epidemiological research and operations research, which have broad application to clinical medicine, are great, and these results will help combat the dual scourges of HIV infection and tuberculosis.

Bull Int Union Tuberc Lung Dis, 1991 Dec, 66(4), 189 - 91
On the risk of infection; Sutherland I; The epidemiological importance of the annual risk of infection with tubercle bacilli has been recognized only recently . Calendar trends in the risk and its association with age have been assessed from tuberculin test data . In The Netherlands, this information has been used to estimate the development of clinical tuberculosis following infection or re-infection . The calendar trend in the risk of infection is the best index of improvement or deterioration in a community . The difficulties of assessing it are outlined.

Eur J Clin Microbiol Infect Dis, 1991 Dec, 10(12), 1013 - 8
Cross-resistance and cross-susceptibility between fluoroquinolone agents; Barry AL et al.; The results of broth microdilution susceptibility tests with 750 bacterial isolates were used to directly compare six different fluoroquinolone antibiotics (ciprofloxacin, enoxacin, fleroxacin, lomefloxacin, ofloxacin and temafloxacin) . Against enteric bacilli, enoxacin and lomefloxacin were similar in their spectra of activity but they differed from the other drugs tested . Against the non-enteric gram-negative bacilli, ciprofloxacin differed from enoxacin and lomefloxacin: fleroxacin, ofloxacin and temafloxacin were nearly identical in their activity . For routine susceptibility tests, ofloxacin and fleroxacin were similar in activity and either drug could be used as a class representative for predicting susceptibility to the other fluoroquinolone agents . Occasionally, strains that are resistant to the class representative may be susceptible to other members of the fluoroquinolone class, but those that are susceptible to the class representative are rarely resistant to the other compounds.

J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 25 - 30
In-vitro activity of temafloxacin against anaerobic bacteria: a comparative study; Finegold SM et al.; The antimicrobial activity of temafloxacin for 328 anaerobic bacteria was determined and compared to that of cefotetan, cefoxitin, ciprofloxacin and metronidazole . The Wadsworth agar dilution technique using Brucella-lysed sheep blood agar was used throughout . At the recommended breakpoint concentration 4 mg/L, temafloxacin inhibited 60/62 (97%) of the isolates of Bacteroides fragilis and 82/87 (94%) of the isolates of other species of the B . fragilis group . Ninety-six percent of the 24 isolates of Peptostreptococcus, 97% of the 31 isolates of other Bacteroides species and 88% of 66 isolates of Fusobacterium species were also inhibited by 4 mg/L temafloxacin . Metronidazole (breakpoint 16 mg/L) had a broader spectrum of activity than temafloxacin (judged by the percentage of strains tested susceptible at the breakpoints employed) with the exception of non-sporing Gram-positive bacilli . The cephalosporins tested (breakpoint 32 mg/L) had a narrower spectrum of activity . Ciprofloxacin (breakpoint 2 mg/L) was the least effective agent against the majority of the anaerobes tested.

Schweiz Med Wochenschr, 1991 Nov 30, 121(48), 1767 - 72
{Diagnosis and treatment of pulmonary infection due to Mycobacterium malmoense}; Barandun J et al.; To date more than 150 patients with Mycobacterium malmoense disease have been reported . These infections are rare and only in one case, so far not published, is this species associated with Aids . Most reported cases were seen in northern Europe . We present three pulmonary cases from Switzerland . M . malmoense causes lung disease resembling tuberculosis clinically and in chest X-ray . Disease is considered to be present when two and more sputums or bronchial washings are acid-fast bacilli smear-positive and culture-positive . M . malmoense grows slowly on egg-based bacteriological media; the incubation time is at least 6 weeks and the use of special solid or liquid media is recommended . Person-to-person transmission is rare and, in contrast to tuberculosis, isolation of the patient is not necessary and subsequent close contact persons do not need to be evaluated . It seems that a combination of isoniazid, rifampicin and ethambutol given for more than 12 months is the best regimen.

Am Rev Respir Dis, 1991 Nov, 144(5), 1153 - 9
Nosocomial outbreak of respiratory tract colonization with Mycobacterium fortuitum: demonstration of the usefulness of pulsed-field gel electrophoresis in an epidemiologic investigation; Burns DN et al.; Between August 1989 and January 1990, 16 patients on an alcoholism rehabilitation ward (ARW) developed positive sputum cultures for Mycobacterium fortuitum . During a 2-wk surveillance period, six of 43 ARW patients but none of 20 staff members had positive sputum cultures . In addition, none of 54 patients and staff on an adjacent ward sharing the same ice machine and water supply had positive cultures, and none of 92 acid-fast bacilli cultures performed on all sputum specimens from all other inpatient sources during the same 2-wk period were positive . The only exposure factor common to all cases was the use of one or both of the ward showers . Compared with 36 ARW control patients, cases were more likely to report clinical criteria for chronic bronchitis (odds ratio, 6.6; 95% confidence interval, 1.5 to 28.6; p = 0.02) . Using phenotype analysis, plasmid profiles, and pulsed-field gel electrophoresis of large genomic DNA restriction enzyme fragments, the 16 case isolates were found to be identical . This strain of M . fortuitum was also cultured from a tap connected to the water line supplying the ARW showers, but not from the showers themselves . No further cases were identified after the showers were disconnected and decontaminated . To our knowledge, this is the first clinical use of pulsed-field gel electrophoresis for genetic comparison of mycobacterial strains . It demonstrates the important potential of this technique for studying the epidemiology of mycobacterial infections . Showers should be considered a possible source of nosocomial respiratory tract colonization with M . fortuitum.

Am Rev Respir Dis, 1991 Nov, 144(5), 1164 - 70
Disseminated tuberculosis in the acquired immunodeficiency syndrome era; Hill AR et al.; To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987 . Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1) . A total of 20 had TB unrelated to HIV disease (Group 2) . The remaining 12 were excluded because the role of HIV could not be determined . Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03) . Chest radiographs showed a miliary pattern in about half of each group . Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group . Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1 . Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01) . Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli . HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Am Rev Respir Dis, 1991 Nov, 144(5), 1160 - 3
Detection of Mycobacterium tuberculosis in sputum samples using a polymerase chain reaction; Eisenach KD et al.; A polymerase chain reaction (PCR) assay for the rapid detection of Mycobacterium tuberculosis in sputum samples is described . The target DNA is a 123-base pair (bp) segment of IS6110, which is repeated in the M . tuberculosis chromosome and is specific for the M . tuberculosis complex . Methodology used to lyse the mycobacteria, extract the DNA, and amplify the 123-bp target DNA is presented . The amplified PCR product is detected by examination of ethidium-bromide-stained acrylamide gels . An internal control using the same primers as the target DNA has been constructed to assess the efficacy of each individual reaction . Of 162 sputum samples tested, 82 were smear-positive for acid-fast bacilli . Of the 94 specimens from patients in whom pulmonary tuberculosis was diagnosed, 51 were culture-positive, smear-positive, or both . Fifty of these were PCR positive . Of the 42 specimens from patients with nontuberculous mycobacterial pulmonary disease, 41 were PCR negative . All 26 specimens from patients without mycobacterial infection were PCR negative . This assay provides a sensitive and specific means for the laboratory diagnosis of tuberculosis within 48 h that is relatively simple to perform.

Acta Cytol, 1991 Nov-Dec, 35(6), 717 - 8
Bancroftian microfilariasis in association with pulmonary tuberculosis . Report of a case with diagnosis by fine needle aspiration; Avasthi R et al.; A 25-year-old man presented with clinical and radiologic features suggestive of pulmonary tuberculosis . Since the examination of Ziehl-Neelsen-stained sputum smears for acid-fast bacilli was repeatedly negative, a transthoracic fine needle aspiration biopsy was performed . Papanicolaou-stained smears of the aspirate showed microfilariae of Wuchereria bancrofti and a tuberculous exudate but no acid-fast bacilli or classic granulomas . Subsequent sputum samples did show acid-fast bacilli, while a nocturnal peripheral blood sample showed microfilariae.

J Infect Dis, 1991 Nov, 164(5), 922 - 7
Progressive disseminated infection with Mycobacterium avium complex after intravenous and oral challenge in cyclosporine-treated rats; Brown ST et al.; Male Sprague-Dawley rats, immunosuppressed with cyclosporine (CsA), developed disseminated infection after intravenous or oral challenge with Mycobacterium avium complex (MAC) . Disseminated infection leading to bacillemia could be established after intravenous inoculation with as few as 5 x 10(3) organisms . When CsA was not given or when CsA was stopped 1 month after infection, animals cleared the bacilli from blood and tissue . Animals developed disseminated infection after oral challenge with as few as 10(6) organisms . Persistent bacillemia occurred when organisms in the spleen exceeded 10(7) . Differences in virulence among strains were observed . Infected tissues showed histopathologic changes similar to those seen in patients with AIDS . The CsA-treated rat is a new model that appears useful for studies of the virulence of MAC strains and the pathogenesis of disseminated MAC infection.

Infect Immun, 1991 Nov, 59(11), 3895 - 902
Intramacrophagic Mycobacterium avium bacilli are coated by a multiple lamellar structure: freeze fracture analysis of infected mouse liver; Rulong S et al.; We used freeze fracture electron microscopy to study the fine structure of Mycobacterium avium inside phagosomes of murine macrophages . M . avium-susceptible C57BL/6 mice were infected with M . avium by intraperitoneal inoculation of 10(8) viable bacilli . We studied the microanatomy of the mycobacteria in 3-month infections of mice, a situation in which bacillary multiplication is extensive . In these samples, freeze fracture revealed that intraphagosomal bacilli were surrounded by a multilamellar coat that was apposed to the cell wall . In thin sections, in contrast, the area corresponding to the coat showed no substructure and was electron transparent (the so-called electron-transparent zone that has been previously reported by others) . The multiple lamellae resembled an onionlike assembly that was inserted in between the mycobacterial wall outer surface and the phagosomal membrane . Each lamella of the M . avium coat was made up of parallel straight fibrils with a width of 5 nm . A variable number of lamellae, sometimes up to 10 or more elements, coated individual bacilli . The multilamellar coat was absent around both extracellular M . avium and intramacrophagic M . avium after short-term (45-min) inoculation of mice . The supramolecular organization of the M . avium lamellar coat as viewed here by freeze fracture is similar to that of purified mycoside C (P . Draper, J . Gen . Microbiol . 83:431-433, 1974; K.-S . Kim, M.R.J . Salton, and L . Barksdale, J . Bacteriol . 125:739-743, 1976), a mycobacterial component currently known as glycopeptidolipid (W.W . Barrow and P.J . Brennan, J . Bacteriol . 150:381-384, 1982) . We conclude that M . avium bacilli growing in macrophages are surrounded by multilamellar capsulelike structures that contain glycopeptidolipid molecules.

Clin Exp Immunol, 1991 Nov, 86(2), 286 - 90
T cell response to purified filtrate antigen 85 from Mycobacterium bovis Bacilli Calmette-Guérin (BCG) in leprosy patients; Launois P et al.; T cell proliferation and IFN-gamma production of peripheral blood mononuclear cells from 25 healthy controls and 39 leprosy patients were tested against BCG-bacilli and culture filtrate . Mycobacterium leprae and purified antigen 85 (the major secreted 30-32 kD protein antigen) from M . bovis strain BCG . In lepromin negative healthy controls, blastogenesis was low to M . leprae and completely negative to antigen 85 . IFN-gamma levels were very low, close to detection limits . In all lepromin positive controls, significant proliferation and IFN-gamma secretion was found in response to M . leprae and antigen 85 . In the group of lepromatous leprosy (LL) patients, 25/29 of patients (with either positive (13) or negative (12) lymphoproliferative response to BCG) were unreactive to M . leprae or to antigen 85 . Four LL patients with positive T cell response to BCG responded with detectable lymphoproliferative response and IFN-gamma secretion to antigen 85 . All tuberculoid (TT) leprosy patients responded to BCG, M . leprae and antigen 85 . Hence, T cells from leprosy patients and controls demonstrate a marked parallelism of responsiveness towards whole M . leprae and purified antigen 85 from M . bovis BCG, suggesting strong cross-reactivity between the two species and underlining the biological importance of such secreted antigens.

Bol Oficina Sanit Panam, 1991 Nov, 111(5), 414 - 22
{Survey of knowledge on tuberculosis . Northeastern sector of Medellín, Colombia}; Zuluaga L et al.; In 1988, 2,287 persons were interviewed in order to evaluate the knowledge about tuberculosis and the instruction given on the subject among the population aged 15 and over in the northeastern commune of Medellin . Interviews were conducted by nurses who had been trained in tuberculosis and in community education and communication . On the basis of a pilot interview, the survey was adapted to the language level of the studied population . Results indicate that those persons with the fewest years of schooling, those between 15 and 24 years of age, and those over 50 years old have the least knowledge about the disease . The population receives information on tuberculosis through friends (15.8%) and health institutions (9.6%) . Individuals with respiratory disease (tuberculosis patients and persons with a cough lasting two or more weeks and testing negative for bacilli) received more information through health institutions, and healthy persons received more through schools.

Bol Oficina Sanit Panam, 1991 Nov, 111(5), 406 - 13
{Prevalence of tuberculosis and respiratory disease in persons older than 15 years of age in the northeastern sector of Medellín, Colombia}; Zuluaga L et al.; A survey was conducted in 1988 to estimate the prevalence of tuberculosis and respiratory disease (cases of tuberculosis and patients with respiratory symptoms who tested negative for the presence of bacilli) in persons over the age of 15 and of low socioeconomic status in the northeastern commune of Medellin . A cluster sample was selected and 3,731 adults were interviewed . The interviews were carried out in the interviewees' homes . For those patients classified as having respiratory symptoms (two weeks with cough, without considering other symptoms), samples of sputum were taken and a series of three examinations for bacilli were performed in order to confirm the diagnosis . When the interviewee could not be located, the material for collection of samples was delivered to family members . The prevalence of tuberculosis was estimated to be 2.68 per 1,000 population, and that of respiratory disease, 70 per 1,000 population . Of those who initiated treatment, 37.5% abandoned it . The prevalence of respiratory disease was higher among persons who did their cooking and sleeping in the same room, those living in poorly ventilated and overcrowded dwellings, and those with the fewest years of schooling.

J Am Acad Dermatol, 1991 Nov, 25(5 Pt 1), 761 - 6
Cutaneous granulomas in children with combined immunodeficiency; Siegfried EC et al.; Noninfectious cutaneous granulomas, particularly in an acral distribution, may be an early sign of mixed cellular and humoral immunodeficiency . Special stains of skin biopsy sections and cultures for bacteria, acid-fast bacilli, and fungi are important in eliminating the possibility of underlying pathogens . In three children with combined immunodeficiency and cutaneous granulomas, the administration of moderate- to high-dose systemic corticosteroids was the most effective therapy . However, careful consideration should be given before administering systemic corticosteroids to an immunocompromised patient.

J Med Assoc Thai, 1991 Nov, 74(11), 502 - 6
Primary peritonitis in childhood nephrotic syndrome: a changing trend in causative organisms; Tapaneya-Olarn C et al.; Three hundred and forty-seven children with primary nephrotic syndrome were analysed retrospectively, there were 55 episodes of peritonitis in 35 patients . Bacterial agents were identified in 60 per cent of the 55 episodes . Gram-positive cocci and gram-negative bacilli were found in equal numbers, with a definite increasing trend of gram-negative bacilli over the last 4 years . There was no predisposing factor of peritonitis regarding age, sex and renal pathology in relation to the development of peritonitis.

Eur J Clin Microbiol Infect Dis, 1991 Nov, 10(11), 959 - 63
Oropharyngeal colonization in the elderly; Sveinbjornsdottir S et al.; A cross-sectional prevalence study of gram-negative bacillary oropharyngeal colonization in the geriatric population with single oropharyngeal cultures was performed on three different groups of individuals, the first consisting of healthy individuals, living independently, the second residing in a nursing facility and the third hospitalized . A longitudinal incidence study by serial weekly cultures was in addition conducted on a fourth group of hospitalized individuals . In the cross-sectional study, gram-negative bacilli were isolated from 23% of the hospitalized group, whereas only 7-10% of the other two groups were colonized (p less than 0.05) . In the longitudinal study, the colonization was intermittent and transient, being most prevalent on admission, i.e . 23%, but gradually decreasing during the hospital stay to 7% after ten weeks . Only hospitalization and prior treatment with antimicrobials increased prevalence of colonization . On only one occasion was a lower respiratory infection predated by oropharyngeal colonization with the same organism, indicating that such colonization may not be a risk factor for the development of pneumonia in the elderly.

Rev Clin Esp, 1991 Nov, 189(8), 379 - 81
{Intestinal tuberculosis in acquired immunodeficiency syndrome}; Carrasco R et al.; We present a case of disseminated tuberculosis with peritoneal and intestinal involvement in a homosexual patient who presented micronodular fibrosis and was infected by HIV, with an AIDS diagnosis since he had previously presented an esophagitis caused by candida . Diagnosis was made from a sample obtained from an ulcerated lesion from rectum-sigmoid region by colonoscopy, and when stained with Ziehl-Nielsen revealed acid-alcohol resistant bacilli (AARB) identified as M . tuberculosis . The torpid evolution of the process, which was complicated by the uncompensation of the cirrhosis determined the patient's death inspite of treatment . The characteristics of intestinal tuberculosis in HIV infected patients is reviewed.

J Clin Microbiol, 1991 Nov, 29(11), 2636 - 8
Gas-liquid chromatographic analysis of cellular fatty acids for identification of gram-negative anaerobic bacilli; Stoakes L et al.; A commercially available, computer-assisted microbial identification system (MIS) employs gas-liquid chromatographic analysis of cellular fatty acids for bacterial identification . MIS was compared with conventional identification systems . Of 225 gram-negative anaerobes tested, MIS identified 72.4% of the strains to the species level, 88.9% to the appropriate group, and 93.3% to the correct genus.

Kekkaku, 1991 Nov, 66(11), 769 - 74
{Role of surgical treatment in atypical mycobacteriosis of the lung}; Inagaki K et al.; During the 15 year period from January, 1976 to September, 1990, we treated 77 patients with atypical mycobacteriosis (AM) of the lung surgically with satisfactory results . There were 56 men and 20 women, a ratio of 2.9 : 1 . The age of the patients ranged from 20 to 76, with an average of 50.7 years . The operative rate was 3.7% against the patients admitted with a diagnosis of atypical mycobacterial infection . The number of the patients and the types of bacilli classified according to Runyon's criteria were 4 for Group I (M . kansasii), 63 for Group III (M . avium complex), 3 for Group IV, and 7 unknown . The operative indications we adopted were, 1) the resistance to most antituberculotics, 2) localized lesion, and 3) progressive deteriorations . Sensitivity study showed that over 90% of the patients had bacilli with complete or incomplete resistance against all antituberculotics except cycloserine . The area of major involvement was localized in the upper lobe in 47, but was bilateral in 14 patients . The period of conservative therapy prior to the surgical treatment ranged from 2 to 164 months, with an average of 28 months . As to the operative procedures, 58 had lobectomy, 12 pneumonectomy , 11 segmentectomy or wedge resection, 12 thoracoplasty, and 17 combined procedures . The incidence of post-operative complication was 16.9% . The recurrences were observed in 8 patients (10.4%), who had multiple and bilateral lesions . Complete cure rate was 83.1% and 64 patients were able to resume normal life . Our results indicate that, if properly selected, time required for the treatment may become shorter and the patients with AM may get better results by surgical treatment.

Kekkaku, 1991 Nov, 66(11), 763 - 7
{The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance}; Anno H; The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989 . Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation . 2) 52% were more than 50 years old . One third showed less than 40 in respiratory index . 3) Most of them did not have effective anti-tuberculosis drug to be used after operation . 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty . 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases . But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25% . Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs . Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.

Mol Cell Probes, 1991 Oct, 5(5), 385 - 95
A simple method for diagnosing M . tuberculosis infection in clinical samples using PCR; Sritharan V et al.; Species identification of Mycobacterium tuberculosis remains a cumbersome process . We have developed a simple method for treating clinical samples which permits direct polymerase chain reaction (PCR) amplification of mycobacterial target DNA without organic extraction . Samples were boiled for 30 min in TE-Triton, then were subjected to 30 cycles of amplification using primers derived from the repetitive clone pMTb4 developed by Patel and coworkers (1990; Journal of Clinical Microbiology 28, 513) . Specificity of amplification was confirmed by hybridization with a specific probe labelled non-isotopically . In a model system consisting of cultured bacilli, this system routinely allows detection of a single organism in a sample . In preliminary studies examining applicability of this method to 96 clinical samples, 74 were positive by both PCR and mycobacterial culture, and eight were negative by both methods . Fourteen samples were negative by culture and positive by PCR, and none were positive by culture and negative by PCR . These results suggest that the PCR method may provide a sensitive alternative to conventional species-specific diagnostic methods, and that non-isotopic labelling can be used to detect hybridization in this assay.

Kekkaku, 1991 Oct, 66(10), 687 - 706
{Management of INH and RFP-resistant refractory tuberculosis}
{A retrospective survey of newly registered pulmonary tuberculosis patients--379 cases at 4 health centers in 1985}
Kameda K, Okazawa A, Ishida M, Kanoh E, Fukushima M.

Osaka Prefectural Habikino Hospital, JapanUsing the registration card of tuberculosis patient, a retrospective analysis was made on newly registered 379 patients with pulmonary tuberculosis in 1985 to examine the treatment duration, the outcome, the duration of registration, and bacteriological relapse . These patients were divided into three groups according to the results of bacteriological examination at the time of registration: (1) patients with positive-bacilli (Group A); (2) patients with negative-bacilli (Group B); and (3) patients without results of bacteriological examination (Group C) . 1) Number of cases were 164 (43.3%) in the group A, 130 (34.3%) in the group B, and 85 (22.4%) in the group C . Sputum specimens from 68 patients (80.0%) of the group C were negative on smear, however, the results of culture were not obtained, and remaining 17 cases (20.0%) were not examined bacteriologically . 2) 54 patients (32.9%) in the group A, 25 (19.2%) in the group B, and 17 (20.0%) had a previous history of tuberculosis, respectively . 3) Number of patients with cavitary lesions at the time of registration were 105 (64.0%) in the group A, 46 (35.4%) in the group B, and 14 (16.5%) in the group C . Patients in the group A showed the highest rate of cavitary lesions . 4) Number of patients receiving treatment less than 12 months were 73 (53.3%) in the group A, 92 (85.2%) in the group B, and 47 (73.5%) in the group C, respectively . 5) 317 patients (83.6%) were omitted during 5 years of period from registration although 62 (16.4%) were still under registration even after 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Gastroenterol, 1991 Oct, 86(10), 1535 - 8
Phlegmonous enteritis in alcoholic fatty liver; Ito M et al.; Phlegmonous enteritis is a rare inflammatory bowel disease . A 52-yr-old man with a history of alcoholic abuse was admitted to the hospital for an acute abdomen and died of septicemia and its complications . Autopsy revealed phlegmonous inflammation of the ileum and severe fatty liver . Numerous Gram-negative rod bacilli were demonstrated in the ileal mucosa . Shortened villi and decreased lysozyme activity of Paneth cells in the small intestine might be results of chronic alcohol ingestion . The relationship between phlegmonous enteritis and alcoholic abuse was strongly suggested in this case.

J Exp Med, 1991 Oct 1, 174(4), 881 - 9
Ammonium chloride, an inhibitor of phagosome-lysosome fusion in macrophages, concurrently induces phagosome-endosome fusion, and opens a novel pathway: studies of a pathogenic mycobacterium and a nonpathogenic yeast; Hart PD et al.; The weak base ammonium chloride has been previously reported to inhibit lysosomal movements and phagosome-lysosome (Ph-L) fusion in cultured mouse macrophages (M phi), thus reducing delivery, to an intraphagosomal infection, of endocytosed solutes that have concentrated in secondary lysosomes . We have now addressed the question, whether NH4Cl might affect any direct interaction (if it exists) between such infection phagosomes and earlier, nonlysosomal compartments of the endocytic pathway, i.e., solute-containing endosomes . The phagosomes studied were formed after ingestion of the mouse pathogen Mycobacterium microti and the nonpathogenic yeast Saccharomyces cerevisiae; and the endosomes were formed after nonreceptor-mediated endocytosis of electronopaque and fluorescent soluble markers . By electron microscopy, survey of the cell profiles of M phi that had been treated with 10 mM NH4Cl so that Ph-L fusion was prevented, and that displayed many ferritin-labeled endosomes, revealed numerous examples of the fusion of electronlucent endosomes, revealed numerous examples of the fusion of electronlucent vesicles with phagosomes, whether containing M . microti bacilli or S . cerevisiae yeasts . Fusion was recognized by transfer of label and by morphological evidence of fusion in progress . The fusing vesicles were classed as endosomes, not NH4Cl-lysosomes, by their appearance and provenance, and because lysosome participation was excluded by the concurrent, NH4Cl-caused block of Ph-L fusion and associated lysosomal stasis . No evidence of such phagosome-endosome (Ph-E) fusion was observed in profiles from M phi treated with chloroquine, nor in those from normal, untreated M phi . NH4Cl-treated living M phi that had ingested yeasts at 37 degrees C, followed by endocytosis of lucifer yellow at 17 degrees C (to accumulate labeled endosomes and postpone label passing to lysosomes), were then restored to 37 degrees C . Fluorescence microscopy showed that as many as half of the yeast phagosomes (previously unlabeled) rapidly became colored . We inferred that this transfer was from endosomes (by Ph-E fusion) because Ph-L passage was blocked (by the NH4Cl) . We conclude that NH4Cl induces Ph-E fusion at the same time as it suppressed Ph-L fusion . We discuss the mechanisms of these concurrent effects and suggest that they are independent; and we consider the implications of NH4Cl opening a direct route for endocytosed molecules to reach an intraphagosomal infection without involving lysosomes.

Infect Immun, 1991 Oct, 59(10), 3639 - 45
Preservation of monocyte effector functions against Mycobacterium avium-M . intracellulare in patients with AIDS; Johnson JL et al.; Mycobacterium avium-M . intracellulare is a frequent cause of late disseminated infection in patients with AIDS . The ability of human peripheral blood monocytes to phagocytose and kill M . avium was examined in an in vitro model . Monocytes were obtained from 13 healthy volunteers and 11 patients with AIDS, three of whom had documented disseminated M . avium infection . Monocytes were precultured for 2 days before infection with two AIDS-associated and two non-AIDS-associated strains of M . avium . Uptake of M . avium as measured by counting intracellular acid-fast bacilli did not differ among healthy subjects, patients with AIDS, or patients with AIDS and previously documented disseminated M . avium infection . Intracellular growth of M . avium was examined by a CFU assay of cell lysates from M . avium-infected monocytes after 0, 4, and 7 days of culture . Intracellular growth inhibition of M . avium at 7 days after infection was comparable between patients with AIDS and healthy donors for all M . avium strains tested . The effects of the addition of recombinant gamma interferon on M . avium uptake and intracellular growth in monocytes also were studied . Pretreatment of monocytes with gamma interferon prior to infection suppressed monocyte phagocytosis of M . avium . Continuously coculturing of monocytes with gamma interferon after infection augmented killing of M . avium among both patients with AIDS and healthy controls for three of the four strains of M . avium tested . The magnitude of this effect, however, was variable from donor to donor and strain to strain . No significant differences were noted between the growth-inhibiting abilities of gamma-interferon-treated monocytes obtained from healthy volunteers and those obtained from patients with AIDS.

Zhonghua Jie He He Hu Xi Za Zhi, 1991 Oct, 14(5), 292 - 4, 320
{The effect of silicon on the tuberculous infection and immune system}; Shen FZ; Our study showed that silicon not only injured cell membrane, cytoplasm and nucleus membrane, but also inhibited the activity of succinic dehydrogenase in monocytes and lung tissue . In such condition, the tubercle bacilli became easier to grow . The tuberculous infection was worse in guinea-pigs infused with silicon . Guinea-pigs immunized by dead BCG or non-toxic tubercle bacillus H37 Ra strain were shown to have some effect against pulmonary tuberculosis.

Indian J Pathol Microbiol, 1991 Oct, 34(4), 280 - 7
Antimicrobial resistance among gram-negative bacilli to newer aminoglycosides and beta-lactams; Jain S et al.; Two hundred and fifty nine i.e . 30.72% of 843 strains of gram negative bacilli were resistant to gentamicin . When tested against newer aminoglycosides, 48.9% were resistant to tobramycin, 4.1% to amikacin and 20.5% to netilmicin . Marked cross-resistance between gentamicin and tobramycin was seen . All these strains were resistant to ampicillin, amoxycillin and co- trimoxazole . However, a high level of antimicrobial activity was seen with third generation cephalosporins, cefotaxime and ceftriaxone . Minimum inhibitory concentrations of gentamicin and tobramycin were of significant level . Gentamicin resistance could be transferred directly in 20 of 45 strains of S . typhimurium where conjugation experiments were done.

J Chemother, 1991 Oct, 3(5), 289 - 94
Antimicrobial activity of isepamicin (SCH21420, 1-N-HAPA gentamicin B) combinations with cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, imipenem, mezlocillin and piperacillin tested against gentamicin-resistant and susceptible gram-negative bacilli and enterococci; Jones RN et al.; Isepamicin, formerly SCH21420 or 1-N-HAPA gentamicin B, is an aminoglycoside that was tested alone or in combination with one of seven broad spectrum drugs against 80 clinical isolates . Half of the strains were gentamicin-resistant but only one isolate (1.3%) was resistant to isepamicin . The broadest spectrum comparison drugs tested alone (ciprofloxacin at 3.8% resistance and imipenem at 5.0% resistance) were associated with the lowest synergy rates when combined with isepamicin . The rank order of synergy (complete or partial) was; cefotaxime = ceftazidime = ceftriaxone = mezlocillin = piperacillin (75% to 80%) greater than imipenem (66%) greater than ciprofloxacin (38%) . Isepamicin/ampicillin combinations produced synergistic killing of those enterococci not having high-grade resistance to gentamicin or kanamycin . Enterococcus faecium strains were also refractory to isepamicin/ampicillin synergy . Isepamicin appears to be widely useable against gentamicin-resistant gram-negative bacilli either alone or combined with most commonly used broad spectrum beta-lactams.

Ala Med . 1991 Oct;61(4):8, 10.
Aquatic hazard Mycobacterium marinum infection; Harris LF et al.; We describe two patients with Mycobacterium marinum infection and review the pertinent literature . M . marinum infection follows trauma, often trivial, in water or from marine life . Clinical manifestations include superficial cutaneous lesions which are either solitary or multiple in a sporotrichoid distribution, involvement of the deeper structures of the hand and wrist and disseminated disease . Biopsy of infected tissue reveals a mixed suppurative-granulomatous reaction with sparse to absent acid-fast bacilli . Definitive diagnosis is achieved by growing the organism from appropriate specimens . Suggested therapeutic regimens consist of rifampin and ethambutol for advanced disease and infection invading the deeper structures of the hand and wrist and one of the tetracyclines or trimethoprim-sulfamethoxazole for early or minimal disease . Surgical debridement is advised when there is persistent pain, a discharging sinus or previous local injection of corticosteroids.

Epidemiol Infect, 1991 Oct, 107(2), 411 - 20
Relationship between cytomegalovirus and colonization of the oropharynx by gram-negative bacilli following renal transplantation; Mackowiak PA et al.; Numerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV) . To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after transplantation . Only 11% of subjects had Gram-negative bacilli isolated from gargle specimens prior to transplantation, as compared to 54% after transplantation . More importantly, after transplantation, subjects with active CMV infections were more likely to have prolonged oropharyngeal carriage of Gram-negative bacilli than subjects without CMV infections (36% v . 25%) . During active CMV infections, the rate at which Gram-negative bacilli were isolated from gargle specimens rose from 28 to 47% . During culture-positive CMV infections, the isolation rate reached 57% and was significantly different from that of CMV-negative samples (P less than 0.01) . The increased rate of Gram-negative bacillary isolation from gargle specimens during CMV infections was not a function of type of immunosuppressive agents used, rejection episodes, antibiotic administration, concomitant hepatitis B, Epstein-Barr (EBV) virus, or herpes simplex virus infections, or alterations in salivary fibronectin concentrations.

Schweiz Med Wochenschr, 1991 Sep 14, 121(37), 1340 - 4
{Mycobacterium marinum granuloma in a fish fancier . Apropos of a case with sporotrichoid lesions}; Borradori L et al.; A 43-year-old fish fancier with fish tank granuloma presented with a sporotrichoid-like skin infection of the right arm with multiple papulo-nodular lesions along the lymphatic drainage . Acid fast bacilli were found in skin biopsy specimens and Mycobacterium marinum grew in cultures . The clinical and histopathological findings in M . marinum infection are reviewed and the differential diagnosis, laboratory findings with this atypical mycobacterium, and therapeutic modalities are discussed . Finally, the importance of an adequate and pertinent patient's history for a correct and timely diagnosis is stressed.

Lancet, 1991 Sep 7, 338(8767), 604 - 5
Solving the weanling's dilemma: power-flour to fuel the gruel?
{Clinical studies on lung disease due to atypical mycobacteria in our hospital during the past 13 years}
Sakurai H, Watanabe Y, Yamanaka M, Moriguchi T, Kobayashi T, Koumo T, Uenoyama T, Moriya O, Nishimoto M.

Osaka Hospital, Japan Anti-tuberculosis AssociationAmong the patients with pulmonary diseases admitted to our hospital during a 13-year period from 1977 to 1989, clinical examinations and laboratory data on admission and the following clinical courses of 102 cases where atypical mycobacteria had been identified three times or more in sputum cultures at the time of hospitalization were investigated . 1 . The ratio of the number of cases positive for atypical mycobacteria to those positive for acidfast bacilli in sputum cultures tested on admission was fairly constant, 6.0 to 7.8% every year since 1981 . In the cases associated with positive sputum cultures for atypical mycobacteria, M . avium complex was observed in 84% of the cases: M . kansasii, M . fortuitum and M . chelonae were found in 13, 2 and 1 cases, respectively, since 1984 . 2 . A total of 102 cases studied consisted of 66 male and 36 female patients; the mean age was 61.9 years . 3 . Sputa became negative on culture in 19 (86.4%) out of 22 cases of primary infection . In all primary infection cases, roentgenographic findings did not worsen and prognosis was extremely good . In secondary infection cases, sputum cultures became negative in 25 (83.3%) out of 30 cases expectorating a small quantity of mycobacteria on admission, where x-ray findings worsened in only one case . In contrast, in 47 cases expectorating a large quantity of the bacilli at the time of admission, negative sputum cultures were attained in only 14 cases (29.8%) and x-ray findings worsened in 10 cases, and their prognosis were poor . 4 . In general, sputum cultures turned negative within 3 months after admission . If sputum cultures remained positive thereafter, it was found very difficult to stop expectoration of the bacilli in these patients, and hence their prognosis are supposed to be greatly affected by the bacteriologic findings in early stages of the disease.

Kekkaku, 1991 Sep, 66(9), 589 - 98
{Analysis of cellular and biochemical contents of broncho-alveolar lavage fluid from patients with pulmonary tuberculosis}; Fukushima K et al.; To evaluate the local immune response in lung and activity of pulmonary tuberculosis . Broncho-alveolar lavage (BAL) was performed on 15 patients with pulmonary tuberculosis . Patients consisted of nine in the active stage and six in the inactive stage . Acid-fast bacilli (AFB) in BAL fluid (BALF) were found in six out of nine active stage patients (BAL-AFB positive group) . The results obtained were as follows; 1) The number of total cells in BALF increased significantly in BAL-AFB positive group . BALF from two patients of this group, who were in the very early stage, revealed that the lymphocytes increased predominantly whereas neutrophils were dominant in BALF from the other four patients . 2) No case showed increase of B cells in BALF . Lymphocytes surface markers were compared between BAL-AFB positive and negative groups . No difference was found in the numbers of OKT3, OKT4 and OKT8 . The positive rates of OKIal, and OKT4/8 ratio were both increased in BALF compared to the BAL-AFB positive group . 3) The numbers of OKT4 and OKT4/8 ratio in peripheral blood, which were taken simultaneously with BAL, were decreased in patients in the active stage . 4) Protein, albumin, IgG, IgA, lysozyme and alpha 1-antitrypsin levels in BALF were all increased in tuberculous patients . No correlation between the activity of tuberculosis and levels of protein, albumin, IgG and IgA was observed . Lysozyme level increased in the inactive stage of patients . On the other hand alpha 1-antitrypsin level increased in the active stage . Fibronectin level in BALF from patients was lower than that from normal controls . 5) Smoking habit had no influence on the above results . 6) Only one case showed the appearance of new lesions after BAL procedure as a complication.

Infect Immun, 1991 Sep, 59(9), 3009 - 14
Live but not heat-killed mycobacteria cause rapid chemotaxis of large numbers of eosinophils in vivo and are ingested by the attracted granulocytes; Castro AG et al.; We studied leukocyte chemotaxis triggered by a local injection of mycobacteria (Mycobacterium avium and M . smegmatis) in BALB/c and C57BL/6 mice . Our experimental model consisted of the induction of a subcutaneous air pouch in the dorsal area of mice and inoculation 6 days later of 10(8) CFU of myocobacteria . Inflammatory exudates were harvested from the air pouch cavities 15, 30, and 45 min after the injection of the inocula . Injection of the microorganisms resulted in the migration of an elevated number of eosinophilic granulocytes into the inflammatory cavities . At 30 min after the inoculation of the mycobacteria, the air pouches contained between (3.9 +/- 0.3) x 10(5) (M . avium) and (3.3 +/- 0.3) x 10(5) (M . smegmatis) eosinophils, corresponding to more than one-third (41.4 to 38.3%) of the leukocytes present in the inflammatory cavities . Less than one-half of the eosinophils were attracted to the air pouches when the same number of heat-killed mycobacteria were inoculated {(1.3 +/- 0.2) x 10(5) cells for M . avium and (1.5 +/- 0.2) x 10(5) cells for M . smegmatis} . Injection of gram-negative bacteria (Escherichia coli), of latex beads, or of casein resulted in the attraction of inflammatory eosinophils in numbers that were comparable to those attracted by the heat-killed mycobacteria . Our data document the fact that live mycobacteria exert a rapid chemotactic effect on eosinophils . We therefore postulate that mycobacteria either contain or induce the production of an eosinophilotactic factor . Because this chemotactic effect occurs during the acute inflammatory response to mycobacteria, it cannot be due to the formation of immune complexes (a major infection-associated chemotactic factor for eosinophils) . The attracted eosinophils had an important role in the local phagocytosis of mycobacteria, as indicated by our finding, derived from thin-section electron microscopy quantifications, that at 30 min after M . avium inoculation the inflammatory exudates contained (2.2 +/- 0.5) x 10(5) mycobacterium-bearing eosinophils (corresponding to 57% of the total eosinophils), as compared with (2.1 +/- 0.1) x 10(5) neutrophils and (1.5 +/- 0.2) x 10(5) macrophages with ingested bacilli . We conclude that mycobacteria induce the attraction of eosinophils to inflammatory sites and that these granulocytes have the capacity to phagocytize these bacilli in situ.

J Leukoc Biol, 1991 Sep, 50(3), 263 - 72
Genetic resistance/susceptibility to mycobacteria: phenotypic expression in bone marrow derived macrophage lines; Radzioch D et al.; Congenic strains of mice susceptible (B10A.Bcgs) or resistant (B10A.Bcgr) to BCG were established . Here we describe the model system which has been established to analyze the functional activities of macrophages in the two strains . We have immortalized bone marrow macrophages from B10A.Bcgs and B10A.Bcgr congenic strains of mice and derived cloned macrophage lines designated B10S and B10R, respectively . B10R and B10S cell lines exhibited surface markers and morphology typical of macrophages . B10S and B10R were similar in their phagocytic activity, in their level of c-fms, in their transforming growth factor beta (TGF beta) mRNAs expression, and in their expression of tumoricidal activity in response to interferon-gamma (IFN gamma) plus lipopolysaccharides (LPS) . However, B10R macrophages expressed a higher level of la mRNA when activated with IFN gamma compared with B10S macrophages . Analysis of the bacteriostatic activity of the two cell lines revealed that B10R macrophages were much more active in inhibiting Mycobacterium smegmatis replication than B10S . To measure the intracellular destruction of bacilli, a bactericidal assay based on hybridization with an oligonucleotide probe specific for mycobacterial ribosomal RNA was designed . The results demonstrated that B10R macrophages were endowed with enhanced constitutive bactericidal activity as compared with B10S . In conclusion we have obtained macrophage lines from bone marrow of B10A.Bcgs and B10A.Bcgr mice that express to a similar extent functional and phenotypic characteristics of macrophages . However, we demonstrate that relative to B10S macrophages, the B10R macrophages have higher expression of la mRNA and that they are constitutively more active in expressing mycobactericidal activity.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Sep, (9), 32 - 5
{The reasons for false positive results with recombinant preparations in HIV infection}; Karal'nik BV et al.; Enzyme immunoassay (EIA) with the use of test systems based on recombinant HIV antigens has yielded positive results much more often than that with the test systems based on HIV lysate . In comparison with the use of protein A-peroxidase conjugate, the use of antiglobulin conjugates decreased the specificity of EIA, thus ruling out the false positive results . The tested sera containing antibodies to antigens of enteric bacilli could yield false positive EIA results with test systems prepared from recombinant antigens due to the interaction of these antibodies with antigens of enteric bacilli . A conclusion on the usefulness of the control for the presence of the components of enteric bacilli, producers of HIV antigen, and their elimination from recombinant preparations is made.

Eur J Clin Microbiol Infect Dis, 1991 Sep, 10(9), 749 - 52
Evaluation of a commercial automated system for the identification of gram-negative enteric bacilli; Limb DI et al.; A total of 908 distinct clinical isolates and 60 reference strains of aerobic gram-negative bacilli were identified by our own in-house biochemical identification system (RHH) and by a commercial automated system (Mastascan Colour) . Overall, both systems performed well in the identification of routine isolates of aerobic gram-negative bacilli, with only six discrepancies between the two systems . These six organisms were species infrequently encountered in the clinical microbiology laboratory . Of the 60 reference strains, many of which were biochemically atypical, the RHH system was unable to identify one and mis-identified two others . The commercial system was unable to identify one strain and misidentified five others . Both systems were inexpensive in terms of consumable materials, and the commercial system was compatible with the routine work of the department.

Lepr Rev, 1991 Sep, 62(3), 276 - 9
The susceptibility testing of 13 strains of Mycobacterium leprae to rifampicin and the determination of minimal effective dosage; Wang HY et al.; By use of the mouse footpad technique, the susceptibility testing of 13 strains of Mycobacterium leprae to rifampicin (RFP) and the determination of minimal effective dosage (MED) were carried out . Among these strains of M . leprae, 8 were obtained from previously untreated multibacillary leprosy patients and 5 from relapsed leprosy patients without using RFP previously . The results showed that the MED of all strains to RFP were less than or equal to 0.001% FRP in the diet, 5 strains being equal to 0.001%, 5 less than or equal to 0.0001%, 2 greater than or equal to 0.0003% and 1 less than or equal to 0.0003% . The results indicated that the MED value of RFP could be lower than that of other reports . Because the critical concentration of RFP for assessment of RFP-resistant strains is not well established a further study would be worthwhile . The results of the determination of sera RFP concentrations in mice administered the RFP diet were identical with that of Holmes' report . Five of the 13 strains also showed that the growth of bacilli were suppressed by 10 mg/kg RFP using the gavage method.

Indian J Exp Biol, 1991 Sep, 29(9), 845 - 8
Correlation between culture of Mycobacterium tuberculosis and antimycobacterial antibody in lumbar, ventricular and cisternal cerebrospinal fluids of patients with tuberculous meningitis; Radhakrishnan VV et al.; In this study positive culture for M . tuberculosis were obtained, 20% in lumbar cerebrospinal fluid (CSF), 75% in ventricular CSF and 87.5% in cisternal CSFs of patients with tuberculous meningitis . Low culture positivity in lumbar CSF is due to the low density of circulating tubercle bacilli in lumbar CSF than in cisternal or ventricular CSFs . However antimycobacterial antibody in lumbar, cisternal and ventricular CSFs circulate in significant titres and are not statistically different from one another . Since specimens of CSF can not be obtained from cisternal or ventricular routes for the routine bacteriological investigations in patients with tuberculous meningitis, detection of antimycobacterial antibody of M . tuberculosis antigen 5 in lumbar CSF by an indirect ELISA may be considered as an aid for the diagnosis of tuberculous meningitis, particularly when repeated CSF cultures are negative for M . tuberculosis.

J Dermatol, 1991 Sep, 18(9), 540 - 4
Squamous-cell carcinoma arising in solar keratosis of a leprosy patient: relationship with positive skin smear examination; Kikuchi I et al.; A 70-year-old Japanese female with lepromatous leprosy developed squamous-cell carcinoma within a long standing area showing solar keratoses on her head . Alopecia had been present at least for the preceding 34 years on her forehead and frontal area of the head, and solar keratoses had existed at least for the previous 9 years . Skin smear examination for acid-fast bacilli which had continually been negative for the previous 2 years (during which 8 examinations were done) became positive . We assume that there may be some relationship between the onset of the tumor and the positive skin smear examination, although the exact connection remains unclarified.

Indian J Cancer, 1991 Sep, 28(3), 155 - 61
Hairy cell leukaemia . A review of nine cases; Chudgar U et al.; Nine consecutive patients with HCL seen over a period of five years were reviewed . Male: Female ratio was 8:1 . Median age at diagnosis was 49 years . Weakness and fatigue (66%) were the commonest presenting symptoms and splenomegaly (66%) was the commonest physical findings . Varying degrees of pancytopenia was the consistent feature in majority of cases . Diagnosis was made on the basis of bone marrow biopsy and characteristic EM picture . Forty-four percent of cases developed serious infection during their clinical course . Gram negative bacilli and fungi were the most frequently isolated organisms . Major sites of infections were pneumonia and septicemia . Splenectomy was carried out in four cases . Rapid recovery of haematological parameters without any significant complication was observed in all these cases . Two patients were treated with alfa-interferon . In both the cases recovery of haematological parameters was slow compared to those under going splenectomy . One patient treated with alfa-interferon died due to infection related complications while the other went into remission.

Tubercle, 1991 Sep, 72(3), 223 - 31
A guinea pig model of experimental airborne tuberculosis for evaluation of the response to chemotherapy: the effect on bacilli in the initial phase of treatment; Smith DW et al.; The purpose of this study was to develop and evaluate a guinea pig model of experimental airborne tuberculosis for its ability to assess chemotherapeutic regimens for their efficacy against virulent tubercle bacilli in vivo during the initial phase of treatment . The tissues examined included primary lung lesions and the metastatic foci in lung and spleen which result from the naturally occurring bacillaemia . The treatments examined, INH + RIF, INH + EMB, EMB + RIF, were initiated 4 weeks after infection and were continued for 8 weeks . Although minor differences were observed in the time of onset of a significant bactericidal effect or in the rate of decline in the microbial population, all three treatment combinations resulted in a significant reduction in the number of M . tuberculosis H37Rv recovered from primary lung lesions, primary lesion-free lung lobes and spleen . X-rays taken of excised inflated lung lobes showed a relationship between the degree of calcification of primary lung lesions and the number of surviving bacilli.

Tubercle, 1991 Sep, 72(3), 161 - 7
An immunogenetic view of delayed type hypersensitivity; De Vries RR; This review, the third in the series on cellular immune reactivity to tubercle bacilli in the centenary year of Koch's classical paper describing this phenomenon and its possible implications, represents an immunogenetic point of view . In fact this will be quite a broad point of view by an immunogeneticist who is not hampered by specific knowledge on therapy or prevention of tuberculosis . In this respect I probably do not differ very much from Robert Koch 100 years ago! An important difference, however, is that we think we now understand a great deal of the cellular and molecular basis of the immunological phenomena observed by Koch . Immunogenetics has contributed considerably to our current understanding and I will try to review that contribution here . Because thus far my main research interest has been in another mycobacterium, namely Mycobacterium leprae, I will use M . leprae and leprosy as an example to illustrate some ideas . The message of this review is that there is a reason for optimism: the knowledge recently gained by cellular and molecular immunologists as well as immunogeneticists has straightforward implications for the rational development of subunit vaccines and immunotherapeutic strategies.

Lepr Rev, 1991 Sep, 62(3), 310 - 4
Fluorescein diacetate and ethidium bromide staining to determine the viability of Mycobacterium smegmatis and Escherichia coli; Jayapal V et al.; The ability of the fluorescein diacetate and ethidium bromide fluorescent staining method to assess the percentage of viable bacterial cells in suspension was compared with the plate counting method . Mycobacterium smegmatis and Escherichia coli bacterial cell suspensions were incubated at 60 degrees C . At different time intervals samples were taken and the percentage of viable cells in each sample was assessed by the fluorescent staining method and compared with the plate counting method . The fluorescent staining method showed a positive correlation with the plate counting method . However, the viable counts by the plate counting method were lower than the staining method when incubated at 60 degrees C, indicating a lag period in the decay of enzymes after bacterial death . Hence, the fluorescent staining technique can be used to assess the trend of bacterial death rather than to assess to exact number of viable bacilli.

Lepr Rev, 1991 Sep, 62(3), 280 - 7
The activity of rifabutin against Mycobacterium leprae; Yoder LJ et al.; Minimal effective doses of rifabutin and rifampicin were determined in Mycobacterium leprae isolated from skin biopsies of newly diagnosed, previously untreated lepromatous leprosy patients . Rifabutin was more potent than rifampicin . Our previous report that rifabutin was fully active against rifampicin-resistant M . leprae could not be confirmed . Examination of two strains of rifampicin-resistant M . leprae from elsewhere, and a repeat experiment on our original strain of rifampicin-resistant bacilli, showed full cross-resistance between rifampicin and rifabutin . A clinical trial in three newly diagnosed, previously untreated lepromatous patients showed that rifabutin has rapid bactericidal activity.

Tubercle, 1991 Sep, 72(3), 168 - 75
Rifabutin in combination with clofazimine, isoniazid and ethambutol in the treatment of AIDS patients with infections due to opportunist mycobacteria . Groupe d'Etude et de Traitement des Infections à Mycobacteries Résistantes; Dautzenberg B et al.; 96 AIDS patients with fever and either acid-fast bacilli on microscopic examination of bacteriological samples or mycobacteria isolated by culture were treated with a daily 4-drug combination of 7-10 mg/kg rifabutin, 5 mg/kg isoniazid, 20 mg/kg ethambutol and 100 mg clofazimine . 46 patients were excluded from efficacy assessment: 13 died before or within the first days of treatment, 5 had negative initial cultures, 14 had initial cultures positive for M . tuberculosis, 4 for M . kansasii, 1 for M . flavescens, 1 for M . gordonae, 7 were lost to follow-up and 1 received no rifabutin . In the 50 remaining patients, 31 had disseminated disease due to M . avium intracellulare complex (MAIC) and 19 had apparently localised disease, due to MAIC in 15 cases and to M . xenopi in 4 cases . Side-effects led to withdrawal of isoniazid in 1 case (hepatic enzymes increased) and rifabutin in another (thrombocytopenia) . After 1 month of treatment, fever decreased from 38.4 +/- 0.6 degrees C to 37.7 +/- 0.5 degrees C (p less than 0.01) and patients stopped losing weight . After 3 months treatment, only 37 patients were alive and still under treatment . Cultures became negative in 16 of 23 patients with available bacteriological data (9 of 14 patients with disseminated disease and 7 of 9 patients with localised disease), relapse occurred before death in 4 patients . 34 patients died before treatment was completed . Death was considered to be related to mycobacterial infection in 5 cases . We conclude that the 4-drug combination is safe and, in some cases, it appears to be effective.

Am J Med, 1991 Aug 8, 91(2A), 132S - 134S
Failure of infection control in intensive care units: can sucralfate improve the situation?
Weinstein RA.
Conventional infection control measures in intensive care units (ICUs) are aimed primarily at stemming cross-infections . The role of patients' endogenous flora in the pathogenesis of nosocomial infection and occasional lapses in aseptic technique in ICUs help to explain the frequent failure of the conventional approaches . Newer control strategies include avoiding gastric and oropharyngeal overgrowth of gram-negative bacilli by using sucralfate to avoid gastric alkalinization and/or suppressing nosocomial flora by use of topical antimicrobials.

FEMS Microbiol Immunol, 1991 Aug, 3(4), 201 - 4
Rapid serodiagnosis of human mycobacteriosis by ELISA using cord factor (trehalose-6,6'-dimycolate) purified from Mycobacterium tuberculosis as antigen; He H et al.; IgG antibodies against purified cord factor (trehalose-6,6'-dimycolate, TDM) in sera of 99 patients infected with mycobacteria (42 patients with tuberculosis excreting tubercle bacilli in the sputum, 11 patients with non-tuberculous mycobacteriosis excreting acid-fast bacilli in the sputum, and 46 patients without bacilli in the sputum but diagnosed as having pulmonary tuberculosis by chest X-ray films and physical examination), five patients with lung cancer, and 100 healthy controls which included subjects positive and negative for the tuberculin test were tested by the ELISA with TDM purified from Mycobacterium tuberculosis H37Rv as the antigen . Of the 99 cases of mycobacteriosis, 83 patients (83.8%) had positive results (48 samples from 53 patients, or 90.5%, with bacilli in the sputum, and 35 samples from 46 patients (76%) with tuberculosis diagnosed clinically) . The sera of the five patients with lung cancer and the 100 controls all gave negative results . Thus, the sensitivity and specificity were 83.8% and 100%, respectively . ELISA with TDM as the antigen is simple, reproducible, and useful for the rapid serodiagnosis of general mycobacterial infections including tuberculosis, because it does not involve the cultivation of bacteria.

Kekkaku, 1991 Aug, 66(8), 517 - 23
{The incidence of pulmonary tuberculosis in an urban area}; Uematsu A et al.; The incidence and prevalence of pulmonary tuberculosis has declined steadily in Japan, but the trends differ greatly by area according to epidemiological status . We studied the incidence and trends of pulmonary tuberculosis in an urban area (population approx . 150,000) during the period of 1979-1988 . The area studied is a part of a large commercial city, characterized as having the most prevalent rate of tuberculosis area in that city . Of 1245 newly registered cases, 80% were over 40 years of age . While the incidence rate decreased to 57% in the last 10 years in this area, compared to 69% decrease for all of Japan, it was still considerably higher than the national average . Especially in the 20-59 age group it continued to be 2 times higher than that of the whole of Japan . Moreover, the positive rate of tubercle bacilli at the time of registration had increased remarkably from 27% in 1979 to 62% in 1988 . These results suggest the tuberculosis continues to be a significant problem in this urban area, although the steady decline in the incidence of tuberculosis had led to a lack of awareness of this disease.

Kekkaku, 1991 Aug, 66(8), 511 - 6
{Active bronchial tuberculosis--a clinical study on 36 cases}; Rikimaru T et al.; A total of 36 patients (16 male and 20 female) with tracheobronchial tuberculosis were admitted during the last nine years and were evaluated for their clinical features . The chief complaint in three quarters of the patients was intractable cough, in particular, in those with tracheal tuberculosis . One of three patients who suffered from wheezing was prescribed steroid, being diagnosed as having bronchial asthma instead of tuberculosis . Plain chest X-rays of two patients revealed no abnormality . Pleural effusion was observed in three patients, and miliary tuberculosis in two patients . Bronchial biopsy was carried out in 23 patients, however, in only 11 patients a histopathological diagnosis of tracheobronchial tuberculosis could be made . In contrast, in all 36 patients smear and/or culture for tubercle bacilli were positive . Therefore, bronchial biopsy was considered not to be essential in making a definite diagnosis of bronchial tuberculosis, although it did not exacerbate the lesion to lead to endobronchial stenosis . Only seven out of 36 patients were in the habit of smoking but three of the four had already broken the habit at least one year before being diagnosed as having the disease . The remaining four patients were still smoking but less than 10 cigarettes a day, with one exceptional patient who was smoking 30 cigarettes on average a day . It has been well known that there is a sexual difference in the incidence of bronchial tuberculosis, namely among females with relatively low population of smokers, the incidence is high . Another probable reason for the higher female incidence is assumed to be due to the structural susceptibility of the bronchus with smaller diameter lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Intern Med, 1991 Aug, 151(8), 1581 - 3
The value of roentgenographic and fiberbronchoscopic findings in predicting outcome of adults with lower lung field tuberculosis; Chang SC et al.; Proper antituberculosis chemotherapy may not prevent occurrence or progression of endobronchial involvement in patients with pulmonary tuberculosis . We previously reported a higher incidence of endobronchial involvement in adults with lower lung field tuberculosis (LLFTB) . We evaluated the value of roentgenographic and fiberbronchoscopic findings in predicting the outcome of adults with LLFTB after 9 months of antituberculosis chemotherapy . The most common change on chest roentgenograms among 101 patients with LLFTB was consolidation, followed by cavitary lesion, lung collapse, and solitary mass . Intrathoracic lymphadenopathy (hilar and/or mediastinal lymphadenopathy) was found in 12 cases . Sputum smear for acid-fast bacilli was positive in 64 patients, and sputum culture for tuberculous bacilli was positive in 37 of 50 patients . Endobronchial involvement was found in 45 of 63 patients who underwent fiberbronchoscopic examination . Of these 45, 18 had ulcerative granuloma, 12 had fibrostenosis, eight had submucosal infiltration, and seven had mucosal redness and swelling . A higher incidence of endobronchial involvement was found in the patients with LLFTB when they presented with roentgenographic findings of pulmonary consolidation, lung collapse, or associated intrathoracic lymphadenopathy . The outcome seemed unfavorable in the patients with LLFTB who presented with roentgenographic findings of lung collapse or pulmonary consolidation, or in those who presented with fiberbronchoscopic findings of fibrostenosis or ulcerative granuloma . Our results show that roentgenographic and fiberbronchoscopic findings are of value in predicting outcome of patients with LLFTB . With proper antituberculosis chemotherapy and close follow-up, fiberbronchoscopy may be clinically indicated in patients with LLFTB to assess the presence and severity of endobronchial involvement . Early surgical intervention can be considered in those with severe endobronchial involvement before serious sequelae occur.

Clin Exp Immunol, 1991 Aug, 85(2), 214 - 8
Immunophenotypic analysis of histiocytes involved in AIDS-associated Mycobacterium scrofulaceum infection: similarities with lepromatous lepra; Delabie J et al.; The present study reports a rare case of systemic M . scrofulaceum infection in an AIDS patient and analyses the inflammatory infiltrate in a lymph node by immunohistochemistry . Special emphasis is put on the histiocytes . The diffuse infiltrate consists mainly of large histiocytes that contain numerous bacilli . These cells display the phenotype of mature histiocytes and in addition coexpress the antigens recognized by RFD7 and RFD9, both markers of different subsets of histiocytes which have been reported to be co-expressed by the infected histiocytes in the infiltrate of lepromatous lepra . Interdigitating reticulum cells are rare as well as T cells which are mainly of the suppressor/cytotoxic type . These findings are similar to those reported for lepromatous lepra and might indicate common deficiencies in T cell-macrophage interactions in both conditions . Superimposed on the diffuse infiltrate of large histiocytes we observed 'monocytic granulomas', the presence of which might be related to a reactional state comparable to erythema nodosum leprosum, a reactional state of lepromatous lepra.

Zhonghua Nei Ke Za Zhi, 1991 Aug, 30(8), 487 - 8, 521
{Etiological diagnoses in 53 cases of pneumonia}; Zhong CY et al.; Secretion was taken from lower respiratory tract for bacterial culture using Japanese made single-sheath catheter brush (SSC) via fiberoptic bronchoscopy in 53 cases with community acquired pneumonia and 16 control cases without pulmonary infection . The results showed that bacteria were isolated in 42 out of the 53 patients, the organisms being pathogenic in 39 out of the 53 (73.5%) . Among the bacteria isolated from the 42 cases, gram-negative bacilli accounted for the highest rate of 36% and pneumococcus the next of 31% . There were only 3 cases yielding contamination . It is shown that SSC technique has less chance of contamination and is convenient and practical.

Indian J Biochem Biophys, 1991 Aug, 28(4), 243 - 6
Cloned single copy DNA sequences of Mycobacterium tuberculosis as DNA probes; Reddi PP et al.; A recombinant genomic clone was isolated from a lambda gt 11 library of M . tuberculosis on the basis of lack of hybridization with M . avium and M . kansasi . The specificity and sensitivity of M . tb DNA probes, 2.5 and 2.3 kb in size, were assessed by Southern blot and dot blot hybridization . These did not cross hybridize to DNA of mycobacteria other than members of M . tb complex, nor with DNA of non mycobacterial origin . Sensitivity was determined to be 200 pg which is equivalent to 10(4) bacilli . Genomic Southern hybridization indicated single copy nature of the probes.

Curr Opin Rheumatol, 1991 Aug, 3(4), 597 - 600
Whipple's disease, familial Mediterranean fever, and adult-onset Still's disease; McMenemy A; Whipple's disease is a multisystem disorder thought to be caused by infection by rod-shaped bacilli . Early diagnosis remains difficult, because initial clinical features are nonspecific . Ultrasonography and computed tomographic scanning were used to demonstrate distinctive lymphadenopathy in Whipple's disease . Magnetic resonance imaging showed central nervous system lesions that were reversible with antibiotic therapy . Familial Mediterranean fever, or recurrent polyserositis, is an autosomal recessive disorder common among patients of Mediterranean heritage . Erysipelas-like skin lesions are commonly described . Other skin lesions, including Schonlein-Henoch purpura, nonspecific purpura, diffuse erythema, and angioneurotic edema are now reported . Renal complications, thought previously to be due primarily to amyloid, are also caused by immunoglobulin deposition resulting in mesangial proliferative glomerulonephritis . Adult-onset Still's disease is a systemic illness characterized by quotidian fever and a fleeting, salmon-colored rash . The long-term evolutions of juvenile-onset and adult-onset Still's disease were compared and found to be similar, except for the occurrence of amyloidosis in the latter group of patients . Prognosis of patients with articular features was worse than that of patients with extra-articular features . A multicenter survey of Japanese patients found few significant differences between Japanese and non-Japanese cases . Less well-recognized features of adult-onset Still's disease, including neurologic complications, uveitis, and peritonitis, are reported.

Zhonghua Yi Xue Za Zhi (Taipei), 1991 Aug, 48(2), 153 - 7
Atypical presentations of tuberculous meningitis--a case report; Wang PY et al.; A case of tuberculous meningitis, proved by cerebrospinal fluid (CSF) cultures, is reported due to atypical findings in CSF . This 19-year-old man developed subacute headache and fever for 2 weeks, followed by focal seizure and left hemiparesis . Initial CSF study showed hemorrhagic lymphocytic pleocytosis with mildly elevated protein and normal sugar content, mimicking viral or postinfectious meningoencephalitis . Follow-up CSF studies showed polymorphonuclear pleocytosis . A concomitant bacterial meningoencephalitis was suspected, though repeated CSF cultures did not isolate any bacteria . The activity of adenosine deaminase in CSF was 12 U/L, highly suggestive of tuberculous meningitis . Magnetic resonance imaging (MRI) showed only a focal meningoencephalitis in the right lateral frontal cortex . Due to progressive deterioration of the clinical status, umbrella therapy, including antimycobacterial drugs and strong antibiotics were given . At a later time, growth of tubercle bacilli was reported in the CSF cultures . Follow-up study of MRI 4 months later, showed thick abnormal enhancement in the basal cisterns and obstructive hydrocephalus, typical findings of chronic basal meningitis.

DICP, 1991 Jul-Aug, 25(7-8), 784 - 90
E5 monoclonal immunoglobulin M antibody for the treatment of gram-negative sepsis; Olsen KM et al.; Despite the advent of aminoglycoside and beta-lactam antibiotics and early antimicrobial intervention, overall morbidity and mortality associated with gram-negative sepsis and bacteremia remain high . Complications of sepsis have been related to the release of endotoxin from the cell walls of gram-negative bacilli . Although antibiotics can effectively kill gram-negative bacteria, they have no effect on lipopolysaccharide lipopolysaccharide (LPS) and may, in fact, enhance its release when cell lysis occurs . Lipid A, the lipid portion of LPS, is composed of glucosamines, polar phosphate groups, and fatty acids . It represents the endotoxic component of gram-negative bacteria and is responsible for host responses to LPS, including fever, hypotension, and shock . E5 is a murine monoclonal immunoglobulin M antibody directed against the lipid A portion of the cell-wall endotoxin that is common to clinically important gram-negative bacilli . A clinical evaluation program of E5 included patients who were moderately to severely ill with clinical evidence of an infection usually caused by gram-negative bacteria . In pharmacokinetic and safety studies, laboratory tests revealed no evidence of antibody-mediated toxicity and serum antibody concentrations in the desired therapeutic range (greater than 5 microgramS/mL) were found as late as 72 hours after initial infusion of E5 . In a Phase II study, mortality rates at seven days in patients with documented gram-negative infection were 22 percent in the placebo group compared with 7 percent in the E5-treated groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunol Today, 1991 Jul, 12(7), 228 - 33
Delayed-type hypersensitivity and cell-mediated immunity in the pathogenesis of tuberculosis; Dannenberg AM Jr; It is widely believed that cell-mediated immunity and the associated ability of macrophages to destroy or inhibit the bacillus are all that is required to control pulmonary tuberculosis . However, although cell-mediated immunity is a major host defense against the tubercle bacillus, it is fully effective only in one of the four stages of the disease . Here, Arthur Dannenberg describes the entire pathogenesis of tuberculosis, with illustrations from the rabbit model of M.B . Lurie . In addition, he documents that the delayed-type hypersensitivity reaction (producing tissue necrosis) greatly benefits the host by arresting the logarithmic growth of bacilli within immature macrophages.

JAMA, 1991 Jul 3, 266(1), 99 - 103
Tuberculous pericarditis; Fowler NO; Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade, and, in older studies, 6% of instances of constrictive pericarditis . However, in some nonindustrialized countries, tuberculosis is a leading cause of pericarditis . The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis . Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol) . Pyrazinamide can be used for the first 2 months, and the total therapeutic period can then be shortened to 6 months after culture conversion . Three months of corticosteroid therapy may be useful in patients in whom pericardial effusion persists or recurs despite the use of antituberculous drugs . Surgical resection of the pericardium is indicated for recurrent or life-threatening tamponade, or when there is persistent elevation of systemic venous pressure unrelieved by pericardiocentesis . As many as one third to one half of patients will eventually require pericardiectomy despite adequate drug therapy.

J Trauma, 1991 Jul, 31(7), 907 - 12; discussion 912-4
Pneumonia: incidence, risk factors, and outcome in injured patients; Rodriguez JL et al.; One hundred thirty (44.2%) of 294 patients hospitalized for trauma and admitted to the Surgical Intensive Care Unit for mechanical ventilation developed hospital-acquired bacterial pneumonia . The predominant pathogens isolated were gram-negative enteric bacilli (72%), but there was not an increase in mortality associated with gram-negative pneumonia compared with similar patients without pneumonia . Of the seven admission risk factors univariately associated with the development of acquired bacterial pneumonia, only emergent intubation (p less than 0.001), head injury (p less than 0.001), hypotension on admission (p less than 0.001), blunt trauma as the mechanism of injury (p less than 0.001), and Injury Severity Score (p less than 0.001) remained significant after stepwise logistic regression . Not surprisingly, as mechanical ventilation is continued, the probability of pneumonia emerging increases . The consequences of hospital-acquired bacterial pneumonia are a significant seven-, five-, and two-fold increase in mechanically ventilated days, intensive care, and hospital stay, respectively . We conclude that the incidence of hospital-acquired pneumonia in injured patients admitted to the ICU for mechanical ventilation occurs in nearly half the patients, is associated with specific risk factors, and significantly increases morbidity but does not increase mortality.

Chest, 1991 Jul, 100(1), 124 - 7
Chronic tuberculous empyema with bronchopleural fistula resulting in treatment failure and progressive drug resistance; Iseman MD et al.; We treated five patients with a past history of tuberculous pleural infection that led to chronic, quiescent, loculated empyema . Reactivation of TB was associated with formation of BPF and recovery of drug-susceptible Mycobacterium tuberculosis from sputum . All patients had recurrence of positive sputum cultures that yielded tubercle bacilli resistant to drugs they were receiving . The lungs demonstrated gross thickening with calcification of both visceral and parietal pleura . Two patients underwent retreatment chemotherapy followed by decortication-empyemectomy and lung resection surgery; both are now culture-negative for TB . One patient received retreatment chemotherapy but refused surgery; he remains clinically stable with negative sputum cultures . Two other patients' organisms became drug-resistant and they remain sputum-culture positive . We believe that thick, calcified pleural walls limit penetration of drugs into the infected empyema space, resulting in suboptimal drug concentrations and drug resistance . Intensified chemotherapy and surgical intervention should be considered in these cases.

Ann Intern Med, 1991 Jul 1, 115(1), 7 - 12
Prevention of bacterial infection in neutropenic patients with hematologic malignancies . A randomized, multicenter trial comparing norfloxacin with ciprofloxacin . The GIMEMA Infection Program . Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto; Mechanisms of interaction among subinhibitory concentrations of antibiotics et al.; Department of Medicine, McMaster University, Henderson General Hospital, Hamilton, Ontario, CanadaOur hypothesis was that pretreatment of bacteria with subinhibitory concentrations (sub-MICs) of antibiotics enhances the susceptibility of the organisms to killing by human polymorphonuclear neutrophils (PMNs) . Our purpose was to study a variety of drugs with different mechanisms of action and to determine whether the mechanism and locus of action altered the sub-MIC effect . The following outcome measures were used: ingestion and killing of bacteria by PMNs, bacterial killing in the absence of phagosome formation, and binding requirements of the bacteria to PMNs . The antibiotics used were representative of a variety of classes, including beta-lactams (piperacillin and imipenem) and quinolones (ciprofloxacin) . Bacterial uptake and killing were measured by using standard techniques, and results were analyzed by using the analysis-of-variance technique and Dunnett's t test . Pretreatment of Escherichia coli with all drugs showed significantly enhanced killing of bacteria by PMNs, which was independent of ingestion by the phagocytes . Even in the absence of phagosome formation, statistically significant killing persisted with piperacillin-pretreated bacteria but not with imipenem- or ciprofloxacin-pretreated organisms . The opsonization experiments showed that contact between bacteria and PMNs was necessary for killing to occur . The sub-MIC effect appears to be independent of the locus or mechanism of action of the antibiotic . It results in enhanced killing by PMNs which is independent of ingestion and also may persist even in the absence of phagosome formation . Killing is dependent upon specific contact between bacteria and an intact phagocyte.

Rev Infect Dis, 1991 Jul-Aug, 13 Suppl 9, S743 - 51
Nosocomial pneumonia: pathogenesis and recent advances in diagnosis and therapy; Scheld WM et al.; Despite recent progress in the prevention and treatment of hospital-acquired infections, nosocomial pneumonia remains an important problem among critically ill patients . Nosocomial pneumonia develops in five to 10 patients per 1,000 admissions and has a mortality rate of 20%-50% . This review focuses on three areas of nosocomial pneumonia that have been the subject of investigation in recent years: (1) pathogenesis, especially the role of gastric colonization with gram-negative bacilli in retrograde pharyngeal spread; (2) diagnosis, particularly by means of bronchoalveolar lavage and the protected specimen brush during bronchoscopy; and (3) therapy with extended-spectrum penicillins, third-generation cephalosporins, imipenem, aztreonam, and quinolones.

Rev Infect Dis, 1991 Jul-Aug, 13(4), 587 - 91
Infections associated with biliary drainage procedures in patients with cancer; Khardori N et al.; A total of 170 therapeutic biliary drainage procedures were carried out in 90 patients with cancer over a 1-year period (January-December 1988) . There were 129 percutaneous transhepatic biliary drainage procedures done in 61 patients and 41 endoprostheses were placed in 29 patients . The overall infection rate related to these procedures was 60.6%, the rate being similar for the two procedures . Infectious complications were experienced by 50% of patients undergoing a biliary drainage procedure . The most common manifestation was cholangitis followed by bacteremia . Other infections included liver abscess, gallbladder abscess, and subphrenic abscess . The most common isolates were enteric gram-negative bacilli, followed by Enterococcus species, Candida species, and Staphylococcus epidermidis . The use of prophylactic antibiotics in 76% of infected patients failed to prevent biliary catheter-related infections . Two patients died of complications related to biliary sepsis . All other infected patients responded to antimicrobial therapy, which included various regimens of beta-lactam agents (third-generation cephalosporin, extended-spectrum penicillin, imipenem-cilastatin, and aztreonam) that were used in combination with an aminoglycoside in 15 patients.

Rev Infect Dis, 1991 Jul-Aug, 13(4), 583 - 6
Infectious complications of hepatic artery catheterization procedures in patients with cancer; Wong E et al.; A total of 353 hepatic artery catheterization procedures were carried out in 211 patients with cancer over a 1-year period (January-December 1988) . The procedures included 49 embolizations in 32 patients, 123 chemoembolizations in 73 patients, and 181 chemoinfusions in 106 patients . The overall infection rate was 3.4% . Infectious complications occurred in 3.1% of patients undergoing hepatic artery embolization alone, 1.9% of patients undergoing hepatic artery chemoinfusion, and 4.1% of patients undergoing hepatic artery embolization followed by chemoinfusion . Four patients had infectious complications that included four episodes each of cholangitis, liver abscess, and septicemia . One patient developed a subphrenic abscess in addition to a liver abscess . Enteric gram-negative bacilli (aerobic and anaerobic) were isolated from all four patients . None of the patients had received prophylactic antibiotics . All patients responded to antimicrobial therapy and percutaneous drainage of abscesses.

Microbiologica, 1991 Jul, 14(3), 261 - 5
Preliminary evaluation of sensititre system for identifying gram-negative bacilli; Mucignat G et al.; The automated microdilution Sensititre System (Sensititre, LtD.) was evaluated for the identification of 120 clinically isolated fermenter and non-fermenter Gram negative bacilli and of 12 ATCC reference strains (American Type Culture Collection) . Daily and overnight (5 and 18 hours) identifications were performed according to the manufacturer . In both cases, the results were compared with those obtained with the overnight API 20E (API System, La Balme les Grottes, Montalieu Vercieu) used as reference method . Concordance between the results obtained after 5 hrs of incubation and those obtained with API 20E was found in 65% of cases (acceptable identification criteria with probability over 80%) . When results were determined after 18 hrs of incubation (identification criteria with probably over 80%) concordance was found in 82.5% . Reproducibility obtained by repeated (10 times) identification with four different strains was 100% both at 5 hrs and 18 hrs . Identification accuracy of the 12 ATCC strains was 8/12 (66.6%) after 5 hrs and 12/12 (100%) after 18 hrs.

J Laryngol Otol, 1991 Jul, 105(7), 558 - 61
Source of tubercle bacilli in cervical lymph nodes: a prospective study; Lau SK et al.; A prospective study searching for associated mycobacterial infection of the upper aerodigestive tract in patients with cervical tuberculous lymphadenitis (TBLN) was carried out . One hundred and thirteen patients with a clinical suspicion of cervical TBLN were included . All patients had a physical examination of the upper aerodigestive tract . Routine endoscopy and biopsy of the nasopharynx were performed . All of them had surgery to the cervical lymph node . Seventy-five patients had histologically confirmed cervical TBLN . Culture of the lymph node specimen showed Mycobacterium tuberculosis in 68 (90 per cent) . In 45 (60 per cent) patients with cervical TBLN the primary foci of infection could not be found . Twenty-nine (39 per cent) had radiographic evidence of active or healed pulmonary tuberculosis . Sputum culture from two patients showed Mycobacterium tuberculosis . Five patients (six per cent) had tuberculous nasopharyngitis . In one of them (one per cent) the tuberculous nasopharyngitis was primary as no other evidence of mycobacterial infection was found . In the present study, mycobacterial infection of other parts of the upper aerodigestive tract was not found.

J Clin Microbiol, 1991 Jul, 29(7), 1422 - 8
Comparison of the autoSCAN-W/A rapid bacterial identification system and the Vitek AutoMicrobic system for identification of gram-negative bacilli; Pfaller MA et al.; The autoSCAN-W/A (W/A; Baxter MicroScan, West Sacramento, Calif.) with the new fluorometric Rapid Neg Combo 1 (RNC) panel is a fully automated fluorometric system for identification of both enteric and nonenteric gram-negative bacilli within 2 h . We compared the W/A with the Vitek AutoMicrobic System (Vitek AMS; Vitek Systems, Inc., Hazelwood, Mo.) for identification of 383 clinical isolates of gram-negative bacilli . The API 20E (Analytab Products, Plainview, N.Y.) and conventional biochemical testing were used as the reference systems . The W/A correctly identified 336 isolates (87.7%) to the species level and classified an additional 29 isolates (7.6%) as correct with low probability (overall identification = 95.3%); the Vitek AMS correctly identified 355 isolates (92.7%) to the species level and classified an additional 8 isolates (2.1%) as correct with low probability (overall identification = 94.8%) . A common set of 134 isolates of gram-negative bacilli was tested in both participating laboratories as a means of assessing interlaboratory agreement with both the W/A and the Vitek AMS . The overall agreements between the two laboratories were 86% with the W/A and 92% with the Vitek AMS . The W/A performed comparably to the Vitek AMS for identification of most gram-negative bacilli, actually exceeding the Vitek AMS for identification of nonenteric bacilli . Rapid time to identification and a high level of automation make the W/A an attractive system for clinical microbiology laboratories.

Rev Hosp Clin Fac Med Sao Paulo, 1991 Jul-Aug, 46(4), 190 - 2
{Bronchial stenosis of tuberculous etiology: pathogenesis and treatment}; Oliveira-Vianna Edos S et al.; Four cases of bronchial stenosis as an unusual complication of tuberculosis are described . In the first case, a 18-year-old woman, the bronchial stenosis resulted from cicatrization of a primary focus . The X-ray examination showed no pulmonary lesion and she did not receive any specific treatment for tuberculosis . In other three patients the bronchial stenosis was due to active disease, and there were acid-fast bacilli in the sputum . They received treatment for tuberculosis which resulted in resolution of stenosis in one of them while in the other two the fibrotic bronchial stenosis persisted.

Nippon Rai Gakkai Zasshi, 1991 Jul-Dec, 60(3-4), 139 - 45
Susceptibility of severe combined immunodeficient (SCID) mice to Mycobacterium leprae: multiplication of the bacillus and dissemination of the infection at early stage; Yogi Y et al.; Inoculation of M . leprae were made into the both hind feet at a dose of 4.8 x 10(6) bacilli per foot in order to determine the susceptibility to M . leprae of SCID mice which is severely deficient in both T- and B cell immunity . SCID mice was found to have an extremely high susceptibility to M . leprae, and the progress of infection observed in the SCID mice were shown a rapid systemic spread of infection at the all over the tissues as well as the growth of the leprosy bacilli at the site of inoculation . Therefore, SCID mice can be used as a suitable multibacillary model for the study of leprosy.

Pneumoftiziologia, 1991 Jul-Sep, 40(3), 34 - 40
{The risk of tuberculosis infection and disease among children in contact with tuberculous foci}; Mihailescu P et al.; Three groups of children aged 0-14 years, in the 4-th district of Bucharest, have been followed up during 1988-89, as follows: a retrospective group--331 contact children in new tb foci registered in 1986-87; a prospective group--213 contact children in newly registered foci in 1988 and a group of 49 contact children in chronic foci . The children have been controlled clinically and X-ray and tuberculin tested on case-finding of the index-case and 3, 6 and 12 months thereafter; those from the retrospective group even after 2-3 years . The non-infected children were BCG vaccinated; in those infected chemoprophylaxis was administrated . The most dangerous infection sources for children were the tb bacilli eliminators on microscopy . The tuberculin conversions were noted during the first 3-6 months after contact; the children from chronic foci can converse even after 1-3 years . The active tuberculosis in children were noted on the initial check-up and were missing during the follow-up period, even in chronic foci . These observations could be accounted to the prophylactic measures applied in contact children, corroborated with intensive treatment of infection sources . Since most of disease cases in children were under 2-3 years of age, we consider necessary to continue the BCG vaccination at birth.

Indian J Exp Biol, 1991 Jul, 29(7), 623 - 7
Repeated isolation of chemoautotrophic nocardioform bacteria from fish epizootic ulcerative syndrome; Chakrabarty AN et al.; Nocardioform actinomycetic organisms were present regularly in, and isolated repeatedly from, different varieties of fish affected with epizootic ulcerative syndrome lesions of dermis, muscle, subcutaneous tissues and internal organs . These acid-fast bacilli, resembling human and rat leprosy bacilli, together with other actinomycotic bodies, appeared to explain the characteristic macrophage granuloma observed in such lesions, similar to those of humans . These isolates possessed fundamental similarities to the human isolates of chemoautotrophic nocardioform bacteria reported earlier.

Mikrobiol Zh, 1991 Jul-Aug, 53(4), 68 - 73
{The selection of the composition of the medium for optimizing the amine-synthetic activity of aerobic bacilli}; Kudriavtsev VA et al.; Nutrient medium chosen as a basic one after preliminary test of several media known from literature has been optimized to intensify biosynthesis and amine nitrogen production by three strains of aerobic sporulating bacteria to culture liquid . The method of mathematical planning used in the experiments has permitted obtaining the components ratio for the medium on which production of amine nitrogen to the environment increased 2.3-3.2 times . The best variants of the optimized medium promoted an increase of the aminosynthetic activity of the studied bacteria by more than 320% . The obtained nutrient medium is appropriate for a wide screening of aerobic bacilli for their ability to synthesize amino compounds.

Nippon Rai Gakkai Zasshi, 1991 Jul-Dec, 60(3-4), 152 - 7
Histo-bacteriological investigation on borderline tuberculoid leprosy; Wang T et al.; The multi-sections, which were stained by Fite method, of skin biopsies taken from twelve active BT cases were examined under the guidance of special stains for demonstration of nerve components . All cases were AFB positive . Bacilli were found in infiltrated nerves in 11 cases, of which, in 7 cases, bacilli were detected in nerve fragments within epithelioid cell granuloma . And bacilli were seen in arrector pili muscles in 2 cases . No bacilli were detected in other sites . Since the survival of M . leprae in nerves is one of the reasons causing relapse, this paper suggests that it would be better to treat active BT cases with multibacillary regimen recommended by WHO even though smear-negative.

Indian J Exp Biol, 1991 Jul, 29(7), 641 - 4
Immunohistochemical demonstration of mycobacterial antigens in intracranial tuberculoma; Radhakrishnan VV et al.; Mycobacterial antigens have been demonstrated immunohistochemically in the paraffin sections of 10 intracranial tuberculous granulomas and the results were compared with the detection of acid fast bacilli by conventional Ziehl-Neelsen method . In none of the 10 specimens, acid fast bacilli were demonstrated while mycobacterial antigens were characterised as diffusely staining granular brownish-pink material within the cytoplasm of giant cells and macrophages . In 14 specimens of granulomatous lesions due to non-tuberculous aetiology, immunohistochemical stains were negative for mycobacterial antigen . Thus demonstration of mycobacterial antigen will be not only useful in establishing mycobacterial aetiology of a caseating intracranial granuloma but also can be used as an alternative method to the conventional Ziehl-Neelsen method.

Infect Immun, 1991 Jul, 59(7), 2265 - 73
Identification of B- and T-cell epitopes within the MTP40 protein of Mycobacterium tuberculosis and their correlation with the disease course; Falla JC et al.; Synthetic peptides derived from the amino acid sequence of MTP40, a recently characterized Mycobacterium tuberculosis protein, were tested by two different immunological assays in 91 individuals . For the purposes of this study, the population was distributed in four groups: active tuberculosis (TBC) patients with elevated bacillus loads (BK+), active TBC patients with low bacillus loads (BK-), healthy individuals living in the same household with tuberculous patients (HH), and normal individuals, who had presumably never been in contact with the bacilli (control) . We found that T cells of individuals belonging to the HH group showed the highest and most frequent recognition of these peptides in a T-cell proliferation assay, while their antibodies showed the lowest recognition of these peptides when tested by enzyme-linked immunosorbent assay . In contrast, TBC patients revealed an inverse pattern of immune response . Interestingly, one of these peptides (P7) was recognized by T cells of 64% of the HH individuals and by 4.5% of normal donors . Another peptide (P4) was recognized by 55% of sera from BK+ patients and by 5.5% of normal donors . The results presented here indicate the existence of T- and B-cell epitopes within the MTP40 protein . Given the particular recognition pattern of this protein, added to the fact that it appears to be a species-specific antigen of M . tuberculosis, a detailed study of the immune response to it may be useful in the design of more accurate diagnostic tests and an improved vaccine against human TBC.

Int J Lepr Other Mycobact Dis, 1991 Jun, 59(2), 278 - 91
Differential handling of bacterial antigens in macrophages infected with Mycobacterium leprae as studied by immunogold labeling of ultrathin sections; Rastogi N et al.; Mycobacterium leprae were purified from the livers of experimentally infected armadillos, and the purity of the bacterial preparation was established by electron microscopy, immunoelectrophoresis of purified bacilli with rabbit serum raised against liver tissues from a noninfected armadillo, and gas chromatography . Such purified and intact bacilli were fixed and embedded by a gelatin-Lowicryl method for electron microscopy which preserved the mycobacterial antigens . Ultrathin sections were labeled with antisera raised in rabbits against the total antigens of the following species of mycobacteria: M . leprae, M . bovis BCG, M . avium, and a rapid-growing, nonpathogenic species, M . fallax . Bacteria were also labeled using serum raised against 2,3-diacyl-trehalose-2'-sulfate (sulfolipid-IV or SLIV) isolated and purified from M . tuberculosis . The immunolabeling was visualized under the electron microscope (EM) by using a secondary probe (goat-antirabbit IgG, H+L, coupled to 5 nm gold particles; GAR-5) . EM results showed that M . leprae bacilli were highly labeled with all of the antisera used except SLIV, which was present only in discrete amounts . All of the antisera used labeled the bacterial "capsule," showing that this structure was not an artifact since it contained mycobacterial antigens . In parallel experiments, the murine J-774 macrophage cell line was infected with purified M . leprae, and fixed for EM at various time intervals for 1 week . Although the phagocytized bacteria did not multiply during the 1-week experiment, macrophages were unable to lyse them . Immunogold labeling of bacterial antigens in ultrathin sections of infected macrophages helped us to conclude: a) bacterial death and/or lysis is not a prerequisite for processing of antigens by infected macrophages; b) there was conclusive evidence for a differential antigen handling, i.e., some antigens were rapidly released (within 2 days, mostly capsular antigens) inside infected macrophages and transported to the macrophage surface, whereas others (the majority of them located in the cell-wall skeleton and in deeper bacterial structures) remained unreleased even after 4 to 7 days of infection; c) although relatively fewer epitopes reacting with anti-SLIV antibodies were found, they were rapidly released (within 2 days) inside macrophages, and exocytized to the macrophage surface . These novel findings are discussed in relation to leprosy and the current knowledge about the processing of bacterial antigens.

Int J Lepr Other Mycobact Dis, 1991 Jun, 59(2), 248 - 54
Clinical and bacteriological progress of highly bacillated BL-LL patients discontinuing treatment after different periods of MDT; Katoch K et al.; Highly bacillated lepromatous patients (BL/LL) with an initial bacterial index (BI) of 4 to 6+ are being treated with a modified World Health Organization-recommended multiple-drug therapy (WHO/MDT) regimen consisting of rifampin 600 mg once a month, clofazimine 100 mg on alternate days, and dapsone 100 mg daily . The clinical and bacteriological profiles of the patients who had discontinued treatment at different durations have been compared with patients who took the same treatment until attainment of smear negativity . All six of the patients who had discontinued treatment at 12-18 months had worsened clinically and bacteriologically, and viable bacilli could be demonstrated in those tested for ATP . In four patients who had stopped treatment at 24-30 months, the BI continued to fall and there was no clinical or bacteriological worsening in 1 to 2 years of follow-up . The fall in the BI in five cases who had discontinued treatment at 36-44 months was comparable to those on continuous treatment, and there was no worsening . These observations indicate that with the conventional MDT regimen it is not advisable to stop treatment at 12 and 18 months . It appears that treatment should be continued for at least 2 years, and longer in the untreated highly bacillated cases . Prospective clinical trials with a sufficient number of cases and long-term follow-up need to be carried out to ascertain the optimum duration.

Int J Lepr Other Mycobact Dis, 1991 Jun, 59(2), 242 - 7
A case of relapse with drug-susceptible M . leprae after multidrug therapy; Constant-Desportes M et al.; A male born in 1930 was diagnosed as smear-positive borderline leprosy in 1971, and was treated with dapsone and/or sulfamethoxypyridazine from 1972 to 1980 with clinical improvement . However, new skin lesions with smears strongly positive appeared in August 1980, and he was diagnosed as having downgraded to lepromatous (LL) leprosy, but the bacilli recovered from the skin biopsy were fully susceptible to both dapsone and rifampin by mouse foot pad technique . Between 1981 and 1983, the patient was treated with 24 months of rifampin 600 mg and dapsone 100 mg daily, supplemented with prothionamide 500 mg daily during the initial 3 months, and his skin lesions gradually improved during treatment with the combined regimen . Afterward, the patient was kept under surveillance without treatment . From 1984 to 1986, his skin smears were negative, and no bacilli could be found from a skin biopsy taken in 1985 . Then in 1987, 52 months after stopping treatment, new skin lesions appeared with a high concentration of Mycobacterium leprae (2 x 10(6)/mg tissue) . The drug-susceptibility test again demonstrated that the organisms were fully susceptible to both dapsone and rifampin . Apparently the relapse was due to remultiplication of drug-susceptible persisters.

J Trop Med Hyg, 1991 Jun, 94(3), 150 - 1
Tuberculosis of the lacrimal gland; Madhukar K et al.; A case of tuberculous dacryoadenitis with abscess formation resolving completely with anti-tuberculous chemotherapy is presented . The growth of acid-fast bacilli in culture from the pus is noteworthy.

Clin Orthop, 1991 Jun, (267), 182 - 5
Isolated articular melioidosis; Saengnipanthkul S et al.; Melioidosis is an infection caused by a gram-negative bacilli, Pseudomonas pseudomallei . This organism can cause fatal infection in domestic animals and are probably transmitted to humans by soil contamination of skin abrasions, ingestion, and inhalation . Melioidosis is being increasingly diagnosed in Western countries in other than its endemic areas of tropical and subtropical zones . In the past, only a few single case reports of articular melioidosis were published in English journals, and almost all were secondary to melioidosis of another organ . Accurate diagnosis of this infection is important because a high mortality rate is usually associated with the septicemic form . Nine cases of isolated articular involvement were diagnosed between 1984 and 1988 in Northeast Thailand . Symptoms were subtle and diagnosis required a high degree of suspicion . Diagnosis depended on bacteriologic methods including Gram's stain, pus and blood cultures, and on an indirect hemagglutination titer of over 1:40 . In addition to general measures for septic arthritis, antibiotic therapy using a combination of intravenous cotrimoxazole, doxycycline, and chloramphenicol was generally satisfactory . Second line drugs (i.e., more effective but also more expensive drugs that the authors administered when patients failed to respond to the first line drugs cotrimoxazole, doxycycline, and chloramphenicol) comprising intravenous ceftazidime and cotrimoxazole were administered in cases with an underlying disease . Comparison of the disease course before and during hospitalization as well as the total days of treatment between two small groups of patients with and without underlying disease revealed no statistically significant difference.

J Urol, 1991 Jun, 145(6), 1264 - 6
Complications after intravesical instillation of bacillus Calmette-Guerin: rhabdomyolysis and metastatic infection; Armstrong RW; Two cases of adverse reaction to bacillus Calmette-Guerin (BCG) bladder instillations are reported . In both cases transient fevers and systemic symptoms developed following the instillations . After an additional instillation 1 patient had high fevers, severe myalgias and profound weakness followed by rhabdomyolysis and anuric renal failure, which required 3 weeks of hemodialysis before recovery . Extensive evaluation revealed no cause other than the BCG instillations . In the other patient a firm subcutaneous nodule gradually developed on the chest wall, which contained nonviable acid fast bacilli.

Bangladesh Med Res Counc Bull, 1991 Jun, 17(1), 23 - 8
A study on the prevalence of tuberculosis in a rural community of Bangladesh; Hafez MA et al.; The population of two villages of Chagalnaiya Upazila was selected for a study on the prevalence of pulmonary tuberculosis through a two stage screening process . Initial screening was conducted on 3406 persons which is 78% of the total population (3920) of the two villages . The initial screening revealed 182 persons with the history of cough lasting 4 weeks or more, chest pain, continuous fever and haemoptysis . Sputum examinations for Acid Fast Bacilli (AFB) of tuberculosis detected 21 sputum positive cases giving a prevalence rate of 6.2 (per 1000 population) higher than the estimated national average of 5.0 per 1000 . Most of the cases were not receiving treatment . Some social and environmental factors of suspected and detected cases were also studied.

Tubercle, 1991 Jun, 72(2), 133 - 9
Spectrum of immune reactivity to mycobacterial (BCG) antigens in healthy hospital contacts in south India; Pitchappan RM et al.; In an effort to study the immunological responses to antigens of tubercle bacilli, 49 tuberculin positive and 41 tuberculin negative hospital contacts aged 20-29 years (staff nurses and students working in Government Rajaji Hospital, Madurai, South India) were studied for serum antibodies (IgG, IgM and IgA classes) to BCG by ELISA and diameter of induration to PPD by Mantoux procedures . The two immunological parameters were correlated in regression analysis . The results have revealed higher anti-BCG serum antibody levels in hospital contacts than in non-contacts, significantly higher antibodies in tuberculin negative hospital contacts than in tuberculin positive hospital contacts, an inverse correlation of tuberculin reactivity and antibodies and a bimodal decline (regression) of antibodies against the increase in skin test induration . This study has thus suggested the existence of an immunological spectrum in hospital contacts from south India; persons at one pole of the spectrum were tuberculin negative and possessed significantly elevated antibody levels and those at the other pole of the spectrum were tuberculin positive and possessed low antibody levels . Thus the spectrum of immune reactivity may be due to an inherent susceptibility/resistance of an individual to Mycobacterium tuberculosis.

Tubercle, 1991 Jun, 72(2), 110 - 4
Efficacy of intermittent pyrazinamide in experimental murine tuberculosis; Dickinson JM et al.; CFLP mice were infected intravenously with Mycobacterium tuberculosis strain H37Rv and the progress of chemotherapy was followed by counts of viable bacilli in the lung and spleen . After spleen counts had reached log10 7.0, 12 experimental groups, each containing 10 mice, were treated for 8 weeks with pyrazinamide (PZA) given in mean daily dosages of 100, 200 or 400 mg/kg/day, with the interval between the doses within each dosage group being 1, 2, 4 or 8 days . All mice were also given 25 mg isoniazid/kg daily . An increase in the mean daily dosage from 100 mg PZA/kg to 400 mg PZA/kg resulted in a decrease of spleen viable counts at the end of treatment from log10 4.2 to log10 3.8 . The organ counts, averaged over the full dosage range, were little altered by spacing out the interval between doses from 1-4 days, while increasing dose size proportionately: the counts with low mean dosages tended, however, to decrease (indicating improved efficacy) while those with high mean dosages increased (P less than 0.001) . Counts increased when the interval was 8 days . Spacing out the doses while keeping the dose size constant resulted in progressive loss of efficacy . These findings suggest that, if PZA is given intermittently, the size of the dose should be increased, though not quite proportionately, to maintain full efficacy . Even with such an increase in dose, however, once weekly treatment would be less effective.

J Antimicrob Chemother, 1991 Jun, 27(6), 817 - 28
Synergistic killing of gram-negative bacilli by cefotaxime, its desacetyl metabolite and human polymorphonuclear neutrophils; Mandell LA et al.; Using an in-vitro model the effects of sub-MIC cefotaxime and its desacetyl metabolite singly and in combination on killing of E . coli by PMNs were studied . Our purpose was to determine if the parent compound and its metabolite had a synergistic effect on killing of E . coli by PMNs . Thymidine-labelled serum resistant Escherichia coli 018:K1:H7 were incubated during log phase growth with varying sub-MICs (1/2, 1/8, 1/32) of cefotaxime, its desacetyl metabolite and both agents together, or phosphate buffered saline (PBS) as a control for 90 min at 37 degrees C . The bacteria were then washed and a series of opsonization experiments was performed using intact and sonicated PMNs . Killing of bacteria was determined at 3, 10 and 20 min . Uptake and killing of bacteria by PMNs were measured using standard techniques . Pre-treatment of E . coli with cefotaxime alone and desacetyl cefotaxime and cefotaxime together resulted in significantly enhanced bacterial killing by PMNs at all three exposure times to PMNs . Pre-treatment of the bacteria with sub-MICs of desacetyl cefotaxime alone showed enhanced killing only after exposure for three minutes . In all cases, any increased killing was independent of ingestion by the phagocytes . The opsonization experiments demonstrated that contact between bacteria and PMNs was necessary for optimal killing to occur . The enhanced killing of the sub-MIC antibiotic pre-treated bacteria was seen even when sonicated PMNs were used . The extent of bacterial killing, however, was less than that seen with intact PMNs.

Maturitas, 1991 Jun, 13(2), 99 - 107
Efficacy of sustained-release vaginal oestriol in alleviating urogenital and systemic climacteric complaints; Foidart JM et al.; In a double-blind, placebo-controlled study, 109 patients suffering from local and vasomotor postmenopausal complaints were randomly assigned to treatment with either depot vaginal suppositories containing 3.5 mg oestriol (E3) or a placebo . The treatment schedule comprised one vaginal suppository twice weekly for 3 weeks initially, followed by maintenance therapy with one vaginal suppository weekly for the 6-month study period . The effectiveness of the therapy was assessed on the basis of questionnaires (Kupperman index for vasomotor complaints and an original urogenital index for local complaints) and gynaecological examinations which included assessments of vaginal cytology, vaginal pH and Doderlein bacilli . To rule out induced endometrial proliferation, endometrial biopsies were performed in 50 women before and after the study . The vaginal depot (E3) formulation showed highly significant superiority over the placebo with respect to therapeutic effect on local urogenital complaints and alleviation of vasomotor complaints, including hot flushes . Analysis of the endometrial biopsies indicated that the monotherapy used caused no endometrial stimulation . Taking into account the minimal rate of adverse effects, the 3.5 mg E3 depot formulation studied represents a useful variant in the range of preparations available for the treatment of post-menopausal complaints.

Infect Immun, 1991 Jun, 59(6), 1905 - 10
Proteins released from Mycobacterium tuberculosis during growth; Andersen P et al.; Proteins secreted from Mycobacterium tuberculosis during growth are believed to be important for protective immunity against tuberculosis . We have investigated the growth of M . tuberculosis in an enriched liquid medium . The release of isocitrate dehydrogenase from the bacilli served as a marker of autolysis and was observed during the late logarithmic growth phase . The release of proteins during the culture period was investigated by enzyme-linked immunosorbent assay and sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Three major groups of proteins, which differed markedly with respect to profile of release and location in intact bacilli, were defined . A short-term filtrate devoid of autolytic products was defined and found to be composed of 33 major components . Five proteins were identified by monoclonal antibodies . Pronounced superoxide dismutase activity was detected in the filtrate . The enzyme was purified and identified as a dominating component of short-term filtrate.

Lepr Rev, 1991 Jun, 62(2), 212 - 6
Localized borderline lepromatous leprosy; Jha PK et al.; A 48-year-old soldier presented with 3 small leprosy lesions localized over the flexor area of the forearm . There was no nerve thickening and clinically the lesions looked like borderline-tuberculoid leprosy . However, these lesions demonstrated a bacteriological index (BI) of 4+ while no acid-fast bacilli (AFB) could be demonstrated from any other site of the body . A lepromin test was negative . Histologically evidence of borderline lepromatous leprosy was conspicuous . The case was diagnosed as localized borderline lepromatous-leprosy and treated with multidrug therapy . After 1 year of treatment, the lesions regressed, a lepromin test was positive (5 mm) and the BI from the lesions fell to 1+.

Lepr Rev, 1991 Jun, 62(2), 206 - 11
Persistent reaction in paucibacillary leprosy: case reports; Saxena U et al.; Three patients of histopathologically confirmed borderline-tuberculoid leprosy showing no acid-fast bacilli and with lesions confined to the face, 2 on the cheek and 1 on the forehead, were given multidrug therapy as recommended by the WHO for paucibacillary cases . Within 3 months the lesions showed signs of upgrading (or reversal) reaction which was substantiated by histopathology . In 1 patient the facial nerve was affected leading to facial palsy . The lymphocyte transformation test did not show a significant rise . All 3 patients were given oral prednisolone for periods varying between 5 and 7 months, but the response was poor except in 1 patient in whom the facial palsy responded favourably . Injections of sodium antimony gluconate tried in 1 patient after stoppage of steroids did not control the reaction . After 18 months of regular follow-up during therapy, the cutaneous reaction in the patient with facial nerve involvement subsided leaving significant atrophy . However, in the other 2 patients the skin lesion persisted with clinical and histopathological evidence of upgrading reaction . The reasons for the unnatural persistence of reaction in these patients is not clear.

Lepr Rev, 1991 Jun, 62(2), 134 - 42
Mycobacteria in nerve trunks of long-term treated leprosy patients; Pereira JH et al.; Mycobacteria were present in 4 out of 8 mixed peripheral nerve trunks from patients (3 BT and 1 BL) treated with DDS and/or MDT for periods ranging from 21 months to 8 years . Most of the bacilli appeared to be 'whole' . Nerve destruction with areas of granulomatous infiltration appeared more active than expected . Possible reasons for a continued presence of bacilli in treated nerves and its implications in 'relapse' are discussed.

J Clin Microbiol, 1991 May, 29(5), 975 - 9
Spiral gradient endpoint method compared to standard agar dilution for susceptibility testing of anaerobic gram-negative bacilli; Hill GB; More efficient and reproducible alternative methods of performing agar dilution susceptibility testing are desirable, particularly for anaerobic bacteria . Anaerobes generally grow more reliably on solid media than they do in broth microdilution wells . A new method, the revised spiral gradient endpoint (SGE) method, was evaluated against the standard agar dilution (SAD) method by using a wide variety of anaerobic gram-negative bacilli (161 strains) and eight antimicrobial agents . For the SGE method, a spiral plater was used to set up a concentration gradient of an antimicrobial agent within an agar plate across which bacterial strains were inoculated as radial streaks . After incubation, the MIC of the antimicrobial agent was calculated from the radial endpoint location where bacterial growth ceased along the streak . The MICs for 90% of strains tested (in micrograms per milliliter) and the cumulative percentages of susceptible strains at the breakpoints for the SGE and SAD methods, respectively, and for all 161 strains were as follows: for metronidazole, 2 and 100 versus 2 and 100; for imipenem, 1 and 99 versus 0.5 and 98; for ampicillin-sulbactam, 8 and 97 versus 8 and 98; for clindamycin, 4 and 90 versus 4 and 91; for cefoxitin, 32 and 95 versus 32 and 95; for mezlocillin, 256 and 88 versus greater than 128 and 86; for ampicillin, greater than or equal to 256 and 51 versus greater than 64 and 51; and for penicillin (in units per milliliter), greater than or equal to 512 and 71 versus greater than 64 and 65 . The excellent agreement of these data and the greater sensitivity reproducibility, and efficiency of the revised SGE method warrant further evaluations . Assuming that these advantages are confirmed, the revised SGE method should be a useful alternative test method when detailed susceptibility data are desired.

Am J Surg Pathol, 1991 May, 15(5), 430 - 7
Histopathology of bacillary angiomatosis of lymph node; Chan JK et al.; Bacillary angiomatosis, a recently characterized pseudoneoplastic vascular proliferation caused by a bacterium identical or related to the cat-scratch disease bacillus, usually presents as cutaneous lesions . We report the histologic findings of this disease involving the lymph nodes of two immunocompromised patients . The lymph nodes showed patchy involvement by coalescent nodules of proliferated blood vessels lined by plump endothelial cells with pale cytoplasm . There were foci exhibiting mild to moderate nuclear atypia . Although neutrophil infiltration was prominent in one case, it was minimal in the other . The interstitium was formed by pink-staining material in hematoxylin-eosin-stained sections, and this proved to be aggregated bacilli on Warthin-Starry stain . Recognition of this potentially fatal disease is important because it is curable with antibiotics.

J Antimicrob Chemother, 1991 May, 27 Suppl C, 1 - 7
An evaluation of the susceptibility patterns of gram-negative organisms isolated in cancer centres with aminoglycoside usage; Muscato JJ et al.; This study in 12 cancer treatment centres across the United States was designed to evaluate the potential for increased resistance to amikacin with unrestricted use . An initial 3-month baseline period during which the use of amikacin was restricted and that of tobramycin and gentamicin unrestricted was followed by a period of at least 12 months when amikacin was the primary aminoglycoside . Resistance of Gram-negative bacilli to these aminoglycosides from hospitalized patients was monitored and compared for the two periods . Amikacin usage increased from a mean of 20.1% to a mean of 83.9% of aminoglycoside patient-days . A reduction in the use of tobramycin and gentamicin were observed with means of 66.1 and 10%, and 13.9 and 6.1%, respectively for the two periods . Resistance to amikacin was 0.85% at baseline and 1.3% at end-point which was not clinically significant (P = 0.614) . Baseline resistance was 6.5 and 7.6%, while final resistance was 2.6 and 4.8%, respectively for tobramycin (P = 0.001) and gentamicin (P = 0.052).

Acta Cytol, 1991 May-Jun, 35(3), 325 - 32
Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome; Finfer M et al.; All Bellevue Hospital cases from a recent 27-month period whose fine needle aspiration (FNA) samples of cervical or supraclavicular masses showed acute and/or granulomatous inflammation were reviewed . The 30 patients included 8 with the acquired immune deficiency syndrome (AIDS), 3 with the AIDS-related complex (ARC), 2 with AIDS risk factors and 17 without known risk factors for AIDS . Of these, mycobacterial infections had been diagnosed in 22 patients: 18 by cultures positive for Mycobacterium tuberculosis and 4 by positive staining for acid-fast bacilli . In addition to the presence of neutrophils, two criteria for the diagnosis of mycobacterial infection were identified on the routinely stained FNA smears: caseous material and granulomas . Caseous material was the most sensitive and specific criterion . Granulomas were often present in patients with mycobacterial infection, but were also occasionally present in patients with other processes . The differences in cytologic specimens between AIDS and non-AIDS patients are discussed . The findings suggest that FNA is a safe and sensitive technique for the diagnosis of mycobacterial lymphadenitis in AIDS patients and that purulent aspirates from appropriate patient populations should prompt the use of special stains and cultures to rule out mycobacterial infection.

Clin Exp Immunol, 1991 May, 84(2), 200 - 6
Killing of Mycobacterium tuberculosis within human monocytes: activation by cytokines and calcitriol; Denis M; Human monocytes were isolated and their ability to harbour growth of virulent tubercle bacilli was assessed, in the presence or absence of various immunomodulators . Calcitriol (1,25(OH2), vitamin D3) alone, at doses of 10(-7)-10(-9) M endowed human monocytes with a significant ability to restrict intracellular growth of the tubercle bacilli . Crude immune lymphokines as well as recombinant interferon-gamma (IFN-gamma) endowed monocytes with no tuberculostatic activity . Similarly, other recombinant cytokines tested, notably colony-stimulating factor-1 (CSF-1), interleukin-1 (IL-1), interleukin-3 (IL-3) and interleukin-6 (IL-6) all failed to stimulate anti-tuberculous properties, and even increased growth of the tubercle bacilli in monocytes, in the case of CSF-1 . Conversely, incubation of crude lymphokines in combination with calcitriol led to total stasis of the growth of M . tuberculosis . Experiments with recombinant cytokines and immunologically active vitamins showed that a combination of IFN-gamma tumour necrosis factor-alpha and calcitriol induced a significant amount of intramonocyte killing of M . tuberculosis . Addition of this cocktail of factors to already infected monocytes led to substantial killing of tubercle bacilli . These sets of experiments establish clearly that combinations of recombinant cytokines and vitamins may induce substantial intramonocyte killing of M . tuberculosis . The mechanism involved in this killing activity was not clarified.

Infect Immun, 1991 May, 59(5), 1823 - 31
Evidence that vesicles containing living, virulent Mycobacterium tuberculosis or Mycobacterium avium in cultured human macrophages are not acidic; Crowle AJ et al.; Mycobacterium tuberculosis and Mycobacterium avium multiply in cultured human macrophages (MP) within membrane-enclosed vesicles . These vesicles are generally assumed to be acidic . The evidence most frequently cited for this assumption is that pyrazinamide, which requires an acid pH to be effective, is effective and streptomycin, which loses most of its activity at a low pH, is poorly effective against tubercle bacilli . This assumption was tested by using the two weak bases chloroquine and NH4Cl to raise the pH of acidic vesicles in MP experimentally infected with M . tuberculosis or M . avium . An immunocytochemical locator of acidic regions in the MP was used to monitor the association of intracellular bacilli with acidity . MP were infected with M . tuberculosis or M . avium and incubated with various combinations of the drugs and the weak bases . Replication of the bacteria in the MP was measured by culture counts . Intracellular associations of the mycobacteria with acidity were assessed by electron micrographs and by using the weak base 3-(2,4-dinitroanilino)-3'-amino-N-methyl dipropylamine, which was detected with colloidal gold-labeled antibodies . It was confirmed by immunocytochemistry that both chloroquine and NH4Cl raise the pH of acidic vesicles in the infected MP . However, neither caused any pH-related change in the antimycobacterial activities of pyrazinamide or streptomycin or of the pH-independent drug isoniazid . Immunochemical analyses showed acidity to be associated with killed but not living mycobacteria in the MP . These findings suggest that living M . tuberculosis and M . avium are located in human MP in vesicles which are not acidic.

Pathol Biol (Paris), 1991 May, 39(5), 461 - 5
Rapid antimicrobial susceptibility testing of gram-negative bacilli using Baxter MicroScan rapid fluorogenic panels and autoSCAN-W/A; Godsey JH et al.; The MicroScan Rapid Neg MIC/Combo panels and autoSCAN-W/A (Walk Away) system utilize automated fluorescence technology for rapid antimicrobial susceptibility testing of Gram-negative bacilli . In a three site clinical study eleven antimicrobial agents were evaluated by comparing results obtained with 741 clinical isolates, using rapid fluorogenic expanded dilution MIC panels and corresponding frozen microdilution reference panels determined visually . Results for 31%, 40%, 12% and 9% of the isolates were available within 3.5, 4.5, 5.5 and 7.0 hours respectively . Results for 7.3% were not available within that time period . For the seven drugs analyzed using a Minimum Inhibitory Concentration range of dilutions, overall agreement (+/- 1 dilution) was 94%, with 1.5% very major, 0.9% major and 2.5% minor errors . For the four drugs analyzed using a Breakpoint range of dilutions, overall agreement (+/- 1 dilution) was 97%, with two percent very major, and one percent major errors . The MicroScan Rapid Neg MIC system is an accurate and rapid method for same day determination of susceptibility of Gram-negative bacilli.

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