Kekkaku, 1991 May, 66(5), 389 - 93 {Primary operation of pericardiectomy and decortication of the right lung for tuberculous pericarditis with empyema}; Niwa H et al.; A 28-year old man who complained of ortho-apnea and fever was diagnosed to have cardiac tamponade . Pericardiocentesis was immediately carried out and peri-cardiac window was created on the 11th day . Typical caseating granulomas with acid-fast bacilli were detected in sections of the pericardium . A positive culture of Mycobacterium tuberculosis was observed in the sputum and the pericardial fluid . Though 3-month anti-tuberculosis treatment with streptomycin, isoniazid, and rifampicin was continued with 6-week steroid therapy, progressive thickness of the pericardium was suggested subsequent constriction . Pericardiectomy for pericarditis and decortication for empyema in the right thorax was performed at the same time . After 10 x 12 cm pericardium was resected through median sternotomy, decortication of the right lung was performed through right posterolateral thoracotomy . In the case with thickened pericardium, early pericardiectomy is recommended. Zentralbl Veterinarmed B, 1991 May, 38(3), 231 - 7 Mycobacterial antigen detection by immunohistochemistry in goat paratuberculosis; Navarro JA et al.; An immunohistochemical method (PAP) for a microscopic diagnosis of paratuberculosis in goats is described as an alternative method to the Ziehl-Neelsen technique . Mycobacterial antigens are only found in enteric and mesenteric lymph node lesions . This method is the most sensible, particularly in cases in which there are no paratuberculosis lesions and the Ziehl-Neelsen technique shows no acid-fast bacilli (AFB). J Antimicrob Chemother, 1991 May, 27 Suppl C, 29 - 40 Pharmacodynamics of amikacin in vitro and in mouse thigh and lung infections; Craig WA et al.; A variety of in-vitro and animal studies were performed to define the pharmacodynamic characteristics of amikacin against Gram-negative bacilli and to determine the impact of the dosing regimen on therapeutic efficacy . Mice with impaired renal function were included in these studies to more closely simulate in animals the pharmacokinetics of amikacin observed in humans . Amikacin exhibited concentration-dependent killing and produced prolonged postantibiotic effects both in vitro and in vivo . In mice with renal impairment, the efficacy of once-daily dosing of amikacin was similar to or greater than that observed with 6- and 12-hour dosing regimens . The antibacterial activity of amikacin in these mice correlated best with the AUC and peak serum concentration . The time course of antimicrobial activity demonstrated in these studies for amikacin against Gram-negative bacilli would support once-daily dosing in humans. J Med Assoc Thai, 1991 May, 74(5), 295 - 7 Tuberculosis of the parotid gland: a case report; Sriumpai S; A case of tuberculosis of the parotid gland, which involved the intraparotid lymph nodes of a 39-year-old Thai man is reported . The histologic characteristics of caseating granulomas with presence of acid and alcohol fast bacilli were criteria for diagnosis . This case is thought to be the first report of tuberculosis of the parotid gland in Thailand. Mikrobiol Zh, 1991 May-Jun, 53(3), 21 - 4 {The action of bacillary inhibitory substances on human-pathogenic, phytopathogenic and saprotrophic fungi}; Shelokhovich AI et al.; The study has shown that the growth of many soil fungi is inhibited by the effect of substances which are produced into the environment by some bacilli-saprotrophs . Besides, these substances can bring about a dimorphism of the Trichoderma, Blastomyces, Emmonsia, Alternaria and Verticillium fungi from the mycelial form into the yeast form, which results in the death of the fungi . The existence of bacilli capable of producing the inhibitory substances, in the soil in the territory of the USSR may explain, to a certain extent, the absence of the coccidioidomycosis and North American blastomycosis agents pathogenic for people and many animals. Mikrobiol Zh, 1991 May-Jun, 53(3), 17 - 20 {Dimorphism in the fungus Coccidioides immitis Rixford et Gilchrist under the action of saprophytic bacilli}; Shelokhovich AI et al.; It is shown that there are specific substances produced and secreted into the environment by saprotrophic bacilli . These inhibit the growth of the coccidioidal fungus in its mycelial form and some cells are converted into the yeast form, which leads to the destruction of the fungi (in natural environment) or, if the conditions allow, to their growth in the yeast form . This phenomenon, existence of a large amount of bacilli antagonistic to Coccidioides immitis, may be one of reasons why the latter has not been isolated so far from the soil in the territory of the USSR. J Indian Med Assoc, 1991 May, 89(5), 132 - 4 Antibacterial susceptibility of anaerobes by agar dilution method; Chakraborti CK et al.; Of the 9 antibacterials, vancomycin alone at its break-point (optimum blood level) revealed highest (93.3%) efficacy on Gram-positive cocci . The remarkable activity of carbenicillin, chloramphenicol and vancomycin on Gram-positive cocci (95.4 to 96.9%), carbenicillin and chloramphenicol on Gram-positive bacilli (94.8% to 98.2%) and chloramphenicol on Gram-negative bacilli (95.4%) was noted by increasing their concentrations 1.5 to 2.5 times above their break-points . These (and even higher) concentration, however, showed relatively lower efficacy of metronidazole, rifampicin, penicillin, clindamycin and erythromycin on Gram-positive cocci (76 to 84.1%), rifampicin, tetracycline, erythromycin, clindamycin and vancomycin on Gram-positive bacilli (81 to 87.9%) and clindamycin, metronidazole, rifampicin and carbenicillin in Gram-negative bacilli (72.7 to 84%) . By and large, rifampicin, chloramphenicol and carbenicillin are also quite effective (72.1 to 75.1%) at lower concentration. Fiziol Zh, 1991 May-Jun, 37(3), 80 - 6 {Effect of Bacillus mucilaginosus biomass on the exocrine function of the pancreas in piglets}; Batoev TsZh et al.; The effect of mucous bacilli on the excretory activity of pancreas in pigs has been investigated . The use of biomass at doses of 0.1, 0.2 and 0.3 g/kg stimulates to a different extent the pancreatic exocrine function in pigs: the pancreatic juice volume increases, on the average, by 17-20% and the secretion of amylolytic, proteolytic and lipolytic enzymes of the pancreatic juice becomes 1.6-2.2, 1.5-1.8 and 1.4-1.7 times higher, respectively . The increased functional activity of pancreas indicates the high reserve secretory potential of the pancreatic secretory apparatus . When brought into action, this apparatus favours more complete segregation and absorption of food nutrients. J Pathol, 1991 May, 164(1), 41 - 5 Measurement of the tissue distribution of immunoperoxidase staining with polyclonal anti-BCG serum in lung granulomata of mice infected with Mycobacterium tuberculosis; Orrell JM et al.; Mice inoculated with Mycobacterium tuberculosis, strain H37Rv were used as a model of human tuberculosis . The microanatomical location of immunoperoxidase staining with a polyclonal anti-BCG serum was within macrophages and appeared granular rather than delineating whole bacilli . Immunoperoxidase staining appears to demonstrate degraded mycobacterial antigens from disrupted organisms and so reflects prior turnover of bacilli . On Ziehl-Neelsen staining, intact or almost intact bacilli are seen and so the extent of this form of staining reflects the current bacillary load . Both methods have limited sensitivity, but with larger mycobacterial loads the area of immunoperoxidase stain measured on a semi-automated image analyser correlated with the numbers of bacilli observed . The immunoperoxidase method will be useful in the evaluation of residual antigen in studying the pathogenesis of experimental murine tuberculosis . In human mycobacterial granulomata, this immunohistochemical technique should provide an alternative method of estimating the extent of bacillary load: this approach may also provide evidence of mycobacterial infection from residual antigen deposits in the tissue when whole bacilli have been successfully cleared. Zhonghua Yi Xue Za Zhi, 1991 May, 71(5), 246 - 8, 18 {Pulmonary infections in renal transplant recipients}; Luo W; Fifty-seven episodes of pulmonary infection occurred in 46 patients during a 11.5-year period, the incidence being 12% (57/475) . After treatment, 22 patients recovered, and 24 died (52%) . The etiology was determined in 47 infection episodes . 38(81%) of them were caused by bacteria, 6 by fungi, and 3 by tubercle bacilli . Comparisons were made between infected and noninfected groups . The results showed that the incidence of rejection episodes, greatly elevated blood sugar level (greater than or equal to 11.1 mmol/L) and granulocytopenia (less than or equal to 1.5 10(9)/L) influenced significantly the morbidity and mortality of pulmonary infection. Nippon Ika Daigaku Zasshi, 1991 Apr, 58(2), 165 - 72 {The effect of extract from human tubercle bacilli (SSM) on HBeAg positive type B chronic hepatitis}; Fujisaki S et al.; The effect on the HBeAg/anti-HBe system of SSM (specific substance Maruyama), an extract from human tubercle bacilli, was evaluated in patients with HBeAg positive type B chronic hepatitis . SUBJECTS AND METHODS: Twenty-five (25) HBeAg positive patients with biopsy-proven chronic hepatitis were injected subcutaneously with SSM solution twice a week for two years . Fifteen (15) comparable patients served as untreated controls for one year . HBeAg and anti-HBe were measured by the RIA method . RESULTS: (1) In the group receiving SSM injections, HBeAg disappeared in 8 out of 25 patients (32.0%) one year after the treatment and in 15 out of 23 (65.2%) within two years . Seroconversion from HBeAg to anti-HBe occurred in 5 of the 25 patients (20.0%) after one year and in 7 out of 23 (30.4%) within two years . Of the 15 untreated controls, HBeAg disappeared in 3 patients (20%), and seroconversion from HBeAg to anti-HBe occurred in 1 (6.7%) within one year . (2) In the SSM group, the HBeAg cut off index decreased significantly (p less than 0.01), from 5.2 +/- 1.9 during the pretreatment period to 2.7 +/- 2.3 twelve months after the treatment . (3) In the SSM group, a transient rise in sGOT and sGPT was observed in some patients three to nine months after starting the treatment . HBeAg disappeared in all these patients . (4) No notable side effects were observed in any of the patients treated with SSM . CONCLUSION: These results indicate that SSM treatment improves the HBeAg/anti-HBe system in patients with HBeAg positive chronic hepatitis. Appl Environ Microbiol, 1991 Apr, 57(4), 901 - 9 Cloning, characterization, and multiple chromosomal integration of a Bacillus alkaline protease gene; van der Laan JC et al.; Extracellular Bacillus proteases are used as additives in detergent powders . We identified a Bacillus strain that produces a protease with an extremely alkaline pH optimum; this protease is suitable for use in modern alkaline detergent powders . The alkalophilic strain Bacillus alcalophilus PB92 gene encoding this high-alkaline serine protease was cloned and characterized . Sequence analysis revealed an open reading frame of 380 amino acids composed of a signal peptide (27 amino acids), a prosequence (84 amino acids), and a mature protein of 269 amino acids . Amino acid comparison with other serine proteases shows good homology with protease YaB, which is also produced by an alkalophilic Bacillus strain . Both show moderate homology with subtilisins but show some remarkable differences from subtilisins produced by neutrophilic bacilli . The prosequence of PB92 protease has no significant homology with prosequences of subtilisins . The abundance of negatively charged residues in the prosequences of PB92 protease is especially remarkable . The cloned gene was used to increase the production level of the protease . For this purpose the strategy of gene amplification in the original alkalophilic Bacillus strain was chosen . When introduced on a multicopy plasmid, the recombinant strain was unstable; under production conditions, plasmid segregation occurred . More stable ways of gene amplification were obtained by chromosomal integration . This was achieved by (i) homologous recombination, resulting in a strain with two tandemly arranged genes, and (ii) illegitimate recombination, resulting in a strain with a second copy of the protease gene on a locus not adjacent to the originally present gene . Both strains showed increased production and were more stable than the plasmid-containing strain . Absolute stability was only found when nontandem duplication occurred . This method of gene amplification circumvents stability problems often encountered in gene amplification in Bacillus species when plasmids or tandemly arranged genes in the chromosome are used. Rev Esp Enferm Dig, 1991 Apr, 79(4), 259 - 64 {An analysis of hospital bacterial infections in cirrhotic patients undergoing selective intestinal decontamination}; Tomas A et al.; Cirrhotic patients with ascites and low levels of ascitic fluid C3 and total protein and cirrhotic patients with gastrointestinal hemorrhage are at high risk of infection . Selective intestinal decontamination with oral norfloxacin is useful to decrease the incidence of infections in cirrhotic patients at high risk . This study analyzes hospital acquired bacterial infections in cirrhotic patients with ascites and low levels of total protein in ascitic fluid (n = 53) and cirrhotic patients with gastrointestinal hemorrhage (n = 26), both submitted to selective intestinal decontamination with norfloxacin during the hospitalization . Seven patients developed eight infections (8.8%): three patients with ascites and low levels of total protein in ascitic fluid and four patients with gastrointestinal hemorrhage (5.6% vs 15.3%, pNS) . Gram negative bacilli were not isolated in any case, but Gram positive cocci were isolated in seven cases . These results suggest that Gram positive cocci must be empirically covered when infection is suspected in cirrhotic patients submitted to selective intestinal decontamination . The analysis of antibiograms in these infections showed a high sensitivity of Gram positive cocci to amoxycillin and clavulanic acid, which could be used as empirical treatment when infection is suspected in these patients. J Dent, 1991 Apr, 19(2), 97 - 9 Amoxycillin with clavulanic acid and tetracycline in periodontal therapy; Abu Fanas SH et al.; The effects of tetracycline and amoxycillin with clavulanic acid on the clinical parameters and subgingival flora of eight patients with rapidly progressive periodontitis was assessed . Subjects received either tetracycline 250 mg four times daily or amoxycillin 250 mg with clavulanic acid 125 mg three times daily for a period of 2 weeks together with subgingival scaling and root planning . Both treatment regimens produced significant reductions in bleeding on probing and probing pocket depths which were still present 16 weeks after the antibiotic therapy . A significant reduction in the mean percentage of black-pigmented Bacteroides spp., Fusobacterium nucleatum and anaerobic corroding bacilli was also obtained . Both treatment regimens were equally effective in reducing the clinical parameter and altering the subgingival flora . The MIC values for Bacteroides gingivalis (Porphyromonas gingivalis) . Bacteroides intermedius (Prevotella intermedia) and F . nucleatum to amoxycillin with clavulanic acid remained constant throughout the period of investigation . The MIC values of these organisms to tetracycline increased. Rev Invest Clin, 1991 Apr-Jun, 43(2), 192 - 4 {Bone marrow involvement in lepromatous leprosy}; Gonzalez Villarreal MG et al.; A case of lepromatous leprosy with bone marrow involvement in a 37 year old man is presented . Bone marrow aspiration was performed for evaluation of anemia and leukopenia . Ziehl-Neelsen stain demonstrated numerous bacilli lying free in the interstitium and in the cytoplasm of foamy macrophages . The patients was treated with dapsone, rifampicin and thalidomide, and obtained a good response . Bone marrow evaluation is useful in the initial study and surveillance of selected patients with lepromatous leprosy and hematological abnormalities. J Gen Microbiol, 1991 Apr, 137 ( Pt 4), 875 - 84 A localization index for distinction between extracellular and intracellular antigens of Mycobacterium tuberculosis; Wiker HG et al.; A series of mycobacterial antigens were quantified by immunoelectrophoresis, enzyme-linked immunosorbent assays, or SDS-PAGE with immunoblotting using antisera against purified mycobacterial antigens . The antigens showed a characteristic distribution profile . Some had a marked quantitative dominance in the culture fluid while others had a marked dominance in sonicates of whole washed bacilli . The majority of the antigens tested could thus be located and grouped as either secreted or cytoplasmic in terms of a localization index (LI) which is described . A 5-week-old Mycobacterium tuberculosis culture fluid preparation with a low degree of lysis was valuable in the delineation of localization indexes . The various secreted antigens showed a great span in LI values, from 5 to 1000 . This variation may express different degrees of secretion efficiency or differences in tendency to adhere to the bacterial surface . The identification of proteins as extracellular or cytosolic according to their LI values was in agreement for cultures of M . tuberculosis with a low degree of lysis and cultures of M . bovis BCG and M . bovis AN-5 with significant lysis of the bacterial cells. Kekkaku, 1991 Apr, 66(4), 299 - 307 {Therapeutic effect of ofloxacin on intractable pulmonary tuberculosis and ofloxacin resistance of tubercle bacilli isolated from the patients . Chest DIsease Cooperative Study Unit of National Sanatoriums in Kinki District}; Nakae I et al.; Ofloxacin, a synthetic antibacterial pyridone-carboxylic acid derivative, was used in the treatment of intractable pulmonary tuberculosis . In this study, the therapeutic effect of Ofloxacin on pulmonary tuberculosis and Ofloxacin resistance were analyzed . All patients had been hospitalized in eight national sanatoria in Kinki district, and were excreting tubercle bacilli resistant to various anti-tuberculosis drugs agents . Ofloxacin was given to 118 patients orally at a daily dose of 300 mg to 600 mg for more than 3 months . A few anti-tuberculosis drugs, which had failed in the negative conversion of bacilli previously, were used in combination . By Ofloxacin, 23 patients (19.5%) showed negative conversion of tubercle bacilli in sputum culture within 5 months, and they remained culture-negative for at least 6 months after conversion . Side-effects were observed in 2 patients . One complained of arthralgia and the other felt abdominal fullness . But both were not serious . From these results, it was concluded that Ofloxacin was effective for intractable pulmonary tuberculosis . The resistance of tubercle bacilli to Ofloxacin increased significantly after it was used. Am Rev Respir Dis, 1991 Apr, 143(4 Pt 1), 707 - 12 Assessment of a daily combined preparation of isoniazid, rifampin, and pyrazinamide in a controlled trial of three 6-month regimens for smear-positive pulmonary tuberculosis . Singapore Tuberculosis Service/British Medical Research Council; Controlled trial of 2 et al.; In a study in Hong Kong 1,386 Chinese patients with sputum smear-positive pulmonary tuberculosis were allocated at random to four 6-month regimens of chemotherapy, all given three times weekly from the start and all containing isoniazid (H) and rifampin (R) throughout . Three contained streptomycin (S) for the first 4 months and pyrazinamide (Z) for 2 months (Z2), 4 months (Z4), or 6 months (Z6); the fourth contained pyrazinamide for 6 months but no streptomycin (Z6noS) . Every dose of all four regimens was given under the direct supervision of clinic staff on a predominantly outpatient basis . During the later part of the intake patients were allocated at random to be given their HRZ either as a combined formulation (Rifater), each tablet containing 125 mg isoniazid, 100 mg rifampin, and 375 mg pyrazinamide, or as the three drugs separately . Among 892 assessable patients with drug-susceptible strains of tubercle bacilli pretreatment, bacteriologic failure during chemotherapy occurred in 4, all Z6noS (2% of 224; p less than 0.005 for the comparison with the S-containing regimens) . During 30 months of follow-up after the end of chemotherapy, bacteriologic relapse occurred in 2 (3%) of 71 Z2, 2 (3%) of 72 Z4, 4 (6%) of 66 Z6, and 6 (9%) of 64 Z6noS patients allocated to Rifater, and in 4 (3%) of 149 Z2, 8 (6%) of 133 Z4, 2 (1%) of 142 Z6, and 6 (4%) of 135 Z6noS patients allocated to separate drugs . In the relapse rates there were no significant differences between the Rifater and separate drug regimens, the different durations of pyrazinamide, or the regimens with and without streptomycin.(ABSTRACT TRUNCATED AT 250 WORDS) Med Trop (Mars), 1991 Apr-Jun, 51(2), 149 - 53 {Lymph node tuberculosis in Cameroon: clinical and anatomo-pathologic aspects; apropos of 333 cases}; Mbakop A et al.; For a period of 11 years and 7 months (1st January 78-31 July 89), 1950 lymph nodes were received in the pathology laboratory of Cameroon . 333 of these, that is 17% revealed typical lesions of tuberculosis . Analysing the information associated to these tuberculoid adenitis revealed that: 46% of the patients were less than 10 years of age; 83.8% of the specimens were taken from the cervical region . 78% of patients had fever, cough was complained of by 56% and 40% had polyadenopathies . Finally, 81% of the tuberculoid lymph nodes analyzed had a diameter less than 5cm while only 33% showed acid fast bacilli on direct examination (Ziehl-Neelsen staining method) on the histologic slides. J Clin Microbiol, 1991 Apr, 29(4), 832 - 3 Inguinal lymphadenitis associated with Capnocytophaga bacilli; Johnson CC et al.; Capnocytophaga organisms are capnophilic, gram-negative bacilli that have been associated with infections deriving from the flora of the oropharynx . We report a case of inguinal adenitis caused by Capnocytophaga species that probably represents sexual transmission of the pathogen. Dent Clin North Am, 1991 Apr, 35(2), 283 - 98 Herpesviruses and other microorganisms of concern in dentistry; Merchant VA; Concern for transmission of microorganisms in dentistry extends beyond hepatitis B virus and HIV-1 . The herpesviruses--HSV, VZV, EBV, HCMV, and HHV-6--cause persistent infections in most of the population and are shed in saliva . Seronegative or immunocompromised dental-care providers and patients are at greatest risk of infection although reinfections may occur in immunocompetent patients . Respiratory viral infections are frequently transmitted within the dental office among staff and between staff and patients . Although most of these infections are of little consequence, others may cause lost time from the office or, occasionally, debilitating, sometimes fatal, disease . The prevalence of infection with M . tuberculosis, previously on a downward trend, is increasing in association with the AIDS epidemic . The transmission of tubercle bacilli by way of aerosols exposes dental-care providers to possible risk of infection . Awareness of the diseases that can be caused by these agents, the ubiquitous nature of these agents, and the prevalence of asymptomatic infections serve as further reinforcements of the need to follow recommended infection control guidelines. Can J Vet Res, 1991 Apr, 55(2), 199 - 202 Experimental disease in young chickens induced by a Mycobacterium paratuberculosis isolate from a patient with Crohn's disease; Van Kruiningen HJ et al.; The susceptibility of young chickens to infection with an isolate of Mycobacterium paratuberculosis which had been recovered from diseased tissues of a patient with Crohn's disease was determined . Two-week-old Leghorn-Cochin chicks were inoculated with strain Linda . Six birds received 10(7) organisms orally, six intraperitoneally, and five intracardially . Six uninoculated birds served as contact controls . Birds from each group were necropsied at two-week intervals . Focal granulomatous lesions occurred in two of six chickens which were inoculated orally, in six of six inoculated intraperitoneally, in three of five inoculated intracardially, but in none of six controls . Of the 11 birds with lesions, acid-fast bacilli were demonstrated in five . Immunoperoxidase reactivity paralleled the presence of acid-fast bacilli. Rev Saude Publica, 1991 Apr, 25(2), 112 - 20 {Estimate of the prevalence of tuberculosis infection among vaccinated school-children by the Bhattacharya's method}; Arantes GR et al.; The successful application of Bhattacharya's method (decomposition of frequency distribution into normal components by a graphic method) in the analysis of the results of tuberculin test performed on a population sensitized by "anonymous" strains of mycobacteria, suggested the possibility of its application to two samples of BCG vaccinated school-children, living in the city of S . Paulo (Brazil) . One of the sample groups, vaccinated between the second and seventh years of life, was surveyed in 1982 and the other, vaccinated during the first year of life, was surveyed in 1988 . In both populations it was possible to characterize the normal component corresponding to children infected by tuberculous bacilli and to quantify them . In the first one, the average size of the reactions was 17.40 mm, the standard deviation 3.72 mm and the proportion of infected children 7.71%, against 4.85% in the unvaccinated control group; otherwise, in the population surveyed in 1988, the average size was 17.00 mm, the standard deviation 4.67 mm and the proportion of infected children amounted to 4.14% against 4.48% in the control group . It is concluded that the method permits the estimation of the prevalence of tuberculosis infection among BCG-vaccinated school-children, provided that the vaccine has been given during the first year of life. Indian J Lepr, 1991 Apr-Jun, 63(2), 218 - 22 Significance of neither green nor red NGR bacilli in FDA-EB staining; Bhatia VN et al.; This Study deals with determination of viability by FDA-EB method . It has been observed that some of the bacilli do not take any colour in FDA-EB preparations . These can be called "neither green nor red" (NGR) bacilli . These non-staining bacilli should be taken into account when reporting viability by FDA-EB method. S Afr Med J, 1991 Mar 2, 79(5), 279 - 80 Colonoscopic features of early intestinal tuberculosis . Report of 11 cases; Pettengell KE et al.; The colonoscopic findings in 11 patients with early tuberculous colitis included erythema alone in 1 patient (9.1%), mucosal nodules indistinguishable from small adenoma in 8 (72.7%), aphthous ulcers in 3 (27.3%), and a deformed ileocaecal valve in 3 (27.3%) . The caecum was the principal site of disease and the ileum was found to be normal in the 4 patients in whom it was entered . In 3 patients (27.3%), skip lesions were present . Acid-fast bacilli were present on histological examination in all cases--in the mucosa of 4 patients and the submucosa or lamina propria in 7 patients. Bone Marrow Transplant, 1991 Mar, 7(3), 241 - 6 Contamination during in vitro processing of bone marrow for transplantation: clinical significance; Lazarus HM et al.; We determined the prevalence and clinical significance of positive microbiologic cultures obtained from 194 consecutive bone marrow harvests intended for infusion in 188 consecutive adult bone marrow transplant patients . Microbiologic cultures were obtained at harvest, after manipulation in vitro (for ABO imcompatibility or purging procedures), and at the time of thawing and infusion (after earlier cryopreservation) . Only one of 194 marrow harvests was culture-positive intra-operatively (from an ABO-compatible allogeneic marrow that was infused without manipulation) . None of 39 other allogeneic marrows (including 21 ABO-incompatible marrows which were manipulated in vitro) and none of 154 autologous marrows (including 40 which were purged in vitro) grew bacteria or fungi . On the other hand, 12 of 153 (8%) bone marrow samples were positive for micro-organisms after thawing at the time of infusion . The predominant organisms cultured were gram negative bacilli (including five Pseudomonas sp.), probably introduced during the thawing process in a water bath . In only one of 13 contaminated marrows was the same organism(s) (Pseudomonas picketti and Pseudomonas paucimobilis) recovered in vivo during the transplant course . This patient experienced a bacteremia which was eradicated without sequelae . Contamination of marrow can occur during the procurement and in vitro handling processes . With proper sterile technique bone marrow infusion does not pose a significant infectious risk for the immunocompromised transplant patient. Rev Infect Dis, 1991 Mar-Apr, 13(2), 265 - 9 Tuberculosis cutis miliaris disseminata as a manifestation of miliary tuberculosis: literature review and report of a case of recurrent skin lesions; Rietbroek RC et al.; The development of severe adverse reactions to antituberculous drugs in a patient with miliary tuberculosis led to unorthodox, suboptimal antituberculous therapy . The patient's failure to respond to therapy was discovered when acid-fast bacilli were detected in new skin lesions . Such lesions have been described in the literature as tuberculosis cutis miliaris disseminata; 24 cases (in addition to that described herein) have been reported thus far . The patient eventually recovered completely after detection and drainage of a large retrofascial tuberculous abscess . This case illustrates the importance of careful examination of the skin in clinical medicine, as tuberculosis cutis miliaris disseminata is an easily overlooked sign of miliary tuberculosis. Rev Infect Dis, 1991 Mar-Apr, 13(2), 257 - 60 Serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans; Hawkins RE et al.; Chryseomonas luteola and Flavimonas oryzihabitans are phenotypically similar gram-negative bacilli and are also referred to as CDC groups Ve-1 and Ve-2, respectively . These bacteria are rarely reported as pathogens in humans . Infections described in the literature include primarily bacteremia in critically ill patients and peritonitis in patients undergoing continuous ambulatory peritoneal dialysis . We describe three cases of polymicrobial infection secondary to infection with group Ve organisms, including the first reported case (to our knowledge) of CNS infection due to F . oryzihabitans . These three cases and a review of literature suggest an association between the presence of indwelling catheters and polymicrobial infections with CDC group Ve organisms . F . oryzihabitans and C . luteola should be added to the expanding list of nosocomial pathogens with a propensity to infect critically ill patients who have undergone surgical procedures and/or had indwelling catheters placed . The isolation of either of these organisms from clinical specimens should prompt a search for a device-related source. J Clin Microbiol, 1991 Mar, 29(3), 592 - 4 Comparison of microbiologic assay methods for hemodialysis fluids; Arduino MJ et al.; To help prevent pyrogenic reactions and bacteremia in hemodialysis patients, the Association for the Advancement of Medical Instrumentation and the Centers for Disease Control recommend microbiologic assay of hemodialysis fluids at least monthly . Five commercially available assay systems were evaluated by using the membrane filtration technique with standard methods agar and trypticase soy agar as the standards for comparison . Each assay system was challenged with dialysate and reverse-osmosis water from local dialysis centers, aqueous suspensions of eight laboratory strains of gram-negative bacilli and nontuberculous mycobacteria, and a mixed microbial flora inoculated into reverse-osmosis water and laboratory-prepared dialysate . Mean viable counts from triplicate samples were obtained after incubation at 37 degrees C for up to 72 h . The efficiency of recovery varied with the specific type of microbial challenge . The SPC water sampler (Millipore Corp., Bedford, Mass.) was the most consistent in obtaining the highest viable counts . Other commercial systems were comparable to each other in overall performance . All assay systems tested provided an acceptable balance between microbial recovery and required sampling time, equipment, and expertise. Res Vet Sci, 1991 Mar, 50(2), 127 - 30 A new dosing schedule for gentamicin in blood pythons (Python curtus): a pharmacokinetic study; Hilf M et al.; Gentamicin is frequently used in the treatment of aerobic Gram-negative infections in reptiles . Pharmacokinetic data to ensure proper dosing are scant, especially for large snakes . A pharmacokinetic study of gentamicin was therefore conducted in four blood pythons . Snakes were given intramuscular injections of either 2.5 mg kg-1 or 3.0 mg kg-1 loading dose followed by 1.5 mg kg-1 at 72 and 96 hours . A linear pharmacokinetic relationship between gentamicin serum concentrations and time was demonstrated in each of the four snakes studied . Peak serum concentrations occurred six to 10 hours after injection and ranged from 4.6 to 8.9 micrograms ml-1 . Half-life was variable and ranged from 32 to 110 hours . Total body clearance and apparent volume of distribution varied little between the individual snakes studied . There was no evidence of renal toxicity . For blood pythons a loading dose of 2.5 mg kg-1 followed by 1.5 mg kg-1 at 96 hour intervals is recommended . If higher concentrations are desired, a loading dose of 3.0 mg kg-1 followed by 1.5 mg kg-1 at 96 hours can be given . These dosing schedules will provide serum concentrations in excess of the minimum inhibitory concentrations for most aerobic Gram-negative bacilli that are pathogenic in snakes; gentamicin accumulation with subsequent renal dysfunction should not occur. Lepr Rev, 1991 Mar, 62(1), 21 - 6 Transmission of viable Mycobacterium leprae by Aedes aegypti from lepromatous leprosy patients to the skin of mice through interrupted feeding; Banerjee R et al.; Female Aedes aegypti which took partial blood meals from the skin lesions of untreated lepromatous leprosy (LL) patients were then allowed to continue feeding on 72-96-hr-old Swiss albino suckling mice (Rockefeller strain) . The bitten portion of skin was removed, divided into two parts and processed for the extraction of bacilli by two different methods using chloroform and petroleum ether . The proboscis of some of the fed mosquitoes was dissected out and examined for viable bacilli (stained by fluorescein diacetate and ethidium bromide) and acid-fast bacilli (AFB) . Out of 50 probosces dissected 45 were found positive for AFB, with bacillary counts ranging up to 246 (average 40.20 +/- SD 41.80) per proboscis . The average percentage of viable bacilli (green solid) in the probosces immediately after feeding on LL patients was 43.90 and thereafter it decreased gradually to 3 on the seventh day . In the petroleum ether extract of mouse skin viable bacilli were observed in numbers up to 37 (average 15.25 +/- SD 10.25) per smear . The number of fluorescing bacilli (green and red) correlated with the total number of AFB. Int J Lepr Other Mycobact Dis, 1991 Mar, 59(1), 12 - 9 Indeterminate leprosy: histopathologic and histochemical predictive parameters involved in its possible change to paucibacillary or multibacillary leprosy; Takahashi MD et al.; In an attempt to find clinical, bacteriological, histopathological, and immunohistochemical parameters to predict the progress of indeterminate leprosy patients to either paucibacillary (PB) or multibacillary (MB) leprosy, skin biopsies from 51 patients with indeterminate leprosy were retrieved from the files of the Sao Paulo Health Institute (Brazil) . All of these patients had progressed to either PB or MB leprosy over a period of time which varied from 2 months to 24 years . Clinical records were examined, and new sections were cut from the paraffin blocks and stained by hematoxylin-eosin and Fite-Faraco stains; the avidin-biotin peroxidase technique was used with primary antibodies to detect bacillary antigens (anti-BCG serum) and nerve branches (anti-S-100 protein anti-serum) . A moderate (++) or strongly positive ( ) Mitsuda skin test was observed in some patients progressing to PB leprosy . Noteworthy is that even patients initially Mitsuda negative may evolve to PB leprosy . a) A 2+ bacterial index and/or the presence of bacilli, even though few in number, in various dermal structures; b) multiple positive antigen sites as detected by anti-BCG anti-serum; and c) dermal nerve involvement, when evaluated as single parameters, correlated with a progression indeterminate to MB leprosy . An index resulting from the summation of the above three parameters identified 13 (72%) of 18 of these cases which progressed to MB leprosy. Int J Lepr Other Mycobact Dis, 1991 Mar, 59(1), 1 - 4 Multibacillary leprosy presenting as a solitary skin lesion; report of three cases and its significance in control programs; Ramesh V et al.; Three patients with solitary skin lesions showing the cardinal signs of leprosy were seen and clinically classified among the paucibacillary cases . Initially, they were treated with two drugs (rifampin and dapsone) as recommended by the WHO Expert Committee . On the first visit of their follow-up, they were seen to be histopathologically either in the borderline (BB) or borderline lepromatous (BL) group, and acid-fast bacilli were demonstrated in the sections . Later they were put on three drugs (rifampin, dapsone and clofazimine) as given for multibacillary cases, and therapeutically they also behaved like bacilliferous leprosy . Such cases are rare and the reasons for the occurrence are not clear . Further studies on the subtle relationship between the local host factors and the virulence of the organisms grown from these lesions may offer an explanation . In light of these cases and previous reports of even lepromatous leprosy presenting as a single skin lesion, field workers--including both medical and paramedical workers--should carefully perform and interpret slit-skin smears from clinically diagnosed paucibacillary cases so that such unusual presentations of the disease are treated appropriately and not missed. J UOEH, 1991 Mar 1, 13(1), 29 - 34 Primary actinomycosis in the liver; Hisaoka M et al.; We present a case of a 71-year-old female with actinomycosis in the liver, which is a rare region to be primarily affected with actinomycosis . The diagnosis was done histopathologically with a partially resected liver specimen taken during surgery for choledocholithiasis . There were no clinical signs of Actinomyces infection before surgery . The hepatic lesion was a 2 cm sized nodule with histological appearances of abscess-forming suppurative inflammation with fibrosis, in which eosinophilic radiate granules with peripheral clubs were found . The Brown-Brenn stain showed Gram-positive branched filamentous bacilli, which were revealed as acid-fastness by the Ziehl-Neelsen method of Putt's modification . These findings were considered to be consistent with actinomycosis of the liver. J Surg Oncol, 1991 Mar, 46(3), 167 - 73 Effect of selective elimination of the oral flora on mucositis in irradiated head and neck cancer patients; Spijkervet FK et al.; Recently it has been reported that chlorhexidine 0.1% rinsing was not successful in eradication of gram-negative bacilli in patients who have head and neck cancer . These bacilli could play a role in irradiation mucositis . This study reports the effect of lozenges containing 2 mg polymyxin E, 1.8 mg tobramycin, and 10 mg amphotericin B qid on the oropharyngeal flora in 15 irradiated head and neck cancer patients . The results were compared with those of a previous study in two groups of 15 patients comparing chlorhexidine rinsing with placebo . In all patients using lozenges, eradication of gram-negative bacilli and yeasts was achieved within 3 weeks . A significant increase of enterococci was found . Mucositis was significantly reduced compared with the previous two groups . All patients showed erythema only, whereas 80% of both the placebo and chlorhexidine rinsing patients suffered from severe mucositis, with signs of pseudomembranes developing from the third week of conventional irradiation protocol . The effect of selective elimination of gram-negative bacilli from the oropharynx and the prevention of severe mucositis may be explained by the eradication of these bacteria and/or neutralization of salivary endotoxin, released by gram-negative bacilli, mediating the inflammatory processes. Ann Allergy, 1991 Mar, 66(3), 267 - 71 Transmission of gram-negative bacilli to asthmatic children via home nebulizers; Wexler MR et al.; Home use of nebulizers has increased in recent years, although adequate studies have not been performed to evaluate for possible contamination or transmission of potentially harmful bacteria . This study of 20 asthmatic children demonstrated that transmission of pathogenic bacteria occurs. Chest, 1991 Mar, 99(3), 752 - 4 Miliary tuberculosis presenting as hepatic and renal failure; Godwin JE et al.; A 67-year-old man developed hepatic and renal failure over a six-day period . Despite full supportive measures, he died on his 11th day of hospitalization with fulminant DIC and hepatic, renal, and respiratory failure . Postmortem examination revealed acid-fast bacilli in virtually all organ systems . Miliary tuberculosis should be considered as a potentially treatable cause of hepatic failure. Bull Acad Natl Med, 1991 Mar, 175(3), 471 - 93; discussion 493-4 {A cursed duo: HIV infection and tuberculosis}; Murray JF; Tuberculosis remains a health problem of extraordinary magnitude, especially in developing countries . Unfortunately, many of the same countries have the additional burden of a remarkably high prevalence of HIV infection . Because of the inherent capacity of tubercle bacilli to take advantage of deficiencies in cell-mediated immunity, tuberculosis has become an extremely important infectious complication of HIV disease in those developing countries in which the two infections coexist; the same is true, although to a lesser extent, in developed countries among those groups of patients with HIV infection, in which there is also a high prevalence of remotely acquired tuberculosis. Microb Pathog, 1991 Mar, 10(3), 199 - 207 Guinea-pig alveolar macrophages kill Mycobacterium tuberculosis in vitro, but killing is independent of susceptibility to hydrogen peroxide or triggering of the respiratory burst; O'Brien S et al.; Alveolar macrophages from the lungs of guinea-pigs that had been vaccinated, boosted and then intravenously challenged with Mycobacterium microti or Mycobacterium bovis BCG killed tubercle bacilli phagocytosed in vitro . The killing was modest, about 40% of phagocytosed bacilli were killed in a day, but alveolar macrophages from animals that had been vaccinated and boosted but had not received the intravenous challenge did not kill bacilli . Different strains of tubercle bacilli had different degrees of susceptibility to these activated macrophages but there was no correlation between killing by macrophages and mycobacterial susceptibility to killing by hydrogen peroxide . The different strains of tubercle bacilli triggered peroxide release from these macrophages but there was no correlation with susceptibility to killing by macrophages or with virulence in the guinea-pig . However, phagocytic uptake of these strains by the activated macrophages was inversely correlated with virulence, and uptake by activated macrophages was less than uptake by normal macrophages. Semin Respir Infect, 1991 Mar, 6(1), 44 - 50 Host determinants of susceptibility to Mycobacterium tuberculosis; Sifford M et al.; Susceptibility to tuberculosis is determined by a number of host factors and may vary according to characteristics of the infecting strain . Native resistance is probably mediated via the macrophage and is under genetic control . Other factors that contribute to native resistance are nutrition, associated disease states, age, and sex . Acquired resistance is mediated via macrophages and controlled by T-helper cells . The ability of an activated macrophage to phagocytize and kill virulent tubercle bacilli is influenced by the function and number of T-helper cells . The macrophages are affected by concurrent disease states and immunosuppressive drugs . Macrophages provide local immunity, once activated, and T-helper lymphocytes provide the long-term systemic immunity. JPEN J Parenter Enteral Nutr, 1991 Mar-Apr, 15(2), 173 - 5 Implication of a distant septic focus in parenteral nutrition catheter colonization; Chuang JH et al.; During a 4-year period, 244 surgical patients receiving total parenteral nutrition (TPN) were studied with emphasis on the relationship between TPN catheter colonization and a preexisting distant septic focus (DSF) . A colonized catheter was defined as a catheter with a positive semiquantitative culture of the catheter tip (greater than or equal to 15 colonies on the plate) . Catheter-related sepsis (CRS) was defined as a catheter with either the same organisms cultured from the catheter tip and from blood or with defervescence following catheter removal . Two hundred sixty-nine catheters were inserted for TPN for a total of 4433 patient days, with a mean length of stay of 16.5 days . Forty-two of the 269 catheters (15.6%) were colonized and more than half (57.1%) of the organisms cultured were Gram-negative bacilli or enterococci . Nineteen of the 42 colonized catheters were associated with CRS with a CRS rate of 7.1% among the 269 catheters . A DSF was present in 165 of the 244 patients or in 188 of the 269 catheters (69.9%) . The colonization rate of 19.1% (36/188) in those catheters with DSF was significantly higher than that of 7.4% (6/81) in those without DSF (p less than 0.05) . Those patients with DSF or with a colonized catheter were associated with a high mortality (p less than 0.001) . Sepsis was responsible for 33 of the 48 patients (68.8%) who died . The data stress the important contribution of DSF to the colonization of TPN catheters and to the mortality of these critically ill surgical patients. Neurosurgery, 1991 Mar, 28(3), 405 - 9 Brain biopsy in tuberculoma: the risks and benefits; Bouchama A et al.; In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas . Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only . To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed . Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients . Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma . One patient had evidence of extracranial tuberculosis . Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery . One case of tuberculous meningitis was probably related to surgery and poor drug compliance . There was no postoperative mortality . Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy . It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk. Clin Exp Immunol, 1991 Mar, 83(3), 466 - 71 Modulation of Mycobacterium avium growth in vivo by cytokines: involvement of tumour necrosis factor in resistance to atypical mycobacteria; Denis M; The protective mechanisms associated with resistance to atypical mycobacteria infections are not clear . In an effort to broaden our understanding of the mechanisms involved, susceptible mice were infected with a virulent strain of M . avium and various treatments were applied so as to modify the course of the disease . Treatment with an antiserum against tumour necrosis factor-alpha (TNF-alpha) significantly enhanced the experimental infection, as judged by enumeration of colony-forming units (CFU) in the spleens and livers of infected mice, suggesting a role for TNF-alpha in resistance to M . avium . In other sets of experiments, recombinant cytokines were directly infused into infected mice . Infusion of recombinant interferon-gamma (IFN-gamma) did not modify the experimental infection significantly, and infusion of interleukin-2 was also without effect . Injection of TNF-alpha enhanced resistance in susceptible animals, as seen by a reduction in the viable bacilli recovered from the spleens and livers . In a final set of experiments, we demonstrate that combinations of cytokines may induce strong resistance against M . avium, namely injection of 1 micrograms of interleukin-1 alpha and 1 micrograms of TNF-alpha at 5-day intervals which was seen to eradicate M . avium in both spleens and livers of susceptible BALB/c mice . Overall, our results suggest that induction of protection against M . avium by treatment with cytokines may be feasible, and that TNF-alpha may be a pivotal molecule in resistance to M . avium. MMWR Morb Mortal Wkly Rep, 1991 Mar 1, 40(8), 129 - 31 Transmission of multidrug-resistant tuberculosis from an HIV-positive client in a residential substance-abuse treatment facility--Michigan; Mycobacteria and human autoimmune disease: direct evidence of cross-reactivity between human lactoferrin and the 65-kilodalton protein of tubercle and leprosy bacilli; Center for Experimental Cytology (INIC), University of Porto, PortugalWe document here by Western immunoblotting and immunogold ultracytochemistry that polyclonal antibodies against human lactoferrin (Lf) bind to tubercle and leprosy bacilli . In situ immunogold labeling of Mycobacterium leprae (present in armadillo liver and in human skin) and of Mycobacterium tuberculosis indicated that receptors for anti-Lf antibodies were present both on the cytoplasm and on the envelope of the bacilli . We found by immunoblotting that the 65-kDa heat shock protein is the major component of M . leprae and M . tuberculosis that is responsible for the binding of the anti-Lf probe . Furthermore, we show that anti-Lf immunoglobulin G eluted from the nitrocellulose-transferred mycobacterial 65-kDa protein band did bind back to Lf . Ultracytochemistry of biopsy samples of human lepromas showed that dead or severely damaged M . leprae was strongly marked by the anti-Lf antibodies; a similar pattern of immunogold marking was observed on M . leprae when antibodies against the 65-kDa mycobacterial protein were used . Our results offer direct evidence that the 65-kDa protein of leprosy and tubercle bacilli is recognized with specificity by antibodies against the human protein Lf . The Lf-65-kDa protein antigenic cross-reactivity may contribute to the formation of autoantibodies and immune complexes as well as to other autoimmune events that are frequent in tuberculosis and leprosy . Our immunocytochemical data also suggest that the cross-reactivity may persist for some time after the death of mycobacteria in infected hosts. Tubercle, 1991 Mar, 72(1), 21 - 7 Evaluation of a polymerase chain reaction for the diagnosis of tuberculosis; Manjunath N et al.; A polymerase chain reaction for the specific detection of Mycobacterium tuberculosis has been developed and evaluated for clinical applicability . Primers were designed to amplify a 240 base pair region in the MPB 64 protein coding gene (nts 460-700) . From among 15 different DNA templates tested (including 10 species of mycobacteria) PCR amplified the DNA from M . tuberculosis complex only, demonstrating its exquisite specificity . Sensitivity studies using serial ten-fold dilutions of M . tuberculosis bacilli determined the limit of detectability to be 10 organisms . A total of 143 clinical specimens were analysed . This consisted of 26 known non-tuberculous specimens (control group) and 117 specimens received at the Tuberculosis Diagnostic Service of AIIMS (test group) . None of the specimens in the control group was positive by PCR . Out of 117 specimens in the test group, 19 were culture positive for mycobacteria and 17 of these isolates were identified as M . tuberculosis . All the specimens from which M . tuberculosis was grown were also PCR positive . The remaining two isolates were identified as mycobacteria other than M . tuberculosis and these two specimens were PCR negative . An additional 14 culture negative specimens were PCR positive yielding an overall M . tuberculosis positivity rate of 26.5% (31/117) compared to 14.5% (17/117) by culture . The superior sensitivity of PCR over culture was more evident in non-pulmonary cases where PCR picked up 10 cases in addition to three culture positives out of 69 specimens . On the other hand, out of 48 pulmonary specimens only four cases in addition to 14 culture positives were picked up by PCR. Mikrobiol Zh, 1991 Mar-Apr, 53(2), 3 - 9 {The microflora in suppurative-catarrhal endometritis in cattle}; Kudriavtsev VA et al.; Microflora isolated from cattle with acute postnatal pus-catarrhal endometritis has been studied . It is shown that the given pathology is caused by associations of different bacterial species . 284 strains isolated from the uterus content of 63 sick animals have been identified, their properties being studied . Pathogenic gram-negative bacilli and gram-positive pus-producing cocci are responsible for the studied pathology . Considerable inoculation capacity has been established for conditionally pathogenic microorganisms of different species and genera whose role in pathogenesis is to be found out. Bull Int Union Tuberc Lung Dis, 1991 Mar, 66(1), 53 - 6 The annual tuberculosis infection rate, the tuberculin survey and the tuberculin test; Bleiker MA; In the present stage of development where tuberculosis mortality has lost its statistical significance because of effective chemotherapy, it is generally recognized that the most reliable measure of the extent of the tuberculosis problem in a population is the "annual tuberculosis infection rate" or incidence of infection . In countries where infection with the bovine type of tubercle bacilli no longer exists, as is the case in the majority of low prevalence countries, the annual infection rate expresses that proportion of the population under study which will be primarily infected, or reinfected with tubercle bacilli from a human source in the course of one year . The annual tuberculosis infection rate is also the best measure for following the trend of the tuberculosis problem in a given population and for evaluating the total effects of organized efforts to control tuberculosis. Bull Int Union Tuberc Lung Dis, 1991 Mar, 66(1), 27 - 32 The impact of HIV infection on the global epidemiology of tuberculosis; Styblo K; HIV is the strongest risk factor for tuberculous disease observed in the last 100 years in subjects infected with tubercle bacilli . Its impact upon tuberculosis incidence is so great that it has disrupted the balance between the tubercle bacillus and the community . The breakdown rate from tuberculous infection to active tuberculosis in persons infected dually is at least 30% . Although adequate chemoprophylaxis would prevent a considerable number of tuberculosis cases among these individuals, its application is not feasible in developing countries with a high prevalence of both tuberculous and HIV infections . Thus it seems that very little can be done against the increase in the incidence of tuberculosis caused by HIV . The only feasible measure to contain the transmission of tuberculous infection is to achieve a high cure rate and a high detection rate of smear-positive and other cases . This would enable us to contain-to an extent-the transmission of tuberculous infection . The results of IUATLD assisted National Tuberculosis Programmes in Tanzania and Malawi show that this can be achieved. Clin Exp Dermatol, 1991 Mar, 16(2), 106 - 9 Comparative efficacy of drug regimens in skin tuberculosis; Ramesh V et al.; Three antituberculous drug regimens have been employed to study the therapeutic response in 90 patients with any one of the commonly encountered paucibacillary forms of skin tuberculosis, namely lupus vulgaris, tuberculosis verrucosa cutis and scrofuloderma . The first two regimens contained rifampicin, isoniazid and either pyrazinamide or thiacetazone, and the third regimen had rifampicin and isoniazid only . The disease was clinically defined as localized when confined to one area and widespread when the lesions were disseminated . The observations revealed that the response of lupus vulgaris and tuberculosis verrucosa cutis was alike in all the three regimens, with the localized lesions subsiding completely after 4 months of therapy and the more extensive forms taking 5 months . Patients with scrofuloderma responded similarly to both the triple drug regimens . The discharge, sinuses and ulcers cleared in 6 months but the lymph nodes took longer to regress, up to 7 months in localized and 9 months in more widespread scrofuloderma . To obtain the same results with rifampicin and isoniazid, all patients with widespread scrofuloderma and one-third of those with localized forms had to be treated for 10 and 9 months, respectively . No serious drug side-effects, apart from giddiness with rifampicin and acneiform eruptions with thiacetazone, were encountered . No instances of relapse were noted in the 50% of patients who were followed-up for 3 1/2 years after therapy . Single-drug therapy with isoniazid for lupus vulgaris, as given in the past, is to be discouraged as it may promote the emergence of drug-resistant bacilli in those with an undetected focus of infection.(ABSTRACT TRUNCATED AT 250 WORDS) DICP, 1991 Feb, 25(2), 153 - 63 The postantibiotic effect: a review of in vitro and in vivo data; Zhanel GG et al.; The term postantibiotic effect (PAE) refers to a period of time after complete removal of an antibiotic during which there is no growth of the target organism . The PAE appears to be a feature of most antimicrobial agents and has been documented with a variety of common bacterial pathogens . Several factors influence the presence or duration of the PAE including the type of organism, type of antimicrobial, concentration of antimicrobial, duration of antimicrobial exposure, and antimicrobial combinations . In vitro, beta-lactam antimicrobials demonstrate a PAE against gram-positive cocci but fail to produce a PAE with gram-negative bacilli . Antimicrobials that inhibit RNA or protein synthesis produce an in vitro PAE against gram positive cocci and also produce a PAE against gram-negative bacilli . In vitro methods used to determine the PAE include colony counts, optical density, and measurement of adenosine triphosphate in bacteria . The exact mechanisms by which antimicrobials induce the PAE have not been clearly delineated . Animal studies reveal in vivo PAEs in accordance with PAEs obtained in vitro for most organism/antimicrobial combinations . The clinical relevance of the PAE is probably most important when designing dosage regimens . The presence of a long PAE allows aminoglycosides to be dosed infrequently; the lack of an in vivo PAE suggests that beta-lactam antimicrobials require frequent or continuous dosing . Important questions remain to be answered concerning the PAE. Biull Eksp Biol Med, 1991 Feb, 111(2), 180 - 1 {Polymer-metal complexes of the Mycobacterium protein antigen prevent the dissemination of postvaccinal infection in the T-deficiency state}; Norimov ASh et al.; Primary obtained triple highly immunogenetic complex consists of nonimmunogenic protein antigen, isolated from the BCG, nontoxic polyelectrolyte and bivalent cuprum ions . Immunization with this complex provides high immunoprotection in the experimented B mice (T-deficit mice) from lethal dissemination BCG . Inoculation of single components of the complex has no protection . Result of these experiments suggest that antigen-polyelectrolyte complexes obtained on the basis of nonimmunogenic protein fraction of the tuberculosis bacilli show the properties of a thymus-independent immunization preparations, and provide immune defense in the T-cell deficit of the immune system. Kekkaku, 1991 Feb, 66(2), 81 - 5 {A method of detecting tubercle bacilli in sputum}; Takahashi Y; Tubercle bacilli were injected intravenously to mice after dusts were injected into their subcutaneous tissue . Out of 23 kinds of dusts tested, a quartz dust enhanced most the growth of mycobacteria injected intravenously in mice . Based on this a mixture of the sputum from patients with pulmonary tuberculosis and finely powdered crystalline silica was inoculated subcutaneously into the flanks of mice . Growth of tubercle bacilli was demonstrated occasionally for the sputum specimens from smear-positive and culture-negative cases, and even for smear- and culture negative cases . When a sputum specimen which yielded many colonies on routine egg medium were tested, the growth of bacteria became visible as early as 2 weeks after inoculation . On the other hand, it took 3 to 4 weeks for the visible growth of bacilli, when a sputum specimen yielded only a few or no colonies on culture medium . In this method, the bacilli appeared earlier and more frequently than in the routine culture method on egg medium . Thus an inoculation into mice with a mixture of the sputum and quartz powder was shown to be a sensitive method for the diagnosis of pulmonary tuberculosis. Indian J Exp Biol, 1991 Feb, 29(2), 187 - 9 Effect of corn-steep liquor on growth and mosquito larvicidal activity of Bacillus thuringiensis var israelensis de Barjac 1978 and B . sphaericus Neide 1904; Kuppusamy M et al.; Influence of corn steep liquor on the cell yield and toxicity of three strains of B . thuringiensis var israelensis and two strains of B . sphaericus was studied and compared with peptone-yeast extract using a laboratory fermentor . Large increase in the cell yield of all the three strains of B . thuringiensis var israelensis was observed when cornsteep liquor was used as the sole nitrogen source . Significant increase in toxicity was also observed in B . thuringiensis var israelensis strains B17 and B113 . Among the two B . sphaericus strains tested, the strain 1593 showed no significant change in cell yield and toxicity, whereas the strain VCRC B42 showed increased cell yield and toxicity in this medium . The results indicate that cornsteep liquor can effectively replace both peptone and yeast extract in the media presently used for large scale multiplication of the two larvicidal bacilli. Ann Thorac Surg, 1991 Feb, 51(2), 215 - 8 Risk factors for nosocomial pneumonia after coronary artery bypass graft operations; Gaynes R et al.; We attempted to determine risk factors for nosocomial pneumonia in patients undergoing a coronary artery bypass graft operation . We reviewed the microbiology and medical records for any patient with a sputum culture who had undergone a coronary artery bypass graft operation in 1988 to identify patients with pneumonia according to a standard clinical definition . We found 19 cases of pneumonia through our initial review; complete medical records were found on 15 cases . Gram-negative bacilli predominated as the most common etiologic agent causing pneumonia in this cohort . There were no clusters noted . Mortality was 26.6% . Pneumonia occurred approximately 4 days after the operation . Thirty-six controls were randomly selected from patients undergoing coronary artery bypass graft operations in 1988 . Logistic regression analysis revealed that a history of chronic obstructive lung disease, duration of more than 2 days of mechanical ventilation after operation but before diagnosis of pneumonia, and receipt of gastric acid inhibitors (antacids or H2-blockers) were independent risk factors for nosocomial pneumonia . Only the last risk factor was amenable to intervention at the time of operation. Cent Afr J Med, 1991 Jan, 37(1), 4 - 7 HIV infection in newly diagnosed tuberculosis patients in Ndola, Zambia; Simooya OO et al.; Between June and December 1987, 131 patients newly admitted to the tuberculosis wards of the Ndola Central Hospital, underwent a history and examination, chest radiography, sputum examination and an enzyme linked immuno sorbent assay (ELISA) (Wellcome), for human immuno deficiency virus (HIV) antibodies . For all sera testing positive, the ELISA was repeated on two different occasions before HIV seropositivity was confirmed . Eighty-three patients (67 pc) had tubercle bacilli on microscopy, whilst 76 patients (58 pc) were HIV positive (7 patients had no sputum on admission) . Nine patients (7 pc) had signs of disseminated tuberculosis while the rest had evidence of pulmonary tuberculosis . Four patients (3 pc) had normal chest radiography, whereas the remainder had intrapulmonary lesions in their films . No association was found between presence or absence of bacilli and HIV seropositivity (P greater than 0.05) . HIV seropositive tuberculosis patients were more likely to be younger and female when compared to HIV seronegative tuberculosis patients (P less than 0.05) . It was concluded that HIV infection is common in newly diagnosed tuberculosis patients and that young and female patients are more likely to be HIV seropositive than their male counterpartsPIP: Between June-December 1987, 131 patients newly admitted to the tuberculosis wards of the Ndola Central Hospital underwent a history and examination, chest radiography, sputum examination, and an enzyme linked immunosorbent assay (ELISA, Wellcome) to test for human immunodeficiency virus (HIV) antibodies . For all sera testing positive, the ELISA was repeated on 2 different occasions before HIV seropositivity was confirmed . 83 patients (67%) had tubercule bacilli on microscopy while 76 (58%) were HIV positive (7 patients had no sputum on admission) . 9 patients (7%) had signs of disseminated tuberculosis while the remainder had evidence of pulmonary tuberculosis . 4 patients (3%) had normal chest radiography, whereas the rest of the group had intrapulmonary lesions on their films . No association was seen between presence or absence of bacilli and HIV seropositivity (;0.05) . HIV seropositive tuberculosis patients were more likely to be younger and female as compared with the HIV seronegative tuberculosis patients (p0.05) . It was concluded that HIV infection is common in newly diagnosed tuberculosis patients and that young female patients are more likely to be HIV seropositive than their male counterparts . author's modified Adv Pediatr Infect Dis, 1991, 6, 137 - 62 Current issues in burn wound infections; Dodd D et al.; As we have emphasized, the diagnosis of burn wound infections in the high-risk burned child can be difficult and depends on a very high degree of suspicion and daily clinical evaluation of the burn wound site by consistent observers . Appropriate precautions include meticulous hand-washing and the use of gloves when handling the wound site and prophylactic application of a topical antibacterial agent such as SSD cream . Wound therapy should include routine vigorous surgical debridement . Surveillance wound cultures should be done weekly to determine the emergency of colonization and aid in the selection of empiric antimicrobial regimens when these are appropriate . Wound biopsy for histological examination and quantitative culture is highly recommended in the severely ill child with an unclear etiology or site of infection . If, despite these measures, sepsis ensues, then systemic antibiotics must be started empirically as an adjuctive therapy to surgical debridement . Knowledge of the organisms colonizing a wound will prove useful in choosing an antibiotic regimen while awaiting definitive results of blood and wound biopsy cultures . Without this information, early burn sepsis therapy should focus on gram-positive organisms, while infection later in the course should raise suspicion of nosocomial pathogens such as P . aeruginosa, other enteric bacilli, and C . albicans . An initial regimen might include nafcillin plus ceftazidime or an aminoglycoside, with anaerobic coverage depending on considerations noted previously . Once the causative agent is identified, therapy must be modified accordingly . Amphotericin B and acyclovir use should be guided by positive cultures from the burn wound site along with systemic evidence of dissemination . Available studies do not yet make clear the role of empiric immunotherapy with intravenous gamma globulin in the burned child . Therefore, its use cannot be recommended at the present time, although the development of specific immunoglobulins (P . aeruginosa, S . aureus) may prove useful in the future . In view of the multiplicity of organisms that may colonize burn wounds, it is likely that passive immunization may be more useful in the treatment of infection than in its prevention . The switch from P . aeruginosa to, for example, Klebsiella pneumoniae or E . cloacae, is not apt to be particularly beneficial in most circumstances . Similarly, an increased understanding of the role of the immune system in the propensity to burn sepsis may guide the development of vaccines or immunomodulators that decrease the risk of infection in seriously burned children and adults. Annu Rev Med, 1991, 42, 267 - 76 Tuberculosis in elderly persons; Stead WW et al.; As tuberculosis has been controlled in the western world, it has retreated into enclaves . The largest of these is among persons who are now over age 65, many of whom carry tubercle bacilli in dormant lesions implanted in earlier years and still capable of causing tuberculosis as life forces wane . The diagnosis is all too often not thought of in this age group; as a result, a patient with what was thought to be an episode of bronchitis or bronchopneumonia may die after having exposed a number of young health workers to tuberculosis in a country where it should have been eliminated several years ago . The purpose of this paper is to heighten the index of suspicion of tuberculosis among physicians caring for the elderly. Probl Tuberk, 1991, (1), 22 - 4 {Features of anti-tuberculosis aid to prisoners}; Kolomiets VM et al.; Characteristic features of medical care of tuberculosis patients staying at places of their confinement are considered on the basis of the examination data collected during a year . Inpatient treatment was primarily indicated for subjects with pulmonary tuberculosis (66%), including 31.9 per cent of the newly diagnosed . It is recorded that the percentage of patients with fibrocavernous process was rather high (13.7%), while those suffering from concurrent conditions and excreting drug-resistant tubercle bacilli made up 41.2 and 45.9 per cent; respectively . Some measures are recommended to optimize sufficiently provided medical care and treatment efficacy. Surg Gynecol Obstet, 1991, 172 Suppl, 42 - 53 Developments in the pathogenesis, diagnosis and treatment of nosocomial pneumonia; Scheld WM; Despite recent progress in the prevention and therapy of hospital acquired infections, nosocomial pneumonia remains an important problem in critically ill patients . Nosocomial pneumonia develops in five to ten patients per 1,000 admissions and has a mortality rate of 20 to 50 per cent . This review updates three areas that have been the subject of investigation in recent years: pathogenesis, especially the role of gastric colonization with gram-negative bacilli in retrograde pharyngeal spread; diagnosis, particularly by bronchoalveolar lavage and the protected specimen brush during bronchoscopy, and therapy with extended spectrum penicillins, third generation cephalosporins, imipenem, aztreonam and quinolones. Skeletal Radiol, 1991, 20(2), 130 - 3 Case report 654: Disseminated tuberculosis; Frankel DG et al.; A case of disseminated tuberculosis with a psoas abscess and associated destruction of bone in a 28-year-old man has been presented . Multiple skeletal lesions and hilar adenopathy were observed . The initial diagnosis from pathological specimens was equivocal, since acid-fast bacilli were not demonstrated . However, special stains of biopsy specimens subsequently confirmed the diagnosis . The initial radiographs suggested disseminated malignancy . Good therapeutic results were obtained, utilizing surgical and chemotherapeutic methods . This case demonstrates the ability of disseminated tuberculosis to mimic other disease processes and shows the difficulty that may exist in establishing a diagnosis of tuberculosis, even with biopsy specimens. J Pharm Sci, 1991 Jan, 80(1), 91 - 5 Synthesis and bactericidal properties of pyridinium chlorides with alkylthiomethyl and alkoxymethyl hydrophobic groups; Weglewski J et al.; The products of a reaction between 3-ethoxymethylpyridine and chloromethylalkyl ether or sulfide were proven to be 1-{(alkylthio)-methyl}-3-{(ethoxy)methyl}pyridinium or 1-{(alkoxy)methyl}-3-{(ethoxy)-methyl}pyridinium chlorides . Bacteriostatic properties of the obtained chlorides against 13 different microbial strains representing cocci, rods, fungi, and bacilli were studied . The MICs were measured by serial dilution . All studied chlorides showed bacteriostatic properties . Particularly high activity against microbes was shown by 1-{(dodecylthio)-methyl}-3-{(ethoxy)methyl}pyridinium and 3-{(ethoxy)methyl}-1-{(tetradecylthio)methyl}pyridinium chlorides. Arch Ophthalmol, 1991 Jan, 109(1), 60 - 2 Chronic postoperative endophthalmitis associated with Actinomyces species; Roussel TJ et al.; Actinomyces species, gram-positive, non-spore-forming anaerobic bacilli were isolated from intraocular fluid obtained from four otherwise healthy patients with a delayed onset of postoperative endophthalmitis . One patient had a mixed anaerobic infection with recovery of both Actinomyces israelii and Propionibacterium acnes . In all four patients, early postoperative visual acuity was good but was eventually markedly reduced by intraocular inflammation that was first observed between 21 days and 4 months following uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation . Inflammation was characterized by anterior segment and vitreous cellular debris in all cases . All eyes responded to therapy that included intraocular, topical, and systemic antibiotics as well as pars plana vitrectomy and partial iridectomy . These cases further illustrate the need for microbiologic investigation, including anaerobic cultures, in all cases of chronic postoperative inflammation following extracapsular cataract extraction, regardless of the time of onset. Scand J Infect Dis Suppl, 1991, 78, 45 - 53 Incidence of multi-resistance in gram-negative bacterial isolates from intensive care units in Belgium: a surveillance study; Verbist L; An in vitro study on the prevalence of resistance to major antibiotics in 1,545 Gram-negative aerobic bacilli isolated from intensive care unit patients was undertaken in 16 community and university hospitals in Belgium . A customized dry microtitre panel carrying 16 antimicrobials over an extended concentration range was used for susceptibility testing . The study revealed a widespread resistance to broad-spectrum penicillins, an alarmingly high incidence of resistance to aminoglycosides and a reduced activity of third generation cephalosporins especially in nosocomial pathogens, and a still relatively high susceptibility to imipenem and ciprofloxacin . Wide variations in percentage of resistance to different antibiotics were observed between hospitals, and these differences were not related to type of hospital or number of beds. J Postgrad Med, 1991 Jan, 37(1), 24 - 6, 26A Tuberculosis of breast (study of 7 cases); Sharma PK et al.; Seven cases of tuberculosis of breast are presented . The clinical features were multiple discharging sinuses, lump, ulcer and recurring abscess of breast . Diagnosis relied on histological appearance . Acid fast bacilli being present in only one specimen and positive culture obtained in one patient . Successful treatment combines antituberculous drug therapy with removal of infected breast tissue. Probl Tuberk, 1991, (5), 25 - 9 {Bacteriostatic activity of blood in patients with pulmonary tuberculosis during polychemotherapy}; Bialik IV et al.; Polychemotherapy comprising 4-6 antituberculosis drugs and prescribed either only daily, daily or given on an intermittent basis (every other day) or only on an intermittent basis was given for 4-8 months to 102 patients with destructive pulmonary tuberculosis (in those newly diagnosed, treated earlier and with a process recurrence) . Four and, less frequently, three drugs were used per day . Bacteriostatic blood activity (BBA) was high in 90.2% of the patients, at the maximal concentrations, bacteriostasis was seen at 32-256-fold blood dilutions; in 76.4% of the patients BBA persisted at a high or moderate level during 24 hours (blood dilutions were within 1:256-1:8) . The maximal and total BBA level was significantly higher in polychemotherapy than in a combination of 3 drugs . In polychemotherapy bacilli excretion was discontinued in 90% and caverns healed in 74.5% of the patients, while in the regimens comprising 3 drugs in the same contingent of patients, similar events occurred in 77% and 60% of the cases, respectively. Neurochirurgie, 1991, 37(4), 253 - 7 {Idiopathic giant cell granulomas of the pituitary gland . Apropos of 2 cases}; Bachour E et al.; Two cases are reported of two women who had developed progressive hypopituitarism without visual disturbances . Pituitary tumors were evoked by radiological findings . The patients underwent surgical removal of invasive intrasellar tumor by transphenoidal route . Giant-cell granuloma was histologically demonstrated with negative special staining for tuberculosis acid-fast bacilli, bacteria and fungi . Secondary granuloma due to tuberculosis, brucellosis or neurosarcoidosis was ruled out by serological grounds . The prognosis was discusses through a follow-up of 7 years in the first case and 7 months in the second one . The appropriately documented 31 cases collected from the literature were compared with our two cases. Indian J Lepr, 1991 Jan-Mar, 63(1), 43 - 60 Mouse footpad pathogenicity of leprosy derived nocardioform bacteria cultivated in vitro; Chakrabarty AN et al.; In vitro cultures of the nocardioform bacteria from leprosy-infected tissues consisted of granules and bacilli . Inoculation of these granules into mouse footpads (MFP) produced a mild, localised, inflammation for 4-6 weeks . The granules evoked typical granulomatous response in the subcutaneous tissue and showed gradual disintegration . Infiltration of muscles, connective tissue and epithelial cells by bacillary/mycelial masses was seen very frequently, and that of nerve bundles occasionally . Plenty of mycelial tufts emanated from many 'macrophage globi' . By 6-8 months, the granules disintegrated nearly completely releasing a large number of acid-fast bacilli (AFB), single layered rings of AFB, small globi and some residual mycelia . These AFB, harvested from the MFP, were similar to or indistinguishable from the bacillary preparations from the in vitro cultures and from the leprosy bacillus obtained directly from humans or as passaged into the MFP, on the basis of many criteria studied, including the 36k gene positivity. Exp Pathol, 1991, 42(3), 169 - 73 Chondrocytes may activate macrophages; Kittlick PD; It is demonstrated that conditioned media of articular chondrocytes cultured with Bacilli Calmette-Guerin are capable of activating macrophages . This activation reaches different levels and is expressed both by different cell survival and enhanced synthesis of glycosaminoglycans that remain cell-associated (exp . group III) or are secreted (exp . group II) . The reason of these variances is unknown . - A protein factor is supposed to be present in variable concentration or activity . Interleukin-1 could not be correlated with the results. Cell Immunol, 1991 Jan, 132(1), 150 - 7 Interferon-gamma-treated murine macrophages inhibit growth of tubercle bacilli via the generation of reactive nitrogen intermediates; Denis M; Murine peritoneal macrophages were isolated and their ability to restrict growth of a virulent Mycobacterium tuberculosis in response to IFN-gamma was assessed in various conditions . Doses of IFN-gamma ranging from 10 to 100 U stimulated high levels of antimycobacterial activity, as seen by inhibition of growth . Addition of catalase, superoxide dismutase, and other scavengers of reactive oxygen species before infection failed to abrogate this restriction of growth, suggestive of a lack of involvement of reactive oxygen species in this phenomenon . Addition of arginase before infection inhibited the bacteriostatic ability of IFN-gamma-pulsed macrophages as did addition of NG-monomethyl L-arginine, an inhibitor of the synthesis of inorganic nitrogen oxide . In both cases, this inhibition was reversed by adding excess L-arginine in the medium . Moreover, nitrite production in macrophages was correlated with their ability to restrict tubercle bacilli growth . These results imply that nitric oxide or another inorganic nitrogen oxide is an important effector molecule in restricting growth of M . tuberculosis in IFN-gamma-pulsed murine macrophages. J Clin Microbiol, 1991 Jan, 29(1), 154 - 7 Role of solid media when used in conjunction with the BACTEC system for mycobacterial isolation and identification; Stager CE et al.; This study evaluated the necessity and the contribution of solid media when used in conjunction with radiometric Middlebrook 7H12 (BACTEC 12B; Becton Dickinson, Towson, Md.) medium for recovery and complete identification of mycobacteria . Each of 1,184 digested, decontaminated respiratory specimens was inoculated into one BACTEC 12B vial, one 7H11 plate, and two Lowenstein-Jensen (LJ) slants . When the 12B vial was smear positive for acid-fast bacilli, the organisms were subcultured onto LJ slants and the BACTEC p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test system was inoculated with the organisms . Niacin tests were performed by using the growth from the original LJ slants and organisms from the LJ slants subcultured from 12B or 7H11 medium . The times to achieve definitive NAP and niacin test results were recorded . Recovery of all 143 isolates found in this study could not be achieved with a single medium . Among the three media, the highest percentage (92.8%) of Mycobacterium tuberculosis isolate recovered was with BACTEC 12B . The use of either 7H11 medium or LJ slants along with a 12B vial increased by 4 to 6% the total percentage of M . tuberculosis organisms that were isolated . Isolation of the M . tuberculosis complex and NAP differentiation in 12B medium were completed in an average of 17 days . On average, isolation and definitive niacin test results for M . tuberculosis cultures were obtained in 39.3 days by a conventional procedure and in 36.3 days when 12B subcultures were used . These results support the conclusion that LJ slants contribute 4 to 6% increased recovery of M . tuberculosis when used in conjunction with 12B medium . Additionally, a subculture onto LJ slants from 12B medium yielded sufficient growth for niacin testing earlier than an original LJ slant did. Chest, 1991 Jan, 99(1), 92 - 7 Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections; Baughman RP et al.; STUDY OBJECTIVE: To determine the utility of bronchoscopy with bronchoalveolar lavage for diagnosing M tuberculosis and fungal infections . DESIGN: Retrospective review of patients over a six-year period . SETTING: In- and outpatients of one University hospital and affiliated Veterans Administration Medical Center . PATIENTS: Those who were subsequently found to have either M tuberculosis or fungal infections . INTERVENTIONS: Bronchoscopy with bronchoalveolar lavage specimens were compared to prebronchoscopy sputum, when available . Specimens were sent for smear and culture for both acid-fast bacilli and fungi . In the case of lavage, an aliquot also was studied for cellular differential . MEASUREMENTS AND RESULTS: For TB, sputum was smear-positive in 6/47 (34 percent) and culture positive in 24/47 (51 percent), while bronchoscopy was smear positive in 34/50 (68 percent) and culture positive in 46/50 (92 percent) . For fungal infections, no sputum was smear-positive and only 1/22 (5 percent) was sputum culture-positive, while bronchoscopy was smear-positive in 14/41 (34 percent) and culture positive in 35/41 (85 percent) . Bronchoscopy washings and BAL provided complementary specimens . Eighty-three patients had adequate lavages and the cellularity was significantly different from controls (lymphocytes: TB 18 +/- 11.2 percent {mean +/- SD}; fungal: 13 +/- 11.1 percent; controls 6 +/- 3.1 percent; p less than 0.001; neutrophils: TB 9 +/- 11.5 percent; fungal: 6 +/- 9.1 percent controls: 2 +/- 1.5 percent, p less than 0.01); however, there was overlap and no pattern was characteristic for TB or fungal infections . CONCLUSION: Bronchoscopy with BAL is useful in diagnosing tuberculosis and fungal infections. Ann Rech Vet, 1991, 22(2), 105 - 26 {Coliform bacilli which produce cytotoxins: importance in veterinary medicine and public health}; De Rycke J; This article reviews published data (October 1st, 1990) on 4 types of cytotoxins produced by animal and human pathogenic strains of E coli, ie, verotoxins, also named Shiga-like toxins, cytotoxic necrotizing factors, haemolysin, and cytolethal distending toxin . The biological and molecular properties are described for each type of cytotoxin, the association of producing strains with animal pathology, and the role of domestic animals as reservoirs of strains pathogenic for man. Rev Pneumol Clin, 1991, 47(1), 39 - 42 {Pneumocystis carinii pneumonia in patients with AIDS in the Congo}; M'Boussa J et al.; Forty-five bronchoalveolar lavages (BAL) were performed in Brazzaville in AIDS patients who did not expectorate acid- and alcohol-resistant bacilli (AARB) . All patients presented with respiratory symptoms (cough, dyspnoea or chest pain), and all but 6 of them had abnormal radiography of the chest . Four cases of pneumocystosis were diagnosed (9%); 3 of these patients had interstitial pneumonia and dyspnoea . No AARB was found at microscopic examination of BAL which showed Pneumocyctis carinii; no culture on Lowehstein's medium could be made . The authors consider that the low prevalence of pneumocystosis in Africa, compared with industrial countries, is due to a smaller dissemination of the parasite in Africa rather than to immunodepression which is known to be more pronounced in AIDS patients from industrial countries. Scand J Gastroenterol Suppl, 1991, 181, 38 - 42 Gastric spiral bacilli in captive cheetahs; Eaton KA et al.; Two kinds of gastric spiral bacilli were identified in the stomachs of captive cheetahs with naturally occurring gastritis . One type was morphologically similar to 'Gastrospirillum hominis' . This organism could not be cultured in vitro . Some of these bacteria had superficial helical filaments, and others did not . The other type was morphologically, biochemically, and bacteriologically similar to Helicobacter pylori . This organism is most likely a new species of Helicobacter . One or both of these bacteria may have been responsible for the gastritis seen in these cheetahs. Ann Fr Anesth Reanim, 1991, 10(3), 230 - 4 {Amikacin concentrations in lung and serum after single intratracheal administration in men}; Lancon JP et al.; This study was designed to assess the diffusion into lung tissue and systemic circulation of amikacin administered endotracheally . Eleven consecutive patients, suffering from lung carcinoma and scheduled for elective pneumonectomy or lobectomy, were included in the study . After induction of anaesthesia and before tracheal intubation, a single 500 mg amikacin dose was administered endotracheally through a catheter whose tip was located 5 cm below the vocal cords . Blood was then collected every 15 min for serum assays, until pulmonary resection had been carried out . Pulmonary concentrations were assessed in a healthy area . Measurements were carried out in duplicate using fluorescence polarizing immunoassay and microbiological methods . Serum peak concentrations were found 105 min after administration (7.97 +/- 5.62 micrograms.ml-1) . Six and 12 h after administration, serum concentrations were 3.19 +/- 1.87 and 1.20 +/- 0.67 micrograms.ml-1 respectively . Mean lung concentrations were 1.85 +/- 2.12 micrograms.g-1, with a corresponding serum level of 7.22 +/- 4.36 micrograms.ml-1 . However, endotracheal instillation of amikacin provided serum concentrations which, were not high enough for treatment of gram negative pneumonia . Lung concentrations are lower than both serum levels and MIC90 for gram negative bacilli . Moreover, there was a major heterogeneity in serum and lung levels, which seemed to be unpredictable . This was probably due to heterogenous tracheal, bronchial and alveolar absorption . The results obtained in this study with a single dose administration should be reassessed in the light of data obtained with long-term amikacin administration. Scand J Infect Dis, 1991, 23(2), 263 - 5 Gas-forming vertebral osteomyelitis in diabetic patients; Chen CW et al.; We report 2 cases of gas-forming vertebral osteomyelitis in diabetic patients . Both were caused by gram-negative bacilli, Escherichia coli and Klebsiella pneumoniae respectively . Both ran a fulminant course to death despite appropriate parenteral antibiotics . We suggest that early surgical intervention may be needed in cases with gas-forming vertebral osteomyelitis. Scand J Infect Dis, 1991, 23(2), 195 - 9 Gentamicin-resistant Klebsiella spp . and Escherichia coli in a neonatal intensive care unit; Aronsson B et al.; A case of septicemia in a 7-day-old infant with a gentamicin-resistant strain of Klebsiella oxytoca prompted an epidemiological survey in a neonatal unit . Within a 3-month period 7 patients presented with symptomatic infection with gentamicin-resistant gram-negative bacilli . Another 3 patients were asymptomatic and only harboured the organisms in the stool . The aminoglycoside modifying enzyme ANT(2")-a was identified with a probe technique in different gram-negative species indicating the spread of a plasmid . After the replacement of gentamicin with amikacin and the adherence to proper barrier precautions the gentamicin-resistant strains disappeared from the ward. Arthritis Rheum, 1991 Jan, 34(1), 63 - 7 Induction of arthritis in rats by aqueous suspensions of mycobacteria without the use of oil; Levine S et al.; We report for the first time the induction of arthritis by an aqueous, rather than an oil, suspension of killed tubercle bacilli . This was accomplished in the highly susceptible dark Agouti strain of rats, by intraperitoneal injection during the healing phase of chemically induced peritonitis . The same procedure (injection after the induction of peritonitis) augmented the incidence of arthritis produced by bovine type II collagen and Freund's complete adjuvant . Enhanced delivery of antigen from the peritoneal cavity to regional lymph nodes in the postinflammatory state was responsible for this increase in the induction of arthritis. Z Erkr Atmungsorgane, 1991, 177(1-2), 60 - 70 {Studies about the therapy of tuberculosis in East Germany (former GDR)}; Schnorr R et al.; On the basis of a questionnaire the therapy of 2285 patients with tuberculosis was evaluated for the years 1987-1989 . The data of the GDR National Tuberculosis Register (9827 patients) were used for statistical comparison . 85% of the patients had a pulmonary tuberculosis, 947 patients (41% of all) excreted tubercle bacilli in the sputum . The average duration of treatment was 31.8 weeks, 94.7% of the patients were hospitalised for treatment for an average time of 12.4 weeks, the following outpatient treatment was 19.4 weeks in average . The initial phase (daily-treatment) in all cases of tuberculosis was 8.6 weeks, the follow-up phase was 23.2 weeks (all data are averages) . The intermittent outpatient drug administration was made in 95% of cases under nurse control in outpatient departments . The initial treatment was started in 92.1% with 3 or 4 drugs (H/R/Z/S or E) . Isoniacid and rifampicin were prescribed in 89.7% and pyrazinamide was used as a 4th drug . In the follow-up phase the combination isoniacid and rifampicin was employed intermittent in 75.7% . The delaytime for the evaluated cases was 38.8 days in average . The result of study shows, in most cases the patients were treated according to the recommendation of therapy . The clinical stay of patients is too long. Respiration, 1991, 58(5-6), 321 - 3 Pulmonary nontuberculous mycobacteriosis showing wandering shadows in chest roentgenograms; Kunikane H et al.; The case of a 68-year-old woman with pulmonary nontuberculous mycobacteriosis, whose chest roentgenograms showed unusual wandering shadows on separate occasions, is presented . Acid-fast bacilli were detected in her sputa and by bronchial washing, and were identified as Mycobacterium chelonae, subspecies abscessus . The findings of computed tomography and transbronchial lung biopsy were also unique because of multiple peribronchial inflammations . Chemotherapy with anti-tuberculosis agents and a new quinolone drug was successful in this case. Probl Tuberk, 1991, (10), 11 - 3 {Patterns of occurrence and detection of pulmonary tuberculosis in the cities and rural areas}; Nachichko NN; The role played by various risk factors in urban and rural areas and the regularities in the occurrence and detection of pulmonary tuberculosis were defined from the analysis of 120 pulmonary tuberculosis contamination cases which were revealed for the first time in the region during 5 years . The study included the patients' age, the pattern of morbidity according to the clinical forms of pulmonary tuberculosis, dependence of morbidity on the number of residents--bacilli excretors, the influence of the risk factors of the disease, the effectiveness of preventive fluorographic screening of the thoracic organs and the diagnosis of pulmonary tuberculosis by general physicians . It was found that the epidemiologic situation for tuberculosis in the rural areas is more unfavourable than that in the urban ones. Autoimmunity, 1991, 10(2), 99 - 105 Increased vascular permeability of Brucella abortus bacilli in the thymus of NZB/W F1 mice; Ohmori J et al.; Various amounts of the bacterium, Brucella abortus (BA) were injected intravenously into autoimmune NZB/W F1 mice and non-autoimmune BDF1 mice and then the localization of BA in the thymus was traced using an immunohistochemical method at 30 min and 3 h after injection . The results showed that a greater amount of BA became consistently localized in the thymic parenchyma in a free form or in a phagocytized form in NZB/W F1 mice in comparison with BDF1 mice, indicating a marked increase of vascular permeability in the thymus of NZB/W F1 mice . The extravascular leakage of BA was clearly dose-dependent . The significance of invasion of bacterial antigens from the general circulation into the thymic parenchyma is discussed in relation to autoimmune states. Australas J Dermatol, 1991, 32(2), 81 - 3 Tuberculous infection of the male genitalia; Vasanthi R et al.; The extremely rare occurrence of genital tuberculosis affecting the penis, seminal vesicles, epididymides, vas deferens and Cowper's gland is described . Diagnosis was made by demonstration of fragmented acid fast bacilli in the discharge, and caseating epithelioid cell granulomata with Langhan's giant cells detected on histopathology . Response to antitubercular drugs was prompt. Microbiol Immunol, 1991, 35(10), 825 - 30 Experimental study on the relapse of tuberculosis after the termination of antituberculous chemotherapy using immunodeficient nude mice; Toyohara M; The effect of cellular immunity induced by tuberculous infection on bacteriological relapse after the termination of antituberculous chemotherapy was studied experimentally using immunodeficient nu/nu mice and immunocompetent dd mice . The efficacy of intensive chemotherapy was excellent even in nu/nu mice; tubercle bacilli in the organs decreased below the detectable limit, but formidable regrowth of bacilli was seen after the termination of chemotherapy . On the other hand, in the case of dd mice that established antituberculous cellular immunity through tuberculous infection, bacteriological relapse was generally very slight . It was concluded that bacteriological relapse was related closely with the established cellular immunity induced by the infected tubercle bacilli. Wien Klin Wochenschr, 1991, 103(22), 690 - 2 {Determination of tuberculostearic acid--progress in early diagnosis of tuberculous meningitis}; Luef G et al.; Rapid diagnosis of cerebral tuberculous meningitis is of the greatest importance in determining the outcome of therapy . Since tubercle bacilli are often not seen on microscopy of the cerebrospinal fluid, and culture of Mycobacterium tuberculosis takes many weeks, there is a need for more rapid and sensitive confirmatory tests . The importance of the detection of tuberculostearic acid in the cerebrospinal fluid in combination with magnet resonance imaging will be shown in this case report. Probl Tuberk, 1991, (11), 37 - 40 {Pulmonary tuberculosis in patients with mental disorders, drug addiction and substance abuse}; Rudoi NM et al.; The clinical manifestations, course and outcomes of pulmonary tuberculosis were studied in 215 patients with concurrent severe mental diseases (112 had schizophrenia and 103 other organic diseases of the central nervous system) . The patients had mainly disseminated pulmonary tuberculosis with copious bacilli excretion and destruction . Their clinical manifestations and the course of a specific process were mainly progressive . Fatal outcomes were most common in tuberculosis patients with concurrent drug addiction and toxicomania . It is recommended that patients with mental diseases, narcomania and toxicomania should undergo a prophylactic fluorographic screening twice a year . Treatment of patients with tuberculosis and concurrent mental diseases should be combined and carried out by a psychiatrist (narcologist) jointly with a phthisiatrist. Rev Mal Respir, 1991, 8(5), 473 - 7 {260 cases of tuberculosis death at the Institute of Pneumophysiology of Bucharest 1976-1985}; Mihaltan F et al.; The case notes of all deaths due to tuberculosis registered at the Institute of Pneumophysiology at Bucharest have been reviewed . Out of 273 patients registered, the diagnosis of tuberculosis was retrospectively confirmed 260 times on either bacteriology or histology and was not confirmed by analysis of the medical notes on 13 cases . Of the 260 cases (70% males) the ages range from 18 to 75 . There was 95 new cases of tuberculosis, 68 were relapses and on 97 occasions it was chronic form . Resistant bacilli were isolated 79 times (63%) . Intolerance to treatment was noted in 95 patients (36%) and an incomplete treatment occurred in 84 patients (32%) . The death occurred before treatment could be instituted in 33 patients . Tuberculosis was multicavitatory in 192 cases (74%), was bilateral in 214 cases (82%) . From the last admission on 140 patients whose bacteriology was available for studies 112 (80%) were positive on direct examination . Compared to another enquiry carried out in Bucarest between 1961 and 1968 on 350 deaths due to tuberculosis, it appeared that the patients in the more recent period were suffering from a more severe form of tuberculosis . The above facts witness the efforts made in Rumania to achieve an early diagnosis and treatment in the management of tuberculosis. Probl Tuberk, 1991, (9), 38 - 40 {Tarivid in the combination therapy of patients with pulmonary tuberculosis}; Koriakin VA et al.; The effectiveness of tarivid, a new drug having a broad spectrum of antimicrobial action and antituberculous effect, was studied . The drug was given to 29 patients with newly detected destructive pulmonary tuberculosis and bacillary excretion . Eight patients had microbacterial resistance to streptomycin, rifampicin and isoniazid, 12 had tolerance to them, in 9 patients tuberculosis was complicated by a nonspecific inflammatory process . The course of treatment ranged from 3 weeks to 3 months . The drug was well tolerated . Its effect was manifested by reduction of intoxication, resolution of the inflammatory and pericavitary pulmonary lesions and bacilli absence . Tarivid can be considered an efficacious drug in the multimodality therapy of tuberculosis patients. Gynecol Obstet Invest, 1991, 32(2), 102 - 6 Evaluation of the improvement of cephems on the prophylaxis of pelvic infection after radical hysterectomy; Kobamatsu Y et al.; Antibiotics, especially cephems, have been improved remarkably in the last 20 years . In order to evaluate the improvement of antibiotics used for the prophylaxis of infections after radical hysterectomy, two groups of patients (group A, 1978-1979, n = 54; group B, 1985-1987, n = 55) were examined in regard to bacteriological and clinical effects . In spite of the improvement of antibiotics, the positive rate of bacteriological analysis had increased from 44.4 to 76.4% . Obvious decrease of gram-negative bacilli and increase of gram-positive cocci (GPC), e.g . Enterococcus, were observed . In contrast, fever index and febrile morbidity of group B decreased significantly more than those of group A . These results indicate that the improvement of antibiotics has brought more effective prophylaxis in the postoperative infection in spite of the high positive rate of GPC. Respiration, 1991, 58(3-4), 171 - 5 Clinical and pathological features of tuberculous pleural effusion and its long-term consequences; Chan CH et al.; A retrospective study of 83 cases of tuberculous pleural effusion showed that the mean age of the patients was 44 years and 10 patients (12%) were over the age of 70 . Pleural fluid was smear positive for tubercle bacilli in none but culture positive in 23% of the cases . Pleural biopsy was a more sensitive method of diagnosis with granulomatous inflammation seen in 97% of cases . Five patients developed significant pleural thickening during chemotherapy requiring decortication . Twenty-two patients with tuberculous effusion diagnosed and treated over 2 years previously were traced for reassessment . None of them had significant pleural thickening and lung function tests did not show significant impairment compared to matched control subjects. Lung, 1991, 169(5), 285 - 9 Percutaneous transthoracic needle biopsies in the rapid diagnosis of pulmonary tuberculosis; Yew WW et al.; From May, 1987, to December, 1990, 173 percutaneous transthoracic needle biopsies (PTNB) using a 19-gauge spinal needle under uniplane fluoroscopic guidance were performed in 160 patients . Thirty-one patients had a final diagnosis of pulmonary tuberculosis . These patients with tuberculosis underwent a total of 35 biopsies . Twenty of 35 (57%) had definite histologic features of tuberculosis with stainable acid-fast bacilli, 4/35 (11.5%) had granulomatous or caseous lesion consistent with tuberculosis, and 11/35 had nonspecific inflammatory changes . When results were matched with the sputum culture results, 15/35 specimens (43%) provided the exclusive means of diagnosis of tuberculosis . Five of 35 (14%) patients developed postbiopsy pneumothoraces . The overall acceptance by patients was good . This report indicates the potential usefulness of PTNB in the rapid diagnosis of selected cases of suspected pulmonary tuberculosis . The yield was comparable to fiberoptic bronchoscopy, currently commonly used in the diagnosis of pulmonary mycobacterial disease . The procedure was noted for its simplicity. Lab Delo, 1991, (9), 66 - 8 {Anaerodisks for the identification of anaerobic microflora}; Cherniavskaia LV et al.; The authors review the present-day methods for the identification of gram-negative anaerobic nonsporogenous bacilli and cocci with the use of anaerodisks . Data are presented on the generic and species composition of obligate anaerobes of the gastric contents, proximal section of the jejunum, and the distal portion of the large intestine . Use of anaerodisks helped identify up to 90% of anaerobic cultures isolated from the gastrointestinal tract of man. J Hosp Infect, 1991 Jan, 17(1), 45 - 51 Pseudomonas pickettii infections in a paediatric oncology unit; Lacey S et al.; Over a 3-month period, seven patients in a paediatric oncology unit developed Pseudomonas pickettii septicaemias . The outbreak was difficult to recognize since the cases occurred at widely spaced intervals and problems were experienced with the identification of the isolates . Many of the isolates were initially misidentified on the basis of a short sugar set used in the laboratory for identification of the non-fermenting Gram-negative bacilli . Moreover, the organisms had varying sensitivity patterns . The source of the organisms proved to be vials of 'sterile' distilled water which had been used for flushing the patients' indwelling Hickman lines . No further cases occurred once the use of this water was discontinued. MMWR Recomm Rep, 1990 Dec 7, 39(RR-17), 1 - 29 Guidelines for preventing the transmission of tuberculosis in health-care settings, with special focus on HIV-related issues; Dooley SW Jr et al.; The transmission of tuberculosis is a recognized risk in health-care settings . Several recent outbreaks of tuberculosis in health-care settings, including outbreaks involving multidrug-resistant strains of Mycobacterium tuberculosis, have heightened concern about nosocomial transmission . In addition, increases in tuberculosis cases in many areas are related to the high risk of tuberculosis among persons infected with the human immunodeficiency virus (HIV) . Transmission of tuberculosis to persons with HIV infection is of particular concern because they are at high risk of developing active tuberculosis if infected . Health-care workers should be particularly alert to the need for preventing tuberculosis transmission in settings in which persons with HIV infection receive care, especially settings in which cough-inducing procedures (e.g., sputum induction and aerosolized pentamidine {AP} treatments) are being performed . Transmission is most likely to occur from patients with unrecognized pulmonary or laryngeal tuberculosis who are not on effective antituberculosis therapy and have not been placed in tuberculosis (acid-fast bacilli {AFB}) isolation . Health-care facilities in which persons at high risk for tuberculosis work or receive care should periodically review their tuberculosis policies and procedures, and determine the actions necessary to minimize the risk of tuberculosis transmission in their particular settings . The prevention of tuberculosis transmission in health-care settings requires that all of the following basic approaches be used: a) prevention of the generation of infectious airborne particles (droplet nuclei) by early identification and treatment of persons with tuberculous infection and active tuberculosis, b) prevention of the spread of infectious droplet nuclei into the general air circulation by applying source-control methods, c) reduction of the number of infectious droplet nuclei in air contaminated with them, and d) surveillance of health-care-facility personnel for tuberculosis and tuberculous infection . Experience has shown that when inadequate attention is given to any of these approaches, the probability of tuberculosis transmission is increased . Specific actions to reduce the risk of tuberculosis transmission should include a) screening patients for active tuberculosis and tuberculous infection, b) providing rapid diagnostic services, c) prescribing appropriate curative and preventive therapy, d) maintaining physical measures to reduce microbial contamination of the air, e) providing isolation rooms for persons with, or suspected of having, infectious tuberculosis, f) screening health-care-facility personnel for tuberculous infection and tuberculosis, and g) promptly investigating and controlling outbreaks . Although completely eliminating the risk of tuberculosis transmission in all health-care settings may be impossible, adhering to these guidelines should minimize the risk to persons in these settings. N Engl J Med, 1990 Dec 6, 323(23), 1581 - 6 Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection; Perkocha LA et al.; BACKGROUND . Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids . Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation . METHODS . We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis . For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection . Tissues were examined histologically on routine sections and with special stains and electron microscopy . RESULTS . The histologic features seen in peliosis hepatis as