Bacillus

Lepr Rev, 1990 Mar, 61(1), 12 - 8
Preliminary observations on experimental leprosy in tupaias (Tupaia belangeri yunalis); Wang HY et al.; The Tupaia belangeri yunalis (tree shrew) is one of the primitive primates . They were inoculated subcutaneously in the footpad or intravenously with Mycobacterium leprae from a patient with multibacillary leprosy . As controls, the footpads of CFW mice were inoculated with the same suspension of M . leprae . The results showed growth of acid-fast bacilli (AFB) in the footpads of locally inoculated CFW mice and in the footpads of both locally and intravenously inoculated tupaias . Whereas the numbers of AFB declined in the footpads of CFW mice after 12 months, they increased in the tupaia footpads, up to 2.44 x 19(9) AFB/g of tissue . The footpads of one tupaia were swollen, which on section revealed a granulomatous infiltration, including foamy and heavily infected macrophages . M . leprae were also seen in the branches of cutaneous nerves . Also AFB occurred in some viscera . Preliminary studies indicate that the AFB multiplying in tupaias are M . leprae.

Int J Lepr Other Mycobact Dis, 1990 Mar, 58(1), 12 - 8
Effectiveness of pefloxacin in the treatment of lepromatous leprosy; N'Deli L et al.; As a first clinical trial of a fluoroquinolone derivative in leprosy, ten previously untreated lepromatous leprosy patients, about two fifths of them with primary dapsone resistance but all susceptible to rifampin, were treated with pefloxacin 400 mg twice daily for 6 months . Definite clinical improvement was observed in all ten patients as early as 2 months after beginning treatment, and the morphological index was also drastically decreased to the baseline during the same period . The rapid bactericidal effects, as measured by serial mouse foot-pad inoculations, were demonstrated to the extent that about 99% of the bacilli were killed during the first 2 months of treatment . However, the bacterial load, in terms of the bacterial index and the number of acid-fast bacilli per mg of tissue, of the patients was only moderately reduced . The side effects were mild, and the patients tolerated the treatment well.

Baillieres Clin Gastroenterol, 1990 Mar, 4(1), 23 - 42
Molecular biology of Crohn's disease mycobacteria; Hermon-Taylor J et al.; A Glasgow surgeon, T.K . Dalziel, published a detailed description of chronic enteritis in humans in 1913 . He proposed that the disease was caused by the same organisms as those responsible for chronic enteritis, Johne's disease, in animals described a few years earlier (1895) . Dalziel's dilemma was that he could see acid-fast bacilli in the diseased animal tissues but not in the diseased human tissues . Little real progress in the medical understanding of the causes of chronic enteritis in humans occurred over the next half a century or more . From 1978, a decade of research in many laboratories using improved methods for the culture of environmental mycobacteria showed that these could be grown in bacillary form from about one in five cases of Crohn's disease, from the same proportion of cases of ulcerative colitis, and from about one in ten control tissues . Spheroplasts were grown from two in five cases of Crohn's disease, one in five cases of ulcerative colitis, and rarely from control tissues . The nature of these agents was often uncertain . We describe work which began in 1985 and led rapidly to the identification of IS900, a DNA repetitive element in an uncharacterized Crohn's disease mycobacterial isolate . With other isolates, these were then shown by DNA fingerprinting to be indistinguishable from Mycobacterium paratuberculosis, Johne's bacillus . Similar techniques also demonstrated the wood-pigeon strain of M . avium in some Crohn's disease cultures . This bacillus can also cause chronic enteritis in calves . IS900 is the first of a family of unusual DNA insertion sequences which extend widely throughout environmental mycobacteria . Use of assays based on PCR amplification of highly specific DNA sequences from these insertional elements, and recombinant and synthetic peptides from their predicted proteins, will revolutionize the detection and characterization of these agents . These methods, applied to animal, human and environmental samples, will indicate new ways for the prevention and treatment of chronic enteritis, as well as other disorders associated with infections by environmental mycobacteria.

J Periodontal Res, 1990 Mar, 25(2), 106 - 12
DNA homologies shared among E . corrodens isolates and other corroding bacilli from the oral cavity; Chen CK et al.; In a previous microbiological study of Eikenella corrodens, we noted the presence of E . corrodens strains with variability in colony morphology, as well as other corroding bacilli phenotypically similar to E . corrodens but which were unidentifiable on the basis of biochemical reactions . This raised questions as to whether E . corrodens constitutes a genetically heterogeneous group of organisms, and whether the unidentified corroding bacilli represent atypical E . corrodens or genetically unrelated organisms . In the present study, the genetic relationship among 14 E . corrodens isolates and 6 unidentified corroding bacilli was examined . DNA base compositions were determined from the melting temperatures of DNA samples . DNA homologies among E . corrodens and corroding bacilli were determined by DNA hybridization in solution using S1 nuclease . The % G + C content of E . corrodens strains varied from 56 to 58%, and from 56 to 60% for unidentified corroding bacilli . The DNA homologies among 12 E . corrodens isolates and 2 reference strains varied from 57 to 97% . Although these E . corrodens isolates exhibited variabilities in colony morphology and biochemical profile, no subspecies was identified . The unidentified corroding bacilli shared less than 33% homology with either of the E . corrodens reference strains . These corroding bacilli were further divided into 3 species on the basis of DNA hybridization studies using radiolabeled DNA from 2 representative corroding bacilli . One of the unidentified corroding bacilli appears to be a component of the normal flora in the human oral cavity . Our results indicate that E . corrodens is a genetically homogeneous species containing no recognizable subspecies.(ABSTRACT TRUNCATED AT 250 WORDS)

Tubercle, 1990 Mar, 71(1), 35 - 8
Abacillary pulmonary tuberculosis; Norregaard J et al.; In Copenhagen, a city with a low incidence of tuberculosis, 72 patients with discrete pulmonary infiltrates on the chest X-ray had a tentative diagnosis of tuberculosis . All were sputum smear negative for acid-fast bacilli . A prospective randomised study was carried out to determine whether these patients would benefit from chemotherapy . Out of the 72 patients, 22 (30.6%) had positive cultures initially and were treated . Of the remaining 50 patients, 22 received chemotherapy and 28 were untreated controls . Among the untreated patients 8 (29%) later became culture positive for M . tuberculosis, whereas none of the treated patients developed culture positive tuberculosis during the follow-up period of 5 years.

Indian J Med Res, 1990 Mar, 91, 111 - 4
Isolation rates of different mycobacterial species from Chandigarh (north India); Chakrabarti A et al.; A total of 4958 patients, clinically suspected to have tuberculosis were screened for mycobacteria by acid fast staining and culture procedures . Mycobacterial species were isolated from 462 (9.3%) patients while acid fast bacilli were demonstrated on smear examination in 83 (1.7%) patients . Mycobacterium tuberculosis was the most common isolate (92%) . Among the nontuberculous mycobacteria, M . fortuitum was isolated in 13 (2.8%), M . avium in 2 (0.4%) and M . szulgai in 1 (0.2%) . In 22 individuals clinically suspected of tubercular pleural effusion, pleural biopsy specimen gave higher isolation of mycobacteria (27.3%) as compared to isolations from pleural fluid specimens (9.1%).

Infect Immun, 1990 Mar, 58(3), 632 - 8
Relative permissiveness of macrophages from black and white people for virulent tubercle bacilli; Crowle AJ et al.; Epidemiological, clinical, and histopathological evidence suggests that black people are more susceptible to tuberculosis than are white people . The cellular basis of this putative susceptibility was investigated in vitro by comparing responses of blood-derived macrophages from black and white donors to experimental infection with virulent tubercle bacilli . Phagocytes from pairs of black and white donors were infected . The uptake and replication of the tubercle bacilli in these cells were measured by microscopic counts and by CFU counts of bacilli at 0, 4, and 7 days . The effects of donor serum, of 1,25-(OH)2-vitamin D3, and gamma interferon on the infection also were studied . Black-donor phagocytes killed more bacilli during phagocytosis than white-donor phagocytes did . However, the bacilli grew consistently and significantly faster in successfully infected macrophages from black than from white donors, especially in the presence of black-donor serum . 1,25-(OH)2-vitamin D3 gave significantly less protection against tubercle bacilli to macrophages from black donors than to macrophages from white donors . The permissiveness of the macrophages from the two races was affected equally by gamma interferon . These results demonstrate some inherent and environmental liabilities in the monocytic phagocytes and serum of black people compared with white people, which may contribute to their greater susceptibility to tuberculosis.

Arch Dermatol, 1990 Mar, 126(3), 331 - 5
In situ characterization of cellular infiltrates in lupus vulgaris indicates lesional T-cell activation; Ramesh V et al.; Skin biopsy specimens from nine patients with lupus vulgaris were examined in situ by means of monoclonal antibodies directed against phenotypes of lymphocyte subsets, Langerhans cells, HLA-DR antigens, and interleukin 2 receptor . The epidermis showed prominent changes, including intense expression of HLA-DR on keratinocytes, increase in epidermal cell layers, moderate to high Langerhans cell hyperplasia, and infiltration by CD3+ pan-T cells as well as CD8+ (cytotoxic/suppressor) and CD4+ (helper/inducer) T cells . The predominant lymphocyte in the dermal granulomas was the activated CD3+ T cell, expressing major histocompatibility complex class II antigens and interleukin 2 receptor . CD4+ and CD8+ cells were randomly distributed among the epithelioid cells, which showed intense staining for major histocompatibility complex class II antigens . In all except two patients, the CD4+ population was greater than that of the CD8+ cells . CD1+ Langerhans cells were scattered in moderate numbers in the dermal granulomas . Acid-fast bacilli were conspicuously absent in the biopsy specimens . These features suggest that T-cell activation and Langerhans cell hyperplasia are prominent features of dermal tuberculosis.

Lancet, 1990 Feb 17, 335(8686), 387 - 90
Tuberculosis and human immunodeficiency virus infection in developing countries; Harries AD; PIP: Estimates show that 5 million people worldwide are infected with human immunodeficiency virus (HIV) . Recent estimates are that 8-10 million new tuberculosis (TB) cases occur each year in the world . 2-3 million die . In developing countries, TB is one of the most common opportunistic infections in people who are seropositive for HIV-1 . About 90% of the TB is pulmonary . Of those without pulmonary tuberculosis, 85% had lymphadenopathy, bone and joint disease, or pleural effusion . In adults and children over 15 who had pulmonary TB, 78% had positive sputum smears for acid-fast bacilli . 66% had cavitation on chest radiography . Many people with TB and HIV infection have typical clinical and radiologic features . However, African clinicians have seen a change . This makes TB harder to diagnose . In Bangui, Central African Republic, 30% of pulmonary TB patients were HIV seropositive . Studies from Zaire and Zambia also had patients with suspected TB and extrapulmonary TB with higher HIV seropositivity rates than those with sputum-positive TB . Haitians show a similar disease pattern to that of Africa . 70% of people with tuberculosis and the acquired immunodeficiency syndrome (AIDS) had extrapulmonary disease compared with 20% of the HIV-negative people with TB . Chemotherapy of TB in Africans who also have HIV infection is not certain . Clinical impressions suggest that the disease responds well to the usual therapy . However, a Central African study found that mortality 12 months after the start of the usual drug therapy was 32.5% in HIV-seropositives compared with 1.5% in HIV-seronegatives . Several countries in Africa use short-course drug therapy for smear-positive pulmonary TB . They use the usual regime for smear-negative and extrapulmonary TB . Since AIDS, there are more skin allergic reactions to the usual drug therapy . There are more severe reactions now . Thiacetazone is the drug which probably causes this reaction . BCG immunization is used to control TB in Africa . World Health Organization guidelines are to withhold BCG from HIV- seropositive people with symptoms . What about infants born to HIV- seropositive mothers?

Pneumologie, 1990 Feb, 44 Suppl 1, 647 - 52
{Possible effects of acquired immunologic deficiency syndrome (AIDS) on tuberculosis in industrial and developing countries}; Styblo K; Tuberculosis is the most frequent infectious complication of AIDS and HIV infection in countries where che prevalence of tuberculous infection is high . HIV infection is the strongest risk factor for developing tuberculosis in individuals infected removly or recently with tubercle bacilli . An increased incidence of tuberculosis has been already documented in several African countries with a high prevalence of both tuberculous and HIV infections (Tanzania, Malawi) . The increase in the incidence of tuberculosis is mainly due to the depression of cellular immunity caused by HIV infection in subjects infected with M . tuberculosis . The occurrence of tuberculosis in HIV-seropositive persons is more frequent in those remotely infected than in those recently infected or reinfected with M . tuberculosis . In developed countries, HIV infection will cause tuberculosis in only a relatively small number of persons, since the prevalence of tuberculosis infection is low in the age group up to approximately 45 years . HIV infection will, therefore, not substantially increase the number of tuberculosis cases.

Aust Vet J, 1990 Feb, 67(2), 43 - 6
Experimental infection of normal and immunosuppressed pigs with Pseudomonas pseudomallei; Thomas AD et al.; A single dose of 5 x 10(8) bacilli of Pseudomonas pseudomallei by intratracheal injection resulted in acute (21 cases) or chronic (19 cases) melioidosis in 40 of 48 pigs . Fifteen (10 acute and 5 chronic) had been immunosuppressed by cyclophosphamide before inoculation . The major clinical signs were initial fever, marked neutrophilia and, in the acute cases, respiratory distress . There were no signs of the nasal and ocular discharge, paresis or diarrhoea seen in acute cases in south-east Asia . The cyclophosphamide treatment caused a significant decrease in the neutrophil count by 7 d after inoculation in all 15 immunosuppressed pigs, and all were culture positive at necropsy . Eight of the 33 non-treated pigs were culture negative at necropsy . Pigs overcoming the initial phase of infection had more abscess-like nodules that were bacteriologically sterile at necropsy than the pigs with acute cases of melioidosis . P . pseudomallei was isolated predominantly from the spleen, lungs and the injection site . Although only one strain was used in this study, it is likely that Australian strains of P . pseudomallei are not as virulent as the south-east Asian isolates.

Acta Pathol Jpn, 1990 Feb, 40(2), 116 - 27
Pulmonary tuberculosis . An occupational hazard for pathologists and pathology technicians in Japan; Sugita M et al.; The incidence of pulmonary tuberculosis among pathology workers in Japan is elevated, presumably due to frequent exposure to tubercle bacilli in the work place . To demonstrate the etiological significance of the association between this disease and occupation epidemiologically, a questionnaire survey was performed to assess the incidence of pulmonary tuberculosis among 1,201 pathologists and 1,187 pathology technicians throughout Japan . Pathology department workers other than pathologists and technicians, such as secretaries (n = 207), and workers in university departments of preventive medicine and public health (n = 732) served as control groups . While non-occupation-related tuberculosis was found in both departmental groups with nearly equal incidence, the incidence of pulmonary tuberculosis among pathologists and pathology technicians after engagement in their current specialist work was significantly higher than that in the control groups (odds ratio = 6.08-10.98) . The incidence of disease among pathology technicians who assisted in autopsies was markedly higher than among those not involved in autopsies (odds ratio = 6.65) . This elevated incidence was significantly related to the duration of work in pathology activities, and showed little change over the last decade . These findings indicate that specific environmental conditions in pathology departments, particularly autopsy of cadavers harboring active tuberculosis, constitute a serious occupational hazard.

Nippon Geka Gakkai Zasshi, 1990 Feb, 91(2), 184 - 90
{A research on the cholestasis caused by continuous endotoxemia}; Nishida M et al.; Intrahepatic cholestasis is often observed in patients without obstruction of the bile duct, who are suffering from severe prolonged infection in the field of peptic surgery . Clinical data were analyzed in recently experienced 18 cases which showed this kind of jaundice . In those case, high rates of endotoxemia and high rates of gram negative bacilli were seen . This fact made us infer that endotoxins might cause jaundice . In order to clarify the mechanism of the jaundice, we made an experimental model of persistent endotoxemia in rats . Low-dose endotoxin was infused continuously to Donryu-rats and bile-output was observed with external bile-guiding tube for 24 hours . In the endotoxin group, bile-output was significantly decreased whereas it was not changed in the control group . In addition, serum bilirubin was elevated in the endotoxin group, whereas it did not change in the control group . Blood-flow of liver tissue and systemic arterial blood pressure did not show any severe decrease under the continuous endotoxemia . Data of bile-output and bile acid showed bile acid independent flow might be depressed by endotoxin infusion . This model was thought to be under non-shock condition and useful to investigate jaundice seen in patients under continuous endotoxemia.

Arch Intern Med, 1990 Feb, 150(2), 333 - 6
Comparative yield of blood culture for fungi and mycobacteria, liver biopsy, and bone marrow biopsy in the diagnosis of fever of undetermined origin in human immunodeficiency virus-infected patients; Prego V et al.; The diagnostic yield of mycobacterial blood cultures, bone marrow biopsy, and liver biopsy for determining the cause of unexplained fever was compared prospectively in eight men and four women with serologic evidence of human immunodeficiency virus infection and fever of undetermined origin . Mycobacterial infection was found in 8 of the 12 patients (Mycobacterium tuberculosis in 3 and Mycobacterium avium in 5) . Mycobacteria were isolated from the blood of 6 of these 8 patients . The mean interval from blood culture inoculation to growth was 28 days . Acid-fast organisms or granulomas were seen in four bone marrow and six liver specimens . Liver biopsy revealed acid-fast bacilli in a higher percentage of cases (75%) than did bone marrow biopsy (25%) . Mycobacterial blood culture is a relatively slow method that occasionally fails to diagnose mycobacterial infection . In febrile patients infected with human immunodeficiency virus, liver biopsy is the most rapid method of diagnosing mycobacterial infection.

Drugs, 1990 Feb, 39(2), 224 - 33
Management of tuberculosis meningitis; Holdiness MR; This article examines the detection, assessment, and therapeutic modalities available for tuberculosis meningitis . Without appropriate treatment this disease is fatal within 2 months of development, and mortality is closely associated with the stage of disease upon initiation of chemotherapy . Initial lumbar puncture reveals smear-positive acid-fast bacilli in up to 40% in most series; however, repeat examinations increase the yield, via direct smear, to as high as 87% . Analysis of cerebrospinal fluid is described, along with advanced techniques for early detection of this infection . Eight antituberculosis agents have known penetration into the cerebrospinal fluid . The most important prognostic factor is the neurological stage at which the individual presents at the initiation of therapy . Various chemotherapeutic approaches are available but it appears the use of rifampicin (rifampin) with isoniazid-containing regimens gives the best results . Regardless of the therapy undertaken, a significant number of individuals are left with some degree of neurological deficit . The roles of bacillus of Calmette and Guerin (BCG) vaccine, steroids, and neurosurgery in the treatment of this disease are also discussed.

J Bacteriol, 1990 Feb, 172(2), 1005 - 13
Peptidoglycan-associated polypeptides of Mycobacterium tuberculosis; Hirschfield GR et al.; Important protein-based immunoreactivities have long been associated with the cell wall core of mycobacteria . In order to explore the molecular basis of such activities, purified cell walls of Mycobacterium tuberculosis were extracted with sodium dodecyl sulfate to produce an insoluble residue composed of the mycolylarabinogalactan-peptidoglycan complex and about 2% of unextractable protein . Treatment of the product from an avirulent strain of M . tuberculosis with trifluoromethanesulfonic acid released a single polypeptide with a molecular size of 23 kilodaltons, accounting for all of the insoluble cell wall protein . Extensive purification and then analysis of the 23-kilodalton protein demonstrated the absence of diaminopimelic acid, muramic acid, or other peptidoglycan components, pointing to either a novel linkage between protein and peptidoglycan or a noncovalent but tenacious association . The released 23-kilodalton protein showed amino acid homology and other similarities to the outer membrane protein OmpF of Escherichia coli . Although a similar product was released in small quantities from cell walls of the virulent M . tuberculosis Erdman and H37Rv by lysozyme treatment, the cell walls of virulent bacilli were dominated by the presence of poly-alpha-L-glutamine, accounting for as much as 10% of their weight . The poly-alpha-L-glutamine was successfully separated from the cell wall proper, demonstrating again the absence of a covalent association between peptidoglycan and the polymer . The antigenicity of these products is demonstrated, and their roles vis-a-vis analogous polypeptides from other bacteria in immunogenicity, pathogenicity, and bacterial physiology are discussed.

Am Rev Respir Dis, 1990 Feb, 141(2), 511 - 3
Utility of Gram's and Giemsa stains in the diagnosis of pulmonary tuberculosis; Fisher JF et al.; Conflicting information in the literature regarding the staining properties of Mycobacterium tuberculosis using Gram's stain and experience in two patients with pulmonary tuberculosis in whom the diagnosis was suspected after staining with non-acid-fast bacillus stains prompted the study of Gram's stain in this disease . The main finding was that mycobacteria appear as refractile, gram-neutral, or faintly gram-positive bacilli after Gram's stain, depending upon the plane of focus in which the organisms are regarded . It is concluded that the diagnosis of mycobacterial disease may be suggested by Giemsa- and Gram-stained smears of clinical specimens . M . tuberculosis may be either gram-neutral or gram-positive.

Pol Tyg Lek, 1990 Jan 22-29, 45(4-5), 91 - 2
{Sensitivity of aerobic bacteria and Candida species to chlormidazole hydrochloride in vitro}; Krasiejko I et al.; Over 100 bacterial stains, including Candida sp., gram-positive cocci and some gram-negative bacilli, were tested . The majority of microorganisms was isolated from man . Only one bacterial strain (5 micrograms/mL) and 76% of Candida strains were sensitive to chlormidazole HCl (10 micrograms/mL) . It may be assumed that most infections with Candida sp . will respond to therapy with drugs containing chlormidazole HCl . Relatively simple and inexpensive tube test may serve to evaluate microbial sensitivity to this agent, especially in case of isolates from patients.

Beitr Trop Landwirtsch Veterinarmed, 1990, 28(2), 191 - 7
{Mortality by crushing in domestic pigs: study of the causes and their relationship to the time and the month of the year in the climatic conditions of Cuba}; Cabrera JF et al.; In the course of 3 years a complex of 25,000 pigs were investigated once per week for the dead among the 398 sucking piglets, and in the case of losses due to crushing to death the type of lesions and the connection with diseases was investigated . Of the piglets investigated, 88 were crushed to death (21.2%), among them 65 (73.8%) diseased--mainly infected by coli bacilli (60 = 68.2%)--and 23 (5.8%) healthy animals . The losses due to crushing to death were highest in January and differed from all other months of the year (p less than 0.05) . Another peak of losses in July was only significant (p less than 0.05) as compared with the values of April and November . January and July also exhibited the highest proportion of coli-infected piglets . The most frequent lesions were edema and cyanosis of the skin, of the mucous membrane, and the hypodermic tissue, haemothorax and haemoperitonaeum, liver cracks, lung cracks, kidney cracks, stomach cracks, large intestine cracks, and multiple fractures of the ribs and of the skull . It is concluded that the losses due to crushing to death can be related to the decrease in vitality of the piglets due to diseases, caused in winter by decreased vitality and in summer by pressure caused by coli infection.

Probl Tuberk, 1990, (2), 15 - 7
{Ways of diagnosing patients with tuberculosis}; Liubkina NI; Data on detection of 1447 tuberculosis cases in Moscow were studied . The majority of the patients (57.5% of tubercle bacilli excretors and 55.8% of abacillary cases registered in 1985-1986) were detected as a result of their referral to health institutions . In the group of patients detected through preventive screening, 98.5% of tuberculosis cases were confirmed by means of a fluorographic method . If compared to the newly discovered cases, the patients with relapses of tuberculosis are detected much more frequently when they complain of the symptoms of this disease . No matter how different the ways of detecting tuberculosis might be, significant differences in the clinical composition of the patients were obtained which have nothing to do with their belonging to a certain social group . Many of the patients with focal tuberculosis, tuberculoma and disseminated tuberculosis are detected through preventive screening while those with infiltrative and fibrocavernous tuberculosis on their referral to health institutions.

Vojnosanit Pregl, 1990 Jan-Feb, 47(1), 17 - 21
{A coding method for the identification of gram-negative bacteria}; Catibusic A; A coded method for identification of gram-negative bacilli based on a short biochemical series including 9 test which is otherwise most frequently used in microbiologic laboratories all over the country is presented . Additional biochemical tests for one gram-negative bacillus which behaves in the same way in the short mixed order is also reported.

Diagn Cytopathol, 1990, 6(2), 118 - 21
Negative images of bacilli and mycobacterial infection: a study of fine-needle aspiration smears from lymph nodes in patients with AIDS; Stanley MW et al.; In patients with the acquired immunodeficiency syndrome (AIDS), four cases of mycobacterial infection in which bacilli appeared as cylindrical, nonstaining "negative images" have been previously described . These may have been extracellular or within histiocyte cytoplasm, and they have been described in aspirations from liver, lymph node, and bone marrow and in bronchoalveolar lavage fluid . We report three additional examples of this finding in fine-needle aspirations from lymph nodes in AIDS patients infected with Mycobacterium avium-intracellulare . Our findings support the concept that these negative images of bacilli are diagnostic of mycobacterial infection . Air-dried Romanovsky-stained material is required for their identification.

Kekkaku, 1990 Jan, 65(1), 42 - 7
{The serodiagnosis of tuberculosis by enzyme-linked immunosorbent assay with tuberculin purified protein derivative}; Kusano N; Tuberculin purified protein derivative (PPD) is a relatively crude antigen prepared from Mycobacterium tuberculosis and has species nonspecificity in immunological reaction . It is, however, more readily available than more highly purified materials . Therefore, the detection of IgG antibody to PPD was done by enzymed-linked immunosorbent assay (ELISA) and its diagnostic useful was evaluated in this study . The patients with active tuberculosis had significantly high titer of IgG antibody to PPD compared with healthy persons and the patients without tuberculosis (P less than 0.001) . An upper limit of normal set (=cut-off titer) at 2 standard deviations above mean of logarithmic titers in 220 healthy adult subjects would result in positive test reactions on the sera from 78 of 100 patients with active tuberculosis . Although 8 of 39 with atypical mycobacteriosis would be positive, 6 of 7 were distinguished almost with tuberculosis by detecting antibodies to PPD from M . intracellulare and M . kansasii concurrently . The antibody titer increased after chemotherapy would be gradually reduced under the cut-off titer when culture of mycobacteria turned to negative and markers of inflammation became negative . In false-negative cases, 4 were patients with hypo-gammaglobulinemia, 6 were with fresh tuberculosis before chemotherapy, 2 were with negative CRP in all clinical course and 4 were with bacilli needed over 7 weeks culture . From these results, this assay is helpful in the diagnosis of tuberculosis and a useful marker for judgment of clinical improvement, although detection of antibody has its limitations.

Kekkaku, 1990 Jan, 65(1), 39 - 42
{Basic and clinical evaluation of rapid diagnosis of tuberculosis by detecting tuberculostearic acid}; Muranishi H et al.; Tuberculostearic acid (TSA) is known to be one of the characteristic lipid in the limited species of the order Actinomycetale, including Mycobacterium tuberculosis . We studied the significance of detecting TSA in the diagnosis of tuberculosis from clinical specimens collected from 791 patients with various respiratory diseases by using gas--chromatography/mass--spectrometry . By our method, the detectable limit of TSA was around 10(2)-10(3) bacilli of Mycobacterium tuberculosis, and our method is as sensitive as culture examination for tuberculosis . In sputa collected from patients with active pulmonary tuberculosis (n=169), TSA positively was around 90%, while less than 10% false positive ws also recognized . In pleural effusion (n=81) and bronchial washing (n=91) collected from patients with active tuberculosis, the positivity of TSA was around 70% . We could also detect TSA in about 30% of clinical specimens collected from patients suspected of tuberculosis . The diagnostic sensitivity of TSA for tuberculosis was similar to that of adenosine deaminase activity (ADA), while TSA was slightly superior to ADA in specificity . These findings indicate that detection of TSA from clinical specimens is useful to make rapid diagnosis of pulmonary tuberculosis.

Kekkaku, 1990 Jan, 65(1), 1 - 8
{Epidemiological study on tuberculosis in Tochigi Prefecture . Part II: The changes in tuberculosis incidence and analysis of relating factors}; Kobayashi M; The incidence rate of tuberculosis has been increasing in recent 5 years in Tochigi Prefecture . The author intends to clarify the factors effecting the changes of tuberculosis incidence during the period from 1962 to 1987 by analyzing the annual statistics of tuberculosis registry and implementation of tuberculosis control programme . The results thus obtained are as follows: 1 . The incidence rate of tuberculosis in Tochigi Prefecture has increased in the past 5 years especially in the younger age group of 0-19 and older age group of 50 and over . The increase can be explained by the recurrence of the disease occurred when they were young, most likely due to incomplete treatment, and secondary infection to young family contacts . 2 . The positive rate of tubercle bacilli was higher in Tochigi Prefecture than the rate in whole Japan during the period from 1979 to 1983, which was resulted from the delay in detection . 3 . Frequency of visits to patients by public health nurses, numbers of X-ray and bacteriological examinations had decreased during the same period when the incidence rate of tuberculosis increased . 4 . Continuous efforts to reinforce the tuberculosis control programme, especially X-ray and bacteriological examination for high risk population, such as family contacts, cleaners and barbers is essential in Tochigi Prefecture.

J Laryngol Otol, 1990 Jan, 104(1), 24 - 7
Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy; Lau SK et al.; The results of a consecutive series of 1,349 fine needle aspiration (FNA) biopsies from the head and neck region of 1,193 patients has been reviewed in order to evaluate the efficacy of this method in the diagnosis of tuberculous lymphadenopathy (TBLN) . Of the 108 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 68 had subsequent surgery and histological confirmation of the cytological appearance . Sixty-three had TBLN, thus the specificity of FNAC was 93 per cent in diagnosing tuberculous related granulomatous lymphadenopathy . One false positive FNAC was reported histologically to be metastatic mucoepidermal carcinoma . Of the 1,193 patients, 90 patients had subsequently TBLN confirmed histologically . Of these 90 patients, FNA from 69 showed granulomatous changes or acid fast bacilli (AFB), thus the sensitivity of FNAC in detecting tuberculous lymphadenopathy was 77 per cent . Fifty-two cytological smears were stained for acid fast bacilli . Nineteen (37 per cent) contained AFB . It is evident from this review that FNAC is an efficient way to detect cervical tuberculous lymphadenopathy.

Rev Infect Dis, 1990 Jan-Feb, 12 Suppl 2, S200 - 9
Development and evaluation of the spiral gradient endpoint method for susceptibility testing of anaerobic gram-negative bacilli; Hill GB et al.; The spiral gradient endpoint (SGE) method for antimicrobial susceptibility testing was evaluated as an alternative agar-dilution procedure that would require less time and materials than the reference standard agar-dilution (SAD) susceptibility test for anaerobic bacteria . For the SGE test a spiral plater produces a drug concentration gradient equivalent to up to eight twofold dilutions in a single agar plate . Bacteria are streaked in radial lines across this gradient, and the drug concentration at the endpoint location where growth ceases can be calculated . Early results demonstrated the need to develop a standardized procedure, various technical improvements, and revised SGE formulas that correct for drug diffusion in calculating endpoint concentrations for tests on aerobes and anaerobes . The revised SGE method demonstrated an overall 90.7% agreement (within +/- 1 twofold dilution) of the minimal inhibitory concentrations with those determined by the SAD method tested in parallel for 161 strains of a wide variety of anaerobic gram-negative bacilli and eight antimicrobial agents . The reproducibility, sensitivity, and significantly increased efficiency warrant further evaluation of the revised SGE method.

J Dent Res, 1990 Jan, 69(1), 55 - 9
Comparative microbiological and immunological studies of subgingival dental plaque from man and baboons; McMahon KT et al.; Baboons may be useful as animal models for the study of human oral diseases and infections . They are closely related to man anatomically, physiologically, and phylogenetically . Plaque and gingival indices were relatively low in 18 baboons (Papio anubis) . The mean scores ranged between 0.62 +/- 0.29 and 0.37 +/- 0.20, respectively . Gram-positive and Gram-negative cocci comprised 27.0 +/- 32.4 and 3.1 +/- 7.5% of the total viable counts in the dental plaque samples . Black-pigmented Bacteroides formed about 1.9 +/- 5.9% of the bacterial population in the samples . Anaerobic Gram-negative bacilli were found in 73.2% of the samples and averaged 19.2 +/- 26.3% of the total recovered flora . Species of the oral Actinomyces and other Gram-positive rods found in humans were not isolated . The composition of the oral flora in baboons appeared to be significantly different from that of man . Isolates of F . nucleatum, L . buccalis, and B . intermedius from the two mammals were biochemically similar, but were distinguishable by analysis with antibody, both by precipitin lines and/or differences between homologous and heterologous titers.

Wis Med J, 1990 Jan, 89(1), 14 - 7
Genital tuberculosis: case report and literature review; Dhillon SS et al.; A 64-year-old woman complained of abdominal pain and postmenopausal bleeding . A uterine curettage demonstrated acid fast bacilli and non caseating granulomas, indicating Mycobacterium tuberculosis . A chest roentgenogram revealed the presence of bilateral upper lobe calcific granulomas . The epidemiologic, diagnostic, and therapeutic implications of genital tuberculosis are discussed.

Intensive Care Med, 1990, 16 Suppl 3, S224 - 8
Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection; Tetteroo GW et al.; Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections . These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections . We randomised prospectively 114 patients into a test group receiving SD-medication (n = 56) and a control group receiving conventional prophylaxis . Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated . The preoperative administration of SD-medication resulted in adequate decontamination within 3-4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively . Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications . This indicates that prolonged use in these patients might be beneficial . This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.

Intensive Care Med, 1990, 16 Suppl 3, S197 - 200
The epidemiology of infections in intensive care units; Emmerson AM; This report identifies some of the risk factors underlying the acquisition of hospital infections in patients admitted to Intensive Care Units (ICUs) . Infection rates vary in different institutes and in different types of ICUs . Patients are particularly prone to septicaemia and respiratory infections and the underlying risk factors are frequently related to poor invasive techniques or contaminated equipment used in supportive therapy . In trauma patients, wound sepsis is common and polymicrobial sepsis is a major problem . Patients in ICUs are temporarily immunocompromised and are at risk from acquiring multiply antibiotic resistant gram negative bacilli . The majority of these are of an endogenous nature and necessitate the empirical use of antibiotics . The misuse of antibiotics however often leads to the selection of difficult to treat gram negative bacilli . Antibiotic usage in ICUs should be strictly controlled and used appropriately, preferably after appropriate microbiological specimens have been collected.

Respiration, 1990, 57(3), 210 - 20
Cursed duet: 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 . Prof . Chretien helped call attention to the link between tuberculosis and HIV infection in France . Now, it is obvious that his cogent observations extend to much of the rest of the world.

Probl Tuberk, 1990, (9), 29 - 31
{Evaluation of the clinical course of pulmonary tuberculosis in aged women}; Sedliachek AM; The course of pulmonary tuberculosis in 34 women aged over 70 and in 30 women aged 35-55 years as controls was analysed . Tuberculosis in the elderly women was detected more frequently and with rather severe forms of the disease when compared to the control group, thus making them a serious epidemic hazard . It proved possible to conduct treatment of practically all these patients with 4 tuberculostatics . Streptomycin was the least tolerated drug . X-ray pictures in 25 per cent of the cases indicated the presence of the middle-lobe syndrome . Besides, all these subjects were excretors of tubercle bacilli . The similar X-ray picture was seen in nobody in the control group . Though extensive changes in the lungs of the elderly women were found later, the course of their management was similar to that of the control group; all the patients displayed no sputum mycobacteria.

Br J Neurosurg, 1990, 4(5), 391 - 6
Avoiding empiric therapy for brain masses in Indian patients using CT-guided stereotaxy; Rajshekhar V et al.; Empiric therapy, especially antituberculous therapy, is frequently given to Indian patients with brain masses . This report documents our experience in avoiding such therapy using CT-guided stereotaxy . Out of 101 procedures done on 99 patients with brain masses, 80 were done to obtain a histological diagnosis and 21 for therapeutic purposes . There was no mortality and 2% morbidity . A positive diagnosis was obtained in 94% (75/80) of patients undergoing a biopsy . Diagnosis of tuberculous lesions was based mainly on the presence of acid-fast bacilli in the biopsy specimen or pus . In six patients the radiological diagnosis was wrong and in one the diagnosis was not certain . Inappropriate therapy was given to three patients, on the basis of a CT or MRI scan, before a biopsy was done . It is essential that a histological diagnosis be obtained in all patients with brain masses and there is no role for empirical therapy except in isolated cases.

Trop Geogr Med, 1990 Jan, 42(1), 97 - 9
Transmission of Mycobacterium leprae from lepromatous leprosy patients to the skin of mice through intermittent feeding; Banerjee R et al.; Batches of hungry Aedes aegypti mosquitoes which partially sucked blood from the skin lesions of proved untreated lepromatous leprosy (LL) patients were allowed immediately to feed on a portion of the skin of a cleanly shaved swiss mouse . The portion of the skin was cut, homogenized on the same day and extracted with chloroform . Out of 10 extracts, stained for acid fast bacilli (AFB), Mycobacterium leprae were demonstrated in eight, indicating transfer of bacilli mechanically to the biting spot through intermittent feeding . Out of 50 probosces dissected and stained for AFB, M . leprae were demonstrated in 45.

Int Arch Allergy Appl Immunol, 1990, 92(1), 50 - 5
Immunohistological analysis of nerve granulomas in neuritic leprosy; Narayanan RB et al.; Immunohistological analysis of infiltrates of nerves in patients with neuritic leprosy was carried out using monoclonal antibodies defining T cell subsets, Langerhans cells, HLA DR antigens, and indirect immunofluorescence . In all, eight nerves were analyzed . 2 of the 8 nerves showed epithelioid cell granulomas surrounded by large numbers of lymphocytes . The predominant lymphocytes in these granulomas were activated T cells expressing CD3 and HLA DR antigens . The proportion of CD3+ and CD4+ cells was higher than that of CD8+ cells . The ratio of CD4+/CD8+ cells in these two biopsy specimens was 5.6 and 1.5, respectively . In these nerves CD4+ cells were diffusely scattered into epithelioid cell granulomas, while CD8+ cells were localized at the periphery of the granuloma . The remaining six nerves showed macrophages containing numerous bacilli, and a few lymphocytes and plasma cells diffusely distributed into the granuloma . In these nerves, only occasional lymphocytes expressing CD3 or CD4 or CD8 and HLA DR antigens were noticed . In two fo the biopsy specimens, a small proportion of CD8+ cells were visualized . Macrophages and Schwann cells were HLA DR+ in all nerves . CD1+ cells were not seen in the infiltrates of any of these nerves . A similar pattern and distribution of cells was noticed in the nerve granulomas of tuberculoid and lepromatous leprosy . These findings suggest that the mechanisms of nerve damage in the patients with neuritic leprosy could be either immunological or non-immunological, depending on the nature and characteristics of the infiltrates.

Surg Gynecol Obstet, 1990, 171 Suppl, 35 - 40
Diagnosis and treatment of pneumonia in the surgical intensive care unit; Burchard K; It is often difficult to detect the onset of parenchymal pulmonary infection (pneumonia) in a surgical intensive care unit (SICU) setting . Clinical and laboratory parameters that usually indicate the presence of pneumonia, such as fever, elevated white blood cell count and abnormal sputum culture, may also be present in patients with nonpneumonic infection . Prompt diagnosis is particularly important for patients in SICU because the mortality rate associated with pneumonia in these patients may be as high as 50 per cent . In the SICU setting, pneumonia is best diagnosed using well-defined roentgenologic criteria . Treatment should consist of a broad-spectrum antibiotic regimen to which all sputum pathogens are sensitive . Such a regimen significantly reduces the mortality rate for patients with pneumonia in an SICU setting . Aztreonam has been found to be as effective against susceptible gram-negative bacilli as traditional agents, such as the aminoglycosides, and to have a significantly milder side effect profile.

Microbios, 1990, 64(258), 7 - 17
Growth of Mycobacterium leprae under low oxygen tension; Ishaque M; Despite numerous attempts, Mycobacterium leprae has yet to be cultivated in vitro . This organism has been considered as microaerophilic . The effects of various known gas mixtures on the in vitro growth of M . leprae were investigated . A gas mixture containing 2.5% O2 and 10% CO2 was found to be more favourable for the growth of this mycobacterium on artificial medium . Growth was evaluated by three parameters namely cell counts, bacterial ATP and DNA . An optimal growth of M . leprae, as determined by all three parameters, on both liquid and solid media was obtained between 18 and 24 weeks of incubation under optimal gas mixture . Solid medium which contained egg-yolk was relatively more beneficial for in vitro growth than the liquid medium . The cultivated bacilli exhibited some important characteristics specific for M . leprae, including growth in mouse foot-pads . The bacilli gradually lost their power of adaptation to grow on artificial media and did not show any ATP or DNA after about 36 weeks of incubation.

Rev Ig Med Muncii Med Soc Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1990 Jan-Mar, 39(1), 27 - 34
{The efficacy of the intensive, short-duration chemotherapy of patients with cavitary pulmonary tuberculosis}; Ionescu C et al.; This study was carried out on 100 cases of cavitary pulmonary tuberculosis in patients eliminating tuberculosis bacilli, as noted at microscopic study . The treatment included four drugs (RHSZ) in 95 case, and 3 drugs in the remaining patients . All the treatments were tailored to individual needs . The duration of chemotherapy was of 6 months in 62 cases . It was prolonged to 9 months in 33 cases and to 12 months in 5 cases . In 81 patients the drugs were applied regularly . The results have demonstrated that at 6 months negative cultures were obtained in 98 patients although the excavations were closed in only 55 cases . At 9 months all the patients were negative but excavations were closed in only 71 . Suppression of elimination of bacilli was achieved in 99 of the cases at 12 months, but the excavations were closed in only 92 of the patients . Ninety-nine patients were investigated after 2.5-3.0 years . Five of them were again positive, 94.5% were negative and the excavations were closed in 91.9% . The importance of the cavitary score is discussed with regard to the risk of renewed positivity, and an association is recommended of surgical collapsing and exeresis at the right time.

Plucne Bolesti, 1990 Jan-Jun, 42(1-2), 107 - 12
{The role of bronchoscopy with a flexible bronchoscope in the diagnosis of pulmonary tuberculosis}; Gorjup V; Bronchoscopy with flexible bronchoscope has been proved as a useful method that has been applied also in the diagnostics of pulmonary tuberculosis during the recent years . In order to evaluate its role and use at the Institute for Diseases of the Chest and Tuberculosis Golnik documentation of 51 patients treated during 1985 and 1986 was surveyed . Prior to the examination from all patients the sputum on Mycobacterium tuberculosis was obtained at least three times and it was negative . Aspirations were obtained from 40 patients and the diagnosis was confirmed in 21 patients by recovery from tubercle bacilli specimens (52.5%) . Transbronchial biopsy was performed in 34 patients and it was positive in 27 (79.4%), out of them in 7 patients the biopsy sample of the lungs was bacteriologically (38.9%) and in 23 patients histologically positive (67.6%) . By bronchoscopy with flexible bronchoscope the final diagnosis was confirmed in 40 patients (78.4%) . Bronchoscopy with flexible bronchoscope as well as transbronchial biopsy have proved to be a successful method in the diagnostics of active pulmonary tuberculosis . It should be used in patients in whom the sputum smear for acid fast bacilli were frequently negative yet there is a suspicion of pulmonary tuberculosis.

Probl Tuberk, 1990, (6), 23 - 6
{The interrelation of bovine and human tuberculosis}; Kassich IuIa et al.; For the last 5 years, the examination of the farms in the Ukrainian SSR revealed the following distribution of Mycobacterium cultures isolated from cattle: M . bovis, 50.5%, M . hominis, 0.4%; M . avium, 1.8%; and atypical bacilli, 47.3% . In 31% of the farms considered to be safe enough in relation to tuberculosis, tuberculin-sensitive cattle was identified, thus totalling 47.3% of these farms where as many as 15 types of atypical Mycobacteria were shown to cause its sensitization . Photochromogenic Myco . cultures were not isolated either from the cattle or from the environmental objects . Single cases of tuberculous cattle infected by the human hosts were found as a consequence of the violation of the rules adopted in the farms to prevent this disease . Bovine tuberculosis-infected people were not detected.

Microbiol Immunol, 1990, 34(2), 197 - 210
Arrest of DNA replication of macrophages in BCG granuloma and peritoneal exudates by bacteria; Kutsukake H et al.; Previously we found that bacterial surface substances induced the suppression of DNA synthesis of macrophages . We examined in the present study whether DNA synthesis of macrophages could be similarly suppressed by whole bacteria themselves . For this purpose we isolated macrophages from BCG granuloma of guinea pigs and rats . The macrophages from both of the animals gave essentially the same results . No isolated macrophages containing bacilli were found to incorporate 3H-thymidine when tested by autoradiography . Further, DNA replication of peritoneal exudate macrophages was markedly and rapidly suppressed in vitro upon phagocytosis of various kinds of bacteria but not of non-bacterial preparations . A close correlation was found between granuloma formation and inhibition of 3H-thymidine incorporation by MDP, its analogs, and various bacteria . These findings suggest that macrophages suppress their DNA replication when they phagocytose bacteria and that they can discriminate between bacteria and non-bacterial preparations.

Acta Clin Belg, 1990, 45(1), 38 - 41
Tracheobronchial tuberculous ulceration . Report of 2 cases; Breysem Y et al.; We describe two cases of tracheobronchial tuberculous ulcerations, without radiological signs of active pulmonary tuberculosis, and with cough as main complaint . Diagnosis was obtained by fiberoptic bronchial endoscopy and subsequent demonstration of Acid Fast Bacilli in biopsy specimen, bronchial aspiration fluid and sputum . A diagnostic fiberoptic bronchoscopy should be performed in persisting cough, even with normal chest X-ray.

Probl Tuberk, 1990, (11), 19 - 21
{Characteristics of newly detected tuberculosis in adolescents}; Charykova GP et al.; Socioepidemiologic and clinico-roentgenologic features of tuberculosis in 107 adolescents were studied . In 33 per cent of the adolescents, the disease was detected on referral to a polyclinic; in 57.5 per cent of them, on planned fluorography; in 5.8 per cent, on examination as contact persons; and in 3.7 per cent, on tuberculin diagnosis . Subjects with secondary forms of tuberculosis constituted the majority among the affected . The proportion of the patients with destructive forms of tuberculosis and the excretors of tubercle bacilli made up 28.4 and 38.6%, respectively . The contact was confirmed in 36 per cent of the adolescents . The disease caused by a primary infection coincided in 9.7 per cent of them, with the rest being infected during their childhood.

Am J Surg, 1990 Jan, 159(1), 79 - 84
Obstructive jaundice promotes bacterial translocation from the gut; Deitch EA et al.; Experiments were performed to determine if obstructive jaundice promotes the translocation of bacteria from the gastrointestinal tract to visceral organs . Three groups of mice were studied: control (n = 20), sham ligated (n = 28), and bile duct ligated (n = 33) . The sham-ligated group underwent laparotomy and manipulation of the portal region, whereas the ligated group had their common bile ducts ligated . Seven days later, the mice were killed, their organs cultured, and the gastrointestinal tract examined histologically . The bilirubin levels of the ligated group (18.7 mg/dL) were elevated compared with the other groups (0.5 mg/dL) (p less than 0.05) . The incidence of bacterial translocation was higher in the ligated (33%) than in the control (5%) or sham-ligated (7%) groups (p less than 0.05) . Since bile is important in binding endotoxin and maintaining a normal intestinal microflora, cecal bacterial populations were quantitated . The cecal levels of gram-negative, enteric bacilli were 100-fold higher in the bile duct-ligated mice in which bacterial translocation occurred (p less than 0.05), indicating that intestinal bacterial overgrowth was a major factor responsible for bacterial translocation . The mucosal appearance of the intestines from the control and sham-ligated groups was normal . In contrast, subepithelial edema involving the ileal villi was present in the ligated group . In conclusion, the absence of bile within the gastrointestinal tract allows intestinal overgrowth with enteric bacilli and the combination of bacterial overgrowth and mucosal injury appears to promote bacterial translocation.

J Assoc Acad Minor Phys, 1990, 1(2), 20 - 3
Pleural tuberculosis in patients with and without AIDS; Ankobiah WA et al.; We retrospectively reviewed the records of 71 patients to determine the epidemiologic and clinical features of pleural tuberculosis in patients with and without AIDS and compared the composition of pleural fluid in these two groups of patients . By age, race, sex, and country of birth, the 21 AIDS and 50 non-AIDS patients with pleural tuberculosis were comparable . However, the AIDS patients were more likely to be intravenous drug abusers than the non-AIDS patients (15/21 vs 6/50, p less than .001) . The clinical presentation of each group was similar except that the AIDS patients were more likely to present without respiratory symptoms (4/21 vs 0/50, p less than .001) . Pleural fluid and pleural biopsy analyses were not different in the two groups . However, AIDS patients had significantly more chest roentgenographic infiltrates (10/21 vs 11/50, p less than .05), hilar/mediastinal adenopathy (4/21 vs 1/51, p less than .007) and a higher prevalence of bilateral effusions (6/21 vs 5/50, p less than 0.05) . AIDS patients were also more likely to have sputum smear/culture positive (10/19 vs 9/49, p less than .001) for mycobacteria . The yield for acid-fast bacilli culture of pleural fluid was higher than previously reported (60%) regardless of AIDS status . Thus, AIDS patients with pleural tuberculosis may present without respiratory symptoms, but otherwise do not differ clinically and epidemiologically from non-AIDS patients . Radiologic and mycobacterial data suggest that pleural tuberculosis in AIDS patients is often part of disseminated mycobacterial infection.

G Ital Endod, 1990, 4(3), 38 - 43
{Morpho-functional characteristics of bacterial species of major importance in endodontic infections}; Lavagnoli G et al.; Most of the bacteria involved in the endodontic infection can be considered as "highly specific", for they appear to be almost irrelevant in the large field of the other human disease from infection . Namely the most important anaerobia responsible for endodontic infection are: Bacteroides, Fusobacterium, Peptostreptococcus, and Veillonella . The group of Bacteroides is composed by several species with different metabolic and genetic characteristics . They are Gram-, non-motile, non-spore-forming rods . Fusobacterium are spindle-shaped, Gram-, non motile, non-spore-forming bacilli . Peptostreptococci are round-shaped, Gram+, non-motile cocci . Veillonella are small, Gram-, non-motile cocci.

Rev Pediatr Obstet Ginecol Pediatr, 1990 Jan-Mar, 39(1), 69 - 77
{The clinico-biological, etiological and therapeutic aspects of acute purulent meningitis in newborn and older infants}; Buta MG et al.; Acute purulent meningitis of the newborn and infant still raise difficult diagnosis problems due to the often misleading onset, and require an energetic and early intervention, adapted, as much as possible, to the etiologic aspects . The study reports on 90 cases of acute purulent meningitis in the newborn and infant, admitted to the pediatric ward of the Bistrita County Hospital, for 6 years (1983-1988) . The clinical and biological aspects were various, sometimes blurred by the antibiotic administration . The study of CSF was the only valuable and compulsory parameter for supporting the diagnosis of meningeal infection and its etiology . In 63.3% cases, the meningeal infection was secondary to a primary infectious focus . Living gram-negative bacilli had the most frequent etiology, both in the newborn and in the infant . Meningitis with nonspecific etiology still hold 45.5%, and the most useful therapy in this situation seemed to be ampicillin + gentamicin + Biseptol and ampicillin + chloramphenicol . The age of the newborn and infant, the male sex, the biologic defects, the type and virulence of the etiologic agent were favouring factors in the appearance and severe evolution of the meningeal infection . Mortality was of 18.8% and the early found sequelae 8.8% . The evolution was favourable, when the diagnosis was precocious and the therapeutic intervention was energetic.

Int J Immunopharmacol, 1990, 12(7), 721 - 7
Cytokine modulation of Mycobacterium tuberculosis growth in human macrophages; Denis M et al.; This study was concerned with the handling of ingested tubercle bacilli by normal human macrophages . Intracellular growth was determined after exposure of macrophages to viable bacilli in vitro and the effect of various cytokines, alone or in combination, on bacilli growth/survival was determined . It was found that Mycobacterium tuberculosis (M.tb) grew quite readily in untreated cultured human macrophages . Treatment with soluble factors showed that a crude lymphokine containing supernatant elicited with Concanavalin A (Con A) was ineffective at reducing growth of M.tb in vitro; similarly a crude lymphokine preparation from M.tb lysate-stimulated mononuclear cells failed to induce any mycobacteriostatic activity in human monocyte-derived macrophages . Recombinant cytokines were then evaluated for their ability to modulate growth of the tubercle bacilli in human macrophages . Recombinant interferon-gamma (IFN-gamma), interleukin-2 (IL-2) and recombinant interleukin 4 (IL-4) were all ineffective at modifying M . tuberculosis growth in human macrophages . Recombinant tumour necrosis-alpha (TNF-alpha) curbed the growth of the bacilli in human macrophages in a reproducible fashion . No cytokine combination was more efficient than TNF-alpha alone . These studies thus highlight the resistance of virulent mycobacteria against different mechanisms of cytokine-induced macrophage bactericidal activity.

Acta Microbiol Hung, 1990, 37(1), 39 - 43
Extracellular enzymes of pulmonary fluid and their bactericidal effects on Mycobacterium tuberculosis; Kumar P et al.; The enzyme activity and bacillary content of cell free pulmonary lavage fluid has been compared in infected and immunized infected animals . Increased enzyme production was found as a result of macrophage activation . Marked decrease in the number of tubercle bacilli was observed in immunized infected animals . The active enzyme production is considered to be the impact of availability of enzyme specific substrate, particularly cell wall components of tubercle bacilli viz . arabinogalactan, arabinomannan and sulphatides . These macromolecules are considered as active substrates for the action of arabinosidase (EC:3.2.1.55), mannosidase (EC:3.2.1.24) and sulphatase-C (EC:3.1.6.1).

Lung, 1990, 168(4), 215 - 20
Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis; Chan HS et al.; The ability to make a definitive diagnosis in sputum smear-negative pulmonary tuberculosis by bronchoscopic aspiration, bronchoalveolar lavage (BAL), and examination of postbronchoscopy sputum were compared . Thirty-four patients with lesions on chest x-rays suspected of being pulmonary tuberculosis were entered into the study . The diagnosis of pulmonary tuberculosis was subsequently confirmed in 28 patients and the method of arriving at the final diagnosis was analyzed . A positive acid-fast bacilli (AFB) smear result was obtained in 4/28 (14%) of cases by a combination of bronchoscopic techniques and postbronchoscopy sputum examination . Prebronchoscopy sputum culture was positive in 12/28 (43%) . Combined with bronchoscopy specimens, a positive AFB culture result was obtained in 26/28 (93%) . Sputum examination, bronchoscopic aspiration, and BAL are complementary techniques and together they give a high yield of definitive diagnosis of pulmonary tuberculosis.

Probl Tuberk, 1990, (4), 7 - 11
{Characteristics of qualitative changes in the Mycobacteria population during the treatment of middle-aged and elderly patients with newly detected pulmonary tuberculosis}; Dorozhkova IR et al.; Clinicobacteriological investigations were applied to 142 new cases of pulmonary tuberculosis at the age of 60 to 89 years . The control group consisted of 132 patients of young and middle ages (from 17 to 40 years) . The form of the process, its extent and the character of the destructions in them were the same as those in the elderly and senile patients . It was shown that the pathogen bacterial forms in the elderly and senile patients were much more frequent than L-forms of M . tuberculosis (67.6 and 42.9 per cent, respectively) . The tubercle bacilli were mainly isolated from pure cultures (45.8 per cent) . L-transformants of M . tuberculosis in the elderly and senile patients were markedly less frequent than in the patients of the control group (69.7 per cent) with analogous forms of tuberculosis . The frequency of L-forms and their rapid reversion into the initial bacterial form of M . tuberculosis (28.0 per cent) and the same period of isolating both the bacterial and L-forms were the distinctive features of the L-forms isolated from the elderly and senile patients . It was suggested that L-forms of M . tuberculosis played an important role in reactivation of the specific process.

Indian J Pathol Microbiol, 1990 Jan, 33(1), 68 - 73
Evaluation of direct microscopy as a screening test in the diagnosis of pulmonary tuberculosis; Kothadia SN et al.; A 'false case' in reference to pulmonary tuberculosis is designated as one where, the primary smear shows presence of Acid Fast Bacilli (AFB) . However, the subsequent cultural examination fails to grow the pathogen . The present study is directed to determine the incidence of false positivity and attempt its correlation with the number of bacilli in the primary smear, age of the patient and chemotherapy . Of the 820 sputum samples processed, 14.63 percent revealed presence of bacilli both in smear and by cultural examination (true positive), 64.02 percent were true negative (smear and culture negative), 15.97 percent were false negative (smear negative culture positive) while 5.36 percent displayed false positivity . The data analysis has further revealed an inverse relationship between the number of bacilli in the entire smear and false positivity . Aged patients (more than 40 years) who were on prolonged and irregular antitubercular therapy showed a higher incidence of false positivity (50 percent) as compared to others . The present study has indicated that primary scrutiny of the smear should be done with due care and a due consideration should be given to clinical presentation, radiological findings and account of chemotherapy while assessing the prognosis . We further recommend that every sample should be simultaneously processed for cultural examination to avoid the false positivity, if any.

Indian J Pathol Microbiol, 1990 Jan, 33(1), 1 - 10
Tuberculous lymphadenitis: correlation of cellular components and necrosis in lymph-node aspirate with A.F.B . positivity and bacillary count; Das DK et al.; Cytomorphologic features of tuberculous lymphadenitis cases as observed in lymph-node aspirates were analysed and correlated with AFB positivity and bacillary count . Cytologic features were categorized under three major groups, viz . epithelioid granuloma without necrosis, epithelioid granuloma with necrosis and necrosis without epithelioid granulomas . These three major groups showed a distinct trend in respect of their cellular constituents . While cases with appreciable lymphocytic and multinucleated giant cells component showed a significant decreasing trend, cases with neutrophilic infiltration showed an increasing trend (P less than 0.001) . In the above three groups, 9.1 percent, 64.7 percent and 77.4 percent respectively showed AFB positivity, the difference being highly significant (P less than 0.001) . All 14 cases with very high bacillary count (greater than 50 bacilli per 500 oil immersion field) were associated with necrosis and 71.4% of them neutrophilic infiltration . A univariate analysis revealed that in presence of lymphocytes, epithelioid cells and Langhan's giant cells, AFB positivity was significantly lower while the picture was just the reverse in presence of necrosis and neutrophilic infiltration (P less than 0.001) . The odd's rations for all these variables were highly significant (P less than 0.001) . However, a multivariate regression analysis revealed that necrosis was the only independent contributing factor towards AFB positivity.

Probl Tuberk, 1990, (3), 41 - 4
{Treatment of the sputum with Soviet-produced chlorhexidine bigluconicum}; Golyshevskaia VI et al.; Soviet chlorhexedin bigluconicum (CHBG) was used for sputum treatment . 129 sputum specimens were investigated . Among them 45 specimens were bacterioscopically negative . The rest contained low, moderate and high numbers of tubercle bacilli . The sputum was incubated on the Lowenstein-Jensen and Finn-II media . Comparison of two treatment methods (with Na3PO4 and CHBG) showed that CHBG had a more sparing effect on tubercle bacilli . The most marked effect was observed with incubation of oligobacillar materials and materials containing low numbers of tubercle bacilli . The highest differences were revealed when the materials were incubated on the Lowenstein-Jensen medium . It was shown that isolation of the cultures from oligobacillar materials increased by 4-14.3 per cent . The growth intensity and rate were higher . The majority of the cultures grew in 3-4 weeks whereas with using Na3PO4 part of the cultures grew during the period between the 6th and the 8th weeks . When the number of tubercle bacilli was high irrespective of the treatment procedure the number of the grown cultures was the same . The germination level was low and amounted to 3.9 per cent after treatment with Na3PO4 and to 2.3 per cent after treatment with CHBG . The method using CHBG is simple, economic and valuable in laboratory practice.

Rev Mal Respir, 1990, 7(3), 209 - 13
{A therapeutic trial of a combination of 3 essential drugs in a short course of chemotherapy in tuberculosis . Results 6 months after the end of treatment}; Agounitestane D et al.; 250 patients suffering from pulmonary tuberculosis who were smear positive received a chemotherapy regime for 6 months combining Rifampicin and Isoniazid every day with a daily supplement of Pyrazinamide for the first 8 weeks . The three drugs given in the initial phase of treatment were administered either separately or in combined preparations according to the 2 controlled randomised groups . During the maintenance phase the drugs were given in a combined form in fixed proportions in the 2 groups . 6 months after the end of treatment the bacteriological results were similar in the 2 groups in the 144 cases which were analysed . Amongst 137 cases with bacilli which were initially sensitive to Isoniazid (68 cases with separate medicines at the beginning and 69 with combined drugs) there was no failure at 6 months, nor any relapse during the course of the first period of surveillance . Amongst 7 cases with bacilli which were originally resistant to Isoniazid (4 and 3 respectively), there were 2 failures at 6 months one in each group with acquired resistance to Rifampicin observed at the time of the failure . There was no difference in the therapeutic results observed whatever the presentation of drugs used during the initial phase of treatment.

Probl Tuberk, 1990, (1), 41 - 3
{Investigation of pathogens in the foci of pulmonary and osteo-articular tuberculosis}; Klimenko MT et al.; The tubercle bacilli detection rate was determined by direct bacterioscopy and the culture plate method immediately in the disease foci in 123 patients with pulmonary tuberculosis and 78 patients with tuberculosis of bones and joints . The culture plate method was shown to have significant advantages over bacterioscopy . However, in some cases with negative responses to the culture plate test, bacterioscopy was the only procedure that detected the pathogen in resected lung tissues . Parallel use of 2 different media in the culture plate test provided higher frequency of the pathogen isolation . Cultures isolated from the lung foci were showed drug resistance in 1/4 of the cases . Cultures from the bone foci were in all the cases but one sensitive to all the drugs used . By their biological properties, all the isolates belonged to human tubercle bacilli . The necessity of microbiological investigation of pathogenes in tuberculosis foci is grounded.

Virchows Arch A Pathol Anat Histopathol, 1990, 416(4), 281 - 6
Spindle cell reaction to nontuberculous mycobacteriosis in AIDS mimicking a spindle cell neoplasm . Evidence for dual histiocytic and fibroblast-like characteristics of spindle cells; Brandwein M et al.; We report 5 patients with AIDS who had an unusual spindle cell proliferation in the lymph nodes and skin caused by nontuberculous mycobacteriosis . The spindle cell proliferation in these tissues may mimic a spindle cell neoplasm and pose a diagnostic problem if an infectious aetiology is not suspected . The fibroblast-like spindle cells contained numerous acid fast bacilli . They were strongly positive for antibody markers of monocyte/macrophage and leukocyte derivation: Leu M3, Mo-9, T-200, and HLA-DR, and variably positive for alpha-1 anti-chymotrypsin and lysozyme . Ultrastructurally these spindle cells were predominantly fibroblast-like with poorly developed features of macrophages . These results reveal the dual macrophage and fibroblastic character of the spindle cells and probably imply a functional differentiation rather than a histogenetic one.

Am J Nephrol, 1990, 10(5), 422 - 5
Streptomycin pharmacokinetics in relapsing Mycobacterium xenopi peritonitis; Sennesael JJ et al.; Relapsing peritonitis due to Mycobacterium xenopi developed in an 80-year-old man undergoing continuous peritoneal dialysis after appropriately treated concurrent bacterial peritonitis . The patient presented with a lymphocytic exudative peritoneal drainage fluid . The diagnosis of tuberculous peritonitis was made by identification of acid-fast bacilli in peritoneal effluent and culture of M . xenopi . Oral antituberculous drugs in combination with intraperitoneal streptomycin achieved suppression of the disease, permitting peritoneal dialysis to be continued with satisfactory clearance and ultrafiltration capacity during a follow-up period of up to 35 months . Streptomycin kinetics revealed that 75% of the intraperitoneally administered dose of streptomycin is absorbed from the dialysate.

Med Cutan Ibero Lat Am, 1990, 18(4), 224 - 6
{Lupus vulgaris after BCG vaccination . A clinical case}; Rodrigues A et al.; The authors report a case of lupus vulgaris in a 22-year-old female patient occurring three months after BCG vaccination, with a period of evolution of two months . The Mantoux intradermoreaction (1 U) was strongly positive, and no acid-fast bacilli were found in the lesion, either by direct analysis or by culture in a Lowenstein medium . The histopathological findings confirmed the diagnosis . Prescribed treatment with isoniazid and rifampicin for three months resulted in complete healing on the sixth month.

J Formos Med Assoc, 1990 Jan, 89(1), 12 - 6
Acute abdomen in childhood leukemia; Chien CH et al.; With the continuing advancement in the treatment of childhood leukemia and the lengthened survival of these patients, an increased incidence of abdominal complications has been observed . A retrospective analysis of 364 patients with leukemia treated at the National Taiwan University Hospital from January 1977 through April 1988 was undertaken . Eleven patients (3.0%) developed abdominal complications during their course of disease, including acute appendicitis, intussusception, intestinal perforation, ovarian cyst rupture, etc . All of these patients had abdominal complications during the initial presentation or relapse of leukemia, and 9 (82%) of them had just received chemotherapy . Ten patients (91%) had thrombocytopenia and 7 (64%) had leukopenia . Blood cultures were positive in 5 patients (45%), and gram-negative enteric bacilli were isolated in 4 of them . All 5 septicemic patients had leukopenia or neutropenia . The clinical manifestations were nonspecific and were often masked . Most of the complications occurred in the right lower abdominal structures . Of the 7 children treated surgically, 3 had long term survival . Among the 4 patients who did not receive an operation, only 1 survived for more than 4 weeks . The mean length of survival tended to be longer in patients with additional surgical treatment . Prompt diagnosis and early aggressive treatment, under modern supportive facilities, appear to offer a more favorable outcome.

J Hosp Infect, 1990 Jan, 15(1), 65 - 72
Bacterial contamination and frequency of changing ventilator circuitry; Cadwallader HL et al.; A questionnaire sent to 40 intensive care units showed that ventilator circuits were changed every 24 h in 62% and every 48 h in 20% of the units . A similar survey in 40 special-care baby units showed that only 9.7% changed circuits daily and the majority were changed weekly (38.7%) or between patients (38.7%) . A prospective study of bacterial contamination of circuits in adult patients showed that when water humidification was used, 28/72 samples from inspiratory and 31/72 from expiratory tubing were contaminated with Gram-negative bacilli . None of 48 sets of tubing was contaminated when a heat-moisture exchanger was used and only one expiratory tube was contaminated in tubing from 45 neonates using a water humidifier . Gram-negative bacilli were isolated from the mouths of 21/36 adults and 6/12 neonates, and also from 6/17 hands of staff after changing circuits . It is suggested that circuits with water humidification may be changed every 48 h in adult patients, and between patients or weekly in neonatal units or between patients if a heat-moisture exchanger is used . Handwashing after removal of a circuit is of major importance in the prevention of spread of infection.

Arch Immunol Ther Exp (Warsz), 1990, 38(5-6), 395 - 406
Capsular and somatic antigens of Klebsiella bacilli; Stankiewicz MM; Capsular and somatic antigens were determined in 100 Kl . oxytoca strains isolated from patients with the respiratory tract inflammations . K antigens were assigned by the capsula swelling test using 77 specific anti-capsular sera . Most frequent were: K14, K2, K55, K8 and K16 antigens . Positive reaction was noted with 64 strains in 2 or more sera . Somatic antigens of Klebsiella oxytoca bacilli were tested by the test tube agglutination reaction . Of 63 strains tested with anti-01 Kl . pneumoniae and Kl . oxytoca sera, all reacted positively in anti-0 Kl . oxytoca serum and 77% strains in anti-01 Kl . pneumoniae serum . Of 29 strains agglutinating in anti-03 sera, 65.5% agglutinated with anti-0 Kl . oxytoca serum and 76% with anti-03 Kl . pneumoniae . The results have revealed that Kl . oxytoca strains investigated have more complicated capsular antigens and different frequency of their occurrence . The most commonly encountered somatic antigen is antigen 01, next in turn is antigen 03, these antigens proved nonidentical with their 01 and 03 counterparts in Kl . pneumoniae strains.

Br J Ophthalmol, 1990 Jan, 74(1), 14 - 8
Histopathological findings in the iris of dapsone treated leprosy patients; Brandt F et al.; From 43 Nepalese leprosy patients skin smear negative, and treated with dapsone (diamino diphenyl sulphone), and without any sign of active leprosy or iritis, specimens from iridectomy during cataract surgery were studied histopathologically . Of 49 iris specimens only six (12%) were found to be without any histopathological change . Atrophy of the iris stroma was seen in 63% and neovascularisation in 6% of all cases . In 16% in which the dilator muscle could be detected, it was atrophic, and in 11% the pigmented epithelium was thinned and atrophic . Cellular inflammatory infiltrations were seen in 88% of all specimens . They were mostly slight in eyes which before operation had been without posterior synechiae of the iris . In most of the eyes in which posterior synechiae had been present moderate or heavy inflammatory cell infiltrates composed of lymphocytes and plasma cells, often associated with macrophages, neutrophils, or eosinophils, were found . In five iris specimens acid fast bacilli were present . This raises the question whether these can survive systemically despite dapsone chemotherapy in the iris, thus leading to dapsone-resistant leprosy and to recurrent iritis.

J Infect Dis, 1990 Jan, 161(1), 71 - 8
Cat-scratch disease presenting as abdominal visceral granulomas; Delahoussaye PM et al.; Three cases of atypical, clinically unsuspected cat-scratch disease (CSD), diagnosed by demonstration of the CSD bacillus in an abdominal visceral organ, are presented . In two cases CSD bacilli were demonstrated for the first time in splenic granulomas in a child and in an adult with acquired immunodeficiency syndrome (AIDS)-related complex . In both cases, there was granulomatous hepatitis as well as splenitis . In the third case, the CSD bacillus was present in hepatic granulomas in an adult with granulomatous hepatitis . In all cases, granulomatous inflammation with suppuration in the viscera was identical to that previously described for lymph nodes in CSD . All patients eventually recovered completely . Clinical awareness of the broad spectrum of CSD should avoid the cost and morbidity of prolonged hospitalization, medications, and invasive surgery for a disease that is self-limited and not clearly responsive to antibiotics and that can usually be diagnosed by noninvasive means.

Am J Med, 1989 Dec 29, 87(6C), 31S - 36S
Comparative pharmacokinetics of ofloxacin and ciprofloxacin; Wolfson JS et al.; Review of publications in which the pharmacokinetics of ofloxacin and ciprofloxacin were compared directly indicates that although similar in many respects, these fluoroquinolones exhibit three differences that may be important clinically . First, ofloxacin is more completely absorbed, achieves higher peak serum concentrations, and has a longer terminal elimination half-life, which result in a fivefold greater area under the curve than that of ciprofloxacin when similar doses are orally administered . Ofloxacin's more favorable pharmacokinetic profile seems to compensate at least in part for the greater activity of ciprofloxacin against gram-negative bacilli in vitro . Second, ofloxacin is eliminated almost entirely via the kidneys, whereas ciprofloxacin is eliminated via both the kidneys and non-renal routes . This suggests that ciprofloxacin may be preferable for patients with variable renal function, whereas ofloxacin may be preferable for patients receiving dialysis because of the need for less frequent administration . Third, concomitant use of ciprofloxacin with either theophylline or caffeine decreases elimination and thereby results in elevated serum concentrations of these methylxanthine derivatives . Because ofloxacin does not cause clinically significant alterations in the pharmacokinetics of either theophylline or caffeine, it may be preferable for patients using these concomitantly.

Arch Fr Pediatr, 1989 Dec, 46(10), 745 - 7
{Acute thyroiditis caused by Eikenella corrodens and abnormality of the left pyriform sinus}; Iniguez JL et al.; A case of suppurative thyroiditis is reported . The initial course was insidious and mimicked De Quervain subacute thyroiditis . The abscess was surgically drained . It contained numerous Eikenella corrodens bacilli . Fibroscopy of pharyngo-laryngeal region showed that the left pyriform sinus was abnormal . Surgical removal of a fistula of the fourth branchial pouch was performed in order to prevent recurrence of the thyroiditis.

Tubercle, 1989 Dec, 70(4), 287 - 92
Antibodies to mycobacteria in healthy and tuberculous badgers from two English counties; Stainsby K et al.; Sera obtained from 2 groups of badgers removed in bovine tuberculosis control operations have been examined for antibodies to 11 species of mycobacteria . From animals without post mortem evidence of tuberculosis, levels of antibodies to mycobacteria were found to increase with age, and different patterns of antibodies were found in animals coming from 2 different places . Some animals (5 out of 60) without evidence of progressive infection had antibodies suggesting contact with tubercle bacilli . Animals found to have tuberculosis at post mortem had increased levels of antibody to common mycobacterial antigen, as do humans with that disease . Only 2 of the 12 tuberculous animals had markedly more antibody binding to Tuberculin than to the other reagents . There was no evidence of greater specificity of antibody binding than was shown by sera of healthy badgers . The suggestion is made that contact with environmental mycobacteria might be a major factor determining distribution of tuberculosis amongst badgers.

Semin Respir Infect, 1989 Dec, 4(4), 245 - 52
Nosocomial bacterial pneumonias; Septimus EJ; Pneumonia is the third most common nosocomial infection and the most difficult to prevent . Fifteen percent of all deaths occurring in hospitals are caused by nosocomial pneumonias . Nosocomial pneumonias prolong hospital stays over 4 days, resulting in at least $3,000 to $5,000 in extra charges per infection . Most cases of nosocomial pneumonias are caused by bacteria, especially gram-negative bacilli . The majority of nosocomial pneumonias appear to result from aspiration of bacteria that have colonized the oropharynx . Additional risk factors include colonization of the oropharynx with gram-negative bacilli, thoracic and upper abdominal surgery, continuous mechanical ventilation, extremes of age, and severity of underlying diseases . Prevention revolves around an effective infection control program, preventing colonization and aspiration, and improving host defense mechanisms . Further research is needed to clarify the role of topical antibiotics and to develop strategies to alter host defenses to prevent or eliminate colonization of gram-negative bacilli.

J Bioenerg Biomembr, 1989 Dec, 21(6), 663 - 77
The Na+ cycle of extreme alkalophiles: a secondary Na+/H+ antiporter and Na+/solute symporters; Krulwich TA et al.; Extremely alkalophilic bacteria that grow optimally at pH 10.5 and above are generally aerobic bacilli that grow at mesophilic temperatures and moderate salt levels . The adaptations to alkalophily in these organisms may be distinguished from responses to combined challenges of high pH together with other stresses such as salinity or anaerobiosis . These alkalophiles all possess a simple and physiologically crucial Na+ cycle that accomplishes the key task of pH homeostasis . An electrogenic, secondary Na+/H+ antiporter is energized by the electrochemical proton gradient formed by the proton-pumping respiratory chain . The antiporter facilitates maintenance of a pHin that is two or more pH units lower than pHout at optimal pH values for growth . It also largely converts the initial electrochemical proton gradient formed by respiration into an electrochemical sodium gradient that energizes motility as well as a plethora of Na+ solute symporters . These symporters catalyze solute accumulation and, importantly, reentry of Na+ . The extreme nonmarine alkalophiles exhibit no primary sodium pumping dependent upon either respiration or ATP . ATP synthesis is not part of their Na+ cycle . Rather, the specific details of oxidative phosphorylation in these organisms are an interesting analogue of the same process in mitochondria, and may utilize some common features to optimize energy transduction.

Am J Clin Pathol, 1989 Dec, 92(6), 797 - 801
Nongranulomatous involvement of the bone marrow in lepromatous leprosy; Suster S et al.; Bone marrow involvement in lepromatous leprosy has been characterized histologically by a proliferation of foamy histiocytes containing lepra bacilli, the so-called Virchow cells . The authors have studied three patients with biopsy-proven lepromatous leprosy in whom Fite stain, performed on histologic sections of bone marrow aspirates, demonstrated numerous bacilli lying free in the interstitium in the absence of Virchow cells or focal collections of foamy macrophages . Two of the patients had a recent diagnosis of lepromatous leprosy by skin biopsy; the third patient had a 33-year history of lepromatous leprosy that had been treated . Bone marrow aspirates were performed in all three patients for evaluation of anemia . The findings indicate that the bone marrow may act as a reservoir for viable organisms in the absence of a host response in treated and untreated patients with lepromatous leprosy . The persistence of viable organisms in the bone marrow in patients with lepromatous leprosy may account for the high rate of relapse and/or recrudescence of the disease following cessation of specific therapy . Bone marrow examination with the Fite modification of the acid-fast stain is therefore indicated in such patients to evaluate bone marrow involvement and the efficacy of treatment.

Int J Lepr Other Mycobact Dis, 1989 Dec, 57(4), 735 - 43
PGL-I antigen and antibody detection in leprosy patients: evolution under chemotherapy; Chanteau S et al.; Multibacillary (MB) and paucibacillary (PB) leprosy patients were tested for circulating phenolic glycolipid-I (PGL-I) antigen and antibodies before treatment . In the 27 MB patients tested, 27 (100%) were antigen positive with levels ranging from 50 to 5000 ng/ml, and 26 (96%) were antibody positive with titers ranging from 1000 to 64,000 . Although the antigen and antibody levels were much higher in MB than in PB patients, we could not demonstrate a correlation between the number of acid-fast bacilli/mg of skin biopsy and these two parameters in 14 MB patients . After starting daily multidrug therapy, 10 MB patients were monitored monthly . As much as 88.75% +/- 10.8% of the PGL-I antigen was cleared from the bloodstream after 1 month while the anti-PGL-I antibody remained stable . This rapid decrease in the PGL-I antigen level strongly suggests the usefulness of this test for monitoring MB patients under chemotherapy.

Hua Xi Yi Ke Da Xue Xue Bao, 1989 Dec, 20(4), 377 - 80
{Antigen presentation of human B lymphocytes on BCG particulate antigen}; Yin TG et al.; The possibility of human B lymphocytes to process and present BCG particulate antigen to BCG specific T cell line was studied . It was found that about 6% of B cells after incubated with BCG for 24 h, showed BCG bacilli in their cytoplasm, by acid fast stain, and became obscure 48 h later . These results demonstrated that human B lymphocytes could phagocytose, process, and degrade BCG particulate antigen . The BCG pulsed B cells acted as antigen presenting cells to BCG specific T cell line . The proliferation and IL-2 production of specific T cell line were significantly enhanced by BCG pulsed B cell stimulation . It was evident that BCG antigen was presented to T cell lines by B cell . The activity of BCG pulsed B cell was time depending . By treating B lymphocytes with chloroquine which interferes with normal lysosome functions could completely inhibit the proliferation of BCG specific T cell line when B lymphocytes were pulsed with BCG or express of BCG . The results revealed that B cells must process antigen before presenting antigen to T cells . It is concluded that B lymphocytes can phagocytose, process and present relevant determinants of BCG particulate antigen to BCG specific T cell line, and that human B lymphocytes may play an important role in the anti-tuberculous immunity in vivo, at least as antigen presenting cells . To pursue the study of this problem, it is suggested to use B lymphocytes deficient mice as experimental models for further investigation.

No To Shinkei, 1989 Dec, 41(12), 1245 - 50
{A case report of multiple intracranial tuberculoma associated with miliary tuberculosis and review of the literature}; Kamai K et al.; We reported a case of multiple intracranial tuberculoma associated with miliary tuberculosis and reviewed the cases reported as intracranial tuberculoma in the past 11 years . A 41-year-old diabetic man was admitted to our hospital for the treatment of miliary tuberculosis and respiratory insufficiency . On admissIon, he had no neurological deficits except mild consciousness disturbance due to respiratory failure . He developed headache and mental confusion three weeks after the beginning of antituberculous therapy with isoniazid, streptomycin, rifampicin, and ethambutol . Neurological examination revealed that he had progressive right hemiparesis and was in a confusional state . Enhanced CT showed multiple intracranial nodular lesions . During 6 weeks, he had progressive neurological manifestations in spite of his initial antituberculous treatment . He responded well, however, to the chemotherapy with combination of isoniazid, kanamycin, pyrazinamide and ethionamide that were sensitive to tuberculous bacilli separated from his sputum . He became minimally right-hemiparetic by 6 weeks after the change of antituberculous medication . Serial enhanced CT scan proved to be of great value in the diagnosis and follow-up study of intracranial tuberculoma . From 1978 to 1988, there were 72 reported cases of intracranial tuberculoma in Japan; 37 were male, 32 were female and 3 were uncertain because of no detailed document . The age of onset was distributed from 6 month to 81 years in age and 2 peaks were seen in the second decade and fifth to seventh decade . Thirty-three (48%) out of 69 cases had multiple intracranial lesions . A few reports commented that neurological complications tended to appear even if they were under antituberculous therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Zhonghua Liu Xing Bing Xue Za Zhi, 1989 Dec, 10(6), 331 - 2
{A report of an outbreak of diphtheria in Anshan area}; Liang Y; This paper reports an outbreak of diphtheria and the result of appropriate preventive and therapeutic measures in Anshan area from Dec . 1984 to Dec . 1987 . This epidemic of diphtheria occurred mainly in a camp of reform though labour organization and in a spring sanatorium among a population of young adult people with higher level of antibodies . It was proved that the special infection origin was a strain of nontoxic diphtheria bacilli . After a combined management including of injection of a refined diphtheria toxoid and an environment disinfection, the incidence of the disease dropped markedly.

Pneumologie, 1989 Dec, 43(12), 691 - 702
{Survey of the initial treatment of pulmonary tuberculosis in West Germany . A study by the German Central Committee for the Prevention of Tuberculosis}; Zierski M et al.; 1405 adult patients were selected for assessment who had been newly notified in the years 1986/87 with confirmed diagnosis of active progressive pulmonary tuberculosis who required treatment . Of these, 83.5% excreted tubercle bacilli in the sputum; radiographic lung cavities were confirmed in 53.6%, and 859 (61.1%) had a concomitant disease . 1173 patients (94.2%) were hospitalized for initial treatment and only 232 (5.8%) received outpatient treatment . The median duration of the hospital stay was 12 weeks . Isoniazid and rifampicin were prescribed in 96% and 93% patients, respectively, mostly all the time, ethambutol in 75% initially and in 50% throughout, streptomycin in 50% initially . Three or four drug regimens including pyrazinamide in the initial phase were employed in 76% of the patients . Premature discontinuation of therapy for different reasons was noted in 135 patients (9.5%) . Of these, treatment was discontinued in 59 (4.2%) due to death; 37 (2.6%) patients died due to tuberculosis . Adverse reactions were observed in 193 patients (13.7%); 0.3% of the patients discontinued chemotherapy because of toxicity . The duration of chemotherapy was between 9 and 12 months in the majority of patients; 30%, however, were treated for more than 12 months . The chemotherapy of 6-months duration was performed only in about 10% of treated patients . Among the patients who completed the treatment, this proved effective in 98% . Although the majority received initially the rational chemotherapy with a three or four drugs regimen, it is concluded that the inpatient stay and the outpatient duration of chemotherapy in the routine clinical practice is too long, therapy control is insufficient.

Q J Med, 1989 Dec, 73(272), 1151 - 9
The haematological and biochemical changes in severe pulmonary tuberculosis; Morris CD et al.; This study surveys the extent and severity of haematological and biochemical abnormalities which occurred in 265 patients with pulmonary tuberculosis, and records the haematological changes that occur with treatment . Anaemia was present in 60 per cent of patients, more frequently in males than in females . Leucocytosis with neutrophilia occurred in 40 per cent, lymphopenia in 17 per cent and monocytopenia in 50 per cent . Platelet count and erythrocyte sedimentation rate were elevated in 52 and 80 per cent respectively . Bone marrow aspiration and trephine biopsy were of limited diagnostic value . Ferritin and vitamin B12 levels were increased in 94 and 57 per cent of subjects respectively whilst serum and red cell folic acid were within normal limits in 83 per cent . The frequency of the important biochemical changes were hyponatraemia (43 per cent) and hypoalbuminaemia (72 per cent); alkaline phosphatase, aspartic transaminase and lactic dehydrogenase levels were elevated in approximately a third of patients possibly due to unsuspected dissemination . There was a close correlation between the acid-fast bacilli in sputum and abnormal values, particularly those of body weight, haemoglobin, platelet count, white cell count and erythrocyte sedimentation rate . Failure of these indices to return to normal was invariably associated with persistent excretion of acid-fast bacilli . We have shown that haematological and biochemical abnormalities in pulmonary tuberculosis are common and may be valuable aids to diagnosis . Some haematological markers also reflect response to treatment.

Kekkaku, 1989 Dec, 64(12), 781 - 98
{Present status and future problem of chemotherapy for tuberculosis}
{Prevention of bacterial infections using ciprofloxacin in granulocytopenic patients with cancer}
Snoeck R, Gerain J, Leleux A, Libert J, Meunier F.

The optimal approach to reduce bacterial infections in granulocytopenic patients is still controversial . Recently, fluoroquinolones have been developed and real progress has been achieved in the prevention of Gram negative bacilli septicemia . This study reports our experience with ciprofloxacin and shows the excellent tolerance of ciprofloxacin by our patients as well as promising data for the reduction of Gram negative bacilli infection . However, practical modalities to prevent infection caused by Gram positive cocci remain to be defined.

Hansenol Int, 1989 Dec, 14(2), 101 - 6
{Difficulties in the use of the Ridley and Jopling classification--a morphological analysis}; Fleury RN; There are many difficulties in the use of the Ridley & Jopling classification in daily practice . The author identified the morphologic parameters whose variations permit to distinguish the polar types and borderline groups according to Ridley . If we avoid the inconstant histologic alterations we believe that this distinction depends basically on the following parameters: epithelioid cell, granuloma of epithelioid cells, numbers of lymphocytes and number of bacilli . A critical analysis is performed of each of these parameters and the author concludes that they are scarce, and that there are great difficulties for the identification and interpretation of their variations for classification purposes . These difficulties are even more important during the reactional episodes.

Surg Neurol, 1989 Dec, 32(6), 445 - 8
Tuberculous abscess of the brain stem; Prakash B et al.; Three cases of tuberculous abscess of the brain stem were treated with excision of the abscess supplemented with antitubercular therapy for 12 to 18 months . The lesions were frankly purulent and tubercle bacilli were demonstrated in the pus . A computed tomography scan demonstrated the site and extent of the lesion . Two of three patients developed the abscess during the course of antitubercular therapy for associated tubercular lesions . In spite of modern antitubercular treatment the abscess did not resolve and surgical excision had to be employed as a curative treatment.

Kekkaku, 1989 Dec, 64(12), 814 - 9
{Complications in tuberculous patients--with special reference to secondary mixed infections}; Oizumi K; An attempt was made to elucidate the mechanism which makes pulmonary tuberculosis intractable . Patients with pulmonary tuberculosis were divided into the following two groups; one group consisted of patients (n = 37) in which tubercle bacilli converted to negative within 6 months after the institution of anti-tuberculous chemotherapy and remained negative thereafter, and the other group (n = 21) in which tubercle bacilli persisted in spite of long-term chemotherapy . A comparison was made on serum factors and blood cell components, which were linked with humoral and cellular immunity respectively, between the above two groups of tuberculosis patients . As the result, reductions was observed in the ratio of serum albumin to globulin and increase in erythrocytes sedimentation rate and in amount of immunosuppressive acidic proteins in the chronic bacillary cases as compared with the patients in which negative conversion of bacilli had been achieved . A depressed cellular immunity was also found in the former group of the patients as evidenced with the reduction in a ratio of helper/inducer T lymphocytes to suppressor/cytotoxic T lymphocytes and in intensity of skin reaction to PPD . The depressed humoral and cellular immunity observed in chronic bacillary cases were one of possible causes of intractability of the disease and also the major cause of the frequent involvement with pulmonary infections with pathogens other than tubercle bacilli . At the second part, a problem in treating patients with both lung cancer and pulmonary tuberculosis was discussed, since iatrogenic immunosuppression was induced almost unavoidably by the use of anticancer agents.(ABSTRACT TRUNCATED AT 250 WORDS)

J Vasc Surg, 1989 Nov, 10(5), 511 - 9; discussion 520-1
Lateral plantar artery bypass grafting: defining the limits of foot revascularization; Andros G et al.; We placed 20 bypass grafts to the lateral plantar artery in 18 extremities to salvage feet with wet (12) or dry (six) gangrene; 15 grafts were implanted in men (75%), and five were implanted in women (25%) . The median age was 65 years . All except two patients had diabetes; eight were treated with insulin . One patient had Buerger's disease, and another had vasculitis with chronic lymphocytic leukemia . History of smoking (65%), hypertension (53%), heart disease (71%), and osteomyelitis in the foot (35%), were noted . Cultures were positive in 15 gangrenous feet, 11 with gram-negative bacilli . Four long femoroplantar bypasses were placed . Ten short grafts were placed from the popliteal artery, and six jump grafts were placed distal to a femoropopliteal or tibial bypass . Hospital stay ranged from 8 to 38 days (median 16 days), and there were two in-hospital deaths . Transmetatarsal or button toe amputations were performed in nine feet . There were two below-knee amputations, one with a patent graft, for a foot salvage rate of 89% at 2 months . In four instances the gangrenous ulcers took longer than 6 months to heal; all other wounds healed within 6 months . The primary and secondary patency rates were 85% at 1 month, and 73% at 3 months and thereafter . Four of five graft failures occurred in the two legs with repeat bypass graftings . All patients with successful revascularization are able to walk, and seven returned to work full time.

J Infect Dis, 1989 Nov, 160(5), 891 - 5
Increased endotoxin and interleukin-1 beta concentrations in cerebrospinal fluid of infants with coliform meningitis and ventriculitis associated with intraventricular gentamicin therapy; Mustafa MM et al.; Intraventricular gentamicin therapy in infants with gram-negative enteric bacillary meningitis and ventriculitis is associated with increased mortality . Therefore, endotoxin, interleukin-1 beta, and cachectin (tumor necrosis factor) concentrations in ventricular cerebrospinal fluid from 21 infants (11 received intravenous antibiotics alone and 10 received intraventricular gentamicin also) were determined and correlated with outcome and other ventricular cerebrospinal fluid indexes of inflammation . Mean interleukin-1 beta concentrations in ventricular cerebrospinal fluid correlated significantly with adverse outcome and with mean concentrations of endotoxin, white blood cells, and protein and inversely with glucose concentrations . Mean and peak endotoxin and interleukin-1 beta concentrations were significantly higher in infants who received intraventricular gentamicin and intravenous antibiotics than in infants given intravenous antibiotics alone . Intraventricular gentamicin may have caused release of endotoxin from gram-negative bacilli in ventricular cerebrospinal fluid, resulting in increased interleukin-1 beta concentrations and inflammation, which could have contributed to the poor outcome in these patients.

Hum Pathol, 1989 Nov, 20(11), 1078 - 83
Immunohistologic analysis of mycobacterial antigens by monoclonal antibodies in tuberculosis and mycobacteriosis; Barbolini G et al.; Four monoclonal antibodies (MoAbs), 60.15, 61.3, 105.10, and 2.16, directed to different proteins of Mycobacterium tuberculosis were used by an indirect avidin-biotin complex peroxidase-antiperoxidase method to detect mycobacterial antigens in lung, lymph node, and joint tissue specimens of tuberculous patients . Using MoAb 60.15, which recognizes a broad range of cross-reactive mycobacterial proteins with a molecular mass of 28 kilodaltons (kD), scattered materials (mycobacterial in origin) were observed, many of which were located within phagocyte cytoplasm . With MoAb 61.3, which reacts with a 35 kD protein present in M tuberculosis, Mycobacterium africanum, and Mycobacterium bovis, many clumped particles similar in size and shape to acid-fast bacilli were observed within the phagocyte cytoplasm (lung tissue) and positive macrophages with lysosomes were distributed throughout the cytoplasm (bronchoalveolar lavage) . The specificity of this MoAb (61.3) was confirmed by the negative staining of positive lymph node specimens obtained from a patient infected with Mycobacterium kansasii . MoAbs 105.10 and 2.16 bind to the cross-reactive 65 kD heat shock protein that is present in mycobacteria and stain scattered particles and dark clumps of bacilli within the phagocyte cytoplasm . On the basis of this study, immunohistochemical detection of mycobacterial antigens appears to be useful in establishing the mycobacterial etiology of caseating granulomas and in avoiding the false-negative results obtained by traditional staining methods.

Am J Surg Pathol, 1989 Nov, 13(11), 909 - 20
Bacillary angiomatosis . The histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease; LeBoit PE et al.; Cutaneous vascular proliferations that clinically or pathologically resemble Kaposi's sarcoma, pyogenic granuloma, or histiocytoid (epithelioid) hemangioma may occur in patients with human immunodeficiency virus infection . These lesions, which respond well to antibiotic therapy, harbor bacilli similar to the agent of cat scratch disease . We evaluated 21 biopsy specimens from 13 patients with this condition, which we have called "bacillary angiomatosis." The architecture resembled that of lobular capillary hemangioma (pyogenic granuloma), but the endothelial cells were often larger, polygonal, and sometimes markedly atypical . The presence of neutrophils, leukocytoclastic debris, and granular material (bacteria), and the absence of either spindled cells, bizarrely shaped vascular channels, or hyaline globules help to distinguish bacillary angiomatosis from Kaposi's sarcoma . By electron microscopy, the protuberant endothelial cells were different from those of histiocytoid hemangiomas in that aggregates of intermediate filaments were absent, while numerous Weibel-Palade bodies were present . The immunophenotype of the endothelial cells was distinct from that of Kaposi's sarcoma; almost all cells showed both Factor VIII RAg and Ulex europaeus lectin positivity . Enzyme histochemistry also showed a pattern distinct from Kaposi's sarcoma . Bacillary angiomatosis presents a unique constellation of clinical and microscopic findings . It is important to be aware of these characteristics, because these lesions are easily treatable with antibiotic therapy.

Rev Inst Med Trop Sao Paulo, 1989 Nov-Dec, 31(6), 368 - 76
{Legionella pneumophila associated with acute respiratory insufficiency . 1st isolation in Brazil}; Pereira Gomes JC et al.; Isolation of Legionella pneumophila sero-group 1 with serological evidence of present infection is reported from a 40 year-old male with serious respiratory infection which developed into acute respiratory failure . It was characterized by severe hypoxemia resistant to high inspired oxygen concentrations and radiographically by diffuse infiltrates in both lungs suggesting the clinical aspect of ARDS . Following the introduction of clindamycin, amikacin, ceftriaxone, volume-cycled ventilator and positive end expiratory pressure (PEEP) of 14 cm H2O, stabilization of clinical conditions and gradual recovery were achieved . Suspecting of legionellosis, blood and tracheal secretions specimens were collected for specific laboratory research . From tracheal secretion cultivated in BCYE medium, gran-negative bacilli were isolated and identified as Legionella pneumophila serogroup 1 through cultural and biochemical characteristics and direct immunofluorescence and slide agglutination tests . Serology (IFA) with blood samples collecting during the 1st, 3rd, 4th and 6th weeks of illness demonstrated antibody titers to the isolated microorganism of 128, 1024, 4096 and 8192, respectively . Definitive results were obtained during the patient's recovery . The authors emphasize: a) the demonstration of the presence of Legionella sp . as a pathogenic agent in Brazil; b) the importance of supportive care in the clinical outcome; c) the need of remembering this pathogen while making differential diagnosis of pneumonias and of continuing to pursue this etiology with specific laboratory methodology.

Mikrobiol Zh, 1989 Nov-Dec, 51(6), 45 - 50
{The effect of the method of inoculation on the growth and variability of Bacillus thuringiensis H14 266/2-1}; Osadchaia AI et al.; The method of inoculation was studied for its effect on the growth and variability of Bacillus thuringiensis H14 266/2-1 when cultivating them in the liquid nutrient medium inoculate with inoculum prepared by different procedures . Optimal conditions of the inoculum preparation are determined . Productivity of the strain when inoculating the medium with the aerial-dry inoculum was studied as compared to the inoculation by the inoculum taken from the mown agar . It is established that selection of the virulent R-form from colonies should serve as a basis for the preparation of the stable morphologically uniform inoculum . The aerial-dried culture of bacilli is shown to be more effective since it is characterized by higher and stable indices of productivity and is more prepared to a long-duration storage than the inoculated agar media . A more rapid transition (by 2-4h) of the culture to the use of the carbon source is marked . The culture of bacilli is different in a higher developmental level: sporulation and crystallization initiate during the first hours of inoculation and by the 24th hour sporulation reaches 100% with the prevailing content of R-form.

Rev Infect Dis, 1989 Nov-Dec, 11 Suppl 7, S1582 - 90
Evolution of antibiotic therapy for infection in neutropenic patients: studies at M . D . Anderson Hospital; Bodey GP; The prompt administration of antibiotics as therapy for fever in neutropenic patients has become an accepted principle . Combinations of an aminoglycoside plus a broad-spectrum beta-lactam agent have been used most extensively, producing response rates of 65%-70% at M . D . Anderson Cancer Center, Houston, Texas . We found that in neutropenic patients aminoglycosides alone were not effective, even against infections caused by susceptible gram-negative bacilli . Among patients with neutrophil counts of less than 100/mm3, only approximately 25% responded . The first studies of combinations of a penicillin plus a cephalosporin were initiated at this institution . Carbenicillin plus cephalothin was as effective as carbenicillin plus kanamycin (57% vs . 56%), and moxalactam plus ticarcillin was as effective as moxalactam plus tobramycin (63% vs . 53%) . Monotherapy with broad-spectrum beta-lactam agents has also been effective, even for the treatment of gram-negative bacillary infections, with response rates of 73%-100% . Recent prospective, randomized trials indicate that agents such as ceftazidime and aztreonam are as effective alone as in combination with an aminoglycoside or another beta-lactam antibiotic . Because of the changing spectrum of infecting organisms, of new approaches to therapy for malignant diseases that alter patients' susceptibility to infection, and of the availability of new antimicrobial agents, antibiotic therapy for fever in neutropenic patients will continue to be a subject for clinical investigation.

J Immunol, 1989 Nov 1, 143(9), 2837 - 43
Effect of a single exposure to ultraviolet radiation on Mycobacterium bovis bacillus Calmette-Guerin infection in mice; Jeevan A et al.; BALB/c and C3H mice were exposed on the dorsal skin to 45 kJ/m2 of UVB radiation from FS-40 sunlamps 3 days before infection with 1 x 10(6) live units of Mycobacterium bovis bacillus Calmette-Guerin (BCG) (Tice strain) in the footpad . At regular intervals, groups of mice were tested for a delayed type hypersensitivity (DTH) response to the purified protein derivative (PPD) of tubercle bacilli, and the course of infection was monitored by measuring the size of the infected footpad, enlargement of the draining lymph node, and the number of bacteria in the spleen and lymph node . In both strains the DTH response to PPD was significantly delayed in UV-treated mice compared to unirradiated mice, when tested 21 and 42 days after BCG infection . By day 50, no significant difference was detected in the DTH response between irradiated and unirradiated mice . UV treatment reduced the size of the lymph node draining the site of BCG infection in both strains of mice and the size of the infected footpad in C3H mice but not in BALB/c mice . In both strains of mice the total number of bacteria in the spleen and the draining lymph node increased after UV irradiation . When irradiated 3, 5, 18, or 21 days after BCG infection, BALB/c mice also showed a significant decrease in their DTH response to PPD, indicating that the UV-induced suppression of BCG occurs both at the induction and the elicitation stages of the immune response . Thus, mice exposed to a single dose of UV radiation either before or after BCG infection showed an impaired DTH response to mycobacteria, which was accompanied by an increase in the multiplication of bacteria in the tissues, even though the organisms were introduced at an unirradiated site . These studies demonstrate that a systemic effect of UV irradiation can interfere with the development and expression of immunity to pathogenic bacteria in mice.

Zhonghua Yi Xue Za Zhi (Taipei), 1989 Nov, 44(5), 305 - 12
Fine needle aspiration biopsy cytology of superficial lymph nodes: comparative with histopathology; Lee JY et al.; Fine needle aspiration biopsy cytology was done in 215 lymph nodes involving cervical, submandibular, supraclavicular, axillary and inguinal regions . One hundred and forty of these were diagnosed by histopathology after excisional biopsy or surgery, including 46 cases of metastatic tumor, 57 of lymphoma (46 were non-Hodgkin's lymphoma and 11 were Hodgkin's disease), and 37 of benign lymphadenopathy . Diagnosis of metastatic malignancy was easily made by aspiration biopsy cytology with a total sensitivity of 95.7% (44/46) . The diagnosis of lymphoma was less satisfactory with a total sensitivity of 82.5% (47/57) . The specificity for diagnosis of benign lymphadenopathy was 97.3% (36/37) with one false positive . The concordance of cell type in aspiration biopsy cytology and histopathology was 75% (33/44) in metastatic malignancy, and 73.5% (28/38) in lymphoma . Typical Reed-Sternberg giant cells were detected in 4 of 11 cases of Hodgkin's disease by aspiration cytology . Out of the 37 cases of benign lymphadenopathy diagnosed by aspiration cytology, 7 were cases of tuberculous lymphadenitis, of which typical Langhans' giant cells were found in 2, and acid fast stain bacilli in 3 cases . There was no complication or needle tract spreading throughout the procedure . We concluded that aspiration biopsy cytology is a simple, safe, reliable, and quick diagnostic method.

Antibiot Khimioter, 1989 Nov, 34(11), 819 - 22
{Effect of various microorganisms on the activity of levorin}; Ivanova LN et al.; Levorin added to nutrient media with growing cultures of aerobic gram-positive bacilli, Escherichia, enterococci and filamentous fungi was partially inactivated . The antibiotic activity decrease depended on the strain characteristics, incubation period and temperature . Fermentation broth filtrates of the experimental strains also inactivated levorin while to a lesser extent than the growing organisms . In contaminated levorin pastes, the antibiotic activity was lower . The fermentative nature of inactivation was not proved.

Antimicrob Agents Chemother, 1989 Nov, 33(11), 1855 - 9
Antimicrobial susceptibility in gram-negative bacteremia: are nosocomial isolates really more resistant?
McGowan JE Jr, Hall EC, Parrott PL.
Bloodstream isolates of gram-negative aerobic bacilli from nosocomial infections are more likely to be resistant to antimicrobial agents than isolates from community-acquired cases are . It is not clear, however, how much this is due to the markedly different distribution of organisms in the two groups . We compared the susceptibilities of organisms of a given species which caused community-acquired bacteremia with the susceptibilities of isolates from nosocomial cases . Nine antimicrobial agents were tested against 1,077 isolates which were obtained during a 4-year nonepidemic period . Marked differences in crude rates of resistance were noted for all isolates from nosocomial cases versus all isolates from cases acquired in the community . When results were adjusted for the different organism distributions in the two groups, statistically significant differences were found for only six drug-organism pairs; in each of these, resistance rates were higher in nosocomial isolates . However, when results were further adjusted for the effect of multiple analyses, no significant differences were seen . The major factor leading to the greater prevalence of antimicrobial resistance in our hospital organisms was the markedly different distribution of organisms in the nosocomial and community-acquired groups . For individual organisms, greater resistance in nosocomial strains was confined to certain drugs . Factors that influence differences in organism distribution may not be solely the result of antimicrobial use.

Rev Infect Dis, 1989 Nov-Dec, 11 Suppl 7, S1613 - 20
Infection in acute leukemia: an analysis of 433 episodes; Wang QN et al.; Two hundred fifty-seven patients with acute leukemia were admitted into our hospital on 346 occasions . There were 433 episodes of infection, with an average of 1.25 episodes per hospitalization; 126 patients (49.0%) died . Infection was the major predisposing factor and cause of death . The incidence of infection increased significantly with prolonged duration of hospitalization, the degree of granulocytopenia, the degree of chemotherapeutic failure, and the use of glucocorticoids . Pulmonary infection (17.3%) was the most common type of infection . Septicemia (12.0%) was also common and was associated with high mortality (71.2%) . Of 22 patients with perirectal abscess, 10 had septicemia . Gram-negative bacilli were responsible for 66.1% of laboratory-documented bacterial infections . For the treatment of infection, empiric use of an aminoglycoside combined with either an antipseudomonal penicillin or a cephalosporin at the first sign of infection was emphasized . Antibiotic administration should be continued for at least 7 days after the patient's temperature becomes normal.

Kekkaku, 1989 Nov, 64(11), 699 - 705
{Pulmonary tuberculosis and diabetes mellitus--report of the 29th B series of controlled trials of chemotherapy . Cooperative Study Unit of Chemotherapy of Tuberculosis of National Sanatoria in Japan (CSUCTNS)}; Hiro Y; The data obtained from 315 cases of pulmonary tuberculosis with positive sputum and complicated with diabetes mellitus were collected and the results were summarized as follows; 1) Patients were collected from admitted patients in 1983 . 2) Ratio of male to female was 3.3 to 1 . 3) Most patients (80.1%) were in the age groups over 50 . 4) Patients were divided into two groups according to the degree of control of diabetes: one group was well controlled and the other was not . Bacilli negative conversion rate was 98.4% in the well controlled group and 91.6% in the other group at 6 months, and the difference was statistically significant.

Kekkaku, 1989 Nov, 64(11), 707 - 11
{Glycolipid-patterns of Mycobacterium tuberculosis as an aid for sub-typing}; Toida I et al.; Total lipids were extracted from Mycobacterium tuberculosis with chloroform-methanol (2:1), applied on a silica-gel thin-layer plate, and developed with chloroform-methanol-acetone (90:10:5) . Glycolipids were detected by spraying Anthrone-reagent and heating . Strain H37Rv of M . tuberculosis showed four Anthrone-positive spots, namely trehalose-monomycolate, unidentified glycolipid, trehalose-dimycolate and GL-Rv, and strain H37Ra showed only two spots corresponding to trehalose-monomycolate and trehalose-dimycolate . Other 4 laboratory-stock strains of M . tuberculosis showed glycolipid-pattern identical with either of these two patterns . One hundred and fifty-eight strains of M . tuberculosis, isolated clinically from tuberculosis patients, were classified into 7 types according to their glycolipid-pattern . Twenty-seven strains contained one more Anthrone-positive spot other than those of strain H37Rv . Pattern II was most frequently observed (60 strains), and then pattern I (33 strains), VI (29 strains), IV (13 strains), V (9 strains), VII (8 strains), and III (6 strains) . Pattern I corresponded to that of strain H37Ra and pattern VI corresponded to that of strain H37Rv . Glycolipid-pattern did not correlate to clinical features of patients from whom the bacilli had been isolated . A glycolipid, which moved to just under the solvent front, was a new glycolipid which has been found by us and designated as GL-Rv . Chemical structure of GL-Rv was clarified by us as trehalose-polyacyl derivatives (no mycolic acid as the acyl residue) . Glycolipid-pattern was very stable and reproducible for each strain of M . tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

APMIS, 1989 Nov, 97(11), 1013 - 7
Penicillin-binding proteins in Listeria monocytogenes; Gutkind GO et al.; The Penicillin-Binding Proteins (PBP) of Listeria monocytogenes 29-CCM-A: 454 (ATCC 15313) are described by the use of 125I-Penicillin X as radiotracer . The membranes of this tolerant bacilli contained at least five proteins with different affinities for the radiotracer or Dicloxacillin . The molecular weights of these proteins were estimated as 76, 74, 67, 66 and 47 KDa . Dicloxacillin induced the formation of straight filaments when present at sub-inhibitory concentrations, while Penicillin G did not induce any visible alteration in the morphology of this microorganism.

J Med Microbiol, 1989 Nov, 30(3), 175 - 81
Radiometric studies on the use of selective inhibitors in the identification of Mycobacterium spp; Collins T et al.; Radiometric selective inhibition tests were developed and evaluated for the rapid differentiation of Mycobacterium spp . Both a p-nitrobenzoic acid (PNB) test and a commercially-prepared p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test successfully differentiated M . tuberculosis and M . bovis from "atypical" mycobacteria or mycobacteria other than tubercle bacilli (MOTT) . Thiophene-2-carboxylic acid hydrazide (TCH) readily distinguished human M . tuberculosis strains from M . bovis, irrespective of resistance to isoniazid . Both PNB and TCH tests were utilised in a routine radiometric susceptibility testing scheme over a period of 1 year in which 110 isolates of M . tuberculosis, 10 of M . bovis and one isolate of BCG were correctly differentiated from 10 isolates of MOTT . The rapidity, sensitivity and specificity of these radiometric tests can play a useful role in mycobacterial identification.

Ann Intern Med, 1989 Oct 15, 111(8), 650 - 4
A tuberculostearic acid assay in the diagnosis of sputum smear-negative pulmonary tuberculosis . A prospective study of bronchoscopic aspirate and lavage specimens; Pang JA et al.; OBJECTIVE: To determine whether the detection of tuberculostearic acid (TBSA) in bronchial aspirate and bronchoalveolar lavage specimens is useful for the rapid diagnosis of active pulmonary tuberculosis in patients suspected of having the disease . SETTING: A pulmonary clinic in a teaching hospital . PATIENTS: Forty patients suspected of active pulmonary tuberculosis but who failed to produce sputum or whose sputum smears were negative for acid-fast bacilli on at least 3 occasions, 29 of whom were subsequently confirmed to have tuberculosis . A group of 13 patients who were having fiberoptic bronchoscopy for other reasons served as controls . INTERVENTION: All patients had fiberoptic bronchoscopy; bronchial aspirate, bronchoalveolar lavage, and sputum specimens were obtained when possible . MEASUREMENTS AND MAIN RESULTS: All specimens were examined microscopically for acid-fast bacilli, cultured for mycobacteria, and assayed for TBSA by gas chromatography and mass spectrometry with selected ion monitoring . Only 4 of the 29 patients with tuberculosis were diagnosed by direct microscopy compared with 26 by TBSA assay . In 2 patients who required surgical biopsy for conventional diagnosis, the TBSA test was positive . There were no false-positive TBSA results in the 13 controls, but 2 of 5 sputum specimens from the 11 test patients in whom tuberculosis was excluded were falsely positive, probably because of contamination with mouth flora . Because sputum can rarely be obtained from these patients and may give false-positive results, it is not a good specimen for TBSA assay . Sensitivities and specificities of the test for the other specimens were as follows: aspirate, 0.52 (CI, 0.32 to 0.71) and 1.00 (CI, 0.75 to 1.00); lavage, 0.68 (CI, 0.46 to 0.85) and 1.00 (CI, 0.84 to 1.00); aspirate and lavage combined, 0.79 (CI, 0.60 to 0.92) and 1.00 (CI, 0.86 to 1.00) . CONCLUSIONS: The TBSA assay for bronchial aspirate and bronchoalveolar lavage fluid is useful for rapidly diagnosing "smear-negative" pulmonary tuberculosis . In these specimens it is highly specific and more sensitive than microscopy . This assay could be used to diagnose other mycobacterial infections, however, it cannot distinguish among species.

FEMS Microbiol Lett, 1989 Oct 15, 52(3), 237 - 41
Functional characteristics of phosphatidylinositol-specific phospholipases C from Bacillus cereus and Bacillus thuringiensis; Volwerk JJ et al.; Phosphatidylinositol-specific phospholipase C was purified from the culture medium of B . thuringiensis to high specific activity using a procedure we recently described for purification of PI-PLC from B . cereus (Volwerk et al . (1989) J . Cell . Biochem . 39, 315-325) . The purified enzymes from B . thuringiensis and B . cereus have similar specific activities towards hydrolysis of the membrane lipid phosphatidylinositol, and also towards hydrolysis of the glycosyl-phosphatidylinositol-containing membrane anchor of bovine erythrocyte acetylcholinesterase . These results indicate very similar catalytic properties for the structurally homologous PI-specific phospholipases C secreted by these bacilli.

Kekkaku, 1989 Oct, 64(10), 679 - 81
{Activated macrophages and cytotoxicity}; Yamamura Y; Cellular immune reaction plays an important role in tuberculous infection . When the host develops cellular immunity, a large number of activated macrophages (M phi) are accumulated in the tuberculous focus by the chemotactic effect of lymphokine, and these M phi lively phagocytize and suppress the multiplication of tubercle bacilli . On the other hand, many M phi are killed during the process of phagocytosis, releasing a large amount of lysosomal enzymes and cytotoxic substances (TNF etc.), possibly causing the tissue damage: caseous necrosis, softening and liquefaction followed by cavity formation . To clarify the process of necrosis in detail, production of TNF-alpha and IL-6 from human M phi was observed . Monocyte/M phi were separated from the peripheral blood of healthy persons, each group with positive or negative tuberculin reaction and tuberculous patients, using a commonly used method . The monocyte/M phi were stimulated in a culture with lipopolysaccharide (LPS) or muramyl dipeptide (MDP) and amount of TNF-alpha and IL-6 in the culture supernatants were estimated . TNF-alpha activity was determined by measuring the lysis of the target cell (mouse L929 cell), and IL-6 by measuring the 3H-thymidine incorporation into IL-6 dependent mouse plasma cell hybridoma, MH60-BSF2, in the presence of TNF-alpha or IL-6, respectively . The results showed that the monocyte/M phi from the tuberculin positive persons, with or without tuberculosis revealed a higher TNF-alpha production activity than those from tuberculin negative healthy cases using either MDP or LPS stimulation . The monocyte/M phi from tuberculous patients produced more TNF-alpha with MDP stimulation than with LPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Kekkaku, 1989 Oct, 64(10), 649 - 53
{Clinical characteristics of tuberculosis in the aged}; Shimokata K et al.; We prospectively studied the clinical characteristics of tuberculosis in the aged from July 1988 to March 1989 . Twenty-five of 101 tubercle-bacilli positive patients were 70 years old or more . In these aged patients, decrease of body weight and of serum albumin was predominant . These findings suggest that undernutrition is remarkable in aged patients with tuberculosis, and it may influence their cellular immunity . In fact, the tuberculin reaction was significantly attenuated in the aged patients compared with patients less than 70 years old . Twelve percent of the aged patients showed a negative tuberculin reaction . In clinical diagnosis, it should be kept in mind that tuberculin reaction is sometimes negative in active tuberculosis patients particularly in the aged . The time required for negative conversion of tubercle bacilli was not retarded in the aged patients due to the use of potent chemotherapy regimens containing isoniazid and rifampicin.

Kekkaku, 1989 Oct, 64(10), 613 - 9
{A cases of isoniazid-induced lupus}; Ueda Y et al.; A case of isoniazid (INH)-induced lupus occurring in a 62-year-old man is presented . He visited our hospital in May 1986 and a cavitary lesion was found in the right upper lobe on a chest roentgenogram . He had no previous history of treatment with antituberculotic agents . Though acid-fast bacilli were not found in his sputum, pulmonary tuberculosis was strongly suspected and INH, rifampicin and ethanbutol were administered . Four days after starting the treatment, minimal left pleural effusion was seen on chest X-ray film . Three months later he began to complain polyarthralgia in his digital joints . In a pleural effusion many lymphocytes were found; and the antinuclear antibody (ANA), the anti-extractable nuclear antigens (ENA) antibody, and the RNase resistant anti-ENA antibody were positive, and their titres were 20x, 1000x and 1000x, respectively, and the immune complex (IC) was 16.0 micrograms/ml (LT5) . In blood serum, the ANA test the anti-ENA antibody and the RNase resistant anti-ENA antibody were positive with titres 40x, 640x and 640x respectively; and the IC was 14.0 micrograms/ml, and the RA test was positive . The improvement of clinical findings and disappearance of auto-antibodies seen after stopping INH confirmed the diagnosis as INH-induced lupus.

Kekkaku, 1989 Oct, 64(10), 605 - 12
{Epidemiological study on tuberculosis in Tochigi Prefecture . Part I: Factor relating to the onset of tuberculosis in three health centers of Tochigi Prefecture}; Kobayashi M; While the incidence rate of tuberculosis had steadily decreased in Tochigi Prefecture until 1981, the rate began to increase since around 1982 in contrast to the continuous decrease in Japan . An interview survey of the factors and the background of newly registered tuberculosis patients in three health centers of Tochigi Prefecture was conducted to clarify the reason of the recent undesirable changes of the epidemiological picture of tuberculosis in Tochigi Prefecture . Those items included in the interview were X-ray and bacteriological findings at registry, mode of detection, previous history of tuberculosis, symptoms, findings at registry, mode of detection, previous history of tuberculosis, symptoms, coverage of previous examination, etc . Of 178 newly registered tuberculous patients in these health center district in Tochigi Prefecture, 175 (98%) were interviewed by public health nurses during the period from April, 1987 to January, 1988 . The results thus obtained were as follows: 1 . 74% of the patients were found by visiting doctors, chiefly with complaints of fever, cough and sputum, followed by health examination (13%) . The proportion of patients detected by visiting doctors was higher in females and the older age groups of 70 and over . 2 . Patients found by visiting doctors chiefly complained of fever, cough and sputum . The positive rate of tubercle bacilli by bacteriological examination was higher in patients complaining of cough and sputum than those without these complaints . The positive rate was higher than that of newly registered cases in whole Japan . The rate was especially high in the age group of 50-69.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiol Infect, 1989 Oct, 103(2), 323 - 32
Investigation of the immune status of mice during and following selective decontamination of the digestive tract; Speekenbrink AB et al.; Selective decontamination of the digestive tract (SDD) employs oral antibiotics to eliminate aerobic Gram-negative bacilli while retaining the anaerobic flora . A combination of SDD and parenteral cefotaxime has recently been reported to strikingly reduce the incidence of infection in patients treated in an intensive therapy unit . The present study describes the effects of SDD and of cefotaxime on the immune response of mice to protein antigens . The in vivo cellular response to ovalbumin and sheep red blood cells was unchanged . However, SDD appeared to decrease the in vitro mitogenic response of spleen cells to phytohaemagglutinin, and cefotaxime similarly affected the response to Concanavalin A . The antibody response to sheep red blood cells was increased in the period after discontinuation of SDD . The antibody response was otherwise not affected . These results indicate that SDD is unlikely to have adverse effects on the immune response to protein antigens.

Arch Pathol Lab Med, 1989 Oct, 113(10), 1120 - 3
The recognition of mycobacterial infections by intraoperative cytology in patients with acquired immunodeficiency syndrome; Jannotta FS et al.; In patients with the acquired immunodeficiency syndrome, mycobacterial lymphadenitis is characterized by the presence of numerous acid-fast bacilli within histiocytes . In Diff-Quik-stained cytologic preparations of such lymph nodes, performed during intraoperative consultations, the presence of mycobacteria is manifested by numerous negatively staining rod-shaped spaces intracellularly within histiocytes, as well as extra-cellularly in the background . Recognition of these characteristic "footprints," or "negative images," of mycobacteria can facilitate early diagnosis and treatment . The morphological characteristics that help to distinguish between Mycobacterium avium-intracellulare and Mycobacterium kansasii are also described.

Arch Intern Med, 1989 Oct, 149(10), 2201 - 5
Mycobacterial disease in patients with human immunodeficiency virus infection; Modilevsky T et al.; We compared the clinical features of disease due to tuberculosis and to Mycobacterium avium complex (MAC) in 94 patients with human immunodeficiency virus infection . Tuberculosis preceded the diagnosis of acquired immunodeficiency syndrome in 26 (67%) of 39 cases, compared with none of 55 with MAC infection . Chest roentgenographic findings suggested mycobacterial infection in 24 (83%) of 29 patients with pulmonary tuberculosis, compared with 7 (25%) of 28 with MAC infection . Sputum smears revealed acid-fast bacilli in 19 (83%) of 23 patients with pulmonary tuberculosis, but only 4 (16%) of 25 cases of pulmonary MAC infection . In 39 patients with tuberculosis, lymphadenitis and pleuritis were present in 13 (33%) and 8 (20%), respectively, but occurrence was rare in patients with MAC infection . In contrast, mycobacteremia was more frequent in MAC infection, occurring in 47 (85%) of 55 cases . In 5 patients, tuberculosis was unsuspected and probably contributed to death . These findings suggest that clinical features often distinguish tuberculosis from MAC infection in patients with human immunodeficiency virus infection . In addition, more intensive diagnostic use of sputum acid-fast smears may improve the outcome in patients with tuberculosis.

Medicina (Firenze), 1989 Oct-Dec, 9(4), 375 - 9
{Treatment of mycobacteriosis}; Covi M et al.; At present the increased incidence of infections with mycobacteria other than tuberculosis and leprae bacilli seems to be correlated with several causes: improved diagnostic techniques, prolonged life expectancy, immunodepression . Rational chemotherapy depends upon the identification of the etiologic mycobacterium and the determination of its drug susceptibility . Besides the "classic" treatment with 3 or 4 antituberculous and, sometimes, nonantituberculous chemotherapics, clinical trials are in progress to assess the effectiveness of new molecules: rifamycin derivatives, fluorinated quinolones, anti-lepromatous drugs, and the latest macrolides . Yet at present, national and international data do not permit to define a standard treatment for every mycobacteriosis; in fact, the drug resistance is high and varies not only between different strains but also within the same strain; moreover, there are discrepancies between in vitro and in vivo results . When possible, appropriated surgery for circumscribed disease is recommended.

Indian J Lepr, 1989 Oct, 61(4), 485 - 94
Process of disintegration and degradation of M . leprae: study of tissue imprints and tissues; Cologlu AS; The existence, distribution and behaviour of degradation products of M . leprae in leprosy lesions were investigated in tissue specimens fixed in neutral formalin and embedded in paraffin . Cytopathologic findings using tissue imprints were unsatisfactory . Sections were stained with hematoxylin-eosin, acid-fast stains, silver methenamine and by an immunochemical (PAP) technique using serial paraffin sections . A comparison in respect of the distribution of the bacilli within the macrophages showed considerable differences between the superficial and deep granulomas . This corresponds roughly with the central, intermediary and peripheral locations . In a small granuloma seen in BL lesions, there were two zones: central and peripheral . In a large LL granuloma, three zones were seen, central, intermediary and peripheral zones . It is suggested that the degradation of disintegrated particles of bacilli might be due to the lysosymal activity of macrophages . The phagocytized bacilli are slowly degraded with long incubation periods, but the undigested debris remains inside the phagosomes . The chemical complexity of cytoplasm, cell wall and lipid fractions of M . leprae, and it is such that the lipid fractions of M . leprae mask some other antigenic components, which may be responsible for the cellular response and lysosymal production . According to our findings we believe that chemotherapy kills M . leprae but degraded products are not removed . These components are chemically complex and digested with difficulty . Lysosymal enzymes could be inhibited from productions by the bacterial debris or the lipid fractions could serve as a mask to delay lysosymal production in the cell . These aspects need further study.

Indian J Lepr, 1989 Oct, 61(4), 458 - 66
Growth of Mycobacterium leprae in a redox system: III . Evidence of growth at low temperature (psychrophilia) and, further refinement of growth medium; Chatterjee BR et al.; Considerable growth enhancement, largely as non-acid fast, slender and long rods has been seen when incubated at 10 degrees C . Concentration of some of the media constituents have been reduced that has improved the quantum of growth . A remarkable proneness to physical disintegration of the grown bacilli has been seen and its significance discussed . Also, the possible immunogenic advantage of non-AF M . leprae has been discussed . The question of identification is still not solved, and work is in progress.

Indian J Lepr, 1989 Oct, 61(4), 445 - 52
Bacillaemia and bone marrow involvement in leprosy; Sen R et al.; Fifty patients (24 new and 26 receiving specific treatment) of leprosy were investigated to study the concentration and morphological index (MI) of the lepra bacilli in skin, peripheral blood and bone marrow . The organisms were detected in 28 cases on skin slit smear examination, in 38 cases on bone marrow examination and in 38 cases on examination of smears made from buffy coat of peripheral blood . Out of 22 cases negative for the bacilli on skin slit smears, 15 had the organisms either in buffy coat or bone marrow or both . Acid fast bacilli in peripheral blood and bone marrow with skin smear negativity were mainly observed in patients with paucibacillary type of the disease and in those who were receiving treatment . Examination of buffy coat and bone marrow for presence of lepra bacilli is suggested to establish the diagnosis in doubtful cases.

Gut, 1989 Oct, 30(10), 1371 - 8
An experimental animal model of granulomatous bowel disease; Mitchell IC et al.; A study has been undertaken of the granulomatous response induced in the ascending colon and terminal ileum of the guinea pig by the direct inoculation of mycobacterial antigens . Live BCG (Pasteur) 2 x 10(7) at two weeks induced epithelioid cell granulomas in both large and small bowel and in the draining lymph nodes . The area of infiltration was significantly greater for a given inoculum in the large bowel . Acid fast bacilli were present on Ziehl Neelson stained sections of the large bowel infiltrate, but only rarely in sections from the small bowel lesions . The response to skin testing with a standardised amount of purified protein derivative was less in animals inoculated in the small bowel . Inoculation with 2 x 10(9) cobalt irradiated BCG gave rise, at five weeks, to granulomas containing lesser numbers of epithelioid cells and caseation was sometimes evident . There was a similar but smaller difference in the degree of infiltration at the two inoculation sites . Ziehl Neelson staining failed to reveal the presence of acid fast bacilli in any sections of the bowel infiltrates . Skin testing with purified protein derivative gave a response which was greater in animals inoculated in the small bowel . An identical dose of Cobalt irradiated M leprae induced at five weeks a predominantly macrophage granuloma in both the large and small bowel, with no significant difference in the degree of infiltration at the two sites . No acid fast bacilli were seen in Ziehl Neelson stained sections of the bowel and skin testing with purified protein derivative was reduced . These findings and their relevance to studies of the aetiology of Crohn's disease are discussed.

Am J Infect Control, 1989 Oct, 17(5), 250 - 7
Nosocomial infection in neonatal intensive care units; Donowitz LG; Nosocomial infection rates in neonatal intensive care units range from 5% to 25% . Both endemic and epidemic infections have been documented, with causative agents including gram-positive cocci, gram-negative bacilli, and viruses . This paper reviews the host, maternal, and environmental factors that influence susceptibility of neonates . Usual preventive measures, such as nursery design, staff apparel, handwashing, employee health, and neonatal care, as well as epidemic control measures to minimize infection risks and limit transmission of infectious organisms, are discussed.

Middle East J Anesthesiol, 1989 Oct, 10(3), 299 - 305
Mortality in the surgical intensive care unit--the role of sepsis and organ failure; Messahel FM et al.; Study of admissions to the surgical intensive care unit (SICU) at King Khalid University Hospital in Riyadh was carried out from 1982 to 1987 . There were 1149 surgical admissions, of whom 96 patients died (mortality rate 8.3%) . Eighty-six patients died of multisystem and organ failure (MSOF) . Sepsis appeared to be the ultimate cause of death in 54 patients of the organ failure group (62.8%) . Twenty four percent of this group had positive blood cultures, and 57% had more than one positive culture site . Gram-negative bacilli and gram-positive cocci were the predominant organisms with only two positive anaerobic cultures . In this study the risk for developing sepsis starts at the age of 50, otherwise our data confirm previous studies on the influence of sepsis and MSOF on mortality in SICU . Recommendations for future improvement in patient's care and investment in antibiotic research are made.

J Clin Microbiol, 1989 Oct, 27(10), 2245 - 8
Evaluation of a rapid method of extracting DNA from stool samples for use in hybridization assays; Coll P et al.; The ability of the Extractor system (Molecular Biosystems, Inc., San Diego, Calif.) to isolate nucleic acid (NA) from stool samples for use in hybridization assays was investigated . Crude NA was recovered from 45 of 50 stool samples by using this system . The amount of NA recovered varied considerably depending on the microbial flora present in the sample (mean +/- standard deviation, 50.2 +/- 46.7 micrograms; range, 2 to 228 micrograms) but did not correlate with the consistency of the sample . Samples containing primarily gram-positive organisms or yeast cells gave lower yields of NA (less than 10 micrograms) than those containing gram-negative bacilli . The five samples which did not yield NA were sterile when cultured aerobically on blood agar plates . Samples of the 45 stools yielding NA were inoculated into broth and grown overnight, and a 10-microliters sample of broth was spotted onto nitrocellulose filters . The NA samples recovered from the Extractor column were applied to nylon membranes by using the Centri-dot system . The NA on the broth blots and the NA on the Centri-dot filters were hybridized with a 310-base-pair probe specific for the 2"-O-aminoglycoside adenylyltransferase {ANT(2")} resistance gene . The Extractor-Centri-dot system demonstrated 61.9% sensitivity and 95.8% specificity in detecting the ANT(2") gene in stool samples containing colonies demonstrating the ANT(2") phenotype . The positive and negative predictive values of the NA blot were 92.8 and 74.2%, respectively.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1989 Oct-Dec, 38(4), 317 - 31
{Reasons for delayed diagnosis of pulmonary tuberculosis}; Anastasatu C et al.; 100 patients at first treatment were investigated according to a complete questionnaire for explaining the causes of tardy diagnosis in pulmonary tuberculosis . The roles of the disease, patient and physician in this delay were followed . The insidious or atypical onset of the disease in 82% of these patients explains the long interval (107.2 days on the average) elapsed between the appearance of the first symptoms and the diagnosis determination . As a consequence of low cultural level, many patients cannot give a correct interpretation of the symptomatology and they seek the physician's help after 69.1 days (on the average) from the appearance of the symptoms . The medical causes are numerous and can be rapidly cured . In the dispensary of general medicine, 55% patients were examined only clinically, 45% clinically and radiologically but only 7% were subjected to the bacteriologic examination for bK and 4% were sent to the TB wards for consultation . As the registration of the patient, his admission into the hospital and the tuberculostatic treatment depend on the bK presence in sputum--sometimes waiting for the result of the culture tests--the average interval between consultation and admission is of about 34.7 days . On admission, high average values were registered: cavities of 4.2 cm in diameter, lesions of 2.8 points and bacteriologically 44 bacilli/100 fields . For improving this situation the following recommendations are made: increase of the health education on TB activity in the population, continuous education of the general practitioners in the TB diagnosis methods, use of the radiologic examination together with the bacteriologic one and the biological tests for the early detection of the pulmonary tuberculosis.

Rev Med Chil, 1989 Oct, 117(10), 1141 - 9
{Infection in severe neutropenia: analysis of 140 episodes}; Gutierrez J et al.; We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients . The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors . No fever developed in 35 (25%) episodes . No cause for the fever was identified in 40% of the remaining episodes . Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27% . Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes . Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%) . The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01) . 16 patients died for an overall mortality of 11% . Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.

Res Microbiol, 1989 Oct, 140(8), 569 - 78
Antigenicity and specificity of selected glycolipid fractions from Mycobacterium tuberculosis; Papa F et al.; Antigenicity of Mycobacterium tuberculosis glycolipids polyphthienoyl trehalose (PPTR), phenolic glycolipid (PGL-Tb1), tetraacyl trehalose-2'-sulphate (SL-I) and diacyl trehalose-2'-sulphate (SL-IV) was examined in rabbits . PPTR did not induce production of IgG antibodies in rabbits, while PGL-Tb1, SL-I and SL-IV glycolipids were efficient in this respect . Immune sera raised in rabbits immunoreacted exclusively with the corresponding antigens, which indicated that they were remarkably specific . Specificity of the immune sera was further examined using crude extracts of representative strains of 39 mycobacterial species, and the data showed that these immune sera reacted only with extracts of M . tuberculosis and M . africanum . An antiserum raised against whole cells of M . leprae immunoreacted with the purified SL-IV antigen from tubercle bacilli.

Proc Natl Acad Sci U S A, 1989 Oct, 86(20), 8073 - 7
Effect of multiple interferon gamma injections on the disposal of Mycobacterium leprae; Kaplan G et al.; The effect of multiple intradermal injections (four to six) of 10 micrograms of interferon gamma on the number of Mycobacterium leprae in the skin of patients with polar lepromatous leprosy and borderline lepromatous leprosy was evaluated . To achieve a maximum zone of induration and cell emigration a preparatory dose of the lymphokine was required . A second group of three injections, given 3-4 days after the initial series, resulted in lesser degrees of induration and was more in keeping with a partial local hyporesponsive state . A marked emigration of T cells and monocytes into the dermis resulted from injections of interferon gamma and persisted for greater than 21 days . A preponderance of CD4+ cells in the infiltrate was seen within a few days and CD4/CD8 ratios remained elevated for greater than 5 weeks . The bacillary load of injected sites evaluated 21 days after lymphokine administration was reduced in 14/17 patients by factors ranging from 5- to 1000-fold . This occurred predominantly within diffuse lesions and occurred rarely in nodular sites . Biopsy samples of injected sites taken 6 months later demonstrated progressive 10-fold reductions in bacilli and the continued presence of a granulomatous response.

Nippon Rai Gakkai Zasshi, 1989 Oct-Dec, 58(4), 250 - 8
Studies on the development of novel anti-leprous chemotherapeutics using nude mice with special reference to a new quinolone carboxylic acid, AT-4140; Tsutsumi S et al.; In order to develop a novel drug for antileprosy chemotherapy, the inhibitory effects of three synthesized compounds, a supplied antituberculous one and three quinolone carboxylic acids were examined on the growth of leprosy bacilli inoculated into the footpads of nude mice . Amongst them, a new quinolone carboxylic acid, AT-4140 whose chemical structure was 5-amino-1-cyclopropyl-6,8-difluoro-1,4-dihydro-7-(cis-3, 5-dimethyl-1-piperazinyl)-4-oxoquinoline-3-carboxylic acid strongly inhibited the growth of leprosy bacilli at doses of 15 and 30 mg/kg . Whereas, the effect of Ofloxacin used as a positive control was limited at the same doses.

Nippon Rai Gakkai Zasshi, 1989 Oct-Dec, 58(4), 241 - 9
The inhibitory effects by combined doses of DDS and several immunostimulants on the growth of leprosy bacilli inoculated into footpads of hybrid nude mice, Jcl:AF-nu; Gidoh M et al.; The inhibitory effects by the combined doses of bacteriostatic DDS and several immunostimulants on the growth of leprosy bacilli (LB) inoculated into the footpads of nude mice were examined, using a strain of hybrid nude mice named Jcl:AF-nu, which is resistible to infections more than strain BALB/c-nu . The results found were: 1 . LB could proliferate up to 10(9) level in the footpads of this strain of hybrid nude mice . 2 . The combined dose of muramyl dipeptide (MDP) or a water-soluble lipoidal amine, CP-46665 and DDS mixed with chow in the content ratio of 0.005% completely inhibited the growth of LB . Whereas, the growth inhibition by DDS alone was only partial . 3 . A derivative of MDP, muroctasin could partially inhibit the growth of LB without combined dose of DDS . 4 . The combined dose of an antitumor beta-1, 3-glucan named ATSO could not enhance the partial growth inhibition due to the dose of DDS through 0.005%-DDS chow . Based on these results, the possibility of Jcl:AF-nu mice as a favorable animal model for examining the synergic inhibitory effect on the growth of LB due to the combined dose of an antileprous chemotherapeutic and an immunostimulant was discussed.

Nippon Rai Gakkai Zasshi, 1989 Oct-Dec, 58(4), 235 - 40
The experimental inoculation with Mycobacterium leprae in autoimmune mice: results of MRL/lpr mice inoculated into the right hind foot (continued); Yogi Y et al.; Using MRL/lpr, NOD and Crj:CD-1 (ICR) mice, inoculations of M . leprae were made into the right hind foot at a dose of 5.8 x 10(6) bacilli per foot in order to study the influence of the immunobiological characteristics of their mice on the growth of M . leprae . To summarize of the results, MRL/lpr mice showed the high susceptibility to M . leprae, while that of NOD mice were poor . In conclusion, the immunobiological characteristics of MRL/lpr, autoimmune mice bearing lpr gene had effect on the multiplication of M . leprae, this mouse is a suitable multibacillary model for the study of leprosy.

Science, 1989 Sep 8, 245(4922), 1112 - 5
T cells against a bacterial heat shock protein recognize stressed macrophages; Koga T et al.; Heat shock proteins are evolutionarily highly conserved polypeptides that are produced under a variety of stress conditions to preserve cellular functions . A major antigen of tubercle bacilli of 65 kilodaltons is a heat shock protein that has significant sequence similarity and cross-reactivity with antigens of various other microbes . Monoclonal antibodies against this common bacterial heat shock protein were used to identify a molecule of similar size in murine macrophages . Macrophages subjected to various stress stimuli including interferon-gamma activation and viral infection were recognized by class I-restricted CD8 T cells raised against the bacterial heat shock protein . These data suggest that heat shock proteins are processed in stressed host cells and that epitopes shared by heat shock proteins of bacterial and host origin are presented in the context of class I molecules.

Chest, 1989 Sep, 96(3), 693 - 5
Miliary PCP in AIDS; Wasser LS et al.; The most frequent radiographic presentation of (PCP) is bilateral interstitial or alveolar infiltrates . Atypical features include lobar distribution, pleural effusions, hilar adenopathy, cyst formation and spontaneous pneumothorax . A diffuse miliary pattern has not been described previously for PCP . A 30-year-old male intravenous drug abuser, with AIDS, presented to our institution complaining of fever and productive cough . Admission chest x-ray film revealed a "classic" miliary pattern . Sputum smears were negative for acid-fast bacilli and both bronchoalveolar lavage and transbronchial biopsy revealed only PCP . Repeat bronchoscopy one month later was unrevealing and marked x-ray resolution occurred after treatment with pentamidine alone . The incidence of atypical roentgenographic features of PCP in AIDS is approximately 10 percent . Given the frequency of this infection in AIDS, knowledge of the unusual presentations is imperative . Based on this report, PCP must be included in the differential diagnosis of a miliary x-ray pattern.

Lepr Rev, 1989 Sep, 60(3), 197 - 201
Bacillaemia in leprosy and effect of multidrug therapy; Chatterjee G et al.; Twenty-five patients of bacilliferous leprosy (17 LL, 8 BL) were studied by the modified haemolysis method for occurrence of bacillaemia and its clearance after two multidrug therapy regimens . Acid-fast bacilli were found in 76% of all patients and in 88.2% LL and 50% BL patients . Bacillaemia occurred with significantly reduced frequency in patients with type II reaction . Acid-fast bacilli were demonstrable in peripheral blood after 1 month in one patient on MDT of an Indian Working Group and 3 lepromatous patients on WHO multidrug therapy . However, bacillaemia could not be demonstrated in any patients after 2 and 3 months of treatment with both regimens.

J Antimicrob Chemother, 1989 Sep, 24(3), 425 - 9
The penetration of aztreonam, a monobactam antibiotic, into intra-abdominal abscesses; Youngs DJ et al.; We have studied the penetration of aztreonam into pus with a low mortality intra-abdominal abscess model in the Wistar rat . The mean peak serum concentration (standard error) of aztreonam was 74.6 +/- 9.88 mg/l at 30 min falling to 2.31 +/- 1.28 mg/l at 8 h . The mean concentration in pus was 17.04 +/- 2.01 mg/l at 2 h and was 14.47 +/- 2.23 mg/l at 8 h . These concentrations are in excess of the MICs of most Gram-negative aerobic bacilli commonly isolated from intra-abdominal abscesses.

Int J Lepr Other Mycobact Dis, 1989 Sep, 57(3), 652 - 8
Identification of Mycobacterium leprae antigens in tissues of leprosy patients using monoclonal antibodies; Khanolkar SR et al.; Five monoclonal antibodies (MAbs) directed against antigens of Mycobacterium leprae were tested for their ability to bind to components of tissue sections prepared from biopsies taken from patients with various forms of leprosy . Immunoperoxidase was the most successful marker system used, although immunofluorescence and alkaline phosphatase were also successful in certain cases . Positivity was high with all five antibodies successfully staining those sections containing a bacterial index of 3+ or more; sections with 0 bacterial counts also had areas staining positively with two of the MAbs . The positive staining in the tissues was confined to areas infiltrated by inflammatory cells; however it was not identifiable as being associated with individual bacteria . These findings suggest that immunostaining with specific monoclonal antibodies can help to identify leprosy in diagnostic samples in which acid-fast bacilli are not identifiable by standard histochemical means . Immunohistochemical techniques are likely to be valuable in studies of the distribution of M . leprae antigens and their association with individual tissue elements.

Clin Chest Med, 1989 Sep, 10(3), 365 - 74
The physician's role in tuberculosis prevention; Glassroth J; Tuberculosis is not only treatable but preventable as well . A number of options exist for reducing the transmission of tubercle bacilli . Practitioners are in a position to intervene directly on behalf of their patients and indirectly by promptly reporting infectious patients to local public health authorities . A considerable body of information supports the use of isoniazid in persons who are infected by Mycobacterium tuberculosis and who also have readily identifiable characteristics that place them at increased risk for developing tuberculosis.

Oralprophylaxe, 1989 Sep, 11(3), 95 - 100
{Effect of Xylitol chewing gum on total saliva and dental plaque in caries-active persons}; Rekola M; Total saliva and toothplaque values were investigated with caries active persons during the use of xylital containing chewing gum . 20 caries active individuals (DMFS 54.4) chewed 5 xylitol chewing gums per day over a period of 4 weeks . The most important result was the reduction in lacto-bacilli values . This may have occurred because of the inability of acid forming bacteria to metabolise xylitol.

Izv Akad Nauk SSSR Biol, 1989 Sep-Oct, (5), 791 - 5
{The possibility of the germination of spores of pathogenic clostridia and bacilli in soil}; Volkova VP et al.; A possibility of germination of clostridia (Cl . tetani and Cl . perfringens) and bacilli (Bac . anthracis, STI vaccine strain) has been studied in model experiments with native soil . Mature spores did not germinate upon contact with native soil of deferent agrochemical types . Addition of meat-pepton medium and other protein, amino acid, and sugar-containing media led only to "swelling" of spores . The data obtained support the conclusions drawn by many researches that pathogenic clostridia and bacilli do not germinate in soil.

Semin Respir Infect, 1989 Sep, 4(3), 216 - 24
Present chemotherapy of tuberculosis; O'Brien RJ; Significant advances in the treatment of tuberculosis have occurred with the introduction of short-course therapy using isoniazid and rifampin throughout therapy . The addition of pyrazinamide to the initial phase of therapy permits shortening of the total duration of treatment to 6 months for most patients . This regimen is well tolerated, results in rapid disappearance of bacilli from the sputum, and has a low rate of relapse . Ethambutol should be added to this regimen for any patient with an increased chance of having isoniazid resistant disease . Periodic culturing of the sputum from patients with pulmonary tuberculosis is essential for monitoring response to therapy . Patient noncompliance with therapy is the most common cause of treatment failure, and any patient suspected of being noncompliant should receive directly observed therapy . For this purpose, most treatment regimens may be adapted to twice weekly administration.

Clin Chest Med, 1989 Sep, 10(3), 341 - 53
Drug-resistant tuberculosis; Iseman MD et al.; Multiply resistant tuberculosis is on the rise throughout the world . It poses the risk that an increasing percentage of patients will have disease that cannot be cured in economically limited nations and, thus, resistant tubercle bacilli will be spread in an exponential manner . For such patients in the United States, aggressive chemotherapy, coupled with surgery in cases of localized disease, is the best hope for cure.

Clin Chest Med, 1989 Sep, 10(3), 315 - 22
The modern mycobacteriology laboratory . How it can help the clinician; Good RC et al.; The mycobacteriology laboratory provides the information necessary to diagnose mycobacteriosis and to suggest proper patient management . When the definite diagnosis of disease due to M . tuberculosis is made on the basis of the laboratory result, contact follow-up studies should continue and the patient may be considered infectious if the bacilli were isolated from the sputum . A report of another Mycobacterium species suggests that a contact follow-up is not necessary, that the patient need not be isolated, and that a therapeutic regimen should be based on the results of drug-susceptibility tests with the isolate . Techniques of molecular biology are being used in the laboratory to provide the necessary information quickly for patient management . BACTEC has been accepted into most clinical laboratories to speed reporting of results . Other methods such as genetic and immunologic probes are under development . New DNA probes have been marketed by GenProbe for the identification of cultures of M . tuberculosis, M . avium, and M . intracellulare . HPLC and GLC have been used for the identification of cultures based on unique mycolic acid patterns of the species . Immunologic probes may eventually be the most specific and sensitive, but additional development is necessary . Mycobacteriophage typing of M . tuberculosis isolates has been developed as a tool to aid in epidemiologic studies . These and other technologies are essential in the support of programs for the elimination of tuberculosis.

Int J Lepr Other Mycobact Dis, 1989 Sep, 57(3), 615 - 21
Effect of chemotherapy on viability of Mycobacterium leprae as determined by ATP content, morphological index and FDA-EB fluorescent staining; Katoch VM et al.; Viable bacterial populations were estimated in bacilli purified from 105 biopsies from 40 untreated and 65 multibacillary leprosy patients treated with multidrug therapy (MDT) for varying periods . The bacilli were purified and viability was determined by ATP content, morphological index (MI), and fluorescein diacetate-ethidium bromide (FDA-EB) staining . Viable populations were calculated, taking 3.58 x 10(-15) g/solid bacillus as the mean ATP content of a viable unit of Mycobacterium leprae . The proportion of viable bacilli was also estimated in the same specimens using solid-staining (MI) and green-staining bacilli by the FDA-EB method . In the untreated cases, the positive viability by ATP assay was 100%, 92% by MI, and 100% by FDA-EB . ATP content per solid bacillus was relatively constant, which was not the case with ATP content per green-staining bacillus . While the MI was zero in all cases, viable bacilli could still be detected by ATP estimations in 5 of the 32 (16%) patients after 2 years of MDT and in 1 of the 20 (5%) patients after 3 years of MDT . No viable bacilli could be detected even by this method beyond 3 years of MDT . On the other hand, green-staining bacilli were demonstrable in 7/32 (22%) of cases after 2 years of MDT, 2/20 (10%) after 3 years of MDT, and 1/13 (8%) after more than 3 years of treatment, indicating that the FDA-EB staining and ATP assay did not detect the same populations . A determination of the ATP content of M . leprae could be used as a reliable and sensitive tool for determining viability of the bacilli.

Kekkaku, 1989 Aug, 64(8), 519 - 27
{Severe respiratory failure with pulmonary tuberculosis during initial phase of chemotherapy}; Ando T et al.; In seven patients with tuberculosis required ventilatory assistance, in our IRCU at the Habikino Hospital, we found worsening of the findings on chest X-ray film and clinical status during initial phase of chemotherapy, although their sputum became negative for acid-fast bacilli . On admission, six of them had large infiltration with cavities and discharged a large number of bacilli with elevation of ESR and hypoalbuminemia . We could get four patents off ventilator after start of PEEP therapy and high dose corticosteroid therapy . But three of them died at last, because they developed severe respiratory failure again . Pulmonary histology was available in five patients . We found interstitial and intra-alveolar pulmonary edema, intra-alveolar organization, hyperplasia of alveolar wall, and hyaline membrane formation . These findings were compatible with diffuse alveolar damage.

Eur J Pediatr, 1989 Aug, 148(8), 751 - 4
Non-tuberculous mycobacterial lymphadenitis in children; Joshi W et al.; Eighty-six children (44 males, 42 females) were identified as having non-tuberculous mycobacterial lymphadenitis . The diagnostic criteria were either culture of the organism from the affected lymph node (n = 68), or, when culture was negative, a positive skin test with non-tuberculous mycobacterial antigens and negative skin test responses to tuberculin purified protein derivative (PPD) in association with typical histological features (n = 18) . All children had histopathological findings of granulomatous inflammation with caseation and/or acid-fast bacilli . Eighty-two percent of the children were under 5 years of age at presentation and 30% were less than 2 years old . Most (79%) were city dwellers . Lymph node enlargement had been present for less than 6 months in almost all children (97.5%) and was almost exclusively in the face and neck region (97%) . Disease was confined to the involved lymph nodes in 56% but had extended beyond the confines of the infected node to form a collar stud abscess in 38% and 6% presented with a skin sinus . Extranodal extension did not show any statistically significant association with the duration of lymphadenopathy . The duration of lymphadenopathy had been greater in those children in whom an organism was not isolated on culture resected tissue (chi 2 = 10.07, P less than 0.01) . All children were treated surgically, and recurrence occurred in five patients . This study describes the clinical and demographic characteristics of non-tuberculous mycobacterial lymphadenopathy in children in a population in which tuberculous adenitis is rare . Recognition of these features may allow earlier diagnosis and appropriate surgical therapy.

Br J Oral Maxillofac Surg, 1989 Aug, 27(4), 334 - 40
Oropharyngeal colonisation with fungi and gram-negative rods in patients treated with radiotherapy of the head and neck; Makkonen TA et al.; Twenty-five patients treated for malignant conditions of the head and neck were investigated for the development of oral radiation mucositis as well as oropharyngeal colonisation with fungi and Gram-negative bacilli . The colonisation rate of the patients increased from 20% to 80% during therapy . The patients were colonised mainly with fungi, but also to a lesser extent with Gram-negative bacilli . During radiotherapy free volatile fatty acids in saliva were determined by direct gas-liquid chromatography . The amounts of acetic, butyric and propionic acid decreased during radiotherapy and remained at low levels 6 months after therapy . Radiation induced mucositis was observed in 28% of the patients after 1 week of irradiation . After 3 weeks of therapy all patients showed varying grades of mucositis . In seven of the 19 survivors (36%) erythema was still present 6 months after radiotherapy.

Antimicrob Agents Chemother, 1989 Aug, 33(8), 1137 - 43
Randomized clinical trial of aztreonam and aminoglycoside antibiotics in the treatment of serious infections caused by gram-negative bacilli; DeMaria A Jr et al.; Aztreonam was compared with aminoglycoside antibiotics (tobramycin and amikacin) in a randomized, prospective, clinical trial in serious infections caused by gram-negative bacilli (GNB) . A total of 43 evaluable patients with 47 infected sites were treated with aztreonam, and 41 evaluable patients were treated with aminoglycosides for 43 infections . Of patients treated with aztreonam, 17 were bacteremic, as were 12 of those treated with aminoglycosides . Clinical and microbiologic response rates were similar, except that only 5 of 11 patients with pneumonia were considered to be clinically cured with aminoglycoside therapy, while 5 of 6 patients with pneumonia treated with aztreonam were cured . Renal impairment was observed in 9 of 54 patients who received aminoglycoside antibiotics, but in only 2 of 53 patients treated with aztreonam . Hearing impairment developed in one patient treated with tobramycin . Transient elevations of serum transaminase levels occurred in 9 of 53 patients treated with aztreonam and in only 2 of 54 aminoglycoside-treated patients . Diarrhea and superinfection occurred with equal frequency in both groups . Serum concentrations of bactericidal activity could not be correlated with the outcome of therapy . Aztreonam appears to have comparable clinical efficacy with aminoglycoside antibiotics for the treatment of serious infections caused by aerobic and facultative GNB . Its use as a single agent for the treatment of serious lower respiratory infections caused by GNB warrants further evaluation.

Proc Natl Acad Sci U S A, 1989 Aug, 86(16), 6269 - 73
Influence of Mycobacterium leprae and its soluble products on the cutaneous responsiveness of leprosy patients to antigen and recombinant interleukin 2; Kaplan G et al.; Experiments were carried out in the skin of patients with leprosy to examine whether suppressor cell populations either exist in the skin of multibacillary lepromatous leprosy patients, can be activated with antigen, or are induced to emigrate into a cutaneous site from the circulation . For this purpose, purified protein derivative of tuberculin, a delayed-type antigen that generates a cell-mediated immune response, was introduced into the skin alone or with nonviable Mycobacterium leprae bacilli . Areas of induration and the resulting numbers and phenotypes of emigratory cells were not influenced by M . leprae and its products . Further studies examined the ability of M . leprae and its soluble products to modify the cutaneous response to intradermal injection of recombinant interleukin 2 (IL-2), a lymphokine that mimics a cell-mediated response . Neither the simultaneous injection of M . leprae and IL-2, nor the prior injection of M . leprae followed in 2 days by IL-2, nor the prior administration of IL-2 followed in 4 days by M . leprae, into the same skin site, modified the zone of induration generated by IL-2 . In addition, the immunocytochemical and histopathological evaluation of biopsy specimens of skin sites showed no difference between sites injected with IL-2 and sites injected with IL-2 and M . leprae . We conclude that suppressor T cells, if they exist, do not influence the gross or microscopic responsiveness of a cell-mediated skin reaction to antigen and IL-2 . IL-2 did, however, enhance the responsiveness of skin-test-positive tuberculoid patients and family contacts to M . leprae antigens by a synergistic effect on the zone of induration and local cell accumulation.

J Infect Dis, 1989 Aug, 160(2), 225 - 36
The human antibody response during natural bacteremic infection with gram-negative bacilli against lipopolysaccharide core determinants; Cross AS et al.; The class-specific antibody response was measured in sequential serum samples from 17 patients after natural bacteremic infection with gram-negative bacilli . There was a five- to sevenfold mean increase over preexisting antibody in levels of IgG (range, less than 1-to 88-fold), IgA (1- to 83-fold), and IgM (less than 1- to 58-fold) antibody to homologous lipopolysaccharide (LPS) in 16 of these patients . In contrast, there was only a two- to threefold mean increase (range, less than 1- to 78-fold) in about half of the patients who had a detectable antibody response to J5 core determinants and in the third who responded to Re core determinants (range, 1- to 20-fold) . All but one of the infective strains of bacteria were smooth on analysis with SDS-PAGE and with rough-specific phages . Humans infected with bacteria that had a rough LPS phenotype, however, did elicit antibody similar to that induced in rabbits after immunization with J5 vaccine . Thus, the human antibody response to natural infection with gram-negative bacilli appears to be directed primarily at homologous, strain-specific epitopes, and the response to the epitopes of LPS core antigens is not against widely shared determinants.

Klin Wochenschr, 1989 Jul 17, 67(14), 717 - 22
Mycobacteremia in AIDS patients . Results of a prospective study; Ruf B et al.; The importance of blood cultures in diagnosing disseminated mycobacteriosis in AIDS patients was evaluated . Blood samples were screened for mycobacteria by culture and microscopic techniques . Mycobacteremia was proven in 20/136 (14.7%) AIDS patients, the agent being M . avium-M . intracellulare (MAI) in 16 cases and M . tuberculosis in four cases . The rate of cases with positive blood samples in disseminated MAI infection was 59.3% (16/27 cases) and in disseminated tuberculosis 57.1% (4/7 cases) . To detect mycobacteria buffy-coat was slightly superior to lysated cell pellets, obtained by a lysis-centrifugation technique . In 4/16 cases with MAI bacteremia, the agent was proven by positive blood smears for acid-fast bacilli only; in these four patients MAI was demonstrated at other body sites . These results illustrate the diagnostic role of blood culture and its use in early diagnosis of disseminated mycobacteriosis, with microscopic examination of blood smears being an important adjunct.

Taiwan Yi Xue Hui Za Zhi, 1989 Jul, 88(7), 744 - 6
{Cervicofacial actinomycosis: report of a case}; Lee FP et al.; Actinomycotic infection involving the head and neck is not commonly diagnosed and is often a diagnostic enigma to the otolaryngologist . The reasons for this are due to the infrequency of this disease itself, the current general lack of familiarity with this disease and the pronounced sensitivity of actinomyces organisms to most of the common antibiotics in current use . The case reported here is fairly typical of cervicofacial actinomycosis . A 26-year-old man suffering from trismus and a noncharacteristic mass over the right parotidomasseteric region for one month after a lower molar tooth was extracted presented at our hospital . There were many yellowish gritty "sulfur granules" found within the pus when surgical drainage was made . Immediate Gram stain examination of these granules showed numerous filamentous Gram-positive bacilli, some of which showed true branching . Bacterial culture grew only an anaerobic organism which was identified as Actinomyces israelii by biochemical tests . This patient improved after further treatment with intensive intravenous penicillin injections for ten days and prolonged oral tetracycline treatment for two months . We suggest that increased alertness of clinicians and microbiologists to the presence of anaerobic organisms as the cause of cervicofacial infections could result in an earlier and more frequent diagnosis of actinomycosis.

J Med Assoc Thai, 1989 Jul, 72 Suppl 2, 33 - 8
Patients colonized by antibiotic resistant bacteria--a potential source of infections in the medical wards; Danchaivijitr S et al.; Bacterial colonization was studied in 12 non-infected female patients admitted into one medical ward, Siriraj hospital, Bangkok, from March to June 1988 . Swabs were taken on the first day of admission, then every other day until discharge, from six sites; i.e . anterior nares, vault of axilla, hands, anterior chest, abdomen and toe web . The times and total number of swabbing were 52 and 312 respectively . All patients were colonized with bacteria . S . epidermidis was found in all patients . S . aureus was found in 9 patients, 48 times (15.4%) . Methicillin-resistant S . aureus (M.R.S.A.) was identified in 4 patients on 10 occasions (3.2%) . Gram-negative bacilli were isolated in 11 of 12 patients, and the number of positive samples was 60 (19.2%) . All bacteria were highly resistant to the commonly used antimicrobials . The study failed to show that colonization increased with the duration of hospitalization . It is concluded that the majority of patients who had been colonized with pathogenic bacteria were important sources of infections in the medical ward.

J Clin Pathol, 1989 Jul, 42(7), 682 - 8
Bacteriological sampling of postmortem rooms; Babb JR et al.; Thirty hospital and coroners' postmortem rooms in the West Midlands were visited over two years . The design, environmental facilities, and hygienic practices were investigated and air exchange rates were measured . Microbiological samples were taken from the environment and from gloves, hands, and protective clothing of staff . Glove punctures were also recorded and a plastic isolator evaluated . Bacterial counts in the air were low and related more to the number of people in the room than to the air exchange rate . There was little evidence of the production of aerosol containing bacteria, although splashing occurred while intestines were being washed out . Surfaces often remained contaminated with Gram negative bacilli after cleaning but numbers were considerably reduced on drying . Decontamination of instruments was satisfactory . A wide range of disinfectants and concentrations was used, but none showed evidence of contamination . Gloves were heavily contaminated after use, and occasionally the hands of the wearer after removal of the gloves . Washing the hands effectively removed residual transient organisms, irrespective of the agent used . The incidence of glove punctures was higher among technicians (38%) than pathologists (12%) . The plastic isolator reduced smells and limited environmental contamination but visibility and acceptability were poor . The results of the study suggest that there is little evidence of risk of infection to staff, providing basic hygienic precautions are taken, but consideration should be given to the prevention of glove punctures.

Infect Control Hosp Epidemiol, 1989 Jul, 10(7), 306 - 11
Indications for alcohol or bland soap in removal of aerobic gram-negative skin bacteria: assessment by a novel method; Eckert DG et al.; A patient contact model was devised for health care workers (HCWs) to define heavy hand contamination with aerobic gram-negative bacilli (AGNB) that requires alcohol for complete removal . In patients, AGNB quantitation was per ml cup scrub fluid; in HCWs per ml glove juice . Following 15-second contact, two Proteeae groin carriers yielding greater than or equal to 4 log10 AGNB (high burden) transmitted greater than or equal to 3 log10 in 67% of 24 tests of six HCWs, and less than or equal to 2 log10 in 29% . Two carriers yielding less than or equal to 3 log10 in 38% . At less than or equal to 2 log10 HCW acquisitions, soap eliminated all AGNB in three of 10; alcohol in eight of eight (p = 0.009) . Contact with densely colonized patient skin may cause heavy AGNB contamination of HCWs' hands that generally necessitates alcohol for complete removal.

Diagn Microbiol Infect Dis, 1989 Jul-Aug, 12(4 Suppl), 215S - 219S
Efficacy of sulbactam/cefoperazone for the treatment of infections in patients with hematologic diseases; Horiuchi A et al.; The efficacy and safety of sulbactam/cefoperazone (SBT/CPZ) was studied in 94 patients with severe infections and concomitant hematologic diseases . All of the study patients were included in the evaluation for safety, and 76 cases were evaluable for efficacy . Clinical efficacy was excellent in 13 cases (17.1%), good in 27 cases (35.5%), fair in seven cases (9.2%), and poor in 29 cases (38.2%) . The bacteriologic eradication was 66.7% for Gram-negative bacilli and 50.0% for Gram-positive bacteria . The efficacy rate for neutropenic patients with counts less than 50 mm3 and 100 mm3 were 47.5 and 42.9%, respectively . Efficacy in patients for whom other antibiotic therapy before treatment with SBT/CPZ had been ineffective was 46.2% . Side effects were reported in one case (1.1%), and abnormal serum liver tests in five cases (5.3%); both returned to normal after discontinuation of the study medication . SBT/CPZ was an effective antibiotic for the treatment of severe infections in the presence of concurrent hematologic diseases.

Med Trop (Mars), 1989 Jul-Sep, 49(3), 305 - 6
{Difficulties in demonstrating Hansen's bacillus in lesions . Analysis of a case}; Valayer P et al.; In one case of leprosy, Ziehl's classic staining technic could not demonstrate the bacteriologic evidence . After using a cold-staining procedure, the Lapeyssonie and Causse technic, numerous Hansen's bacilli (B.H.) were detected in the lesions.

J Neurooncol, 1989 Jul, 7(2), 153 - 64
Brain tumours in childhood in Bombay: I: Histopathology showing changing patterns; II: Tissue culture with light and electronmicroscopy, stressing ingestion & degradation of bacteria by glial cells in vitro; Dastur DK et al.; The pathological pattern of 86 brain 'tumours' in childhood during the years 1981-85 (out of a total of 586 for all ages), showed a higher proportion of neoplasms and a much lower of tuberculomas compared to the preceding three decades . A large number of histologically unusual cases was revealed . Through tissue culture of brain tumours we carried out morphological, histochemical and fine structural study of the tumour cells in vitro . The abundant presence of lysosomal acid phosphatase, in outgrowing cells, correlated with the detection of lysosomal dense bodies and vacuoles in araldite sections, by light and electronmicroscopy . In view of the phagocytic propensity of schwann cells for M . leprae as the important factor in leprous neuritis, TC preparations of gliomas, (in addition to acoustic schwannomas and meningiomas), were inoculated with two mycobacteria, M . scrofulaceum and the ICRC bacillus . There was a pronounced intracytoplasmic uptake, i.e . endocytosis, of acid-fast bacilli by the growing cells of these tumours . This was confirmed by electronmicroscopy which showed intact and degrading bacilli in various stages, in such cells of a typical cerebral astrocytoma used as an illustrative case in this paper . Ingestion and Digestion appear to be an inherent property of growing tumour cells in vitro . Fine structural examination of in vitro growth of an unusual subependymal giant cell astrocytoma, not inoculated with bacilli, served as a control . Cells of both tumours showed copious autophagic activity and cytoskeletal features of developing microtubules and filaments.

Rev Hosp Clin Fac Med Sao Paulo, 1989 Jul-Aug, 44(4), 156 - 9
{Percutaneous synovial biopsy in the diagnostic evaluation of the patient with rheumatic disease}; Rodrigues CJ et al.; Forty seven percutaneous synovial biopsies from 22 patients with rheumatoid arthritis, four of whom with the juvenile form, 13 with indetermined polyarthritis and 12 with monoarthritis, were evaluated . The histopathological examination confirmed the clinical diagnosis in 76% of cases with rheumatoide arthritis and juvenile rheumatoid arthritis, and it suggested the diagnosis of rheumatoid arthritis in 80% of cases with indetermined polyarthritis . In two cases of monoarthritis it reveled acid-fast bacilli, and a granulomatous process in one . These resuls suggest that the synovial biopsies can be useful for the establishment of diagnosis in patients suffering from indetermined poly or monoarthritis.

Kekkaku, 1989 Jul, 64(7), 479 - 83
{M . kansasii lung infection occurring in a compromised host with idiopathic pulmonary fibrosis}; Umeki S et al.; A 61-year-old man was admitted to our hospital because of persisting cough, sputum and shortness of breath for four months . Brushing specimens and BALF bronchoscopically obtained revealed acid-fast bacilli and TBLB showed pathological findings consistent with interstitial pneumonia . Based on these results, clinical symptoms, chest roentgenograms on admission and identification of M . kansasii, a diagnosis of M . kansasii lung infection occurred in idiopathic pulmonary fibrosis was made . The patient's symptoms consistent with M . kansasii lung infection and his sputum became negative 6 weeks after antituberculosis chemotherapy with INH, SM and RFP . Because of an increasing dyspnea due to pulmonary fibrosis, however, the patient received oxygen therapy . This case suggested an increasing tendency of compromised hosts associated with M . kansasii lung infection.

Res Microbiol, 1989 Jul-Aug, 140(6), 419 - 23
Selective inhibition of the Mycobacterium tuberculosis complex by p-nitro-alpha-acetylamino-beta-hydroxypropio phenone (NAP) and p-nitrobenzoic acid (PNB) used in 7H11 agar medium; Rastogi N et al.; The potential of p-nitrobenzoic acid (PNB) and p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) for discriminating the Mycobacterium tuberculosis (M.tb) complex from other mycobacteria was evaluated in cases of clinical isolates . For this purpose, 500 micrograms/ml of PNB and 5 or 10 micrograms/ml of NAP were incorporated in 7H11 agar medium, and appropriate dilutions corresponding to about 10(6) viable units were then plated on PNB- or NAP-containing media . Results were reported as growth or no growth as compared to a parallel control . Our data reconfirmed the potential of PNB to discriminate M.tb complex bacteria . This study also showed for the first time that the NAP test (used until now in 7H12a broth only) can also be successfully applied using 7H11 agar . Also, preliminary data with 5 micrograms/ml of NAP on a limited number of strains suggested that it may discriminate the M.tb complex bacilli from M . xenopi and M . gastri better than PNB in 7H11 agar.

Kekkaku, 1989 Jul, 64(7), 475 - 7
{Two cases of long-lasting SPCN status}; Yokouchi H; The author experienced two model cases of long-lasting SPCN (smear positive and culture negative) status . The both cases having no prior chemotherapy, which were suggestive of relationship of SPCN to the use of RFP and the presence of huge cavity wherein tuberculous bacilli were most abundant . In these two cases, the laboratory examination showed resistance of the bacillus against INH which was most effective in tuberculous chemotherapy and the bacillus were sensitive against RFP . The SPCN continued for more than half a year . The both cases had huge cavity in the lung . The culture of bacillus was continued for 16 weeks, and no growth of colony was observed . Moreover, in one case, RFP was prescribed 1.2 g/day, much higher than the ordinary dose . The case was a medical doctor, and this dose was prescribed according to his wish . As mentioned above, these two SPCN cases were very suggestive of the model of explaining mechanisms of SPCN with simultaneous presence of huge cavity, resistance against INH and sensitivity to RFP.

Rev Infect Dis, 1989 Jul-Aug, 11(4), 612 - 5
Bacillus species infections in neonates; Patrick CC et al.; A case of neonatal meningitis due to Bacillus cereus is presented . Postmortem histopathologic examination revealed an invasive disease involving the brain parenchyma, with a cellular composition consistent with an indolent process indicative of possible perinatally acquired infection . One other neonate from our institution with systemic disease due to a nonanthrax bacillus is described, and a review of the English-language literature since 1900 reveals four additional neonates infected with these unusual pathogens . Such Bacillus species infections are rare but should be suspected when gram-positive bacilli are noted on gram stain, especially in an immunocompromised host.

J Clin Microbiol, 1989 Jul, 27(7), 1543 - 7
Direct identification of Mycobacterium tuberculosis, Mycobacterium avium, and Mycobacterium intracellulare from amplified primary cultures in BACTEC media using DNA probes; Peterson EM et al.; DNA probes (Gen-Probe, San Diego, Calif.) directed at the Mycobacterium tuberculosis complex and Mycobacterium avium-M . intracellulare complex were used to identify acid-fast bacilli directly from specimens grown in BACTEC 12B bottles (Becton Dickinson and Co., Towson, Md.) . Clinical specimens were inoculated directly or after decontamination into a BACTEC 12B bottle, Middlebrook 7H11 agar, and Lowenstein-Jensen medium . Conventional media were incubated at 37 degrees C in 5% CO2 and examined weekly for 6 weeks . Identification of isolates grown on conventional media by standard biochemicals, morphology, and growth characteristics served as the reference method for identification . BACTEC bottles were incubated at 37 degrees C, and a growth index was taken twice a week . When a growth index of greater than or equal to 100 was reached, 1 ml of BACTEC 12B medium was put into each of three microfuge tubes which were centrifuged for 15 min at 15,000 x g . Pellets were used in hybridization reactions with an M . tuberculosis complex probe, an M . avium probe, and an M . intracellulare probe . The results of the hybridizations of the three probes with the same sample were compared, and the highest percent hybridization was divided by the average of the lower hybridization values . If this value, the derived patient ratio (DPR), was greater than or equal to 3, then the specimen was considered positive for the organism giving the highest percent hybridization . Of the 1,988 specimens cultured, the results of conventional tests for the 190 conventional culture-positive specimens were 64 M . tuberculosis, 61 M . avium, 14 M . intracellulare, 30 other Mycobacterium spp., and 25 non-acid-fast bacilli . There were four cultures that each contained two different Mycobacterium spp . Directly probing the BACTEC 12B sediment, at DPR of >/= 3 the M . tuberculosis probe identified 83% (53 of 64) of M . tuberculosis isolates, the M . avium probe identified 92% (56 of 61) M . avium isolates, and the M . intracellulare probe identified 86% (12 of 14) of M . intracellulare isolates . There were no false-positive results at this DPR level . The false-negative results from probing the sediment from the BACTEC 12B bottle could not solely be attributed to the number of organisms present, the growth index, or antimicrobial therapy.

Rev Prat, 1989 Jun 8, 39(18), 1576 - 80
{Nosocomial pneumopathies}; Leroy O et al.; The criterion used for the diagnosis of nosocomial pneumonia is an infiltrate on X-ray of the chest, not present on admission, associated with new sputum production . The main causative pathogens are Staphylococcus spp . and Gram-negative bacilli . The most common pattern in the development of pneumonia is colonization of the oropharynx followed by aspiration into the lungs in patients with impaired normal defences . The factors which significantly predispose to nosocomial pneumonia are tracheal intubation, low level of consciousness, chronic lung disease, thoracic or upper abdominal surgery, large volume aspiration and age over 70 years . The fatality rate is high (32 p . 100 to 55 p . 100) . In most cases the curative treatment requires a combination of antimicrobial agents . At the moment, preventive measures remain an elusive goal.

S Afr Med J, 1989 Jun 3, 75(11), 527 - 8
The diagnostic yield of prebronchoscopy sputa and bronchial washings in patients with biopsy-proven pulmonary tuberculosis; Levy H et al.; We report on a series of 35 patients with pulmonary tuberculosis diagnosed by flexible fibre-optic bronchoscopy and transbronchial lung biopsy after 3 sputum specimens had been microscopy-negative . This study re-evaluates this invasive procedure . Additional prebronchoscopy specimens of expectorated sputum yielded the diagnosis in 7 of 16 cases (43.8%) on microscopy . Sputum culture results were positive in 12 of 33 (36.4%) . Pleural fluid culture was diagnostic in 1 case, and in another miliary tuberculosis was demonstrated on bone marrow trephine biopsy . The availability of these results could therefore have obviated the need for bronchoscopy in 14 of the 35 patients (40%) . Bronchial washings were positive for acid-fast bacilli on microscopic examination in 13 of 34 cases (38.2%) and culture-positive in only 18 of 34 (52.9%), and should therefore not be the sole procedure utilised when bronchoscopy is performed . Transbronchial lung biopsy remains a valuable procedure to confirm pulmonary tuberculosis in patients whose sputum is culture-negative for mycobacteria.

Pathol Biol (Paris), 1989 Jun, 37(5 Pt 2), 582 - 4
{Pefloxacin and cat-scratch disease}; Patey O et al.; Three patients with cat scratch diseases were treated with pefloxacin (800 mg p.d.) . Three of four criteria of the diagnosis were present . The pathogen of the disease is probably an intracellular Gram negative bacilli with a deficient wall . Improvement was obtained in one case and partial response in two other cases.

Kekkaku, 1989 Jun, 64(6), 413 - 9
{Two cases of miliary tuberculosis with SIADH}; Sugawara H et al.; Two cases of miliary tuberculosis with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) were reported . Case 1 . A 70-year-old woman suffering from general fatigue and appetite loss developed neck stiffness and stupor three days after admission . The chest X-ray film showed a miliary pattern in both lungs . The lumber puncture showed high pressure and increased leucocytes in the cerebrospinal fluid . Serum natrium concentration was 113 mEq/L . Tubercle bacilli were seen in the broncho-alveolar lavage fluid by the Ziehl-Nielsen staining . An improvement in electrolytes balance was produced by 2.5% NaCl and antituberculous treatment, then her mental function recovered . Case 2 . A 71-year-old man was admitted with gastric ulcer . When he developed dry cough thirty days after admission, the chest X-ray film showed a miliary pattern in both lungs . Acute respiratory failure advanced concomitantly . Tubercle bacilli were seen in the sputum (Gaffky 5) by the Ziehl-Nielsen staining . Antituberculous treatment was started . Although the miliary shadow improved gradually, hyponatremia was rather progressing . The following values for serum constituents were determined: sodium, 118 mEq/L; antidiuretic hormone, 10.3 pg/ml . Antituberculous treatment and supplement of NaCl (10 g/day) improved serum natrium level . He had no mental disturbance in his clinical course . In both cases, thyroid, renal and adrenal function were normal . Systemic edema and dehydration did not exist at the state of hyponatremia, and it was very clear that laboratory data were compatible with SIADH criteria . Miliary tuberculosis is one of the least commonly recognized causes of SIADH.

Wei Sheng Wu Xue Bao, 1989 Jun, 29(3), 232 - 3
{An electron microscopic study on the ultrastructure and enzyme cytochemistry of Pseudomonas putrefaciens}; Chen WL et al.; In this paper, PTA staining, ultrathin sectioning and electron microscopic enzyme cytochemistry techniques were used to study the ultrastructure, as well as reactivity and localization of catalase and peroxidase in Ps . putrefaciens . Its ultrastructure is similar to that of other gram-negative bacilli . Catalase is distributed in the cytoplasm, while peroxidase localized at cytoplasmic membrane and mesosomes.

J Med Assoc Thai, 1989 Jun, 72(6), 317 - 20
Mycobacterium other than tubercle bacilli in various environments in Bangkok; Imwidthaya P et al.; This research was designed to isolate Mycobacterium other than tubercle bacilli in various environments in the Bangkok area, in 1987 . The results were as follows, one hundred samples of soil yielded 1 Mycobacterium gordonae, 2 M . chelonei, 57 M . fortuitum, 1 Nocardia asteroides, one hundred samples of natural water from the Chao Phraya River and the canals of Chao Phraya River yielded 2 M . chelonei, 18 M . fortuitum, 1 N . asteroides and 1 N . brasiliensis, thirty samples of tap water yielded 3 M . gordonae . But thirty samples of water from swimming pools were negative for Mycobacterium.

Vet Hum Toxicol, 1989 Jun, 31(3), 213 - 7
Influence of T-2 toxin on BCG vaccine efficacy against murine pulmonary tuberculosis; Ziprin RL et al.; Unvaccinated mice were treated with T-2 toxin either 6 days before or 1 day after exposure to aerosols of virulent Mycobacterium tuberculosis . Mice were also treated with T-2 toxin 6 days before vaccination with Mycobacterium bovis (BCG) . There was a T-2 toxin mediated increase in the number of viable vaccine organisms recovered from the spleens of toxin-treated mice at 3 weeks after vaccination, and splenomegaly at post-vaccine weeks 3 through 5 . At the seventh week after vaccination, toxin-treated vaccinated, toxin-treated non-vaccinated, vaccinated, and untreated mice were exposed to aerosols of viable M tuberculosis . The number of viable mycobacteria in the lungs was determined at weeks 3, 5, 7, and 9 after pulmonary infection . The number of viable tubercle bacilli recovered from the lungs of vaccinated mice was significantly lower than from unvaccinated mice . However, T-2 toxin-treatment did not alter the vaccine efficacy.

Arch Intern Med, 1989 Jun, 149(6), 1437 - 9
Culture-proved disseminated cat-scratch disease in acquired immunodeficiency syndrome; Schlossberg D et al.; A male homosexual (positive for the human immunodeficiency virus) with a recent cat scratch developed fever, epitrochlear and axillary lymphadenopathy, and retinitis . Subsequently, he developed skin (epitheloid hemangioma) and mucosal lesions (Kaposi's sarcoma), multiple liver abscesses, and pleural effusion . Warthin-Starry stains and/or electron micrographs of lymph nodes and skin lesions demonstrated bacilli characteristic of those associated with cat-scratch disease . Cultures of lymph node, pleural fluid, and liver abscess specimens yielded organisms believed to be the causative agent of cat-scratch disease . We believe that disseminated cat-scratch disease may become an indicator of opportunistic infection signaling acquired immunodeficiency syndrome in a patient who is positive for the human immunodeficiency virus.

Ann Ophthalmol, 1989 Jun, 21(6), 233 - 7
Unsuspected mycobacterial endophthalmitis with increased aqueous lactate dehydrogenase levels in a child; Croxatto JO et al.; A 12-year-old boy had chronic uveitis resistant to medical therapy OS . Clinical examination and serologic tests did not show any infectious or systemic disease . Cytologic study from aqueous paracentesis revealed atypical cells . Ultrasonography disclosed diffuse posterior chorioretinal thickening . The diagnosis of diffuse retinoblastoma was considered, and an aqueous aspirate was assayed for lactate dehydrogenase . It contained six times the level present in a matching sample of serum . The blind eye was enucleated, and pathologic examination showed a necrotizing granulomatous endophthalmitis containing acid-fast bacilli.

Int J Lepr Other Mycobact Dis, 1989 Jun, 57(2), 506 - 10
An electron microscopic study of lymphatics in the dermal lesions of human leprosy; Mukherjee A et al.; The dermal lymphatic vessels in lepromatous and tuberculoid leprosy lesions were studied by light- and electron-microscopy . In the lepromatous patient, lymphatic vessels were seen in both intra- and peri-granulomatous areas . The lymphatic lining cells contained lipid droplets, lysosomes, and numerous pinocytotic vesicles . Cells bearing bacilli were only occasionally seen . In the tuberculoid cases, lymphatic vessels were seen only along the edges of the granulomas and the lining cells were less prominent . Inflammatory cells, both lymphocytes and histiocytes, were found traversing the walls of lymphatic vessels in both groups of patients . The results of the study confirm the continued and increased functioning of the lymphatic drainage system in dermal leprosy lesions, and indicates that it may be a major route for the clearance of lipids from the lipid-rich bacilliferous lesions in the lepromatous patient . The lymphatic pathway appears to be a minor pathway for the dissemination of Mycobacterium leprae in comparison with the blood vascular system.

Arch Intern Med, 1989 Jun, 149(6), 1279 - 84
Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis; Gerecht WB et al.; Forty-six patients with cholangitis were randomized to receive therapy with mezlocillin sodium (24 patients) or a combination of ampicillin sodium--gentamicin sulfate (22 patients) . The biliary concentration of mezlocillin was 112 times higher than that of ampicillin and 778 times higher than that of gentamicin . The ratio of the concentration in serum or bile over the minimum inhibitory concentration against aerobic gram-negative bacilli (therapeutic index) was higher for mezlocillin than for either ampicillin or gentamicin . Twenty (83%) of 24 patients were cured following mezlocillin therapy compared with 9 (41%) of 22 patients after ampicillin-gentamicin therapy . The 3 patients with superinfection were in the ampicillin-gentamicin arm of the study . Fewer toxic or adverse effects occurred in association with mezlocillin treatment than with ampicillin-gentamicin treatment . Mezlocillin therapy was more effective, less toxic, and less expensive than treatment with ampicillin and gentamicin for patients with cholangitis.

Am J Surg, 1989 Jun, 157(6), 607 - 14
A comparison of monobactam antibiotics in surgical infections; DiPiro JT et al.; The introduction of gentamicin almost 20 years ago provided an effective option for the treatment of gram-negative bacillary infections . During the past few years, the availability of aztreonam (a monobactam), imipenem (a carbapenem), and newer cephalosporins within vitro activities comparable with aminoglycosides against many gram-negative bacilli, has stimulated a reassessment of the role of aminoglycosides in treating these infections . When determining the role of new antimicrobials as potential replacements for more established agents, the clinical focus should be on three factors: comparative efficacy, safety, and cost . Consideration of cost is relevant only when efficacy and safety are equivalent . Other factors, such as comparative in vitro antimicrobial activity, pharmacokinetics, and effect on normal flora can also influence the selection of an antimicrobial regimen . A new class of antimicrobials, the monobactams, is the focus of this review . The only member of this class currently in clinical use is aztreonam . A comparison with aminoglycosides is particularly relevant because aztreonam is active against aerobic gram-negative bacilli . This review will discuss the acknowledged concerns with aminoglycoside use and compare the characteristics of aztreonam and currently marketed aminoglycosides.

Chest, 1989 Jun, 95(6), 1193 - 7
A reevaluation of sputum microscopy and culture in the diagnosis of pulmonary tuberculosis; Levy H et al.; This prospective study was undertaken to determine the interpretation of "scanty-positive" acid-fast bacilli on microscopy and to reevaluate simultaneous microscopy and culture of sputum for the accurate diagnosis of pulmonary tuberculosis (PTB) . A total of 2,560 specimens were processed from 727 patients . There were 435 positive specimens (17.0 percent), originating from 139 patients, 10 by microscopy only, 176 by culture only, and 249 on both microscopy and culture . Review of the hospital records showed that 107 patients had PTB, 1 had Mycobacterium kansasii colonization, and 31 were thought not to have PTB . Sensitivity and specificity were 53.1 and 99.8 percent for microscopy, 81.5 and 98.4 percent for culture, and 77.6 and 100 percent for microscopy and culture, respectively . Seventy-five microscopy specimens (46 patients) were reported as scanty-positive, of which five (four patients) were deemed false positives, yielding a positive predictive value of 93.3 percent . In those patients with positive sputum microscopy, acid-fast bacilli were detected in one of the first four specimens . Seven isolates (three patients) were mycobacteria other than tubercle (0.27 percent of specimens and 1.6 percent of mycobacteria cultured) . Despite the ready availability of laboratory evidence of disease, only 73 percent of cases were diagnosed by ward staff and 36 percent notified by the primary physician . Eleven patients (10.3 percent) died, six of whom had not received diagnoses of PTB before death . Sputum microscopy and culture remains reliable despite Bayesian predictions when applied to a population with a decreasing incidence of tuberculosis.

Clin Exp Immunol, 1989 Jun, 76(3), 458 - 62
Relapses after stopping chemotherapy for experimental tuberculosis in genetically resistant and susceptible strains of mice; Lecoeur HF et al.; Three strains of mice (Swiss albinos, C57BL/6,C3H/OuJ) were injected intravenously with 3.7 x 10(6) colony forming units (CFU) of M . tuberculosis, H37RV, sensitive and resistant to antibiotics (90% of bacilli sensitive, 9% resistant to Streptomycin and 0.9% resistant to Kanamycin) . Two weeks later, chemotherapy was started 6 days a week for a 6-month period with isoniazid (INH) and rifampicin (RMP) . Twenty mice of each strain were killed at the end of the chemotherapy and the others were kept without antibiotics for a second 6-month follow-up period before being killed . The early multiplication of bacilli during the first 2 weeks following infection and before chemotherapy, was similar in the three strains of mice . Chemotherapy had the same apparent efficacy in the three strains of mice, nearly all the mice being cured as assessed by a negative spleen culture on Loewenstein-Jensen medium at the end of chemotherapy . But after the 6-month follow-up period, the C3H strain presented a statistically significantly higher level of positive spleen culture ('relapse') than seen in the C57BL/6 strain, and an increased number of mycobacteria per relapsing mouse spleen . It has been estimated with the help of resistant and sensitive bacilli that the relapses were due in most of the cases to the regrowth of one or very few bacilli, giving a clone . It seems that the C3H strain of mice, known to carry the Bcg-r allele of the Bcg gene, might be less able to develop a specific acquired resistance capable of stopping the delayed development of a highly virulent strain of mycobacteria.

Lepr Rev, 1989 Jun, 60(2), 124 - 8
Improved staining of leprosy bacilli in tissues; Harada K et al.; A technique which reliably demonstrates Mycobacterium leprae, M . tuberculosis and fungi in tissues is described . It is based on the oxidation of cell wall lipid substances by chromic or periodic acid, and the subsequent release of aldehydes which are then capable of reducing ammoniacal silver salt solutions to metallic silver . The organisms so demonstrated appear uniformly solid . The sensitivity of the method and the ease of examination and recognition of bacilli and their products are recommendations for the use of the method in diagnosis and research, disregarding morphological appearances.

Hosp Pract (Off Ed), 1989 May 15, 24(5), 71 - 5, 80-2, 92 passim
Cutaneous manifestations of bacterial sepsis; Musher DM; In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues . The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial . In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage . Endotoxin probably plays a prominent role in producing these lesions . That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures . More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved . The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation . Lesions of symmetric peripheral gangrene characteristically do not have bacteria present . The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon . However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction . In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage . An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction . Favoring a role for other bacterial substances is the predisposition of V . vulnificus to cause cellulitis or of C . fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown . It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both . In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process . In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded . In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm . As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)

Kekkaku, 1989 May, 64(5), 367 - 72
{A case of localized pleural tuberculosis exacerbated during antituberculous chemotherapy}; Fujieda K et al.; A 24 year-old male with pulmonary tuberculosis in right upper lobe developed two lesions of extrapulmonary pleural tuberculoma during the course of antituberculous therapy . He had no history of lung tuberculosis nor pleurisy . However, the chest X-ray film on first admission showed scattered nodular shadows in right upper lung field . He had no subjective symptoms and no abnormalities of laboratory findings except mild iron deficiency anemia, from which he recovered completely without specific therapy . Three months after starting the antituberculous therapy including SM, INH, and RFP, a new round homogeneous opacity appeared in the right lower lung field (S4) . Chest CT scan revealed the lesions in S10 as well as in S4 . Microscopic examination of the specimen obtained by ultrasound-guided needle aspiration biopsy disclosed positive acid-fast bacilli . Because of the lack of effect of drug therapy on pleural lesions, surgical treatment was performed . The visceral pleura was found adherent fibrously to parietal pleura, which was easily separated by hand . However, at the site of lesions, the adhesion was so tight that extrapleural resection was needed . Because lung tissue and tumor were connected tightly, the lung had to be partially resected . Most content of tumors were caseous necrosis . Although main lesion was located outside of the lung, intrapulmonary invasion was also noticed . Double lesions of this kind of disease seem to be very rare . There is no evidence of relapse until eight months after surgery.

Acta Cytol, 1989 May-Jun, 33(3), 287 - 97
The cytologist and bacterioses of the vaginal-ectocervical area . Clues, commas and confusion; Schnadig VJ et al.; To evaluate the role of the cytologist in the diagnosis of bacterial vaginosis, the predominant bacterial patterns seen in 157 Papanicolaou-stained cervical smears were assessed and classified as large bacillus, anaerobic or scanty . A large bacillus pattern was found in 73 smears (46%), an anaerobic pattern in 77 (49%) and scanty bacteria in 7 (5%) . Comma-shaped (curved) bacilli were found in 34 smears . The prevalence of clue cells in smears with anaerobic patterns was 73% . Gardnerella vaginalis was cultured from 89% of the cases with anaerobic-type smears containing clue cells and from 88% of those with anaerobic-type smears lacking clue cells . Mobiluncus sp . was cultured from 83% of the cases with anaerobic-type smears showing curved bacilli and 14% of those with anaerobic-type smears lacking curved bacilli . Papanicolaou-stained smears were found to be more sensitive and more specific for identifying clue cells than were wet preparations . A positive association was found between a positive KOH "whiff" test and the presence of curved bacilli on the Papanicolaou-stained smear . The clinical significance of these findings is discussed.

Pathol Biol (Paris), 1989 May, 37(5), 437 - 41
{Diffusion of ceftriaxone in healthy and infected peritoneal tissue}; Rio Y et al.; The authors studied the peritoneal diffusion of ceftriaxone in the four quadrants of the abdomen (right and left inguinal and right and left hypochondrium) in 50 adult patients divided into 4 groups: pre-operative IVD administration of ceftriaxone in patients with healthy peritoneum, 1 g (group I), 2 g (group II): pre-operative IVD administration of ceftriaxone in patients presenting peritonitis 1 g (group III), 2 g (group IV) . After laparotomy, a fragment of peritoneal membrane was resected from each of the four quadrants, the product was extracted from the peritoneum by a crushing technique and the assayed by HPLC with concomitant blood level assay . The mean assayed concentrations in situ are respectively in groups I to IV: 27.2, 31.2, 31.36 and 43.65 micrograms/g, with a rapid time of appearance (30 minutes) and a homogeneous topographic distribution for all peritoneal sample sites . In cases of peritonitis, the concentrations are higher by a factor of 1.15 and 1.39 for the dosages of 1 and 2 g as compared to healthy peritoneum . Beyond the third hour after injection, peritoneal concentrations remained high at 9.8 micrograms/g in patients having received 1 g of ceftriaxone and very high at 22.6 micrograms/g in patients having received 2 g . These levels are therefore effective whatever the posology in antibioprophylaxis, taking into account the MIC of the product on Gram- bacilli.

Mod Pathol, 1989 May, 2(3), 239 - 43
Mycobacteria can be seen as "negative images" in cytology smears from patients with acquired immunodeficiency syndrome; Maygarden SJ et al.; The cytologic diagnosis of mycobacterial infections has historically depended on the recognition of the characteristic granulomatous or purulent host response and the identification of acid-fast bacilli with special stains . However, immunocompromised patients with infections may not mount the expected response and the pathologist must have a high index of suspicion for the presence of organisms . We report the cytology findings from three patients with acquired immunodeficiency syndrome in which mycobacteria were seen on the routine modified Wright-stained (Diff-Quik) slides without special stains in the absence of granulomatous inflammation . The organisms appeared as negative images--unstained, rodshaped structures against the deep blue background of the stain . The findings were confirmed with Ziehl-Neelsen stain and culture . Implications for patient management are discussed.

Appl Environ Microbiol, 1989 May, 55(5), 1128 - 35
Evidence for colonization and destruction of hinge ligaments in cultured juvenile Pacific oysters (Crassostrea gigas) by cytophaga-like bacteria; Dungan CF et al.; Several strains of cytophaga-like gliding bacteria (CLB) were isolated as numerically dominant or codominant components of bacterial populations associated with proteinaceous hinge ligaments of cultured juvenile Pacific oysters, Crassostrea gigas . These bacteria were morphologically similar to long, flexible bacilli occurring within degenerative lesions in oyster hinge ligaments . Among bacteria isolated from hinge ligaments, only CLB strains were capable of sustained growth with hinge ligament matrix as the sole source of organic carbon and nitrogen . In vitro incubation of cuboidal portions of ligament resilium with ligament CLB resulted in bacterial proliferation on the surfaces and penetration deep into ligament matrices . Bacterial proliferation was accompanied by loss of resilium structural and mechanical integrity, including complete liquefaction, at incubation temperatures between 10 and 20 degrees C . The morphological, distributional, and degradative characteristics of CLB isolated from oyster hinge ligaments provide compelling, albeit indirect, evidence that CLB are the agents of a degenerative disease affecting juvenile cultured oysters . The motility, metabolic, and hydrolytic characteristics of hinge ligament CLB and the low moles percent G + C values (32.4 to 32.9) determined for three representative strains indicate that they are marine Cytophaga spp.

J Med Microbiol, 1989 May, 29(1), 63 - 73
A comparison of Bacteroides ureolyticus isolates from different clinical sources; Duerden BI et al.; Clinical isolates of corroding, gram-negative, anaerobic bacilli (provisionally identified as Bacteroides ureolyticus) from superficial ulcers and soft tissue infections (15), non-gonococcal, non-chlamydial urethritis (12) and adult periodontal disease (14) were compared with reference strains of B . ureolyticus, B . gracilis and Wolinella recta in a series of conventional tests of morphology, biochemical activity, tolerance of dyes and bile salts, and antibiotic sensitivity, gas-liquid chromatographic analysis of metabolic products, and in whole-cell analysis by pyrolysis-mass spectrometry (Py-MS) . A numerical taxonomic approach was used with the results of conventional tests and the grouping obtained was compared with that obtained by Py-MS . All the ulcer and soft-tissue isolates and the urethritis isolates were oxidase- and urease-positive and formed a homogeneous set consistent with the reference strain of B . ureolyticus . The dental isolates differed from B . ureolyticus strains and were heterogeneous amongst themselves . None corresponded with the reference strains of B . gracilis or W . recta . The conventional and Py-MS approaches to characterisation produced similar groupings and each distinguished between a single cluster of ulcer-urethritis strains and several clusters of dental strains, although the dendrograms derived from the two approaches differed in the order of the clusters; in the Py-MS dendrogram one subcluster of four dental strains came within the main ulcer-urethritis cluster and a cluster of five ulcer strains was separated as a distinct group.

Arch Neurol, 1989 May, 46(5), 529 - 35
Brain-stem tuberculoma . An analysis of 11 patients; Talamas O et al.; The clinical and radiologic findings in 11 patients with brain-stem tuberculoma were reviewed . Clinical manifestations included various combinations of focal signs and symptoms of subacute onset, similar to those produced by other space-occupying lesions of the brain stem . Evidence of systemic tuberculosis was found in six cases (55%) . Computed tomography (CT) usually showed an isodense or hyperdense brain-stem mass with abnormal contrast enhancement; associated supratentorial granulomas were found in four cases, and hydrocephalus was found in two cases . Magnetic resonance imaging showed irregular brain-stem lesions with long T1 and short T2 relaxation times . Cerebrospinal fluid findings were also nonspecific, as smears for acid-fast bacilli were most often negative . An incorrect diagnosis of pontine glioma was made in one patient . In contrast, proper integration of data from CT and magnetic resonance imaging findings, cerebrospinal fluid analysis, and x-ray films of the chest permitted an accurate diagnosis in ten cases . Prompt therapy with antituberculous drugs resulted in clinical improvement, documented by CT, in most patients . Brain-stem tuberculoma should be suspected in patients with space-occupying lesions of the brain stem who live in geographic areas where tuberculosis is endemic . Early diagnosis and prompt medical therapy are important in preventing mortality and reducing morbidity.

J Urol, 1989 May, 141(5), 1197 - 8
Persistent acid-fast bacilli following intravesical bacillus Calmette-Guerin; Linn R et al.; Intravesical bacillus Calmette-Guerin immunotherapy has great efficacy in the treatment of superficial transitional cell carcinoma of the bladder . We report a case of persistent acid-fast bacilli contained within granulomas of the bladder, prostate and epididymides 1 year after treatment with intravesical bacillus Calmette-Guerin . Although commonly encountered immediately after therapy, there are no reported cases of persistent acid-fast bacilli following intravesical administration of bacillus Calmette-Guerin.

Diagn Microbiol Infect Dis, 1989 May-Jun, 12(3), 211 - 5
Comparison of AMS-Vitek, MicroScan, and Autobac Series II for the identification of gram-negative bacilli; Truant AL et al.; Identification of Gram-negative bacilli by AMS-Vitek, MicroScan, and Autobac Series II was evaluated with 434 clinical isolates comprising glucose fermenters and glucose nonfermenters . The organisms were tested in each of the three systems (the AMS Vitek GNI card, the MicroScan Combo Plus Panel, and the Autobac 18 chamber cuvette) . API 20E was used as the primary reference system . MicroScan and Vitek correctly identified 96.1% and 95.6% of the organisms, respectively . The Autobac Series II identified 82.3% of the organisms correctly . Results with MicroScan, Vitek, and Autobac were available in 24-48 hours, 4-18 hours, and 3-8 hours, respectively.

Rev Infect Dis, 1989 May-Jun, 11(3), 413 - 25
Melioidosis: review and update; Leelarasamee A et al.; Melioidosis prevails in Southeast Asia and northern Australia . Sporadic cases have been increasingly reported from countries located between 20 degrees north latitude and 20 degrees south latitude as well as in travelers and in soldiers who have resided in these areas . The organisms are commonly found in water and soil and are usually transmitted to humans by cutaneous or respiratory routes . Clinical manifestations range from subclinical infection to overwhelming septicemia that resembles disseminated or localized suppurative infection due to various pathogens . A rapid and accurate diagnosis can be made by demonstration of small, few, and frequently bipolar-stained gram-negative bacilli in exudate or pus . The indirect hemagglutination test is of diagnostic value in cases with involvement of the internal organs or pyrexia of unknown origin . Chloramphenicol, doxycycline, trimethoprim-sulfamethoxazole, and kanamycin constitute conventional and effective chemotherapy . Newer antimicrobial agents such as piperacillin, amoxillin-clavulanic acid, ceftazidime, imipenem, and carumonam are active in susceptibility tests against the causative microorganism, Pseudomonas pseudomallei . Clinical trials for demonstration of the effectiveness of the latter agents in overwhelming septicemic melioidosis are ongoing in endemic areas.

J Exp Med, 1989 May 1, 169(5), 1565 - 81
Analysis of naturally occurring delayed-type hypersensitivity reactions in leprosy by in situ hybridization; Cooper CL et al.; Analysis of tissue lesions of the major reactional states of leprosy was undertaken to study the immune mechanisms underlying regulation of cell-mediated immunity and delayed-type hypersensitivity (DTH) in man . In situ hybridization hybridization of reversal reaction biopsy specimens for INF-gamma mRNA expression revealed a 10-fold increase in specific mRNA-containing cells over that observed in unresponsive lepromatous patients . Expression of huHF serine esterase, a marker for T cytotoxic cells, were fourfold increased in reversal reaction and tuberculoid lesions above that detected in unresponsive lepromatous individuals . Immunohistology of reversal reactions confirmed a selective increase of Th and T cytotoxic cells in the cellular immune response . Of interest, the microanatomic location of these serine esterase mRNA-containing cells was identical to the distribution of CD4+ cells . Analysis of erythema nodosum leprosum (ENL) lesions revealed differences in the underlying immune processes in comparison with reversal reaction lesions . Although phenotypic Th cells predominated in ENL lesions, IFN-gamma and serine esterase gene expression were markedly reduced . We suggest that reversal reactions represent a hyperimmune DTH response characterized by a selective increase of CD4+ IFN-gamma producing cells and T cytotoxic cells, which result in the clearing of bacilli and concomitant tissue damage . In contrast, ENL reactions may be viewed as a transient diminution of Ts cells and activity leading to a partial and transient augmentation in cell-mediated immunity, perhaps sufficient to result in antibody and immune complex formation, but insufficient to clear bacilli from lesions.

J Biochem Biophys Methods, 1989 May, 18(3), 209 - 19
One-step affinity purification of Bacillus neutral proteases using bacitracin-silica; Van Den Burg B et al.; A purification procedure for neutral proteases from bacilli is described, in which bacitracin-silica was used as affinity medium . This enabled a one-step purification of the proteases directly from culture supernatant . Since neutral proteases are extremely sensitive towards autodigestion, conditions were chosen such, that autodigestion was largely prevented . Isopropanol appeared to be useful in both eluting the enzymes from the affinity medium, and inhibiting enzymatic activity during this step . The bacitracin-silica medium allowed high flow rates: with columns prepared for use in an FPLC system flow rates up to one column volume per minute were feasible, and still gave satisfactory results . The neutral proteases purified by this method were found to be homogeneous both by SDS-PAGE and analytical gel filtration.

Am J Hosp Pharm, 1989 May, 46(5), 973 - 7
Sterility of total parenteral nutrient solutions stored at room temperature for seven days; Takagi J et al.; The sterility of total parenteral nutrient (TPN) solutions stored at room temperature for up to seven days after preparation was studied . The study was conducted in two parts . In part 1, a positive control phase was conducted to validate that the filter set would capture bacteria or fungi in the TPN solutions . In part 2,300 unused TPN solutions were retrieved from patient-care areas within 24 hours of preparation . These solutions were randomized into three study groups of 24, 72, or 168 hours after preparation . Each TPN solution was filtered aseptically using an inline 0.22-micron filter . The filters were suspended in brain-heart infusion broth and incubated at 35 degrees C . Filters were visually evaluated for turbidity as an indicator of microbial contamination . Microbial growth was reported in 2 of 100 samples filtered 24 hours after preparation (group 1) and in 1 of 100 samples filtered 72 hours after preparation (group 2) . No growth was detected in TPN solutions filtered 168 hours after preparation (group 3) . Turbid samples were subcultured, and contaminants were identified as coagulase-negative Staphylococcus species and gram-positive bacilli in the group 1 samples and coagulase-negative Staphylococcus species in the group 2 samples . The difference in contamination rates among the three groups was not significant . TPN solutions may be stored after preparation at room temperature for an extended time (up to 168 hours) without increasing the risk to patient safety . However, at this institution, expiration dates are extended only to the time that supports practical recycling of standard TPN solutions (72 hours).

Acta Cytol, 1989 May-Jun, 33(3), 305 - 8
Pseudotumoral tuberculosis of the uterine cervix . Cytologic presentation; Vuong PN et al.; The cytologic presentation of a case of pseudotumoral tuberculosis of the uterine cervix is described . The presence in cervicovaginal smears of epithelioid cells arranged in clusters mixed with Langhans' giant cells was highly suggestive of tuberculosis . This diagnosis was confirmed by the detection of acid-fast bacilli in histologic preparations and cultures from biopsy specimens.

Am Rev Respir Dis, 1989 May, 139(5), 1090 - 3
Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings; Gordin FM et al.; We analyzed the outcome of therapy for 139 patients who were treated for a presumptive diagnosis of pulmonary tuberculosis based on radiographic abnormalities . Patients who had acid-fast bacilli seen on sputum smears and patients who had received adequate therapy for tuberculosis in the past were excluded from the analysis . Accuracy of the diagnosis was determined by comparison of clinical and radiographic findings after 3 months of isoniazid, rifampin, and ethambutol, as well as the results of sputum cultures . Of 139 patients started on therapy presumptively, 66 (48%) were determined to have current tuberculosis (16 had positive cultures, 43 because of improvement in their chest films, and 7 because of clinical improvement) . Adverse reactions requiring change of therapy occurred in six of 72 (8.3%) patients determined to have inactive tuberculosis . One patient had both tuberculosis and carcinoma found at bronchoscopy after 3 months of therapy . For purposes of comparison, chest radiographs of 59 patients documented by culture to have current tuberculosis were reviewed . Of these, 45 (70%) were improved at 3 months . Presumptive therapy is of benefit in that it stops progression of the disease at an early stage and decreases the potential for spread of tuberculous infection . In addition, such therapy coupled with systematic reevaluation of patients substantiates the diagnosis or indicates that further evaluation is needed . These benefits must be weighed against the adverse reactions and costs of overtreating patients with inactive disease . Determining the appropriateness of presumptive therapy must be based on local factors including prevalence of tuberculosis and available resources.

Am Rev Respir Dis, 1989 May, 139(5), 1082 - 5
HIV infection in patients with tuberculosis in Kinshasa, Zaire; Colebunders RL et al.; To better define the interrelationship of infection with human immunodeficiency virus (HIV) and tuberculosis (TB), we conducted three HIV serosurveys of inpatients and outpatients with confirmed or suspected TB in Kinshasa, Zaire . HIV seroprevalence in hospitalized sanatorium patients did not change significantly in serosurveys conducted in 1985 and 1987 (92/231 {40%} versus 85/234 {36%}) . These proportions were significantly higher than the 17% HIV seroprevalence observed in a 1987 serosurvey of 509 consecutive patients with an initial diagnosis of pulmonary TB seen at an outpatient TB diagnostic center in Kinshasa (p less than 0.001) . HIV seroprevalence was higher in sanatorium patients with extrapulmonary TB (22/46 {48%}) and suspected pulmonary TB (60/132 {45%}) than in patients with bacteriologically confirmed pulmonary TB (94/287 {33%}) (p less than 0.02) . Mycobacterium sputum isolation rates were similar in HIV-seropositive (28/34 {82%}) and HIV-seronegative patients (135/159 {85%}) . All isolates were Mycobacterium tuberculosis . Eighteen (21%) of 84 HIV-seropositive sanatorium patients in 1987, who were followed for two months after admission, had died, compared with 11 (9%) of 128 HIV-seronegative patients (p less than 0.01) . However, clearance rates of acid-fast bacilli from sputum after standard therapy were equally good in HIV-seropositive and HIV-seronegative survivors . With the growing AIDS problem, the serious TB burden in sub-Saharan Africa may become even more onerous and may critically overload the stressed African health care systems.

Rev Cubana Med Trop, 1989 May-Aug, 41(2), 307 - 12
{Bacteriologic study in patients with multibacillary leprosy treated with rifampicin and acedapsone}; Olivares Sabournin R et al.; A bacteriologic study of 116 patients with multibacillary leprosy from Guantanamo City is made . Samples for bacteriologic examination were derived from both auricular lobules, the two elbows, and the middle phalanges of the third finger . The microscopic examination found acid-alcohol-resistant bacilli in 19% of patients, while failure to find any of these organisms occurred in 81%.

Med Clin (Barc), 1989 Apr 22, 92(15), 561 - 3
{Early detection of tuberculosis by the evaluation of contacts}; Ruiz Manzano J et al.; We have evaluated the close contacts of 191 patients diagnosed of tuberculosis in our center between 1984 and 1987 . The overall number of evaluated contacts was 666, and the mean number of contacts for each index case was 3.7 . In 55% of the evaluated population PPD reaction was positive, and their mean age was 33.3 years . In 132 cases chemoprophylaxis was given during one year (22%) . Forty-one new cases of tuberculosis were detected, with a mean age of 25.6 years . In ten new cases the source of infection was familial . When the contacts were distributed according to the bacteriologic status of the index case (direct investigation of tubercle bacilli positive in 103 cases and negative in 167), the rate of disease and infection was significantly higher among those related to positive patients . In the group related to negative patients we discovered 7 new cases of active tuberculosis . Our results confirm the usefulness of the systematic evaluation of the contacts of tuberculous patients in our area, as it permits the identification of an important number of new patients which should be adequately treated . This practice contributes to interrupt the epidemiologic transmission chain of the disease and to facilitate its eradication.

Am Rev Respir Dis, 1989 Apr, 139(4), 867 - 70
Smear- and culture-negative pulmonary tuberculosis: four-month short-course chemotherapy; Dutt AK et al.; Patients with positive tuberculin reaction, abnormal chest radiograph, and negative bacteriology are often treated empirically for tuberculosis (TB) after exclusion of other causes . Therapy generally consists of two bactericidal drugs (rifampin {RIF} and isoniazid {INH}) for 9 months or INH for 9 to 12 months . With such a small bacillary population, even less therapy might suffice . Thus we began in January 1980 to discontinue therapy at 4 months when there was sufficient evidence of a paucity of bacilli demonstrated by at least three negative smears and cultures for TB at the start of therapy . To date, 452 such patients have been so treated . Radiographic abnormalities included pulmonary infiltration of varying extent, pleural residuals, and hilar adenopathy . The full course of therapy could not be completed in 38 (8.4%) patients due to death, relocation, or drug toxicity . Side effects of the drugs occurred in 21 (4.7%) patients, but toxic hepatitis occurred in only four (0.9%) patients . Thus, 414 patients completed the full 4-month course of therapy . Of these, 126 (30.4%) patients showed radiographic and/or clinical response suggesting active infection . The remainder showed no such improvement, suggesting either a mistake in diagnosis or dormant TB . During follow-up of the 414 patients from 6 to 78 months (median, 44 months), five (1.2%) patients relapsed: three among responders and two among nonresponders . Thus, among persons suspected of having TB but with negative bacteriology, 4 months of chemotherapy with INH and RIF gave results comparable to those achieved with 9 months of therapy in smear- and culture-positive cases.

J Histochem Cytochem, 1989 Apr, 37(4), 455 - 62
Immunogold labeling method for Mycobacterium leprae-specific phenolic glycolipid in glutaraldehyde-osmium-fixed and Araldite-embedded leprosy lesions; Boddingius J et al.; Phenolic glycolipid (PGL)-I, a Mycobacterium leprae-specific antigen currently used for serodiagnosis of preclinical leprosy, has thus far not been localized subcellularly in leprosy bacilli and their host cells . In this study, we developed an immunogold-labeling technique for qualitative identification of PGL-I sites in glutaraldehyde-osmium-fixed and Araldite-embedded M . leprae and host macrophages in human skin biopsies . Such "hard-fixed," plastic-embedded skin and nerve biopsies from patients with varying cell-mediated immunity to leprosy are amply available worldwide . Our method involves etching of plastic sections with H2O2, incubation with swine serum to eliminate nonspecific labeling, and long (22 hr) incubation at room temperature with monoclonal antibodies to PGL-I . Gold labeling was seen predominantly on cell walls of M . leprae, in vacuolar spaces of bacillated phagolysosomes, and occasionally on the cytoplasm and cell membrane of M . leprae . Host macrophage cytoplasm was labeled very infrequently . This technique allows studies on possibly persisting antigenic PGL-I in multibacillary leprosy patients during or after multidrug therapy . The method may also prove useful for subcellular localization of specific bacterial lipids in other mycobacterial diseases, including tuberculosis.

Rev Med Chir Soc Med Nat Iasi, 1989 Apr-Jun, 93(2), 261 - 7
{Bacterial liver abscess cured by nonsurgical treatment . Comments on 8 cases}; Dimitriu SM et al.; Eight cases (3 children aged 7-15 years and 5 adults aged 16-46 years) of hepatic abscess in whom a cure was obtained by medical therapy are presented . The abscess occurred during septicemia (2 cases), cutaneous staphylococcosis (2 cases) and pyocholecystitis (1 case) . In 3 patients the abscess remained cryptogenic . The clinical diagnosis was confirmed by scintigraphy, ultrasonography and in one case by radiography with contrast substance in the abscess . The microorganisms, isolated in 3 patients from the abscess and in one patient from hemoculture, were S . aureus (3 cases) and gram negative bacilli (1 case) . The systemic antibiotic therapy consisted in the administration of gentamicin and oxacillin or rifampicin in 4 cases and gentamicin and chloramphenicol or ampicillin and metronidazole in other 4 cases for an average interval of 39 days . The associated local therapy (3 cases) consisted in one or more punctures, followed by the injection of gentamicin.

Antimicrob Agents Chemother, 1989 Apr, 33(4), 566 - 8
Influence of protein binding on therapeutic efficacy of cefoperazone; Peterson LR et al.; The effect of protein binding of cefoperazone (89.3% bound to rabbit serum) on antibacterial activity in serum was tested in a model that simulated a closed-space infection in a neutropenic host . Four gram-negative bacilli were tested in the model with cefoperazone doses of 20 and 200 mg/kg administered intramuscularly every 6 h for 16 doses . Cefoperazone efficacy was measured at 92 h by determining the log10 decrease in bacterial count from that of the control for five paired studies with three isolates . A significantly better response was demonstrated when the free (non-protein-bound) drug concentration exceeded the MICs and MBCs for the infecting microorganisms at the infection site at all times (P less than 0.005) . This supports the concept that free (unbound) drug is the active component in treating bacterial infections.

J Clin Periodontol, 1989 Apr, 16(4), 234 - 41
Scanning electron microscopic examination of pocket wall epithelium and associated plaque in localized juvenile periodontitis; Verderame RA et al.; The purpose of this investigation was to describe the morphologic characteristics of epithelial-associated plaque in periodontal pockets of patients with localized juvenile periodontitis (LJP) . 25 tissue specimens obtained from 10 adolescent patients were examined by scanning electron microscopy . Specimens were evaluated to determine the following specific features: (1) distribution of microbial colonies on the epithelial surface; (2) topographic features of pocket epithelium associated with microbial colonies; and (3) the predominante microbial morphologic types comprising the colonies . Observations made during this investigation revealed the following . (1) The surface epithelium in the coronal one-third of the pocket wall was essentially healthy in appearance and exhibited no distinct microbial colonies or unusual topographic features . (2) The surface epithelium in the middle one-third area featured randomly-dispersed microbial colonies consisting of 3 major morphotypes: cocci, bacilli and coccobacilli . Also in this zone, there was morphologic evidence of microbial penetration of the epithelial barrier along intercellular spaces . (4) The apical one-third zone was characterized by lymphocytic infiltration, epithelial cavitation and ulcerations, and singular organisms entrapped in fibrin meshworks . There were no distinct microbial colonies in this zone, although individual spirochetes, fusiforms, filamentous organisms, and short and long rods were observed.

Am J Trop Med Hyg, 1989 Apr, 40(4), 390 - 8
Isolation of Fusobacterium nucleatum and electron microscopic observations of spirochetes from tropical skin ulcers in Papua New Guinea; Falkler WA Jr et al.; Tropical ulcer is a disabling condition of the lower leg affecting mainly young adults and older children . Microscopic observations of lesion material have shown fusiform bacilli and spirochetes . We used anaerobic culture techniques to isolate and identify these fusiform bacilli . Electron microscopic (EM) studies were performed to characterize the spirochetes . Material collected on swabs was used to inoculate pre-reduced media and to prepare smears for gram staining; the swabs were placed in fixative for EM study . After incubation, colonies containing fusiform bacilli were subcultured . The anaerobic gram-negative fusiform isolates were identified as Fusobacterium nucleatum using biochemical reactions, hemagglutination testing, and reaction of antigen preparations of the isolates and ATCC strains in serological tests with rabbit antisera . EM observations of negatively stained spirochetes revealed an 8-16-8 periplasmic flagellar arrangement . F . nucleatum and spirochetes may participate in the pathogenesis of this polymicrobic infection.

Nippon Rai Gakkai Zasshi, 1989 Apr-Jun, 58(2), 92 - 111
{Epidemiological immunological studies on leprosy in Okinawa . 6 . Lepromin, lymphocyte transformation, FLA-ABS and leproagglutination tests in the in-and out-patients with leprosy and the relationships among these tests and personal or family history or clinical findings of the patients}; Minagawa F et al.; In- and out-patients with leprosy in Okinawa were surveyed by using the following immunological tests: cutaneous reaction to Mitsuda's lepromin (40 million bacilli/ml) (LPR), lymphocyte transformation test with Dharmendara's antigen (DL-LTT), that with phytohemagglutinin (PHA-LTT), fluorescent leprosy antibody absorption test (FLA-ABS) and Leproagglutination test with cardiolipin-lecithin antigen (LAT) . A correlation between two tests and a relationship between the test and personal or family history or clinical finding of the patients were evaluated by non-parametric statistics . Spearman's rank correlation coefficient was significant between LPR and DL-LTT, while a reverse correlation was found between LPR and FLA-ABS, DL-LTT and FLA-ABS, and DL-LTT and LAT, respectively . High reactivity in PHA-LTT was found in almost all of patients, irrespective of type and stage of leprosy, suggesting general immune responsiveness of leprosy patients in Okinawa . The other tests showed a significant difference in the mean rank of reaction values according to clinical findings such as type and stage of leprosy, property of skin lesion, loss of eyebrow, and bacteriological test . The use of LPR and DL-LTT for the study of cell-mediated immunity in leprosy was therefore confirmed . FLA-ABS was found useful for early serodiagnosis, while LAT for the study of autoimmunity in leprosy . None of these immunological tests showed significant difference among the subgroups of patients classified by the following items: presence or absence of consanguineous patient with leprosy, living place, place of onset, presence or absence of neural symptoms such as the enlargement of peripheral nerve, claw hand and facial palsy, ocular and nasal involvement, ENL in lepromatous and borderline leprosy and conditions in the treatment . On the other hand, LPR showed higher reactivity in female than in male, in the patients at home than those discharged, and in the patients with drop foot than those without . Higher reactivity of DL-LTT was also found in male than in female and in the patients with plantar ulcer than those without . FLA-ABS reactivity was significantly higher in the discharged patients than the inpatients, in the period of 5 to 9 years after onset than that of 20 or more years, but the reactivity was lower in the patients with drop foot than those without . LAT reactivity was significantly higher in the 30-39 years old patients than 0-19 years old, and in the patients with physical work than those with mental.(ABSTRACT TRUNCATED AT 400 WORDS)

Nippon Rai Gakkai Zasshi, 1989 Apr-Jun, 58(2), 85 - 91
{Cell mediated immune response in leprosy lesions}; Fujita M et al.; Five biopsies from 2 leprosy patients, tuberculoid (TT), and polar lepromatous (LLp), were studies using immunoperoxidase procedures with monoclonal antibodies . Immunohistochemical patterns of them were remarkably different . In a TT patient, epithelioid cells and helper/inducer T (Leu 3a+) cells made the central core of a granuloma surrounded by suppressor/cytotoxic T (T8+) cells and B cells, indicating a possible immune-mediated cell response . The distribution of B cells suggests that not only T but also B cells may take part in the formation of the granuloma . In contrast, helper/inducer cells, suppressor/cytotoxic cells, and macrophages of a LLp patient were admixed uniformly at the site of the lesion, indicating a poor immune response . Although the ENL skin lesion of this LLp patient did not eliminate the bacilli, HLA-DR expression by keratinocytes and increased numbers of helper/inducer cells found in an ENL lesion, comparable to the findings of TT leprosy, suggests that a cell mediated immune response may play some role in the pathogenesis of ENL reaction.

Nippon Rai Gakkai Zasshi, 1989 Apr-Jun, 58(2), 112 - 26
{Peripheral nerve lesions of experimental leprosy in monkeys . V . Histopathological finding of cutaneous nerves and cutaneous sensory organs}; Fukunishi Y; The skin samples of each palm side and dorsum side of finger, nose and peripheral nerves running under the finger skin at the area between proximal phalanx and distal phalanx of mangabey monkey A022 and rhesus monkey A125 were studied by histopathological methods (semithin section and light microscopic findings) . Results found about this study were as follows . 1 . In spite of the existence of a large amount of leprosy bacilli at the areas of corium and subcutis, some of Meissner's corpuscles, Vater-Pacinian corpuscles (or Golgi-Mazzoni's corpuscles) and Krauze's end bulbs-like structures were observed . 2 . Occasionally, several intracytoplasmic foamy structures containing a large amount of leprosy bacilli were observed at the shallow and deep layers of stratum papillare of corium, where leprosy bacilli were not so remarkable as shown on Figure 4 . So, it was thought that the affinity of leprosy bacilli to free nerve endings should be exist there . 3 . Some of M . arrector pili were kept in good condition in spite of the existence of multiplying leprosy bacilli around the hair follicles . 4 . It was thought that the histopathological findings of the fascicles of cutaneous nerves were classified to 4 patterns . The first pattern of histopathological finding of the cutaneous nerve was shown as A on Figure 25 . In this pattern observed in almost of all the fascicles locating at the subcutis, no leprosy bacillus was observed inside the fascicles, and the nerve fibers were kept in good condition . The second pattern observed in almost of all the fascicles located at the corium, was shown as B on Figure 25 . In this pattern, a large amount of leprosy bacilli were observed inside the fascicles, and the nerve fibers were often kept in good condition . The third pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as C on Figure 25 . In this pattern, not only multiplying leprosy bacilli but also remarkable fibrosis were found inside one fascicle, and many nerve fibers disappeared by the existence of the bacilli and fibrosis . The final pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as D on Figure 25 . In this pattern, remarkable fibrosis was observed inside the fascicles, and the nerve fibers often disappeared by the existence of fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS)

J Dermatol, 1989 Apr, 16(2), 150 - 3
Penis tuberculid (papulonecrotic tuberculid of the glans penis): treatment with a combination of rifampicin and an extract from tubercle bacilli (T.B . vaccine); Nakamura S et al.; A case of penis tuberculid (papulonecrotic tuberculid of the glans penis) and its treatment with combination of oral rifampicin (RFP) and injection of an extract from tubercle bacilli (T.B . vaccine) were reported . We also examined the literature and discovered 37 cases of this disease in Japan in the last 10 years (between 1978 and 1987).

Vaccine, 1989 Apr, 7(2), 92 - 3
ICRC 'anti-leprosy vaccine'; Deo MG; A vaccine containing ICRC bacilli, which are leprosy-derived cultivable mycobacteria, induces lepromin conversion in LL patients and lepromin-negative persons . 'Up-grading' of lesions and reversal reaction are observed in some vaccinated patients . The bacillus shows antigenic cross-reactivity with Mycobacterium leprae . These observations provided the basis for launching a large-scale field trial of the vaccine in India in February 1987 . The objective of the two-arm trial is to assess efficacy of the ICRC vaccine against BCG, which forms the control arm, in lowering the incidence of leprosy in healthy household contacts of leprosy patients . Recently, a very high molecular weight fraction, named PP-I, has been isolated from the sonicate of ICRC bacilli . PP-I, which is a glycolipoprotein, is a strong T-cell immunogen and shows antigenic cross-reactivity with a similar fraction isolated from M . leprae . A 'subunit' vaccine containing the PP-I of ICRC bacilli is currently undergoing phase I and II clinical trials in India.

J Antimicrob Chemother, 1989 Apr, 23(4), 485 - 91
The post-antibiotic effect defined by bacterial morphology; Lorian V et al.; Three strains of Escherichia coli were incubated with either ciprofloxacin or ampicillin . Filamentation of bacteria was observed after 1-2 h . After 5 h of contact with either drug the percentage of filaments exceeded 90% . The organisms were washed and incubated on drug free medium . Antibiotics when bound to an enzyme render that enzyme inactive; upon removal of the organisms from the antibiotic, the synthesis of enzymes resumes . The period of time encompassing the inactive enzymatic state of the organism at the time of removal from the drug to the time that enzymes restore complete function is our definition of the post-antibiotic effect (pae) . Bacterial morphology reflects the variations in activity of these enzymes . The pae was determined by both the morphology of the organisms and the current growth kinetic method . The presence of 10% filaments and 90% bacilli was selected to indicate the endpoint of the pae by morphological criteria . The pae by morphology was 4 h for ciprofloxacin and 3 h for ampicillin . By the growth kinetics method it was 2 h for ciprofloxacin and zero for ampicillin.

Pathol Biol (Paris), 1989 Apr, 37(4), 245 - 8
{Rectal ulcer infected by Mycobacterium fortuitum . Apropos of 4 cases}; Demoulin L et al.; From October 1986 to November 1988, 4 cases of rectal ulcers from which M . fortuitum was isolated were observed . The patients, all women, were respectively 24, 83, 85 and 86 years old . The complaints were: anorectal pain, rectal bleeding and stools mixed with glairy material . The ulcers were situated in the anterior, posterior or lateral wall of the rectum; one of these perforated in the perirectal space with development of a local abscess . The presence of M . fortuitum in the lesions was established by detection of mycobacteria in the smear (2 cases) or in the histological section (1 case), and by positive cultures (all cases) . All strains were susceptible to aminoglycosides, quinolones (except 2), macrolides and to imipenem . They were resistant to current antituberculous drugs, to tetracycline and to beta-lactamines . Two patients healed, one spontaneously and the other one with antibiotics (amikacin and norfloxacin for 3 months); two patients died, one because of cardiac failure and intercurrent infection and the other one after rectal bleeding . The histopathological pattern of the lesions was pleomorphic: chronic aspecific inflammatory reaction, granulomatous tissue with Langhans cells (1 cas), necrotic abscesses without caseation, intratissular acid-fast bacilli (1 case) . The isolation of M . fortuitum in the rectal ulcers has been discussed.

Antimicrob Agents Chemother, 1989 Apr, 33(4), 551 - 9
Development of a DNA probe from the deoxyribonucleotide sequence of a 3-N-aminoglycoside acetyltransferase {AAC(3)-I} resistance gene; Tenover FC et al.; The aacC1 gene encoding the 3-N-aminoglycoside acetyltransferase {AAC(3)-I} was cloned from enteric plasmid pJR88, and its deoxyribonucleotide sequence was determined . Significant nucleotide homology was noted in the region extending from the proposed -35 sequences through the first 59 base pairs of the aacC1 gene open reading frame (ORF) and the upstream flanking regions and ORFs of several other antibiotic resistance genes . Sequences were noted to be homologous with the 6'-N-aminoglycoside acetyltransferase {AAC(6')-I}, 2''-O-aminoglycoside adenylyltransferase {AAD(2'')}, and 3''-O-aminoglycoside adenylyltransferase {AAD(3'')} resistance genes; the OXA-1, OXA-2, and PSE-2 beta-lactamase genes; and several dihydrofolate reductase genes . Small regions of homology were noted in the 3'-flanking regions of these resistance genes as well . A DNA probe for the aacC1 gene was selected from the nucleotide sequence information and was tested against a series of genetically and enzymatically defined strains . The probe, which proved specific for the aacC1 gene, was then tested against a series of 58 gentamicin-susceptible and 219 gentamicin-resistant gram-negative bacilli isolated from patients at the Seattle Veterans Administration Medical Center . Only six clinical isolates were noted to carry the aacC1 gene . Each was resistant to gentamicin but susceptible to kanamycin, tobramycin, and amikacin . The presence of homologous regions of DNA at both the 3' and 5' ends of the aacC1 gene reinforces the importance of choosing probes from within the ORFs of genes and of avoiding flanking sequences . When the homology with other sequences extends into the ORF, as it does with the aacC1 gene, development of a specific probe may require determination of the nucleotide sequence.

J Trauma, 1989 Apr, 29(4), 430 - 4
Results of a multicenter outpatient burn study on the safety and efficacy of Dimac-SSD, a new delivery system for silver sulfadiazine; Deitch EA et al.; Dimac with silver sulfadiazine (Dimac-SSD), a new silver sulfadiazine delivery system, was evaluated prospectively in a multicenter study for the treatment of outpatient burn injuries . The goal of this study was to evaluate the effect of Dimac-SSD on the microbiology of the burn wounds and to quantitate its clinical safety and efficacy . A total of 197 patients were evaluated . Eight (4%) of these patients did not complete the study . Six patients withdrew because of local discomfort caused by the Dimac-SSD and two patients were terminated because of technical problems . The mean +/- SD duration of treatment with Dimac-SSD was 12 +/- 8.5 days, during which time the mean number of dressing changes was 2.9 per patient . During treatment with Dimac-SSD, the burn wound bacterial flora remained stable and overgrowth with Pseudomonas species or Gram-negative bacilli did not occur . Only four (2%) patients developed clinical infections; thus the Dimac-SSD appeared to have good antimicrobial effectiveness . This dressing was not associated with any organ system or metabolic side-effects and patient discomfort during application and removal was minimal . Thus this new delivery system for silver sulfadiazine was associated with excellent wound healing, a low incidence of wound infections, reduced frequency for dressing changes, and excellent patient compliance.

Am Rev Respir Dis, 1989 Apr, 139(4), 871 - 6
A controlled trial of 3-month, 4-month, and 6-month regimens of chemotherapy for sputum-smear-negative pulmonary tuberculosis . Results at 5 years . Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council.
{Peripheral nerve lesions of experimental leprosy in monkeys . VI . Tuberculoid leprous granuloma in an African green monkey}
Fukunishi Y.

Histopathological finding of left n . peroneus superficialis, left rami calcanei medialis (n . tibialis), left n . medianus, left ramus superficialis, n . radialis and left rami muscularis, m . palmaris brevis of african green monkey 8182 (Delta Regional Primate Research Center, USA) were studied by semithin section method . African green monkey 8182 was inoculated with leprosy bacilli isolated from lepromata of mangabey monkey A 015-natural infection . The length of period between date of inoculum and date of death of the monkey was about 5 years . 1 . A typical tuberculoid leprous granuloma was observed in a fascicle of n . peroneus superficialis . 2 . In the other fascicles of n . peroneus superficialis, proliferation of collagen fibers was remarkable not only at surrounding of myelinated nerve fibers but also at perineurium . Some of myelinated nerve fibers inside these fascicles were kept in good condition . 3 . Infiltration of small amount of lymphocytes, proliferation of collagen fibers, and a few leprosy bacilli were observed inside some of fascicles of rami calcanei medialis . 4 . In the fascicles of n . medianus, ramus superficialis of n . radialis and rami muscularis of n . ulnaris at m . palmaris brevis, proliferation of collagen fibres was observed not only at surrounding of myelinated nerve fibers but also at perineurium.

Lab Anim, 1989 Apr, 23(2), 89 - 95
Pathology of rats intranasally inoculated with the cilia-associated respiratory bacillus; Matsushita S et al.; Five-week-old Wistar/Ms rats were inoculated intranasally with a lung homogenate containing a strain of cilia-associated respiratory (CAR) bacillus and were examined on days 4, 7, 14, 21, 28 and 56 postinoculation (PI) . Some rats showed clinical signs with wheezing and considerable body weight loss from day 21 PI . Gross lesions, including enlargement of lungs with focal atelectasis, bronchiectasis and emphysema, were observed from day 21 PI . Histologically, round cell infiltration was first present in the lamina propria of the nasal respiratory mucosa on day 7 PI . From day 14 PI, colonization of the CAR bacillus (4-8 micron in length), associated with round cell infiltration in the lamina propria and the peripheral regions, was observed in the ciliated mucosa of the bronchioles, bronchi, trachea and nasal cavities . Generally, the lesions progressed and expanded from upper to lower airways with time . Sporadic mucopurulent bronchopneumonia was observed from day 21 PI in some rats . The CAR bacilli (0.2-0.25 micron in diameter) were also demonstrated electron-microscopically in the ciliated epithelium of the intrapulmonary airways . The CAR bacillus antigen was demonstrated on the ciliated mucosa of the affected airways by the indirect immunofluorescence assay technique . Microbiological examination revealed that the rats used in this study were free from other known respiratory pathogens throughout the experimental period . Thus, it is suggested that the CAR bacillus alone can produce a murine respiratory disease . Fourteen days were needed for pathological lesions to develop.

Pneumonol Pol, 1989 Apr, 57(4), 249 - 52
{2 cases of drug-resistant pulmonary tuberculosis treated with ofloxacin}; Krasucka-Kluzniak A et al.; Two cases of chronic, cavernous pulmonary tuberculosis with bacilli resistant to several drugs are presented . Both patients were treated with a new antituberculous drug ofloxacin . The agent was used with other antituberculous drugs . Sputum negativization was seen in only one of the patients, while the in other only a decrease of dissemination was observed.

Med Lab Sci, 1989 Apr, 46(2), 101 - 6
Isolation of Mycobacterium tuberculosis from faeces; Allen BW; Faeces from patients with Myco, tuberculosis in their sputum was decontaminated using NaOH, acid and an alkaline precipitation method . Treated specimens were diluted, to reduce the number of surviving normal flora, and cultured in liquid selective media . Sub-cultures were made on selective agar and Lowenstein-Jensen medium . Both alkaline methods were superior to acid treatment . Use of all three methods, dilution and culture, yielded growth of Myco, tuberculosis from 90% of patients' faeces, although previous reports have cited only 25-30% of patients excreting bacilli in their faeces.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1989 Apr-Jun, 38(2), 137 - 41
Growth of some mycobacterial strains in 7H12 Middlebrook liquid medium in the presence of auramine; Botis S et al.; The action of auramine on the growth of some mycobacterial strains in 7H12 Middlebrook liquid medium as well as the interaction between auramine and calf thymus DNA were investigated . It was concluded that the inhibitory effect of auramine on the growth of some mycobacterial strains belonging to the TB complex or MOTT bacilli is the result of a double mechanism: interaction of auramine with mycolic acid and interaction between the dye and the mycobacterial DNA.

Dig Dis Sci, 1989 Apr, 34(4), 640 - 3
Electron microscopic detection of Whipple's bacillus in sarcoidlike periodic acid-Schiff-negative granulomas; Spapen HD et al.; We describe a patient with Whipple's disease without apparent intestinal involvement at initial presentation . Electron microscopy demonstrated the typical bacilli in PAS-negative lymph node and muscle biopsy specimens.

Taiwan Yi Xue Hui Za Zhi, 1989 Mar, 88(3), 278 - 81
Mycobacterium fortuitum mastitis following augmentation mammaplasty: report of a case; Juang YC et al.; A 26-year-old woman was admitted to the Veterans General Hospital with the chief problem of recurrent abscess formation over the right breast one month after augmentation mammaplasty . Pus aspirated from the right breast grew Mycobacterium fortuitum, a rapidly growing atypical Mycobacterium, in 4 consecutive cultures . The infected mammanoplastic prosthesis was surgically removed . Acid-fast bacilli were found on pathologic examination of the surgical specimen . Amikacin, doxycycline and ethambutol were given for two weeks according to the sensitivity test . The patient underwent reconstructive surgery of her right breast 10 months later . A specimen obtained from that surgery showed no more acid-fast bacilli on pathological examination . To date there are no signs of recurrence . We suggest that the possibility of mycobacterial infection should be kept in mind when the pus is reported as being "sterile" on an ordinary bacterial culture.

Rev Clin Esp, 1989 Mar, 184(4), 185 - 6
{Endobronchial tuberculosis}; Hueto J et al.; Eight hospitalized patients with endobronchial tuberculosis are reported . Diagnosis was reached in six patients by the demonstration of acid-alcohol resistant bacilli in the bronchial aspirate . In the fifth patient microscopic examination of the bacteria in the liquid obtained by aspiration of a paraspinal abscess was positive . In the last patient diagnosis was established by the positive growth in Lowenstein's medium of lymph node extracts . The clinical, radiologic, endoscopic and microbiologic features are discussed.

J Med Assoc Thai, 1989 Mar, 72(3), 154 - 9
Fiberoptic bronchoscopy in diagnosis of patients with suspected active pulmonary tuberculosis; Wongthim S et al.; Patients suspected of having active pulmonary tuberculosis, in whom acid-fast bacilli (AFB) are not demonstrated on sputum direct smear, present a difficult diagnostic and therapeutic problem . Flexible fiberoptic bronchoscopy is a useful procedure in evaluating these patients . Within five years, during the period of January 1983 to December 1987, 112 patients who were suspected of having active pulmonary tuberculosis underwent fiberoptic bronchoscopy . The diagnosis of pulmonary tuberculosis was established by using this procedure in 76 per cent of cases . Immediate diagnosis were made from microscopic specimens obtained from bronchoscopy in 38 of 65 patients (58%) . It is concluded that fiberoptic bronchoscopy should be performed in evaluating patients with negative smears for AFB who are clinically suspected of having tuberculosis before initiating a trial of antituberculous drugs . The technique is safe and markedly efficacious in making an immediate diagnosis and uncovering other diseases that present themselves like tuberculosis.

J Neurol Sci, 1989 Mar, 90(1), 67 - 76
Tuberculosis of the nervous system . A clinical, radiological and pathological study of 39 consecutive cases in Riyadh, Saudi Arabia; Bahemuka M et al.; Thirty-seven consecutive adults and 2 children with tuberculosis of the nervous system were studied . Twenty-eight patients (72%) had intracranial or intraspinal tuberculomas and only 11 patients (28%) had tuberculous meningitis . Of the 14 patients (36%) with intracranial tuberculomas 6 presented with epilepsy of late onset including convulsive status epilepticus(2) . The 6 patients with multiple tuberculomas some of which were situated in the infratentorial compartment were surprisingly free of major neurological disability of systemic disturbance . Thirteen patients (33%) presented with spinal cord compression due to tuberculoma . Eight of these had associated bony abnormalities such as collapsed vertebrae and loss of pedicles usually regarded as characteristic of malignant disease and 2 presented with clinical features of acute transverse myelitis . Eleven patients (28%) had tuberculous meningitis . One of these died, 1 had a protracted illness with gait ataxia and hydrocephalus and 1 other patient was disabled by hemiplegia, dysphasia and epilepsy but the remaining 8 recovered fully . Tuberculosis outside the nervous system was found in 13 patients (33%) in 12 (31%) of whom it was pulmonary . Acid fast bacilli were demonstrated by Ziehl-Neelsen stain in 16 patients (52%) out of 31 from whom specimens were available . Mycobacterium tuberculosis was eventually cultured from only 6 specimens . These data suggest that the clinical and radiological features of tuberculosis of the nervous system in Saudi Arabia may differ substantially from those reported from other countries . In our study there was low morbidity and low fatality rate . Two patients had infratentorial tuberculomas, and 8 patients had bony abnormalities in the vertebral column, typical of malignant disease.

Indian J Pediatr, 1989 Mar-Apr, 56(2), 213 - 7
Comparative bacterial study of oral rehydration solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley; Adhikari RK et al.; Result of bacterial study on Oral Rehydration Solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley is reported . Of the total 100 water samples collected from different sources and area all the samples, as a base line study, were subjected for the examination of bacterial presence . Eighty eight percent of the water samples studied were found to be unsatisfactory for drinking . Thirty five percent of the ORS prepared in unboiled water and kept for 24 hours at room temperature showed increased bacterial count whereas none of the ORS prepared in 5 minute boiled water and kept for 24 hour at room temperature showed any bacterial growth . Decreased bacterial count was not found in any of the ORS prepared in unboiled water . Typical coliform bacilli were found grown in 57.0% of the ORS prepared in unboiled water samples.

Int J Lepr Other Mycobact Dis, 1989 Mar, 57(1), 65 - 72
Light- and electron-microscopic study of M . leprae-infected armadillo nerves; Liu TC et al.; Lesions in peripheral nerves of armadillos experimentally infected with Mycobacterium leprae were studied by light- and electron-microscopy . Bacilli could be found clearly inside axons of unmyelinated nerve fibers . Heavily bacillated Schwann cells were seen embracing unmyelinated axons with interrupted cytoplasmic membranes . This indicated the initiation of rupture of those cells which were responsible for the liberation of bacilli into the axons . The nerve lesions were divided into three grades according to their severity: grade I showed lesions focalized in the perineurium; grade II lesions were scattered inside nerve tissue; and in grade III lesions the nerve tissues were diffusely affected . No regressive changes, such as fibrosis or scar formation, were seen in the nerve lesions . Bacillated macrophages were not as foamy as those of human lesions, indicating that these bacillated cells were younger or more easily disrupted with a higher turnover than the cells in human lesions . This would promote the spread of lesions in armadillos, and would explain the less foamy appearance of the cells . We found bacilli inside lymphatics surrounding the nerves, substantiating the opinion that lesions spread to peripheral nerves not only by a hematogenous route but also by the lymphatics.

Rev Infect Dis, 1989 Mar-Apr, 11 Suppl 2, S484 - 90
Evaluation of the protective potency of new tuberculosis vaccines; Wiegeshaus EH et al.; Animal models used to evaluate the relative protective potency of a panel of tuberculosis vaccines have yielded dissimilar data . Moreover, it is not known which animal model predicts the protective potency of vaccines for humans . Accordingly, animal models should be developed on the basis of an understanding of the key events in the pathogenesis of tuberculosis in humans . Vaccines such as bacille Calmette-Guerin (BCG) appear to protect against tuberculosis by inhibiting the bacillemic phase of primary infection with virulent tubercle bacilli; therefore, such vaccines can be expected to provide protection against tuberculosis developing via the endogenous reactivation pathway but not against disease developing via the exogenous reinfection pathway . To protect against disease developing by the latter pathway, it would appear that new vaccines produced by recombinant DNA technology or through use of monoclonal antibody would have to inhibit the implantation of bacilli at the portal of entry in the lungs . Experience with BCG vaccine indicates that factors other than the inherent potency of the vaccine play a decisive role in the outcome of vaccine trials in humans . These same factors will probably influence field trials of any new generation of tuberculosis vaccines.

Rev Infect Dis, 1989 Mar-Apr, 11 Suppl 2, S385 - 93
What animal models can teach us about the pathogenesis of tuberculosis in humans; Smith DW et al.; Technology that permits the reproducible infection of laboratory animals with virulent tubercle bacilli under conditions that simulate those under which humans are infected is now available . This technology has been used to investigate a series of fundamental questions about the pathogenesis of tuberculosis . An integrated view of the pathogenesis of tuberculosis has been constructed that combines studies from animal models and our understanding of the key events in the development of cavitary pulmonary tuberculosis in humans . This view, developed as a guide for further hypothesis testing, indicates that whether cavitary pulmonary tuberculosis develops by endogenous reactivation or by exogenous reinfection is determined solely by the route by which the tubercle bacillus reaches the apical-subapical region of the lung . It is in this region that the bacillus survives the cell-mediated immune response . This view of the pathogenesis of tuberculosis permits identification of the factors in a given geographic region that govern the probability of the development of cavitary pulmonary tuberculosis by one or the other pathway . Knowledge of these factors permits the identification of the appropriate strategies for tuberculosis control.

Nihon Kyobu Shikkan Gakkai Zasshi, 1989 Mar, 27(3), 310 - 6
{A clinical study of terminal pneumonia}; Mochizuki Y et al.; A total of 210 cases of terminal pneumonia were studied out of 1183 autopsied cases at Tenri Yorozu Hospital from 1978 to 1985 . Underlying diseases included lung cancer (77 patients), gastric cancer (26 patients), leukemia (24 patients) . There was no statistical significance between the time from death until autopsy and the bacterial examination of autopsied lung and blood . P . aeruginosa and Klebsiella sp . were the most frequently isolated organisms . Seventy percent of isolated organisms were gram negative bacilli . In spite of administration of antibiotics, bacteria isolated from specimens before death were sometimes the same as the one isolated from specimens after death . In addition it was recognized that multiple intensive examinations of sputum are necessary for rapid diagnosis of pneumonia . It was also noted that the longer the duration of antibiotic administration, the more frequently P . aeruginosa was isolated . Finally the possibility of pneumonia should be kept in mind in compromised hosts.

Tubercle, 1989 Mar, 70(1), 53 - 6
Broth culture: the modern 'guinea-pig' for isolation of mycobacteria; Martin T et al.; Three cases of mycobacterial infection were confirmed in our laboratory by exclusive isolation of the pathogen in Middlebrook 7H9 broth medium . The mycobacteria failed to grow in all three cases on three different solid media . In one patient Mycobacterium tuberculosis was isolated from a pleural biopsy; a lymph node biopsy from another patient also yielded M . tuberculosis and M . avium-intracellulare was isolated from the spinal fluid of a patient with acquired immunodeficiency syndrome (AIDS) . Only the broth culture was positive in all three cases . We suggest these findings emphasise the need for laboratories to use a liquid medium in addition to egg-based or agar media, especially for isolation of mycobacteria from specimens with small numbers of bacilli.

Jpn J Med, 1989 Mar-Apr, 28(2), 247 - 50
Bacillus cereus septicemia associated with rhabdomyolysis and myoglobinuric renal failure; Tomiyama J et al.; A patient with acute myeloblastic leukemia (AML) developed septicemia due to Bacillus cereus with subsequent rhabdomyolysis and myoglobinuric renal failure . He died despite intensive care . Postmortem examination revealed diffuse muscle necrosis with infiltration of Gram-positive bacilli and widespread bacterial microthrombi in various organs . Septicemia associated with rhabdomyolysis has been described in 12 cases . This case represents the first reported case of B . cereus septicemia associated rhabdomyolysis . Renal failure and shock were considered to be the most important prognostic factors, and either direct infiltration or toxin of the bacteria was suggested to be the mechanism of rhabdomyolysis in sepsis . B . cereus can be one of the lethal organisms in immunocompromised patient such as the present case . Rhabdomyolysis should be considered when a patient with septicemia complains of muscle pain . Prompt hydration and correction of acidosis are important to prevent renal failure and shock.

Rev Infect Dis, 1989 Mar-Apr, 11 Suppl 2, S411 - 9
A cloned DNA fragment for identification of Mycobacterium tuberculosis; Patel RJ et al.; The identification of Mycobacterium tuberculosis is a lengthy process . Attempts were made to develop a more rapid, specific, and sensitive assay for identifying tubercle bacilli in biologic specimens by differentially screening plasmid libraries of Sau3AI-digested M . tuberculosis H37Rv (ATCC 25618) DNA with homologous and heterologous DNA for clones that hybridized strongly with M . tuberculosis DNA alone . Three clones, pMTB1, pMTb2, and pMTb3, were selected for further study . Southern analysis indicated that these clones reacted strongly with DNA from strains of M . tuberculosis isolated in different parts of the world, weakly with DNA from other mycobacterial species, and not at all with Escherichia coli or human DNA . Smaller fragments of mycobacterial DNA contained in plasmid pMTb3 were subcloned into pBR322 (pMTb4) or pUC12 (pMTb5) . These recombinant plasmids hybridized with DNA from M . tuberculosis, Mycobacterium bovis, and Mycobacterium bovis BCG (bacille Calmette-Guerin) Montreal and may provide the reagents needed for the development of new methods for rapid diagnosis of M . tuberculosis infections.

Rev Infect Dis, 1989 Mar-Apr, 11 Suppl 2, S369 - 78
Immune mechanisms in the pathogenesis of pulmonary tuberculosis; Dannenberg AM Jr; The pathogenesis of pulmonary tuberculosis and the beneficial and detrimental effects of the host's cell-mediated immune response in this disease are reviewed . Tubercle bacilli are hardly facultative intracellular pathogens that live and multiply in nonactivated macrophages . Before tubercle bacilli can be destroyed by macrophages, these cells must be activated by T lymphocytes and their lymphokines . Such activation is the essence of cell-mediated immunity . Cell-mediated immunity also has a detrimental component, called delayed-type hypersensitivity . This component causes caseous necrosis of host tissues whenever the bacillary antigens reach high levels . Such levels occur intracellularly in macrophages of highly susceptible hosts and extracellularly in liquefied caseous foci of resistant hosts . Vaccines containing antigens that create more cell-mediated immunity and less delayed-type hypersensitivity are greatly needed.

J Exp Med, 1989 Mar 1, 169(3), 893 - 907
The reconstitution of cell-mediated immunity in the cutaneous lesions of lepromatous leprosy by recombinant interleukin 2; Kaplan G et al.; Human rIL-2 (10-30 micrograms) was injected intradermally into the skin of patients with lepromatous leprosy with high bacillary loads . All patients responded to the lymphokine with local areas of induration that peaked at 24 h and persisted for 4-7 d irrespective of whether the site was "normal skin" or a nodular lesion . Within 24 h there was an extensive emigration of T cells and monocytes into the site . The percentage of the dermis infiltrated by mononuclear cells increased by more than sevenfold, peaking at 4 d and persisting for greater than 15 d . Both CD4+ and CD8+ T cells entered the site . T cells of CD4+ phenotype predominated at 2-7 d but by 11 d, CD8+ cells were predominant . Considerable numbers of T6+ Langerhans' cells appeared in the dermis by 72 h and persisted for 3 wk . By 4 d the thickness of the overlying epidermis had increased twofold, and keratinocytes were expressing MHC class II antigen and the IFN-gamma-induced peptide IP-10 . Starting at 48 h, there was an extensive destruction of mononuclear phagocytes that contained structurally intact or fragmented M . leprae observed at the electron microscope level . The organisms, either free or contained within endocytic vacuoles, were discharged into the extracellular space and then reingested by blood-borne monocytes . This was followed by marked reductions in the number of acid-fast organisms in the injected site, evident as early as 4-7 d and more marked at 2-3 wk after injection . 13 of 15 patients exhibited a disposal of acid-fast bacilli ranging from 5- to 1,000-fold with a mean value of approximately 100-fold . The administration of IL-2 leads to the generation of an effective cell-mediated immune response, recapitulating an antigen-driven event and leading to striking local reductions in M . leprae . In comparison with the purified protein derivative of tuberculin reaction, bacilli are cleared more promptly, although emigratory cells persist for a shorter time.

Infect Immun, 1989 Mar, 57(3), 840 - 4
Inhibition by retinoic acid of multiplication of virulent tubercle bacilli in cultured human macrophages; Crowle AJ et al.; The immunologically active vitamin retinoic acid (RA) was tested for the ability to increase the resistance of cultured human macrophages (MP) to experimental infection with virulent Mycobacterium tuberculosis Erdman (tubercle bacilli {TB}) . It was added to MP in various concentrations and addition regimens . Protection against TB was measured by counting live TB (CFU) in lysates of samples of MP taken at 0, 4, and 7 days after MP infection . RA was protective when added after infection at the pharmacologic concentration of 10(-5) M and when added before infection at the physiologic concentration of 10(-7) M . The protection lengthened intracellular generation times for TB, occasionally caused bacteriostasis, and regularly kept CFU counts at 7 days (end of the period of infection) 1 to 2 log10 CFU below control values . Significant protection was seen in a series of 16 experiments with MP from seven different donors, but the degree of protection varied considerably . The protection depended partly on and was inversely proportional to concentrations of a serum substitute or autologous serum used as a supplement in the RPMI 1640 MP culture medium . It was strongest at concentrations of serum below 1% . RA at concentrations used in the MP cultures did not inhibit TB in the absence of MP . These results suggest that RA (vitamin A), like vitamin D, may have some immunoprotective role against human tuberculosis, as historically intimated by the regular use of vitamin A- and D-rich cod liver oil for the treatment of tuberculosis before the introduction of modern chemotherapy.

Int J Lepr Other Mycobact Dis, 1989 Mar, 57(1), 54 - 64
New data on the ultrastructure of the membrane of Mycobacterium leprae; Silva MT et al.; In previous reports on the ultrastructure of Mycobacterium leprae, we described the occurrence of symmetric membranes in normal-looking bacilli from fresh or frozen samples primarily fixed with aldehydes . In those reports we admitted that such a symmetric profile, which is not found in the other normal mycobacteria, would not represent the structure of the normal membrane of the leprosy bacillus . We, therefore, re-analyzed the ultrastructure of the membrane of M . leprae . In the present work the micromorphology of the M . leprae membrane was studied by transmission electronmicroscopy after the fixation of fresh samples by OsO4 plus calcium followed by glutaraldehyde plus formaldehyde and calcium followed by uranyl acetate . The study of samples from two patients with lepromatous (LL) leprosy, three armadillos with natural leprosy, and one nude mouse with experimental leprosy showed that normal-looking bacilli present in lead-stained sections had asymmetric membranes with a thickness of 6.49 +/- 0.36 nm . These membranes showed periodic acid-Schiff (PAS)-positive components exclusively located in the outer half of the bilayer . We demonstrated that the symmetric profile of the M . leprae membrane described in our previous reports corresponds, as admitted in those reports, to an abnormal membrane structure . Such an abnormality was now found to result from the use of primary fixation with aldehydes or of samples stored frozen before fixation . These results indicate that, although ultrastructurally similar to that of the other mycobacteria, the membrane of M . leprae has a peculiar sensitivity to fixation by aldehydes . Such a characteristic, which was not found in M . lepraemurium, M . aurum, M . avium, and M . tuberculosis H37Ra, must reflect a unique membrane molecular structure, which is presently unknown.

J Infect Dis, 1989 Mar, 159(3), 549 - 55
Association of tuberculosis and M . tuberculosis-specific antibody levels with HLA; Bothamley GH et al.; In the search for HLA-linked immune response genes that control susceptibility to tuberculosis, we performed HLA typing and measured antibody titers to well-defined Mycobacterium tuberculosis antigenic determinants in 101 patients with sputum smear-positive pulmonary tuberculosis and 64 healthy controls from Surabaya, Indonesia . HLA-DR2 and DQw1 were associated with sputum smear-positive pulmonary tuberculosis (attributable risk = 36% and 39%, respectively), while DQw3 was associated even more strongly with the control group (preventive fraction = 57%) . Antibody titers to the TB71 and TB72 epitopes of the 38-kDa protein, present only on tubercle bacilli, were strongly associated with DR2 (Pcorr = .001 and .024, respectively) . The association of both the disease and the antibody response to the 38-kDa antigen of M . tuberculosis with Class II HLA genes HLA-DR2 indicates that Ir-gene-mediated regulation of the immune response to this antigen may be of pathogenic significance for the development of sputum smear-positive tuberculosis.

Wiad Lek, 1989 Feb 15, 42(4), 245 - 8
{Polymyositis in pulmonary tuberculosis}; Wislowska M et al.; A case in reported of the clinical syndrome of polymyositis in a young man . The syndrome masked pulmonary tuberculosis . Sudden appearance of pains and weakness of the muscles of the shoulder and abdominal muscles was accompanied by fever up to 40 degrees C, and macular rash on the trunk and extremities . During the disease right-sided pneumonia developed and regressed after treatment with antibiotics (tetracyclines, penicillin) . Laboratory investigations showed high ESR, high leucocyte count, high levels of transaminases, CPK and LDH, and in cutaneo-muscular++ biopsy specimen scan subepidermal infiltrations were present . The patient was treated with corticosteroids with a striking improvement of the general condition . During this treatment left-sided pleural effusion developed . Bacteriological examination of the pleural fluid, including tests for acid-fast bacilli, was negative in direct examination, but these bacilli were cultured from fluid . No malignant cells were found . After antituberculous treatment the condition of the patient and the biochemical parameters became normal.

J Med Assoc Thai, 1989 Feb, 72(2), 90 - 6
Amikacin pharmacokinetics in plasma and pleural fluid; Limthongkul S et al.; The pharmacokinetics of amikacin in plasma and pleural fluid were studied in nine adult patients with pleural effusions . After a single intravenous bolus of 7.5 mg of amikacin per kg, concentrations in plasma and pleural fluid were measured by fluorescence polarization immunoassays . Pleural fluid pH and PCO2 were also measured . The plasma pharmacokinetics was similar to other studies . However, in the present study the central compartment was significantly greater than the peripheral compartment . Our study suggested that there might be a significant binding of amikacin to the inflamed and/or damaged pleural as suggested by the significant correlations between the apparent volumes of distributions of central and total compartments with pleural fluid pH and PCO2 . In pleural fluid, amikacin kinetics followed a large reservoir model with maximum concentration, 4.34 +/- 0.50 mg/L, occurring at 5.64 +/- 0.67 hours post-dose and its half-life was 13.50 +/- 2.93 hours . This concentration was lower than the minimal inhibitory concentration (MIC) for most of the sensitive strains of Gram-negative bacilli and therefore the antibiotics should be given as early as possible for gram-negative pneumonia.

Zhonghua Jie He He Hu Xi Za Zhi, 1989 Feb, 12(1), 15 - 7, 61
{Studies on the virulence in the guinea pig of tuberculosis bacilli isolated from patients with pulmonary tuberculosis before treatment in Shanghai}; Yang DY; The virulence in guinea-pig of 44 tubercle bacilli cultures from patients of tuberculosis before treatment in Shanghai and 26 from Tokyo has been studied for comparison . The results showed that the virulence of tubercle bacilli from Shanghai was lower than that from Tokyo . The difference was statistically significant (P less than 0.01) . Among the 44 cultures from Shanghai high virulence accounted for 54.5%, low virulence 15.9% and middle virulence 29.5% whereas for the cultures from Tokyo high virulence accounted for 96.2% and middle virulence 3.8%.

Kekkaku, 1989 Feb, 64(2), 121 - 33
{The immunology of tuberculosis}; Tokunaga T; An introductory overview on the present state and future prospect of the immunology of tuberculosis is presented with the following six chapters . 1 . Contribution of tuberculosis immunologists to the modern immunology . When one reminds Koch's phenomenon, Freund's adjuvant, and the findings or new ideas of, for instance, cell-mediated transfer of tuberculin allergy, test of MIF which was first described as "lymphokines", effector macrophages activated with immune lymphocytes against mycobacterial infection, MHC-restriction for presenting tuberculin-antigen from macrophages to T cells, everyone may agree with saying that the tuberculosis immunology contributed greatly to the opening and development of modern immunology . 2 . Central dogma of tuberculosis immunology . Tuberculosis immunology possesses a central dogma : infection of tubercle bacilli----phagocytosis----antigen presentation----expansion of specific T cell clone----production of lymphokines----macrophage activation----killing of the bacilli . Recent knowledges from modern immunology have clarified many things in or around this immunological process . However, there remain many important questions . In the following chapters and subtitles, what have been clarified and what are still unsolved will be described . 3 . Induction of tuberculosis immunity . (1) Mechanisms of phagocytosis with macrophages, and natural resistance . (2) Antigen presentation and sensitized T cells . 4 . Expression of tuberculosis immunity . (1) Lymphokines . (2) Activation of macrophages . (3) Immune suppression . 5 . Special characters of tubercle bacilli in relation to the host response . Biochemistry of cellular components of tubercle bacilli and their biological activities have been reported by many investigators already in this journal . Therefore, the following items only are discussed here . (1) Mycobacterial proteins produced by gene-technology . (2) Adjuvant active derivatives of MDP . (3) DNA from BCG and its biological activities . (4) Difference of immunity induced by viable and dead bacilli . About (4), possible mechanisms to explain the difference are discussed, with emphasis of both MPB70 protein as an antigenic metabolite released from viable bacilli and the heat-shock mycobacterial proteins . 6 . Unsolved problems in tuberculosis immunology . (1) Mechanisms of endogenous reactivation . (2) Development of new vaccine . (3) Others . In addition to the practical problems on tuberculin diagnosis and BCG vaccination, problems to be solved in and around the central dogma are discussed . Some examples of these problems are illustrated in Fig.7 in English.

Br J Exp Pathol, 1989 Feb, 70(1), 103 - 10
Influence of BCG-induced immunity on the bactericidal activity of isoniazid and rifampicin in experimental tuberculosis of the mouse and guinea-pig; Dhillon J et al.; The influence of previous BCG vaccination on the bactericidal activity of isoniazid and rifampicin has been studied using serial counts of viable tubercle bacilli in the spleens and lungs of mice and guinea-pigs infected intravenously with M . tuberculosis, strain H37Rv . In mice, BCG vaccination decreased the bactericidal activity of isoniazid in the spleen, but did not affect its activity in the lungs, where immunity is less strongly expressed . BCG did not influence the bactericidal activity of rifampicin in either organ . In contrast, previous BCG vaccination in the guinea-pig increased the bactericidal activity of isoniazid and rifampicin in the spleen and lungs . The differences between the animal species might result from the immune response being mainly bacteriostatic in the mouse but bactericidal in the guinea-pig.

Am Rev Respir Dis, 1989 Feb, 139(2), 549 - 52
1,25(OH)2-vitamin D3 synergizes with pyrazinamide to kill tubercle bacilli in cultured human macrophages; Crowle AJ et al.; Pyrazinamide (PZA) is believed to be mycobactericidal in vivo . Because it is ineffective at neutral pH in vitro, it is thought to owe its in vivo activity at least partly to acting upon tubercle bacilli (TB) in the helpfully low pH of macrophage (MP) phagolysosomes . However, when it was tested in TB-infected cultured human MP, it was not bactericidal and was able only to slow intra-MP bacillary growth . Recent evidence has suggested that human MP need hormonal support from certain vitamin D metabolites to resist TB . This support was not provided in the culture medium of the earlier experiments in which the PZA was relatively ineffective . Here, PZA has been retested in MP cultured in medium supplemented with the hormonally active metabolite of vitamin D, 1,25(OH)2-vitamin D3 (1,25D3) . The MP were infected with virulent TB and incubated in various concentrations of PZA . 1,25D3 was added to postinfection medium at 4 micrograms/ml . Inhibition or killing of intracellular TB was quantitated by counts of culturable TB from samples of lysed MP taken at zero, 4, and 7 days after MP infection . Previous evidence for the protectiveness of 1,25D3 alone for human MP against TB was confirmed . The weak inhibition of TB in MP by PZA alone also was confirmed . The two used together synergized to decrease concentrations of PZA which were inhibitory and to switch the action of PZA from weakly inhibitory to bacteriostatic or mildly bactericidal . 1,25D3 had no direct anti-TB effect, and it did not synergize with PZA in the absence of MP, as determined with acidified bacteriologic culture medium in the BACTEC radiometric system.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Dis Child, 1989 Jan, 64(1 Spec No), 34 - 8
Routine endotracheal cultures for the prediction of sepsis in ventilated babies; Slagle TA et al.; Serial cultures of endotracheal tube aspirates were carried out in 94 neonates who were intubated and had been ventilated for longer than one week . A similar change in bacterial colonisation with duration of ventilation was seen in infants who subsequently developed sepsis and those who did not . In both groups, 177 aspirates (more than 90%) obtained during the first week of ventilation were sterile . Thereafter, colonisation with mixed Gram positive flora emerged followed by growth of Gram negative bacilli . For the infants who developed sepsis, the correlation between pathogens isolated from blood during the episodes of sepsis and those from previous endotracheal tube isolates was poor; in only five of the 26 cases of sepsis (19%) was the same single strain of organism isolated from culture of the blood and of the endotracheal tube aspirate . Other markers of infection such as endotracheal tube aspirate white blood cell counts and changes in bacterial flora were not useful in predicting systemic infection . Routine surveillance cultures of endotracheal tube aspirates in ventilated infants are not helpful in predicting the pathogens that are isolated from the blood during episodes of sepsis.

Head Neck, 1989 Jan-Feb, 11(1), 60 - 6
Modern management of cervical scrofula; Deitel M et al.; From 1970 to 1984, 32 patients were treated for tuberculous (TB) masses, which measured 1.2-5.5 cm . The posterior triangle was involved in 19 patients, anterior triangle in 7, and more than one triangle in 6 (3 bilateral) . A superficial node was excised for diagnosis . Acid-fast bacilli were identified on the smear of 18 patients . Caseation necrosis was present in 27 specimens, sarcoidosis in four, nonspecific lymphadenitis in one; all cultures grew Mycobacterium tuberculosis . A chest x-ray showed no active TB . Chemotherapy was given for 9-18 months (9 months when only one node was diseased and 18 months with extensive nodal involvement) . Follow-up examinations in all patients (greater than 3 years, mean 8.6 years) has revealed no recurrence . The need to excise all cervical TB nodes, chronically inflamed and often fused to important structures, was eliminated by adequate chemotherapy.

J Wildl Dis, 1989 Jan, 25(1), 122 - 3
Isolation of Aeromonas hydrophila from a captive caracal lynx (Felis caracal); Ocholi RA et al.; Aeromonas hydrophila was isolated from the internal organs of a captive caracal lynx (Felis caracal) which died of acute septicemia . Grossly, patchy areas of focal necrosis were found in the lungs, liver and kidney; there was ulceration in the stomach and intestines . Microscopically, lesions contained cellular debris, neutrophils, lymphocytes and gram-negative bacilli . This is the first report of isolation of Aeromonas hydrophila from a captive wild animal in Nigeria.

Infect Immun, 1989 Jan, 57(1), 225 - 30
Intestinal multiplication of Mycobacterium paratuberculosis in athymic nude gnotobiotic mice; Hamilton HL et al.; In this study gnotobiotic mice were inoculated with a human isolate of Mycobacterium paratuberculosis (strain Linda; ATCC 43015) in an attempt to investigate the pathogenesis of intestinal paratuberculosis . Mycobacterium paratuberculosis-monoassociated nu/+ mice developed a persistent low-level intestinal infection but did not support progressive bacillary multiplication . In contrast, monoassociated nu/nu mice eventually harbored approximately 10(7) M . paratuberculosis per g of intestinal tissue . Acid-fast bacilli and granulomas were observed in the intestinal mucosa and livers of nu/nu but not nu/+ mice . Similar results were obtained after intragastric inoculation of M . paratuberculosis into nu/+ and nu/nu flora-defined mice . These observations suggest that the presence of an intact cellular immune system is important for limiting intestinal multiplication of M . paratuberculosis . The results of this study may be relevant to our understanding of the pathogenesis of Johne's disease in ruminants and of human inflammatory bowel diseases that have a mycobacterial etiology (e.g., some cases of Crohn's disease and Mycobacterium avium-Mycobacterium intracellulare enteritis in patients with acquired immunodeficiency syndrome).

Probl Tuberk, 1989, (8), 54 - 8
{Antigenic composition of immune complexes in the blood and bronchoalveolar lavage fluid of patients with tuberculosis and aspecific inflammatory diseases of the respiratory organs}; Abramovskaia AK et al.; The level and antigenic composition of immune complexes (ICs) in 49 patients with nonspecific inflammatory diseases of the respiratory organs (NIDRO) and tuberculosis were studied in relation to separate indices of systemic and local immunity . Involvement of the ICs in the pathogenesis of tuberculosis and NIDRO was shown and the role of the level and composition of the ICs in the prognosis and differential diagnosis of the indicated pathological processes was revealed . It was noted that in patients with active tuberculosis and in patients with chronic bronchitis and residual lesions after cured tuberculosis of the respiratory organs the ICs mainly formed by antigenic substances of tubercle bacilli . In the patients with chronic bronchitis and suppurative affections of the lungs the ICs formed due to antigenic substances of bacterial infections . The use of a technique for simultaneous cleavage of the ICs in blood and bronchoalveolar secretion provided determination of etiology of the inflammatory processes in the lungs and bronchi . The technique proved to be highly efficient for early differential diagnosis of tuberculosis and NIDRO.

Probl Tuberk, 1989, (8), 48 - 50
{Intermittent polychemotherapy of patients with chronic destructive pulmonary tuberculosis with associated diabetes mellitus}; Cheren'ko SA; Forty patients with chronic destructive tuberculosis of the lung and concomitant diabetes mellitus treated with the routine chemotherapeutic agents without any effect were subjected to intermittent polychemotherapy . Combinations of 4, 5 and 6 drugs were used . Some of them were administered intermittently . The period of the polychemotherapy ranged from 4 to 8 months and was followed by less intensive regimens . It was shown that the polychemotherapy allowed one to increase the treatment efficacy in the patients with chronic destructive tuberculosis of the lung and concomitant diabetes mellitus . Discontinuation of tubercle bacilli isolation, cavern healing and partial cavern regression were observed in 25 (63 per cent), 11 (26 per cent) and 27 (54 per cent) patients, respectively . The clinical picture did not change in 6 patients (15 per cent) . Adverse reactions to the polychemotherapy developed in 17 patients (42.5 per cent) . Markedly pronounced adverse reactions requiring discontinuation of the drug use in 7 (17.5 per cent) of them were recorded . Lowering a dose of the drug, applying corticosteroids, pyridoxine, nicotinic acid, cerucal, lipamide, carsyl and unithiol allowed one to eliminate the adverse reactions developed.

Z Erkr Atmungsorgane, 1989, 173(1), 63 - 7
{Effectiveness of INH-rifampicin treatment of lymph node tuberculosis}; Weinecke A; The efficacy of the therapy of tuberculous lymphadenitis using two drugs with bactericidal activity is described . In this localization, the tuberculous process implies tubercle bacilli only in limited quantity, and thus, in contrast to the requirements and recommendations for the treatment of pulmonary tuberculosis, the application of only two drugs with bactericidal activity is sufficient . The treatment of 128 patients with histologically confirmed tuberculous lymphadenitis consisted in daily application of isoniazid and rifampicin during 4 to 6 weeks, followed by an intermittent treatment with the same drugs for 6 to 9 months . The follow-up period was 7.5 years . Complete involution of the diseased lymph nodes was obtained in two thirds of the patients, partial involution in the remaining third . In one patient, a relapse occurred . The indications of this regimen are discussed.

Z Erkr Atmungsorgane, 1989, 173(1), 37 - 9
{Microepidemics of tuberculosis}; Dankova D et al.; Persons with unknown tuberculosis exist even in countries with favourable situation of tuberculosis and contribute to the transmission of tuberculosis . The features and characteristics of 12 tuberculosis microepidemics observed in Czech Socialist Republic (10 mil . inhabitants) in 1983 to 1987 are described . The intensity of transmission of tuberculous infection is determined by the amount of tubercle bacilli excreted and by the duration of exposition . In 10 source cases bacilli were detected by direct smear examination . Eight microepidemics occurred in families, 4 at school . Prolonged close contact, as well as occasional exposure to the infection were demonstrated . There were infected 109 children and adults . Tuberculosis developed in 27 children and adults . The examination and follow-up of persons in contact with tuberculosis patients belong to the important control procedures.

Plucne Bolesti, 1989 Jan-Jun, 41(1-2), 46 - 57
{Clinical study of a 6-month chemotherapy regimen in the treatment of pulmonary tuberculosis . Results approximately 2 years after completion of chemotherapy}; Fortic B; The early and late results of 6 months' chemotherapy (2/INH, RMP, PZA and 4/INH, RMP) of newly detected, bacteriologically positive pulmonary tuberculosis are presented . In the initial period during hospitalisation in nonselected 290 patients 100% conversion of sputum was obtained while in the continuous out-patients' treatment 1.3% of patients were again found to have sputum positive for acid fast bacilli . Toxic reactions on drugs were found in 5.8% of patients: in 3.4% the hepatitis developed yet in all in mild course . The narrowing of medical contraindications for 6 months' regimen is suggested especially in chronic alcoholics since in 15.2% of them the therapy with 9 months' regimen had to be introduced (INH, RMP, EMB/SM) . In more than 2 yrs' follow up after the end of chemotherapy in 2.4% of patients--mostly noncooperative alcoholics--the recidivation was found already a few months after discontinuation of the therapy . The problem of chronic alcoholics and noncooperative patients for short course chemotherapy is discussed . The special measures are suggested: obligatory hospitalisation during initial therapy, supervising chemotherapy in out-patients' departments as well as intermittent regimen and prolongation of 6 months' therapy.

Probl Tuberk, 1989, (7), 39 - 43
{Clinico-immunological substantiation of the use of rifampicin in the combined therapy of adults and adolescents with destructive pulmonary tuberculosis}; Chernushenko EF et al.; The effect of various doses of rifampicin on intensity of rosette formation was studied, and the immunological criteria for selective use of the drug in combined specific chemotherapy of extended destructive tuberculosis of the lungs were determined . It was shown that differential use of rifampicin with an account of its administration multiplicity and route promoted a decrease in the hospitalization terms and increased rate of discontinuation of tubercle bacilli isolation and cavern healing . The clinicoroentgenological findings were confirmed by the immunological tests characterizing various elements of the immunity system in patients.

Probl Tuberk, 1989, (4), 27 - 30
{Treatment of patients with destructive pulmonary tuberculosis with chemotherapeutic preparations combined with sodium nucleinate}; Kharakter ZhZ et al.; The treatment efficacy was studied in 90 patients with destructive tuberculosis of the lungs . 50 of them were subjected to combined chemotherapy with inclusion of sodium nucleinate and 40 were treated with the tuberculostatics alone . It was shown that sodium nucleinate improved the host metabolism and in particular increased nucleonemia . As compared to the controls in the patients treated with sodium nucleinate there was a decrease in the periods of the host disintoxication, discontinuation of tubercle bacilli isolation and closing of destructive cavities . Sodium nucleinate was satisfactorily tolerated by the patients, it induced no adverse reactions and had a favourable effect on the patients immunity.

Probl Tuberk, 1989, (3), 52 - 5
{Experimental validation of the expediency of the use of ultra-high frequency therapy in combination with antibacterial drugs in infiltrative tuberculosis of the lungs}; Lomachenkov VD et al.; The influence of the U.H.F . electric field in combination with specific antibacterial therapy on the character of morphological shifts, isoniazid accumulation, collagen fractional composition and tubercle bacilli population in the foci of infiltrative tuberculosis of the lungs was studied experimentally . The effect of this preformed physical factor on the process of tuberculosis was shown to be favourable . Under the action of the U.H.F . electric field microcirculation in the lungs improved, and the levels of isoniazid accumulation in tuberculosis foci increased 1.9-fold leading to decreasing of mycobacterial populations . By restricting specific inflammation, the U.H.F . electric field prevented excessive collagen formation.

Kekkaku, 1989 Jan, 64(1), 31 - 5
{A case of Mycobacterium scrofulaceum lung infection occurring in old lung tuberculosis lesion}; Umeki S; A 68-year-old man was admitted because of a persistent productive cough of 6 weeks' duration and detection of acid-fast bacilli from sputum . Based on chest roentgenograms and isolation of Mycobacterium scrofulaceum from sputum, on admission, a diagnosis of Mycobacterium scrofulaceum lung infection was made . Although the organisms were resistant to 0.1 microgram/ml of INH, 2.5 micrograms/ml of EB and 10 micrograms/ml of RFP, sputum converted to negative by the use of INH (0.4 g/day), EB (0.5 g/day) and RFP (0.3 g/day) for 2 months . The incidence rate of nontuberculous lung mycobacteriosis seems to be increasing recently . This is partially considered to be due to an increase of various strains of nontuberculous mycobacteria in the environment . A striking advance of clinical medicine and changes in the constitution of human society and environment surrounding us produce an increase in the number of compromised hosts . The lung disease due to Mycobacterium scrofulaceum, a kind of opportunistic pathogen, is considered to be increasing in a wide variety of compromised hosts in the future.

Eur Respir J, 1989 Jan, 2(1), 96 - 7
Lethal extrapulmonary mycobacteriosis; Kos S et al.; A 60 yr old previously healthy man was treated for gradually elevating fever and rash followed by leucopenia and mycosis of the gastrointestinal tract; he died within 6 weeks of the first symptoms appearing . Histologic examination revealed disseminated tuberculosis of paratracheal lymph nodes, liver, spleen and bone marrow with the presence of acid fast bacilli by smear examination . Multiple colonies of the same strain of Mycobacterium kansasii were isolated by bacteriological examination of lymph node and spleen tissue . Neither macroscopical nor histological examination showed any evidence of lung tuberculosis . The final diagnosis of the described acute disease and rapid death was stated as generalized extrapulmonary mycobacteriosis, which is a rare observation.

Scand J Infect Dis, 1989, 21(3), 303 - 9
Plasmid-mediated beta-lactamases among aminoglycoside resistant gram-negative bacilli; Huovinen S et al.; Plasmid-mediated beta-lactamases were characterized by DNA hybridization in 371 aminoglycoside resistant gram-negative bacilli with known aminoglycoside resistance mechanism . Positive hybridization was detected in 50% to a TEM-1 probe, in 2% to a SHV-1 probe, and in 3% to both probes simultaneously . No hybridization was obtained to OXA-1, OXA-2, PSE-1/PSE-4/CARB-3 or PSE-2 beta-lactamase probes . TEM-1 beta-lactamase occurred simultaneously in 82% of strains showing the AAC(3)-V type of aminoglycoside resistance mechanism . Using isoelectric focusing as a control method, we found potentially plasmid-encoded beta-lactamases, other than TEM-1 and SHV-1, at various pIs in 13% of 288 randomly selected strains . The pIs of these strains or strains showing positive hybridizations did not fit to pIs of recently characterized plasmid-mediated enzymes against third-generation cephalosporins (e.g . CTX-1) . In addition, the strains did not show resistance to cefotaxime or ceftazidime . According to the in vitro susceptibility data ceftazidime and cefotaxime were active against most of the aminoglycoside resistant strains studied . In contrast, the activity of piperacillin was much lower than that of the cephalosporins tested.

Res Microbiol, 1989 Jan, 140(1), 33 - 41
Rapid identification of Mycobacterium species; Moinard D et al.; Identification of Mycobacterium species is currently a long and fastidious procedure . We have developed a rapid (5-h) standard method using the API-ZYM system and rapid nitratase, urease and catalase tests . Pigmentation and growth rate were noted (but were only necessary for complete identification of 6% of strains) . The tests were assigned numerical values from which a profile number was derived . A total of 716 strains were studied: 434 belonging to the M . tuberculosis complex and 282 other mycobacteria including 21 from M . avium complex . All M . tuberculosis complex strains were differentiated from all other mycobacteria and M . bovis was clearly separated from M . tuberculosis . All M . avium complex strains were differentiated from other mycobacteria . Among mycobacteria other than tubercle bacilli, 97% of the strains studied were identified . The method has proven to be simple, rapid and standardizable . It is suggested that the use of a code list could permit identification of most mycobacteria.

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