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 secret