Probl Tuberk, 1989, (1), 51 - 4 {Biological activity of tubercule bacilli in an epizootic infectious process}; Bokun AO; The studies showed that during epizootic infectious processes of tuberculosis in cattle and due to multiple subcultivation and long-term storage on artificial nutrient media tubercle bacilli changed their properties and biological activity which was evident first of all from their lower virulence and sensitizing capacity. Clin Microbiol Rev, 1989 Jan, 2(1), 90 - 117 Crohn's disease and the mycobacterioses: a review and comparison of two disease entities; Chiodini RJ; Crohn's disease is a chronic granulomatous ileocolitis, of unknown etiology, which generally affects the patient during the prime of life . Medical treatment is supportive at best, and patients afflicted with this disorder generally live with chronic pain, in and out of hospitals, throughout their lives . The disease bears the name of the investigator who convincingly distinguished this disease from intestinal tuberculosis in 1932 . This distinction was not universally accepted, and the notion of a mycobacterial etiology has never been fully dismissed . Nevertheless, it was 46 years after the distinction of Crohn's disease and intestinal tuberculosis before research attempting to reassociate mycobacteria and Crohn's disease was published . Recently, there has been a surge of interest in the possible association of mycobacteria and Crohn's disease due largely to the isolation of genetically identical pathogenic Mycobacterium paratuberculosis from several patients with Crohn's disease in the United States, the Netherlands, Australia, and France . These pathogenic organisms have been isolated from only a few patients, and direct evidence for their involvement in the disease process is not clear; however, M . paratuberculosis is an obligate intracellular organism and strict pathogen, which strongly suggests some etiologic role . Immunologic evidence of a mycobacterial etiology, as assessed by humoral immune determinations, has been conflicting, but evaluation of the more relevant cellular immunity has not been performed . Data from histochemical searches for mycobacteria in Crohn's disease tissues have been equally conflicting, with acid-fast bacilli detected in 0 to 35% of patients . Animal model studies have demonstrated the pathogenic potential of isolates as well as elucidated the complexity of mycobacterial-intestinal interactions . Treatment of Crohn's disease patients with antimycobacterial agent has not been fully assessed, although case reports suggest efficacy . The similarities in the pathology, epidemiology, and chemotherapy of Crohn's disease and the mycobacterioses are discussed . The issue is fraught with controversy, and the data generated on the association of mycobacteria and Crohn's disease are in their infantile stages so that a general conclusion on the legitimacy of this association cannot be made . While no firm evidence clearly implicates mycobacteria as an etiologic agent of Crohn's disease, the notion is supported by suggestive and circumstantial evidence and a remarkable similarity of Crohn's disease to known mycobacterial diseases. Probl Tuberk, 1989, (12), 19 - 21 {Progressive and acute forms of tuberculosis in young children}; CHugaev IuP; Factors involved in the development of acute tuberculosis in the form of miliary tuberculosis in 6 infants and meningeal tuberculosis in 24 infants as well as factors involved in progression of primary tuberculous infection in 8 infants without affection of the meninx but with fatal outcomes were studied . The most severe processes were shown to be more frequent in 1- and 2-year-olds being in family contacts with persons isolating tubercle bacilli (81.6 per cent), not vaccinated or defectively vaccinated with the BCG vaccine (78.9 per cent), not subjected to chemoprophylaxis (93.5 per cent) and chemotherapy (96.2 per cent) because of late tuberculosis diagnosis before hospitalization . It is recommended to improve tuberculosis control in the foci where infants are registered, to improve vaccinal prophylaxis and chemoprophylaxis to markedly increase the level of the knowledge of the general pediatrician with respect to early diagnosis of tuberculosis, to increase sanitary education of the population, including knowledge of the nature of tuberculosis. Mikrobiyol Bul, 1989 Jan, 23(1), 77 - 9 {In vitro activities of aztreonam and sulbactam/ampicillin for gram-negative bacteria}; Ozkuyumcu C et al.; In this study antibiotic susceptibilities of gram negative bacilli to Aztreonam and Sulbactam/Ampicillin were evaluated by using microdilution technique . Aztreonam inhibited 42% of the strain and Sulbactam/Ampicillin compound to 29% of them. Med Oncol Tumor Pharmacother, 1989, 6(4), 291 - 6 Combination of pipemidic acid, colistin sodium methanesulfonate and nystatin may be less effective than nystatin alone for prevention of infection during chemotherapy-induced granulocytopenia in acute leukemia; Sampi K et al.; Pipemidic acid (PPA) and colistin sodium methanesulfonate (CLM) may selectively suppress aerobic gram-negative bacilli . Twenty-nine patients with acute leukemia were randomized after each course of consolidation chemotherapy to receive a single agent of nystatin (NYS) (34 courses) versus a combination of NYS, PPA and CLM (36 courses) . The duration of fever over 39 degrees C was longer with the three drug combination (4.6 +/- 5.1 days) than with NYS alone (1.8 +/- 1.8 days) (P less than 0.01) . Four cases of pneumonia occurred and four patients including one having pneumonia died of infection with the three drug combination, while no pneumonia or death occurred with NYS alone (P = 0.06 and P = 0.06, respectively) . The combination of NYS, PPA and CLM may be less effective than NYS alone for the prevention of infection in acute leukemia patients with chemotherapy-associated granulocytopenia. Probl Tuberk, 1989, (9), 46 - 8 {Tuberculosis morbidity in regions with a low population density}; Galimov SA; Tuberculosis incidence was studied in the northern areas of Irkutsk Province with low population density . In the areas slower lowering of pulmonary tuberculosis incidence was noted . The main contingent of the new cases included persons with the disease detected during fluorographic examinations . In the areas with low population density, the percentage of the new cases with tubercle bacilli isolation and late diagnosis of tuberculosis was higher than in the areas with high population density . The influence of migration on the epidemiological status with respect to tuberculosis in the areas with low population density was less significant as compared to that in the areas with high population density. Acta Leprol, 1989, 7 Suppl 1, 226 - 30 A study of the relatedness of Mycobacterium leprae isolates using restriction fragment length polymorphism analysis; Williams DL et al.; The inability to cultivate Mycobacterium leprae in vitro has severely hampered comprehensive phenotypic analysis of individual isolates, leaving unanswered the question of the relatedness of these isolates . Since the nucleotide sequence of a bacterial chromosome is its "genetic fingerprint", we have employed the use of restriction fragment length polymorphism (RFLP) analysis of chromosomal DNA of M . leprae isolates to assess the relatedness among these isolates . DNA of M . leprae was harvested from infected armadillo tissue originally inoculated with bacilli from lepromatous lesions of human patients from geographically distinct regions of the world . Restriction endonuclease (EcoRI, PstI, and PvuI) digests of chromosomal DNA were analysed using DNA probes encoding all or part of the 28-kDa, 65-kDa and 70-kDa proteins of M . leprae . Comparison of the resultant autoradiographs showed that the RFLP patterns were all identical indicating that these isolates contained no polymorphism with respect to the restriction endonuclease sites analysed . These results indicated that the M . leprae isolates tested in this study were indistinguishable at the genotypic level, suggesting the possibility of homogeneity among members of the species, M . leprae. Biomed Pharmacother, 1989, 43(2), 141 - 3 Antimycobacterial chemotherapy in inflammatory bowel disease; Picciotto A et al.; We report on a case, ulcerative colitis and another of Crohn's disease . During a relapse which was unresponsive to conventional therapy, acid-fast bacilli were found in colonic biopsies . Conventional therapy was substituted with antimycobacterial chemotherapy (rifampicin, isoniazid and ethambutol) which was responsible for a marked improvement . However, a relapse occurred during chemotherapy and no acid-fast bacilli were found . The patients became responsive to sulphasalazine and corticosteroid therapy once again . It appears that Mycobacteria play a collateral role in inflammatory bowel disease and that once they have been eliminated the original disease re-emerges. Rev Pneumol Clin, 1989, 45(2), 81 - 5 {Multifocal tuberculosis of bone . Apropos of an exceptional case}; Vaylet F et al.; Multifocal tuberculosis of bones (MTB) is exceptional in Europe . To the few cases found in the literature the authors add another case well documented by computerized tomography and nuclear magnetic resonance and remarkable for the number of bone lesions and their coexistence with extra-skeletal lesions . The patient was a 28-year old man native of the Ivory Coast in whom the imaging techniques demonstrated no less than 19 different bone lesions plus an abscess of the iliopsoas muscle and a prevertebral pus collection . The diagnosis of MTB was confirmed by the finding of alcohol- and acid-fast bacilli at needle aspiration of the bone lesions and by the presence of folliculo-caseous Ziehl-stained granuloma on bronchial biopsies . Fourteen months after treatment with specific 4-drug therapy, the outcome is favourable . This case is exceptional by the diffusion of bone lesions and by their association with bronchial lesions due to lymph node fistulization . Modern imaging techniques (CT, NMR), clearly demonstrated the bone lesions and their extent. Rev Mal Respir, 1989, 6(4), 335 - 42 {Rifabutine in the treatment of mycobacterial infections resistant to rifampicin . Preliminary results . Group for the Study and Treatment of Resistant Mycobacterial Infections (GETIM)} {Reasons for the late diagnosis of pulmonary tuberculosis in the outpatient polyclinic network} Baras ES. A total of 1019 patients were referred by polyclinics of Dushanbe to the Republic Tuberculosis Dispensary for examination and in 109 of them active tuberculosis of the lungs was diagnosed . In 41 of them, a degradation phase was stated and 38 isolated tubercle bacilli . Many of the patients with active tuberculosis of the lungs had been previously observed for prolonged periods by district therapists . Incorrect diagnoses of acute respiratory diseases, pneumonia, chronic nonspecific diseases of the lung and other diseases were recorded in their medical histories . In 0.97 per cent of the persons hospitalized in a therapeutic unit for various diseases of the viscera, acute pulmonary tuberculosis was diagnosed . Retrospective analysis of the outpatient and in-hospital histories of the new cases of pulmonary tuberculosis showed that the mistakes in the diagnoses at the outpatient stage were mainly due to imperfect medical examination of the patients. Probl Tuberk, 1989, (8), 13 - 7 {Characteristics of localization and occurrence of tuberculous infection in rural areas}; Lomachenkov VD et al.; A long-term observation for 12 years revealed a tendency to stabilization of localization of tuberculous infection foci in rural areas and their main concentration in large villages . In such villages 82.7 per cent of new cases of tuberculosis and 80.3 per cent of new cases of tuberculous infection were recorded . The tension of the epidemiological situation with respect to tuberculosis in rural areas directly depended on the number of tubercle bacilli carriers living in such areas . It was maintained by three factors: migration of the bacilli carriers, the number of new cases of bacillary tuberculosis of the lungs and the results of their therapy . Among persons having family contacts with tubercle bacilli carriers, the incidence of pulmonary tuberculosis was 12.4 and 40.6 times higher than that resulting from professional and village contacts, respectively . A differential approach to organization of anti-epidemiological measures, early detection and prophylaxis of tuberculosis in rural areas is proposed. Probl Tuberk, 1989, (5), 19 - 22 {Status of bacteriological services in tuberculosis institutions of the RSFSR and prospects of their improvement}; Dolzhanskii VM; Organization of the work of bacteriological laboratories in tuberculosis institutions of the RSFSR is discussed in regard to the aspects of their lawful status, functions and activity results . It was shown with extensive materials (from more than 30 administrative territories) that systemic bacteriological examination of the groups of high tuberculosis risk markedly lowered the number of the sources of tubercle bacilli isolation not registered in tuberculosis dispensaries . Patients with urogenital pathology were found to be frequent sources of tubercle bacilli isolation . It was recommended to decrease the number of assays for drug resistance of the isolates, to perform them only by clinical indications and to change the investigation procedure by testing mainly the resistance of tubercle bacilli. Probl Tuberk, 1989, (1), 32 - 4 {T-suppressors and their functional activity in tuberculosis in middle-aged and elderly subjects}; Adambekov DA et al.; The role of T-suppressor cells in regulation of the immune response in patients with pulmonary tuberculosis and in healthy persons in regard to their age was studied . 226 persons were examined . The findings showed that ageing was accompanied by an increase in the functional activity of T-suppressor cells . In the elderly and senile persons with active tuberculosis there were observed higher counts of T-suppressor cells and their increased specific and nonspecific activity . With aggravation of the tuberculosis process the lymphocyte activity increased . These shifts were likely to be the basis of incomplete immune responses to tubercle bacilli in elderly and senile patients with tuberculosis. Probl Tuberk, 1989, (1), 12 - 4 {Bacteriological method of examination in the diagnosis of reactivation of the tuberculous process among contingents in ambulatory care group VII}; Krivtsova AE et al.; Under field conditions repeated bacteriological examination of tuberculous persons registered in the dispensary group VII was performed in 2 regions of the Kazakh SSR with different levels of the epidemiological process . The frequency of tubercle bacilli isolation in the persons ranged from 2.7 per cent in the region with a relatively favourable situation with respect to tuberculosis to 14.5 per cent in the region with the epidemiologically unfavourable situation . On the whole, in both the regions the main number of tubercle bacilli carriers was detected among the persons living in sparsely populated cattle breeding areas, the most distant from the Region centre . Analysis of the bacilli isolation quantitative aspect showed that massive (39.6 per cent) and moderate (42.8 per cent) tubercle bacilli isolation predominated. J Egypt Public Health Assoc, 1989, 64(1-2), 45 - 54 Diagnosis of tuberculous meningitis by immunofluorescence and enzyme immunoassay; Hassan EM et al.; Cerebrospinal fluid was collected from 29 patients with tuberculous meningitis, 21 and 7 patients with bacterial and viral meningitis and 5 normal subjects . Pressure, aspect, glucose, protein and cellular content of CSF were studied . Detection of acid fast bacilli in direct film stained by Zeil Neilsen (Z.N.) and fluorochrom (Fl.Ch.) and Culture on Lowenstein Jensen media were done . Then specific immunoglobulin G & M to Mycobacteria were assayed by Immunofluorescence (IF using BCG) and by Enzyme Linked Immunosorbant assay (ELISA) using protein-A of M . Tuberculosis . It was found that diagnosis of M . Tuberculosis by CSF culture was more sensitive than by direct CSF film stained with Z.N . or Fl.Ch . stain (positive in 44.8%, 10.3% and 17.2% of cases respectively) . It was noticed that the detection of CSF IgG antibodies was more sensitive than IgM antibodies either by IF or ELISA . By comparing ELISA and IF tests for detection of specific anti-mycobacterial immunoglobulin in CSF, it was clear that the sensitivity and specificity of ELISA was more than IF test . A positive result for antimycobacteria IgG antibodies was obtained in 79.3% and 58.6% of cases respectively (p less than 0.05) . None of the CSF of normal controls, bacterial and viral meningitis cases gave positive antimycobacteria IgG by ELISA while 9.5% of the CSF of bacterial and 14.3% of aseptic meningitis cases gave positive results with IF . The sensitivity, specificity and predictive value of the described ELISA test, make it useful for early diagnosis of tuberculous meningitis. Probl Tuberk, 1989, (12), 12 - 4 {The epidemiological hazard of patients with active pulmonary tuberculosis and undetermined bacterial shedding}; Arenskii VA et al.; The degree of the epidemiological hazard of new cases of active pulmonary tuberculosis with unconfirmed isolation of tubercle bacilli and patients registered in groups I (without isolation of tubercle bacilli) and II of the dispensary observation was estimated in comparison to persons isolating tubercle bacilli . The hazard of the patients with active tuberculosis of the lungs and not confirmed isolation of tubercle bacilli for the members of their families and neighbours was shown to be 5-6 times lower than that of the patients isolating tubercle bacilli . However, it was 5-6 times higher than that for the population as a whole . It was proposed to perform primary epidemiological arrangements after registration of new cases of active pulmonary tuberculosis or persons with suspected pulmonary tuberculosis before verification of the diagnosis and availability of the results of bacteriological examinations. Probl Tuberk, 1989, (10), 43 - 6 {Effects of low-frequency ultrasound on Mycobacterium tuberculosis}; Shaikhaev AIa et al.; The effect of low frequency ultrasound on various strains of tubercle bacilli was studied in 105 experiments . The analysis of the experimental results showed that under the conditions corresponding to those of dissection, sawing and sanation during the surgical operations the ultrasound had a bactericidal action on tubercle bacilli, both sensitive and resistant to antituberculous drugs . In 75 per cent of the objects there was an ultrasound-induced change in the drug resistance of tubercle bacilli in the direction of its lowering . Low frequency ultrasound had not stimulant effect on the growth and multiplication of tubercle bacilli. Probl Tuberk, 1989, (9), 10 - 3 {Tuberculotic cirrhosis and indices of its activity}; Il'ina TIa; Clinical pictures of tuberculous cirrhosis were studied in 195 persons observed in various groups of dispensary registration . In addition, bacteriological-morphological data relating to 79 operated patients were compared and bacteriological investigations were performed in 145 x-ray negative phthisiologists and 80 patients with nontuberculous diseases of the respiratory organs . It was shown that in the majority of the patients and persons with posttuberculotic cirrhosis the symptomatic process of the disease was mainly defined by concomitant diseases . The bacilli isolation was an insignificant the most common but not the only characteristic of cirrhosis activity . For its determination it is advisable to observe such persons in group O of dispensary registration and to perform provocative treatment. Probl Tuberk, 1989, (8), 29 - 32 {Thin-needle aspiration biopsy of the lung in the diagnosis of tuberculosis}; Sedliachek AM et al.; The results of bacteriological examination of materials collected by thin needle aspiration biopsy (TNAB) of the lung in patients with suspected cancer are presented . Koch's bacilli were detected in 67 cases per 1470 examinations performed for a period of 11 years . Positive bacterioscopic results were stated in 20 patients with negative cytological results . In 17 cases drug sensitivity of tubercle bacilli was determined which was important for the treatment tactics . The examination showed that the bacteriological detection of tubercle bacilli in the materials collected with TNAB was more simple and more available than cytological diagnosis of tuberculosis. Probl Tuberk, 1989, (7), 59 - 62 {Method of combined micro- and macrocultivation of Mycobacterium tuberculosis in egg medium using agar gel disks}; Bil'ko IP; A procedure for combined micro- and macrocultivation of tubercle bacilli in the egg media by using agar gel disks was developed and experimentally tested . The essence of the procedure lies in plating mycobacteria on agar gel disks applied to the egg medium in Petri dishes followed by incubation at 37 degrees C for 5-7 days . Later on the agar gel disks are removed from the medium and examined microscopically for growth of tubercle bacilli in microcolonies (microcultivation) . Then the gel disks are applied to the medium in the dishes from which they were removed and again incubated until macroscopically evident growth of tubercle bacilli is observed (macrocultivation). Probl Tuberk, 1989, (7), 29 - 32 {Clinical picture and course of newly detected pulmonary tuberculosis in elderly and senile patients, discharging L-forms of Mycobacterium tuberculosis}; Kochetkova EIa; One hundred and forty two new cases of pulmonary tuberculosis of elderly and senile ages were observed clinically . In terms of the vegetating mycobacterial population, all the patients were divided into 3 groups . It was shown that pronounced clinical and x-ray signs of pulmonary tuberculosis were characteristic of the patients isolating only bacterial forms of the pathogen (group 1) . Intensive chemotherapy of the patients of that group was the most efficient . At the same time lethality in that group was the highest . In the patients isolating both the bacterial forms and the L-forms of the pathogen (group 2), the clinical signs of the disease were similar to those in the patients of group 1 . However, the time-course of their clinical, x-ray and laboratory indices was slower and the therapy results were less satisfactory than in the patients isolating pure cultures of tubercle bacilli . In the patients isolating only L-transformed variants of tubercle bacilli (group 3), the clinical symptoms were characterized by their latent onset and torpid course . The treatment results in the patients of that group were not sufficient. Diagn Cytopathol, 1989, 5(3), 260 - 2 Role of culture for mycobacteria in fine-needle aspiration diagnosis of tuberculous lymphadenitis; Radhika S et al.; A total of 390 cases of tuberculous lymphadenitis was subjected to fine-needle aspiration cytology; 100 of the aspirates were subjected to culture for mycobacteria . The overall acid-fast bacilli (AFB) positivity in smears was 23.58%, with a maximum positivity of 32.94% in smears with both necrosis and granuloma . The overall rate of isolation of mycobacteria on culture was 35% . Mycobacteria were more frequently isolated from caseating lesions (40%) than noncaseating lesions (9%) . Caseating lesions with granuloma had the highest AFB (smear and/or culture) positivity at 52% . Mycobacterium avium infection was diagnosed by culture in one case. Probl Tuberk, 1989, (6), 3 - 7 {The etiologic significance of ultrafine forms of the causative agent of tuberculosis in the development of sarcoidosis of the respiratory organs}; Khomenko AG et al.; Pathological material, i . e . bronchoalveolar lavage fluid (BALF) and blood plasma from patients with various pathological processes in the lungs was studied . Eighty seven patients with sarcoidosis of the respiratory organs were subjected to complex microbiological investigation and ultrasmall forms of tubercle bacilli were detected in BALF of 67 (77 per cent) of them . Histological examination revealed alveolitis and granulomas of lymphoid-macrophagal nature in the lungs of the experimental animals exposed to the material from the sarcoidosis patients. Acta Leprol, 1989, 7 Suppl 1, 36 - 8 Effect of lyophilization on viability of Mycobacterium leprae multiplied in nude mouse; Nakamura M et al.; In an effort to preserve Mycobacterium leprae in vitro, the effect of freezing and drying, i.e., lyophilization, on viability of M . leprae was studied . The viability of the bacilli was quantitatively measured with foot-pad inoculation method using nude mouse . The results obtained demonstrate that the viability of M . leprae was reduced approximately 10(-2) to 10(-3) from that of the starting material, during the process of lyophilization; no viable bacilli were detected in the lyophilized sample containing less than 1.8 X 10(3) bacilli . On the other hand, the bacilli capable of multiplication in nude mouse foot-pads were found in the lyophilized sample with more than 10(5) bacilli . From the results obtained here, it could be suggested that there might be a possibility to preserve M . leprae in vitro by means of lyophilization. Acta Leprol, 1989, 7 Suppl 1, 156 - 9 Comparative intracellular growth of difficult-to-grow and other mycobacteria in a macrophage cell line; Rastogi N et al.; We have recently developed a murine macrophage cell line (J-774) model which permits the growth of various mycobacteria (8) . The purpose of the present investigation was to compare the intracellular growth of various difficult-to-grow mycobacteria (Mycobacterium paratuberculosis, M . ulcerans), and other pathogenic (M . tuberculosis H37Rv, M . kansasii, M . bovis) and nonpathogenic or avirulent (M . tuberculosis H37Ra, M . bovis BCG, M . gastri) mycobacteria . Electron microscopic studies were also performed to elucidate whether the formation of an electron-transparent zone (ETZ) around phagocytized bacilli was linked to their intramacrophagic survival . Furthermore, the comparison of intracellular growth of a pathogenic (M . kansasii) and nonpathogenic (M . gastri) mycobacteria sharing the same phenolic glycolipid antigen at their surface (Mycoside-A, 5), suggested that these antigens did not play a primary role in intracellular survival and multiplication of these bacteria . Also, we were unable to propagate M . ulcerans inside J-774 macrophages, which were massively lyzed after infection (due to a characteristic toxin secreted inside the macrophages?) . These results are discussed in terms of the validity of the J-774 model for studying intracellular growth of mycobacteria. Acta Leprol, 1989, 7 Suppl 1, 153 - 5 Immunotherapy of treated BL/LL cases with BCG: histopathological, immunohistological and bacteriological assessments; Katoch K et al.; The persistence of dead as well as viable bacteria is an important therapeutic problem in multibacillary leprosy . In highly bacillated patients, viable bacteria are detectable in 10-15% of cases after 2 years of treatment and none of these cases became smear negative by 2 years of recommended multidrug therapy (MTD) . Immunotherapy trials using BCG (0.1 mg) by intradermal route have been undertaken in cases who had MDT for 2 years and who had viable bacilli by ATP photometry and/or FDA-EB staining . Biopsies and smears were taken from local as well as distant sites at 0.4 weeks and 6 months after BCG vaccination . Biopsies were processed for ATP counts, FDA-EB staining, histopathology and immunohistology for cell types at 0.4 weeks . There was transient effect on BI, ATP counts, FDA-EB staining at local as well as distant sites in some cases . Histopathology and immunohistological findings suggest that there is tendency to form epithelioid cell granuloma at local site in all cases and at distal sites in some . There was infiltration of subepidermal zone in one case, 4 weeks after vaccination . BCG may be of use as potential immunotherapeutic agent but its usefulness needs to be investigated in depth preferably in the beginning or early phases of chemotherapy and with also repeated inoculations. Acta Leprol, 1989, 7 Suppl 1, 125 - 7 Demonstration of PGL I antigens in skin biopsies in indeterminate leprosy patients: comparison with serological anti PGL I levels; Huerre M et al.; The survey of histological findings in leprosy patients from 1985 to March 1988 has been carried out at the Pasteur Institute in Noumea . Histologically, according to Ridley Jopling criteria, 82 patients were classified, 14 as T.T., 12 as B.T., 2 as B.B., 7 as B.L., 4 as L.L.s., 24 as L.L.p . and 19 as Indeterminate leprosy . Histological examination of tissues sections, using a monoclonal anti-PGL I antibody showed PGL I antigen in histiocytic cells of the infiltrate and more rarely in Langerhans cells in 7 cases of indeterminate leprosy . The Ziehl staining method revealed the presence of alcoholo resistant bacilli in only one case . For 10 patients, histological findings were compared with serological results . In 3 cases, the diagnosis was confirmed by the 2 techniques (immunohistology and serology) . In 2 cases by only immunohistology or by serology and in 3 cases the diagnosis was not confirmed by either methods . These results showed the interest of the immunohistological and serological methods in indeterminate leprosy, specially in children . A study of household contacts may be of interest. Acta Leprol, 1989, 7 Suppl 1, 107 - 12 In situ locations of Mycobacterium leprae-specific antigens . Immunoelectronoptical studies; Boddingius J et al.; Lipid or protein antigen sites in Mycobacterium leprae proper and in M . leprae -infected human or armadillo tissues were investigated by immunogold-electron microscopy . Simultaneous preservation of immunogenicity of antigens and conservation of ultrastructural details of M . leprae and host cells was aimed at by subjecting organisms and tissues, prior to immunolabelling, to differing fixation, embedding and ultramicrotomy techniques . The M . leprae-specificity of monoclonal antibodies (MoAbs) utilized in the study was tested first . Hereto, ultracryosections of M . leprae, M . tuberculosis and M . nonchromogenicum suspended in gelatin were employed . MoAb anti-phenolic glycolipid I (PGL I) and MoAb anti-36 kD were found to be specific for M . leprae . MoAb anti-65 kD also labelled the cytoplasm of M . tuberculosis . After incubation with MoAb anti-lipid MAIS, employed as control MoAb, no gold labelling of leprosy bacilli or host cells was seen . PGL-I immunogenicity was still present after "hard" fixation of M . leprae and host cells in glutaraldehyde-OsO4 and after Araldite embedding . This enabled the qualitative demonstration of PGL-I inside the cell wall and capsular area of M . leprae and in vacuoles of bacillated phagolysosomes of macrophages in Araldite-embedded human skin biopsies and armadillo liver parenchymal cells . Sites of 65 kD and, to a lesser extent, of 36 kD protein antigens in M . leprae were demonstrable only in ultracryosections of non-fixed organisms and not in Araldite sections . Results are discussed and recommendations for future investigations on M . leprae antigen sites are presented. Acta Leprol, 1989, 7 Suppl 1, 10 - 5 Non-cultivable mycobacteria in ulcers of the skin; Salem JI et al.; In biopsies of 54 patients suffering from chronic dermatological lesions (mostly ulcers of the skin) acid-fast bacilli were found in 14 . In these 14 cases in 4 were lesions caused by M . tuberculosis, in 1 the lesion was caused by M . avium-intracellulare, in 1 the lesion was caused by M . fortuitum and in 2 the lesions were caused by non-cultivable mycobacteria (Feldmann-Hershfield ulcer?) . In 2 cases the cultures were heavily contaminated, and the diagnosis remained uncertain . In the remaining 4 cases the mycobacteria were considered occasional isolates without clinical significance. Med Dosw Mikrobiol, 1989, 41(1), 9 - 14 {Effect of various peptides on the growth of Mycobacterium tuberculosis}; Malski M; Ten oligopeptides containing asparagine, glutamic acid, leucine or alanine on growth of Bacillus tuberculosis were tested . The experiments were performed on AS medium free of peptones . Bacterial suspensions were inoculated and the number of colonies and rapidity of bacilli growth under an influence of peptides tested was compared . Out of peptides studied and their different combinations the best turned to be combination of 0.01% glutathione +0.002% Gly-Asn + 0.0033% Leu-Gly . This combination allowed to appear on average 46% colonies more than on medium without peptides and first growth of tubercle bacilli was seen on average 3.2 days earlier than on medium free of peptides . Addition to the medium containing three above listed peptides of 0.1% of Bacto Tryptone (Difco) caused an increase of 127% of colony number of tubercle bacilli and their growth appeared 1.7 day earlier as compared to growth on medium containing these three peptides. Probl Tuberk, 1989, (5), 43 - 6 {An immunologic method for identification of M . tuberculosis and M . bovis (BCG) based on the use of monoclonal antibodies}; Androsova MV et al.; Monoclonal antibodies interacting with specific selectivity with human tubercle bacilli (monoclonal antibodies of the cell producing strain 62D) and bovine tubercle bacilli (BCG) (monoclonal antibodies of the cell producing strain 60D) were produced with hybridoma technology . A rapid, productive and safe procedure for identification of M . tuberculosis and M . bovis (BCG) was developed on the basis of solid phase enzyme immunoassay . The immunological procedure was compared with the biochemical (niacin) method for identification of mycobacteria . The immunological procedure was shown to be reliable and promising for practical use. Probl Tuberk, 1989, (3), 14 - 8 {Isolation of mycobacteria L forms as a prognostic criterion of recurrence and aggravation of tuberculosis in patients with extended residual tuberculous lesions of the lungs}; Dorozhkova IR et al.; To elucidate the role of tubercle bacilli L-forms in tuberculosis relapsing and aggravation in patients with extended residual lesions in the lungs, 117 patients mainly with extended and neglected destructive tuberculosis of the lungs were observed for a period of 5 to 7 years with using microbiological and clinico-roentgeno-laboratory examinations . Analysis of the immediate and remote results of the treatment showed that in the group of the abacillary patients according to the routine microbiological investigations who continued to isolate L-forms of tubercle bacilli at the background of remaining destructive cavities in the lungs aggravations and relapses amounted to 46.6 per cent . The etiological role of the L-forms was proved by absolute identity of the biological properties of the L-form revertants isolated from in vitro subcultures and tubercle bacilli, isolated from the patients during the process relapsing. J Basic Microbiol, 1989, 29(1), 41 - 8 An electron microscopic study of alterations in the morphology and permeability of purified Mycobacterium leprae; Prabhakaran K et al.; This communication reports the association of changes in ultrastructure of Mycobacterium leprae with alterations in its permeability . To study morphologic changes of the organisms under different conditions (of temperature and exposure to NaOH and trypsin), ultrathin sections of the bacteria were cut and examined in an electron microscope . In the untreated bacilli and those washed with trypsin, the cytoplasmic membrane and the cell wall (peptidoglycan layer) remained intact; dapsone showed little effect on diphenoloxidase of the bacteria . M . leprae is unique among mycobacteria in possessing an unusual form of the enzyme diphenoloxidase . The antileprosy drug dapsone is a potent inhibitor of the enzyme, but it does not readily penetrate the bacteria where the cell envelope remains intact . The cell wall of M . leprae exposed to -80 degrees C or washed with NaOH was partially detached from the cell membrane; dapsone readily penetrated these organisms and inhibited the bacterial enzyme . In the above preparations, the cytoplasmic membrane appeared undamaged and the bacteria remained viable, as evidenced by multiplication in mouse foot pads . At 50 degrees C, the peptidoglycan layer became completely separated from the membrane and the cytoplasm was partially denatured . These organisms were permeable to dapsone, but were no longer viable . At 100 degrees C, the structural organization of the bacilli was completely destroyed, and of course, they lost their enzyme activity as well as viability . Evidently, the intact cell wall layer mediates the exclusion of dapsone from M . leprae, and there is no correlation between its viability and permeability . The ultrathin sections also reveal the internal organization and cytoplasmic inclusions of M . leprae, as never before seen. Probl Tuberk, 1989, (2), 37 - 9 {Immediate and late results of the surgical treatment of patients with post-tuberculosis cavities}; Vorozhtsova MP; Examination of lung sections from patients with residual posttuberculous cavities not discharging tubercle bacilli for long periods revealed latent bacterial lesions of cavern wall tissues and active specific processes in 73.6 and 92.1 per cent of the cases respectively . Bacteriological investigation of the resected lungs revealed no significant advantages of the tuberculostatic therapy with using rifadin at various stages for 2-4-month courses in comparison to the therapy without rifadin . The immediate results of the surgical treatment were indicative of its high efficiency; closing of destructive cavities, low numbers of postoperative complications which could be easily corrected . At late observation periods the surgical treatment provided more reliable rehabilitation. Infect Immun, 1989 Jan, 57(1), 239 - 44 Pathogenicity of Mycobacterium avium for human monocytes: absence of macrophage-activating factor activity of gamma interferon; Toba H et al.; Mycobacterium avium is a frequent opportunistic pathogen in the acquired immunodeficiency syndrome (AIDS) . We compared 12 strains of M . avium in an in vitro model of pathogenicity . Peripheral blood-derived monocytes from healthy individuals were infected with M . avium in vitro . Bacterial uptake and intracellular replication were assessed by microscopic count of acid-fast bacilli and CFU of bacteria, respectively, in lysed monocytes . The CFU assay showed that among five AIDS-associated strains, only one replicated in monocytes . Two of seven non-AIDS-associated strains replicated intracellularly . In addition, we examined the effect of gamma interferon (IFN-gamma) on M . avium infection . IFN-gamma treatment of monocytes decreased phagocytosis and had no effect on the intracellular replication of M . avium . Thus, most strains of M . avium do not multiply within monocytes from healthy individuals and IFN-gamma does not have macrophage-activating factor activity for M . avium infection of human monocytes. Medicina (B Aires), 1989, 49(5), 533 - 6 {Ceftizoxime: in vitro evaluation}; Fernandez AJ et al.; The effect of ceftizoxime, a new aminothiazolil-syn-methoxy-iminocephalosporin has been evaluated on 169 strains of Gram negative bacilli isolated from hospitalized patients and compared with that of cefotaxime and of ceftriaxone . The effect of these 3 cephalosporins and of cefalotin was also evaluated on 50 strains of staphylococcus . CIM50 of ceftizoximel was as follows: K . pneumoniae less than .032, aureus and S . epidermidis less than .2 CIM90 for the same species was: K . pneumoniae less than .25, E . coli less than .63, E . Cloacae and S . marcescens less than 8, S . aureus less than 32, S . epidermidis less than 16 . The values obtained with cefotaxime and ceftriaxone were similar . Cefalotin was clearly more active on staphylococcus strains with CIM50 and CIM90 for both species of less than .25 and less than .2 respectively. Z Erkr Atmungsorgane, 1989, 173(1), 75 - 80 {Ten years of quality control in the microscopic detection of acid-fast bacilli}; Reinhardt A; The results of proficiency tests in screening for acid-fast bacteria are reported . Out of 52 participating laboratories, the results obtained by 47 of them could be evaluated . Thanks to this current check of quality and annual evaluation, erroneous results were detected, their cause could be determined and measures to secure reliability of the examinations were taken. Lab Delo, 1989, (4), 58 - 61 {Tinctorial properties of microorganisms isolated from blood}; Andreeva ZM et al.; Cultures isolated from human and animal blood have been examined in tests with 3% KOH solution; their sensitivities to various concentrations of sulfanol have been tested in order to specify the tinctorial characteristics of these cultures; antibiotic sensitivity of this group of microorganisms has been studied with the use of discs . The findings evidence that gram-variable nonspore-carrying aerobic bacilli isolated from human and animal blood should be referred to gram-positive microorganisms; their antibiotic sensitivity has been detected . The tests employed in the study may be rationally used for the identification of polychromic bacteria isolated from the blood. Biochim Biophys Acta, 1988 Dec 8, 946(1), 40 - 8 Permeability studies of lipid vesicles from alkalophilic Bacillus firmus showing opposing effects of membrane isoprenoid and diacylglycerol fractions and suggesting a possible basis for obligate alkalophily; Clejan S et al.; Previous studies of the membrane lipids of extremely alkalophilic bacilli had indicated that both facultative and obligate alkalophiles contained a substantial fraction of isoprenoid lipid as well as high concentrations of cardiolipin . Facultative alkalophiles differed from obligate strains in having a phospholipid fatty acid composition that would be expected to result in a more ordered membrane structure . Current studies of ion permeability in vesicles prepared from lipids from obligately alkalophilic Bacillus firmus RAB and its facultatively alkalophilic strain, OF4, support the suggestion that membranes of the latter strain form a tighter barrier structure, with the difference especially pronounced at near neutral pH values . The water permeability of whole cells and the reflection coefficients for acetamide in vesicles were also consistent with a tighter membrane in the facultatively alkalophilic strain than in the obligately alkalophilic strain . The permeability properties of vesicles prepared from phospholipids from these organisms were studied as a function of the addition of either homologous membrane isoprenoid or diacylglycerol . For each permeability parameter that was assayed, in lipids from both strains, the isoprenoid fraction decreased the permeability, whereas the diacylglycerol fraction increased the permeability of the vesicles to solute. Tubercle, 1988 Dec, 69(4), 255 - 65 Surveillance of diagnostic and treatment measures in Bavaria, 1974-1976 . Results 2 and 5 years after the start of chemotherapy; Blaha H et al.; A central surveillance register for all bacillary pulmonary tuberculosis cases reported in Bavaria (population in excess of 10 million) was established from 1974 to 1976 . The aim of the study was to discover the quality and efficiency of health services delivery to the population in the field of tuberculosis under routine conditions, and to find out the relapse rate after cessation of chemotherapy in expatients who were found to be negative 2 years after starting chemotherapy . A total of 7850 German patients with bacillary pulmonary tuberculosis were diagnosed in Bavaria from 1974 to 1976 corresponding to an average annual rate of 25.7 per 100,000 population: 71% of them were smear-positive and 29% were positive by culture only . Reactivations formed 25% of all bacteriologically confirmed cases . Most (71%) smear-positive new cases were discovered because of symptoms . Of the 5157 cases of bacteriologically confirmed pulmonary tuberculosis reported during 1975 and 1976, 4% died from tuberculosis, 1% from sequelae of tuberculosis and 9% from causes other than tuberculosis . A further 3% of patients had drug side-effects, 3% were uncooperative, 2% emigrated or had no permanent address and 1% had no chemotherapy or no information on treatment . The overall results of treatment were very satisfactory: sputum conversion among 3991 patients in the group with complete treatment was achieved in 97.4% at 2 years, and in those with incomplete treatment in 96.2% . The duration of chemotherapy was long, i.e . 19 months or more in two thirds of the patients . The average reactivation rate during the 3rd, 4th and 5th follow-up years was 0.8% annually; it was higher among males than females and the rate increased with age . Of the 157 patients found to be bacteriologically positive at 2 years after the start of chemotherapy 46 died during the 3-year observation period and 109 were alive at 5 years, 23 of whom were harbouring tubercle bacilli. Antimicrob Agents Chemother, 1988 Dec, 32(12), 1769 - 75 Effects of clindamycin and metronidazole on the intestinal colonization and translocation of enterococci in mice; Wells CL et al.; The intestinal colonization and translocation of enterococci was studied in mice treated intramuscularly with metronidazole or clindamycin, with or without oral streptomycin . Treatment with metronidazole resulted in selective elimination of strictly anaerobic cecal bacteria, with a 100-fold increase in the numbers of aerobic and facultative gram-negative bacilli and a 10,000-fold increase in the numbers of aerobic and facultative gram-positive species . Clindamycin had a similar effect on the cecal flora except that the numbers of aerobic and facultative gram-positive bacteria decreased at least 10-fold . The predominating gram-positive species in the cecal flora or metronidazole-treated mice was an enterococcus, but this organism could not be recovered from the ceca of clindamycin-treated mice . Translocating bacteria (primarily gram-negative enteric bacteria) were recovered from the mesenteric lymph nodes of the majority of mice given metronidazole or clindamycin . Gram-positive bacteria were not recovered from the mesenteric lymph nodes of 20 clindamycin-treated mice, whereas 26% of 19 metronidazole-treated mice had translocating enterococci . With addition of streptomycin to the metronidazole and clindamycin regimens, mice treated with metronidazole-streptomycin became colonized predominantly with an enterococcus, and this was the only translocating species recovered from 13% of 23 mice; however, enterococci could not be detected in the ceca of clindamycin-streptomycin-treated mice, and Bacillus spp . were recovered from the mesenteric lymph nodes of 8% of 24 mice, reflecting the composition of the cecal flora . The apparent elimination of enterococci from the ceca of clindamycin and clindamycin-streptomycin-treated mice was inconsistent with the observation that the average (n=6) peak levels of clindamycin in blood and ceca were 25 and 21 microgram/ml, respectively, whereas the in vitro MIC was 128 microgram/ml . However, this apparent in vivo activity of clindamycin against enterococci was not evident in mice given 10(9) oral enterococci; the concentrations of cecal enterococci in both clindamycin-streptomycin- and metronidazole-streptomycin-treated mice were 10(10) to 10(11) enterococci per g, with translocating enterococci recovered from approximately half of these antibiotic-treated mice . Thus antibiotic therapy with metronidazole, clindamycin, metronidazole-streptomycin, and clindamycin-streptomycin resulted in a wide variation in the cecal population levels and translocation frequencies of enterococci . This variation appeared to be related to the discrepancy between the in vivo and in vitro activities of clindamycin against enterococci. Aust N Z J Surg, 1988 Dec, 58(12), 947 - 50 Fine needle aspiration biopsy of tuberculous cervical lymphadenopathy; Lau SK et al.; Fine needle aspiration biopsies of 42 histologically confirmed tuberculous cervical lesions were studied . Thirty-four patients had subsequent excision of cervical lymph nodes and eight had incision and drainage of cervical abscesses . All aspirates except two (which were inadequate) were satisfactory for diagnosis and contained inflammatory cells . Twenty-seven smears revealed cells typical of granulomatous lymphadenopathy, that is, epithelioid and multinucleated giant cells . Of all aspirates, 17 smears had bacteriological staining by Ziehl-Nielsen technique, nine of which (53%) were positive for acid-fast bacilli . An aspiration biopsy diagnosis of granulomatous or tuberculous cervical lymphadenopathy was made in 30 patients (71%) . In regions where mycobacterial infection is common, the presence of granulomatous changes in lymph node aspirates is highly suggestive of tuberculosis . When the aspirates contain purulent material or when tuberculosis is suspected, staining and culture for mycobacteria should be performed . FNA biopsy is a sensitive, specific and cost-effective way to diagnose tuberculous cervical lymphadenopathy and is recommended. Eur J Clin Microbiol Infect Dis, 1988 Dec, 7(6), 807 - 9 In vitro interaction between the penem FCE 22101 and ceftazidime; Barry AL et al.; FCE 22101, a penem antimicrobial agent, was found to resist hydrolysis by bacterial beta-lactamases and to have a strong affinity for Type Ia enzymes . Like imipenem, FCE 22101 was shown to be capable of inducing resistance to a wide range of beta-lactam antibiotics . FCE 22101 antagonized the in vitro activity of ceftazidime against enteric bacilli that commonly produce inducible enzymes . This penem should not be combined with other beta-lactams for chemotherapeutic purposes. Brain Behav Immun, 1988 Dec, 2(4), 341 - 5 Immunological and cytological studies of autoimmune demyelination and multiple sclerosis; Colover J; The early history of experimental allergic encephalomyelitis is reviewed from the point of view of the characterization and recognition of myelin basic protein and the active agent in acid-fast bacilli, namely muramyl dipeptide . Protocols effective in inducing demyelination are pinpointed . Special attention is paid to the protocol which depends on pretreating guinea pigs with muramyl dipeptide and foreign protein followed by a second injection of foreign protein and then the animals are injected with myelin basic protein and Freund's complete adjuvant . Variations in the timing and amounts of muramyl dipeptide are described as are their effects on the demyelination . The myelin breakdown has been studied with a monoclonal antibody reactive to P2 . Similar pretreatment enhances the demyelination in Semliki Forest virus infection in mice . The changes in the blood brain barrier are found at 7 days after the myelin basic protein is injected and show grossly increased uptake by the cerebral vascular endothelium of IgG and perivascular uptake of IgG . The changes in the cerebrospinal fluid (CSF) proteins are described (IgG and albumin) . Studies of P2 protein in the CSF by means of a new ELISA technique have been performed on human CSF in multiple sclerosis. Int J Lepr Other Mycobact Dis, 1988 Dec, 56(4), 580 - 7 Effects of freezing and thawing on the viability and the ultrastructure of in vivo grown mycobacteria; Portaels F et al.; The influence of different frequencies of freezing-thawing cycles on the viability of in vivo grown mycobacteria was investigated . Pieces of armadillo tissues naturally or experimentally infected with Mycobacterium leprae were analyzed . The viability of M . leprae was determined by mouse foot pad titration . The viability of cultivable mycobacteria, sometimes present in armadillo tissues, was determined by culture . Electron-microscopic studies were performed on fresh or frozen-thawed armadillo tissues with natural leprosy and on livers of C57BL/6 mice experimentally infected with M . avium or M . lepraemurium . We found that the percentage of viable M . leprae bacilli is identical for naturally infected and experimentally infected tissues, frozen and thawed once . When the tissues were subjected to a second freezing-thawing cycle, a considerable loss of viability was observed (65%-97%) . A third freezing-thawing cycle was lethal for most of the M . leprae cells, and after four freezing-thawing cycles no viable bacilli were found . The cultivable mycobacteria present in some armadillo tissues were found to be more resistant than M . leprae to freezing-thawing since these mycobacteria could still be cultivated after four freezing-thawing cycles . The results of the electron-microscopy study support the conclusion that M . leprae is more sensitive to freezing-thawing than the cultivable mycobacteria and show that the cytoplasmic membrane appears to be the target for the lethal action of freezing-thawing on mycobacterial cells . These results emphasize the importance of avoiding repeated thawing and refreezing of M . leprae-infected tissues when viable M . leprae cells need to be studied.(ABSTRACT TRUNCATED AT 250 WORDS) Ann Clin Lab Sci, 1988 Nov-Dec, 18(6), 463 - 7 Comparison of the inhibitory and bactericidal activity of aztreonam and amikacin against gram negative aerobic bacilli; Fung-Tomc JC et al.; Aztreonam has been compared both in vitro and in clinical trials to aminoglycosides in its activity against aerobic gram-negative bacteria . The inhibitory and killing abilities of aztreonam and amikacin were examined against five gram-negative bacillary strains . Time kill analysis was carried out at serum-achievable concentrations (25 micrograms per ml amikacin, 100 and 200 micrograms per ml aztreonam) and levels found three to five hours post-infusion (8 micrograms per ml amikacin and 25 micrograms per ml aztreonam) . Amikacin killed all five strains faster than aztreonam at all the concentrations tested . Regrowth and the presence of persisters were observed in aztreonam-treated cultures . In the presence of amikacin, there was no detectable increase in cell mass, as measured by optical density . However, following aztreonam treatment, bacterial cell mass increased in the first two to three hours before decreasing . Long, filamentous cells were observed in aztreonam-containing cultures . Though amikacin and aztreonam are bactericidal drugs, prolonged bacterial survival, continued cell growth, regrowth, and persisters were observed only in aztreonam-treated cultures. Infect Control Hosp Epidemiol, 1988 Nov, 9(11), 501 - 3 Factitious meningitis: a recurring problem; Penn RL et al.; Although gram-negative meningitis is rare in our hospital, between July, 1982 and July, 1983 clusters of cerebrospinal fluid (CSF) smears were reported positive for gram-negative bacilli . Fourteen specimens were obtained by diagnostic lumbar punctures, and one was obtained during a myelogram . No CSF cultures were positive, and a diagnosis of factitious meningitis was eventually established for each patient . Nonviable gram-negative bacilli were found in 6.7% of manometers, and 23.3% to 90% of the specimen tubes tested from the same lots of commercial lumbar puncture trays . It was estimated that there were between 44 and 333 organisms per specimen tube . Two lots of the commercial myelogram trays yielded nonviable gram-negative bacilli from 50% of the specimen tubes and 33.3% of the manometers tested . Retrospective review of laboratory records for 1982 and 1983 revealed 23 total CSF smears positive for gram-negative bacilli . No CSF grew gram-negative bacilli, and chart reviews confirmed a diagnosis of factitious meningitis in each case . In addition to the clusters of false-positive smears, this had occurred sporadically in both years . The problem did not recur after separate sterile tubes were provided for CSF collection . Physicians and laboratories should be aware that nonviable contaminants in commercial products may be a source of false-positive CSF gram-stained smears. Appl Environ Microbiol, 1988 Nov, 54(11), 2838 - 41 Comparison of rapid NFT and API 20E with conventional methods for identification of gram-negative nonfermentative bacilli from pharmaceuticals and cosmetics; Palmieri MJ et al.; The accuracy of the Rapid NFT and the API 20E identification systems was evaluated by comparing them with conventional biochemical methods for the identification of gram-negative, nonfermentative bacilli . The organisms were recovered from preserved, nonsterile pharmaceutical and cosmetic products . A total of 123 test isolates that are commonly encountered in these products were used . By using the criteria of accurate and reliable identification without employing additional tests, Rapid NFT was found to be more accurate after 48 h of incubation than API 20E for characterizing isolates to the species level . Therefore, close agreement between NFT and conventional methods for identification of industrial gram-negative isolates provides evidence that the Rapid NFT system is an improved and rapid method for identifying these organisms to the species level with minimal use of supplementary tests. Arch Surg, 1988 Nov, 123(11), 1359 - 64 Immunosuppression and intestinal bacterial overgrowth synergistically promote bacterial translocation; Berg RD et al.; Gram-negative, enteric bacilli of the indigenous gastrointestinal tract microflora translocated primarily to the mesenteric lymph nodes in mice given either oral penicillin G sodium or clindamycin hydrochloride . These bacteria also translocated to the mesenteric lymph nodes in mice injected with cyclophosphamide or prednisone . However, in mice treated with the combination of an oral antibiotic plus an immunosuppressive drug, the translocating bacteria spread systemically to the peritoneal cavity . When the treatment with clindamycin and prednisone was extended to 12 days, the mice died of lethal sepsis beginning eight days after treatment . Thus, the combination of intestinal bacterial overgrowth and host immunosuppression synergistically promoted bacterial translocation from the gastrointestinal tract that resulted in lethal sepsis. Mol Gen Mikrobiol Virusol, 1988 Nov, (11), 45 - 9 {Glycine-dependent cryotransformation of Bacillus cereus by plasmid DNA}; Loginova OG et al.; A new technique for transformation of naturally noncompetent strains of Bac . cereus is proposed . Penetration of the DNA into recipient cells is based on two-step effect . At the first step of the process bacilli are affected by glycine in the early logarithmic phase of growth of the common periodic culture . At the second step the mixed DNA and recipient cells are frozen-thawed . The process permits the transforming DNA penetration via the outer membrane layer of the recipient cells having the affected permeability under the conditions of keeping bacillar recipient cells intact . The efficiency of transformation of Bac . cereus by the plasmids pUB110 and pBC16 DNA by the proposed technique is 1.10(4) and 3.10(3) of transformants per 1 mkg of the plasmid DNA. J Gen Microbiol, 1988 Nov, 134 ( Pt 11), 3011 - 8 A frequency matrix for probabilistic identification of some bacilli; Priest FG et al.; A matrix comprising frequencies for positive results for 44 Bacillus taxa for 30 characters has been constructed . The 44 taxa include most of the common species and several clusters of environmental isolates including those described as B . firmus-B . lentus intermediates . The tests, which were chosen for their high diagnostic value, included some of the traditional tests used for identification of bacilli supplemented with a range of sugar fermentations and other characterization tests . The matrix was evaluated by identifying hypothetical median organisms, cluster representatives and a panel of 23 reference strains . All reference strains achieved Willcox probabilities above 0.995 . Fifty-eight environmental isolates were also subjected to the 30 tests and identification was attempted . Forty-one strains (70%) achieved a Willcox probability greater than 0.95, which was considered an acceptable identification, and were assigned to 12 taxa . If the SE of taxonomic distance was also considered in the identification score (an acceptable value being less than 7.0), the number of acceptable identifications was reduced to 34 (59%) . It was encouraging that bacteria from garden soils identified to the common species such as B . subtilis, B . cereus and B . licheniformis whereas some of the bacteria from an estuarine habitat were identified as species such as B . firmus which are normally identified with that habitat. Immunol Lett, 1988 Nov, 19(3), 223 - 7 The efficacy of a cell-mediated reaction in the disposal of M . leprae in human skin; Kaplan G; The inability of lepromatous leprosy patients to mount a cellular immune response against Mycobacterium leprae antigens is not understood . The extensive intracellular replication of bacilli in the phagocytes and the relative paucity of T lymphocytes in the lesions suggest that these patients might be incapable of generating normal delayed type hypersensitivity responses in their skin . In order to elucidate this problem we evaluated the patient's response to local antigen administration . Our observations suggest that the majority of lepromatous patients can respond normally to intradermal injections of a soluble antigen such as purified protein derivative of tuberculin . The underlying lepromatous lesions do not inhibit mononuclear cell infiltration or differentiation . Moreover, the generation of a cellular immune response in the lesions appears to modify the lepromatous lesion to a lesion resembling the tuberculoid type . This process involves local T cells recruitment, granuloma formation and a reduction in the bacterial load at the antigen responsive site. J Exp Med, 1988 Nov 1, 168(5), 1811 - 24 The nature and kinetics of a delayed immune response to purified protein derivative of tuberculin in the skin of lepromatous leprosy patients; Kaplan G et al.; We have analyzed the nature and kinetics of a delayed, cell-mediated immune response to a purified protein derivative of tuberculin (PPD) in the skin of 154 naturally sensitized patients with lepromatous leprosy . After the intradermal injection of 5 U of PPD, biopsies were taken at 1-21 d and studied for the composition, extent, persistence, and organization of the emigratory cell response by light and electron microscopy . Induration of positive sites occurred promptly, reached a maximum diameter at 4 d, displayed a major extravasatory element, and was evident for as long as 21 d . The cellularity of the site exhibited a biphasic course, reached a maximum at 7 d, involved as much as 70% of the dermis and millions of new cells, and was elevated threefold above preinjection levels at 21 d . The emigratory cells were limited to T cells and circulating monocytes . T cells were more evident as they entered a preexisting lepromatous lesion containing parasitized macrophages and only occasional T cells many of the CD8+ phenotype . The predominant emigratory T cell was CD4+ although CD8+ cells were in evidence . The CD4/CD8 ratio of the lesions started at less than unity and in two distinct steps reached levels as high as 5:1 . In most sites CD4+ cells were in the majority at 21 d . A well-defined granulomatous response with epithelioid and giant cells was apparent at 4 d, reached a maximum at 7 d, and involved all PPD sites at this time point . The generation of these differentiated mononuclear phagocytes from newly emigrated monocytes was never observed in the underlying lepromatous lesion but is a constant feature of the tuberculoid leprosy response . Epidermal thickening and keratinocyte proliferation, sequellae of the dermal reaction, reached a maximum at 7 d and gradually resolved by 3 wk . A constant feature of the PPD response was the extensive destruction of preexisting macrophages containing Mycobacterium leprae bacilli or their products . This was associated with the presence of and intimate contact with highly polarized lymphoid cells of unknown phenotype . Cell destruction did not involve other elements of the dermis and spared parasitized Schwann cells . Newly emigrated T cells and monocytes were never seen within the perineural sheath in contact with neural elements . It appears that a single antigenic stimulus leads to a very long-term, defined series of events with distinct temporal patterns . It includes waves of emigratory T cells, the maturation and organization of monocytes, the generation of killer cells, and the extensive destruction of parasitized macrophages.(ABSTRACT TRUNCATED AT 400 WORDS) J Biol Chem, 1988 Oct 15, 263(29), 14748 - 52 ATP synthesis is driven by an imposed delta pH or delta mu H+ but not by an imposed delta pNa+ or delta mu Na+ in alkalophilic Bacillus firmus OF4 at high pH; Guffanti AA et al.; Starved whole cells of alkalophilic Bacillus firmus OF4 that are equilibrated at either pH 10.2, 9.5, or 8.5 synthesize ATP in response to a pH gradient that is imposed by rapid dilution of the cyanide-treated cells into buffer at pH 7.5 . If a valinomycin-mediated potassium diffusion potential (positive out) is generated simultaneously with the pH gradient, then the rate of ATP synthesis and the level of synthesis achieved is much higher than upon imposition of a pH gradient alone . By contrast, imposition of a large chemical gradient of Na+, either in the presence or absence of a concomitant diffusion potential, fails to result in ATP synthesis . We conclude that this organism does not possess a sodium-motive ATPase that can be made to synthesize detectable levels of ATP by imposition of a suitably large chemical or electrochemical gradient of Na+ . On the other hand, a proton-translocating ATPase is in evidence when protons are provided at very high pH, corroborating our earlier work on extremely alkalophilic bacilli . Oxidative phosphorylation must, then, be catalyzed in these organisms by a proton-translocating ATPase even though the putative bulk driving forces for such a catalyst are low under optimal growth conditions . Stable, imposed pH gradients of 1 unit, comparable to the magnitude of the total electrochemical proton gradient of growing cells, result in much lower ATP concentrations than observed in such cells . We hypothesize that ATP synthesis in growing cells utilizes protons that are made available by some localized pathway between proton pumps and the ATP synthase. N Engl J Med, 1988 Oct 13, 319(15), 978 - 82 Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice; Lowry PW et al.; Seventeen cases of otitis media caused by Mycobacterium chelonae were detected among patients seen at a single ear-nose-and-throat (ENT) office (Office A) in Louisiana between May 5 and September 15, 1987 . All the patients had a tympanotomy tube or tubes in place or had one or more tympanic-membrane perforations, with chronic otorrhea that was unresponsive to standard therapy with antimicrobial agents . Middle-ear exploration in six patients revealed abundant granulation tissue; multiple granulomas and acid-fast bacilli were demonstrated on a section of tissue from one patient with a nonhealing mastoidectomy incision . Thirteen of the 14 ear isolates obtained from patients seen in Office A had the same unusual pattern of high-level resistance to aminoglycosides . M . chelonae and other nontuberculous mycobacteria were recovered from several sources of water in Office A, as well as in another ENT office (Office B) in a neighboring city that was visited by the index patient . Only one additional case was detected in Office B during the same period . Otologic instruments in Office A were cleaned in an ultrasonic bath with tap water and a liquid detergent; the contents of the bath were changed only once weekly . Instruments in Office B were placed in boiling water between patient examinations . This outbreak establishes M . chelonae as an agent of otitis media and underscores the need for high-level disinfection or sterilization of ENT instruments between examinations to prevent the transmission of this organism to patients in the office setting. J Urol, 1988 Oct, 140(4), 751 - 4 Granulomatous prostatitis following bacillus Calmette-Guerin immunotherapy of bladder cancer; Oates RD et al.; Granulomatous prostatitis is a recognized complication of intravesical bacillus Calmette-Guerin immunotherapy of superficial bladder cancer . Of 32 patients receiving such therapy 13 underwent prostatic core biopsy and/or fine needle aspiration for clinical indications . Prostatic induration or nodularity developed in 12 patients and 1 underwent biopsy for staging of known prostatic carcinoma . Granulomatous prostatitis was found in 100 per cent of those patients who underwent biopsy or aspiration, indicating that the incidence of this finding is at least 41 per cent following bacillus Calmette-Guerin immunotherapy . Acid-fast bacilli were demonstrated within the prostate of 3 patients with granulomatous prostatitis . The mean interval between the initiation of therapy and diagnosis of granulomatous prostatitis was 11.5 months . Bacillus Calmette-Guerin related granulomas of the prostate may be differentiated histologically from nonspecific granulomatous prostatitis, allergic prostatitis and postoperative granulomas . The clinical implications of these findings are discussed. Br J Dis Chest, 1988 Oct, 82(4), 421 - 5 Massive haemoptysis in the acquired immunodeficiency syndrome; Wasser L et al.; A 32-year-old male intravenous drug abuser was admitted to our institution with constitutional symptoms and sputum smears containing acid-fast bacilli, but no parenchymal disease on chest radiograph . He subsequently developed massive haemoptysis and required an emergency lobectomy . The pathology specimen revealed miliary tuberculosis with extensive caseation, schistosomiasis and cytomegalovirus . This is the first report of massive haemoptysis in the acquired immunodeficiency syndrome . The severe pulmonary haemorrhage was most likely due to miliary tuberculosis. Pathology, 1988 Oct, 20(4), 340 - 5 Synovial involvement by Mycobacterium marinum . A histopathological study of 25 culture-proven cases; Collins RJ et al.; The present culture-proven cases are contrary to the generally held view that infection with Mycobacterium marinum is habitually a superficial infection without potentially serious consequence . A wide spectrum of pathological lesions may be seen in the synovium and adjacent tissues in patients infected by M . marinum . Variations in the morphology of the inflammatory reaction occurs both between cases and, to a lesser extent, in different areas of individual cases . The inflammation ranges from the common non-specific diffuse form, to lesser areas of focal non-caseating lesions, to rarer focal caseating types of granulomatous reaction, and can include an acute inflammatory cell component . Fibrinous exudate on the synovial surface is a recurrent feature and is often the site harbouring most acid-fast bacilli . The variation of inflammatory reaction with time and the possible effects of local steroid injection are discussed. Clin Exp Immunol, 1988 Oct, 74(1), 20 - 5 Demonstration of increased anti-mycobacterial activity in peripheral blood monocytes after BCG vaccination in British school children; Cheng SH et al.; A blood sample was taken from children aged 13-15 years immediately before BCG vaccination and 8 weeks after . The children were tuberculin skin-test negative to PPD-S before vaccination and positive after . Mononuclear cells were separated from the blood, infected with Mycobacterium microti at a low bacterium/monocyte ratio and allowed to form monolayers in microtitre wells . The infected monolayers were rinsed daily and the change in number of live bacteria in monolayers and supernatants was monitored by colony counts on agar . The cells were bacteriostatic during the first day, thereafter growth accelerated in pre-vaccination monolayers . When monolayers received pulsed exposures to autologous lymphocytes that had been incubated with whole dead tubercle bacilli the growth rates of M . microti were increased . However, growth rates in lymphocyte-pulsed monolayers were significantly lower after vaccination than before . It is proposed that this difference reflects the protective effect of vaccination. Am Rev Respir Dis, 1988 Oct, 138(4), 891 - 4 Nosocomial Mycobacterium fortuitum colonization from a contaminated ice machine; Laussucq S et al.; Between October 15 and November 18, 1985, 5 patients on a medical ward of the Albany VA Medical Center (Ward 8A) became colonized with Mycobacterium fortuitum . Because other patients in Ward 8A were at risk of developing disease with M . fortuitum, microbiologic surveillance to identify colonization in sputum was begun . By February 15, 1986, 30 colonized patients had been identified in this ward but none in another ward with a comparable patient population, which suggests a source unique to Ward 8A . Because water has been recognized as a source of opportunistic mycobacterial pathogens, we conducted a retrospective case-control study using a telephone survey questionnaire to examine a number of water exposures in 10 patients and 20 control subjects . Exposure to ice from the Ward 8A ice machine, but not to potable water, was associated with colonization with M . fortuitum . Large-volume water samples from a variety of sources were cultured for acid-fast bacilli . M . fortuitum was isolated only from the ice machine in Ward 8A . The ice machine was disconnected, and no additional patients became colonized . Although ice machines are infrequently implicated in nosocomial outbreaks, they represent a potential source for pathogens that survive or replicate in water. J Trop Med Hyg, 1988 Oct, 91(5), 229 - 30 The utilization of bacilli as larvicidal agents against anopheline and culicine mosquitoes in Turkey . I . Larvicidal activity of Bacillus thuringiensis serotype H-14; Matur A et al.; Standard IPS-82 and a wettable powder (Bactimos) of Bacillus thuringiensis (H-14) were tested against local mosquito species, Cx . pipiens and An . sacharovi, in the laboratory in Turkey . The dose-mortality regression lines for both organisms had similar slopes with each formulation . Bactimos was less effective against both organisms, especially at higher concentrations (LC95/LC50 5.78 vs 1.95). Eur Respir J, 1988 Oct, 1(9), 804 - 6 Fibreoptic bronchoscopy in smear-negative pulmonary tuberculosis; Chawla R et al.; Fifty smear-negative pulmonary tuberculosis patients underwent fibreoptic bronchoscopy . Bronchial aspirate smears of twelve patients and post-bronchoscopic sputum smears of fourteen patients were positive for acid-fast bacilli (AFB) . Bronchial biopsy provided the diagnosis in 9 out of 30 patients . Brush smears were positive in 28 patients, being the only positive sample in ten cases . A high yield from brush smears was obtained due to their preparation from caseous material wherever visible in the bronchi . With these results a rapid diagnosis was established in 36 of the 50 patients . When culture results were available, a definite diagnosis of tuberculosis was made in 45 of the patients . The yield from brush smears was found to be significantly better when compared to bronchial aspirate smears (p less than 0.01) and post-bronchoscopic sputum smears (p less than 0.01). Indian J Lepr, 1988 Oct, 60(4), 566 - 71 Reliability of direct skin smear microscopy in leprosy; Gupte MD et al.; Skin smear direct microscopy is an important tool for diagnosis of leprosy . The study was planned to understand the reproducibility of skin smear reading by a trained technician . Skin smears were collected from known patients of leprosy from the field area . They were stained for acid fast bacilli following the standard cold staining procedure and were read following the Ridley scale . A sample of smears was re-examined on two occasions by the same technician, following blind procedure . There was a systematic under reading on the second occasion, which was attributed to the defective storage of the slides . However, the agreement between second and third examinations was very good (Concordance 81.34%, Kappa 0.74) . The finding was confirmed on a repeat examination . It can be concluded that the Direct Skin Smear Microscopy is a reliable and reproducible technique under experimental conditions. Indian J Lepr, 1988 Oct, 60(4), 535 - 41 Bacillaemia in leprosy: correlation with slit-skin and nasal smears; Chatterjee G et al.; Twenty five multibacillary patients (BL/LL) were studied for bacillaemia . Majority (76%) showed acid fast bacilli in peripheral blood . There was good correlation between bacillary load in peripheral blood and bacteriological index (BI) but poor correlation with morphological index (MI) of skin slit smear and BI/MI of nasal smear. APMIS, 1988 Oct, 96(10), 927 - 32 The role of host factors for the chemotherapy of BCG infection in inbred strains of mice; Cox JH et al.; Host factors have previously been considered to play a role in the efficacy of "incomplete" antituberculous chemotherapy . We investigated this aspect using a model of intravenous infection with M . bovis-BCG in three inbred strains of mice . Viable splenic counts of bacilli (CFU) were monitored following a three week regimen of rifampicin (R) and isoniazid (H) given either immediately or from three weeks after infection . At the end of the immediate (0-3 weeks) therapy the spleens of all mice were sterile and only a minority of animals had demonstrable CFU's at 23 weeks after infection . However, following the delayed-onset (3-6 weeks) therapy we found a pronounced relapse of BCG growth which was about 10 times higher in CBA/Ca and BALB/C than in C57B1/6 mice . These results indicated that host immunity which developed during the first three weeks after infection may have aggravated the relapse of bacterial growth following chemotherapy . This interpretation was corroborated by the finding that the immunosuppressive drug cyclosporin given concurrently with R/H reduced the splenic viable counts of BCG. Infect Immun, 1988 Oct, 56(10), 2760 - 2 Immunolabeling of lipopolysaccharide liberated from antibiotic-treated Escherichia coli; Flynn PM et al.; Increased anti-core glycolipid antibody binding was visualized by immunoelectron microscopy after incubation of Escherichia coli K1:O7 cells with a bacteriolytic antibiotic and compared with binding in control cells . The findings suggest that the core glycolipid regions of the lipopolysaccharides of some gram-negative bacilli can be effectively sequestered until liberated by antibiotic-induced cell lysis. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 639 - 45 Humoral response to defined epitopes of tubercle bacilli in adult pulmonary and child tuberculosis; Bothamley G et al.; In order to investigate the humoral response to tuberculosis in different categories of patients, serum antibody levels to six epitopes of Mycobacterium tuberculosis in adult pulmonary and child tuberculosis were determined . Serum antibody titres were determined by competitive inhibition with radio-labelled murine monoclonal antibodies in 67 adults and 85 children with tuberculosis and in 79 age-matched controls . BCG vaccination (n = 39) and self-healed tuberculosis (n = 11) in adults gave rise to higher antibody titres to TB68, TB23 and TB72 epitopes (all p less than 0.003) when compared to non-vaccinated controls (n = 18) . TB68 titres were higher (p = 0.006) in self-healed than in vaccinated adults . Adult sputum-negative patients (n = 15) had higher titres to TB71 (p = 0.015) and ML34 (p = 0.02) epitopes compared to BCG-vaccinated healthy controls, while sputum-positive patients (n = 41) had higher titres to all epitopes tested (all p less than 10(-4} . The diagnostic sensitivity, with a 95% specificity, was best with the combination of probes TB23, TB68, TB72 for sputum-positive (85%) and TB78, ML34 (53%) for sputum-negative patients . Antibody titres in children with tuberculosis were lower than in adult patients; diagnostic sensitivity in histologically or microbiologically proven cases (n = 18) was only 44%, while that in mediastinal lymph-adenitis (n = 67) was 13.5% . This study suggests that the magnitude and specificity of the humoral response to tubercle bacilli varies with site and severity of infection; the implications for pathogenesis or protective immunity are discussed. Biull Eksp Biol Med, 1988 Oct, 106(10), 464 - 7 {Specificities of bacterial death in culture and suppurative wounds}; Pal'tsyn AA et al.; Electron microscopic autoradiographic study has been performed . In tissue sections, obtained from suppurative wounds, diploforms of cocci and bacilli have been observed . In the former cells DNA and RNA synthesis was normal, however, in the latter cells no synthesis was detected . Such diploforms were not observed in fresh and exhausted cultures . Possible existence in the body of a factor directly injuring bacterial genome is discussed. Infect Control Hosp Epidemiol, 1988 Sep, 9(9), 394 - 7 Bacillus species pseudomeningitis; Lettau LA et al.; A cluster of cerebrospinal fluid Gram's stains showing gram-positive bacilli and of cerebrospinal fluid cultures growing Bacillus species in a large community teaching hospital prompted an epidemiologic and microbiologic investigation . Pseudomeningitis was suspected and confirmed when cultures of uninoculated commercial trypticase soy broth with 5% Fildes enrichment grew Bacillus species . Secondary contamination of the pipettes used for inoculation accounted for the positive cerebrospinal fluid Gram's stains . The costs of this pseudo-outbreak included unnecessary antibiotic therapy, lumbar punctures, and hospitalization . Such adverse effects can be minimized by increased physician awareness of pseudoinfections and by prompt investigation of such occurrences. Obstet Gynecol Surv, 1988 Sep, 43(9), 569 - 75 Use of expanded spectrum cephalosporins for the treatment of obstetrical and gynecological infections; Mercer LJ; The antianaerobic cephalosporins, cefoxitin, ceftizoxime, cefotetan, and moxalactam, are compared in the treatment of obstetric/gynecologic infections associated with mixed aerobic and anaerobic pathogens . All of the antianaerobic cephalosporins have demonstrated similar efficacy in the treatment of mixed female genital tract infections . Thus, antibiotic selection requires a comparison of the antimicrobial activity, pharmacokinetics, adverse effects, and overall cost of therapy . All agents have excellent activity against the Gram-negative bacilli, and recent comparative data show that ceftizoxime is highly active against the Bacteroides sp . Dosing frequency and drug toxicity contribute to the overall cost of drug therapy . Cefoxitin is the only antianaerobic cephalosporin that cannot be dosed on a 12-hour basis . Ceftizoxime and cefoxitin, unlike moxalactam and cefotetan, do not contain the MTT group that has been associated with bleeding abnormalities . Substantial cost savings can be realized by using an antianaerobic cephalosporin administered every 12 hours . The experience at the Chicago Lying-in Hospital is presented. J Clin Microbiol, 1988 Sep, 26(9), 1884 - 6 Microbial inhibition on hospital garments treated with Dow Corning 5700 antimicrobial agent; Murray PR et al.; We evaluated the efficacy of the antimicrobial activity of cotton-polyester fabric treated with 3-(trimethoxysilyl)propyldimethyloctadecyl ammonium chloride (DC 5700), a quaternary ammonium compound bound irreversibly to the material . Significant antimicrobial activity was observed with 58 of 61 gram-positive cocci but with only 1 of 35 gram-negative bacilli and 0 of 5 yeasts . No inhibition of bacilli or yeasts was observed when the DC 5700 concentration ranged from 0.05 to 1.0% or when antimicrobial activity was assayed by the agar overlay bioassay or broth agitation methods. Z Geburtshilfe Perinatol, 1988 Sep-Oct, 192(5), 221 - 5 {Effect of atypical pathogen colonization on cervical priming in cervix insufficiency}; Kesternich P et al.; In a prospective study the cervical bacterial flora of pregnant women with insufficiency of the cervix is compared with the flora of asymptomatic pregnant women . It could be demonstrated, that in case of insufficiency of the cervix a different bacterial flora is found: in addition to the incidence of pathological bacterial groups, a shift of the physiological flora with Doederlein's bacilli to a mixed flora is observed . New findings in the cervical priming lead to the idea, that an atypical cervical flora could influence the cervical priming . The changing of the cervical environment is able to induce an increased production of prostaglandins with cervical dilatation of its structure . Regarding the different cervical flora in case of cervical insufficiency, the importance of the circular suture in the prophylactic management of premature delivery will be discussed . The results lead to the necessity of precise vaginal check-up and therapy of genital infections during pregnancy. Ophthalmology, 1988 Sep, 95(9), 1269 - 75 Microbial keratitis complicating penetrating keratoplasty; Fong LP et al.; A retrospective review of 68 consecutive episodes of microbial keratitis complicating 66 penetrating keratoplasties (PKs) showed major risk associations: suture-related problems (50%), contact lens wear (26%), previous herpes simplex infection (15%), graft failure (15%), and persistent epithelial defects (15%) . Topical steroid (85%) and antibiotic (59%) usage were common iatrogenic factors . Half the infections occurred more than 1 year after grafting . Bacterial infections involving gram-positive organisms (59%) predominated, except for patients with extended-wear hydrophilic contact lenses, which usually involved gram-negative bacilli . The incidence of fungal infections (6%) was relatively low . Recommendations to minimize microbial keratitis include prompt attention to exposed, broken, or loose sutures, and preventive and therapeutic management of epithelial defects . The inadequacy of low-dose antibiotics in precluding microbial infection in many cases and the propensity to develop infections with resistant organisms suggest that guidelines for using postoperative and prophylactic topical antibiotics require reevaluation. J Clin Microbiol, 1988 Sep, 26(9), 1714 - 9 Humoral immune response in human tuberculosis: immunoglobulins G, A, and M directed against the purified P32 protein antigen of Mycobacterium bovis bacillus Calmette-Guérin; Turneer M et al.; The P32 protein antigen of Mycobacterium bovis BCG, identified as antigen 85A in the BCG reference system, was used to investigate the humoral immune response in human tuberculosis (TB) . Immunoglobulin G (IgG), IgA, and IgM directed against P32 were measured by an enzyme-linked immunosorbent assay . Mean IgG and IgA antibody levels differed significantly (P less than 0.001) between active-TB patients (50 untreated and 52 treated) and healthy control subjects (111 unvaccinated tuberculin negative, 38 unvaccinated tuberculin positive, and 72 recently BCG vaccinated) . Mean IgG antibody levels, but not mean IgA antibody levels, were higher (P less than 0.05) in patients with positive microscopic examination for acid-fast bacilli than in patients with negative microscopic examination . A positive relation was found between mean levels and the extent of disease . There was no difference in mean IgM antibody levels between patients and controls . By setting the upper normal limit at the 95th percentile of the 221 healthy subjects, the sensitivities were 46% in untreated and 63% in treated patients for IgG and 30 and 50%, respectively, for IgA . Of the untreated patients, 56% were positive for either IgG or IgA antibodies . Among the untreated patients with negative direct smear, 35% were positive for IgG and 24% were positive for IgA . When both immunoglobulin classes were combined, the serological test was positive in 47% of those patients . Neither naturally acquired tuberculin hypersensitivity nor BCG vaccination affected positivity frequencies in healthy subjects . Only active TB seemed to induce significant anti-P32 antibody levels and to be associated with positivity . A serological test with P32 as the antigen might therefore be helpful for the rapid diagnosis of TB. Int J Lepr Other Mycobact Dis, 1988 Sep, 56(3), 443 - 8 Histopathological changes in the eyes of mangabey monkeys with lepromatous leprosy; Malaty R et al.; Leprosy is the third leading cause of preventable blindness; however, little is known about the spread of infection to the eye . We have studied the eyes of three sooty managabey monkeys . Two were experimentally infected with Mycobacterium leprae; the third was not infected . In one of the infected animals there was histopathological evidence of lepromatous leprosy as evidenced by a chronic inflammatory infiltrate at the limbus, and detection of acid-fast bacilli in the corneal stroma, blood vessel walls, and corneal nerves . The latter were damaged as a result of the bacillary invasion . Electron microscopy revealed involvement and distortion of keratocytes with M . leprae and invasion of the corneal stroma by macrophages containing bacilli . Both infected animals showed focal collections of lymphocytes in the superficial stroma of the conjunctiva and in the ciliary body . This is the first report of the ocular manifestations of leprosy in any primate, including man, in which the duration of infection is known. Int J Lepr Other Mycobact Dis, 1988 Sep, 56(3), 428 - 36 Transitory macrophage activation in the granulomatous lesions of Mycobacterium lepraemurium-induced lepromatoid leprosy in the mouse; Rojas-Espinosa O et al.; A kinetic study on the evolution of granulomas that appear in the liver of NIH mice inoculated with 10(8) Mycobacterium lepraemurium by the intraperitoneal route has been performed . The liver was chosen because of its nonlymphoid histology which allowed us to visualize the appearance and maturation of the cell infiltrates generated as a consequence of the mycobacterial infection . The study analyzed both the macrophage activation within the granulomas and the fate of bacilli within the macrophage . The results showed that this mycobacteriosis induces a relatively early macrophage activation (a very likely result of a cell-mediated immune response triggered by the bacilli) that peaks between 45 and 60 days postinoculation, fades thereafter, and practically disappears several days later . Bacilli are susceptible to the microbicidal effects of activated macrophages, but when the macrophages are turned off (probably due to active suppressive mechanisms), the surviving bacilli reinitiate the infection with no further macrophage opposition . As a result, more phagocytes are attracted to the infection sites and the cell infiltrates grow steadily to become confluent, increasing the granuloma fraction and eventually replacing the liver parenchyma . The findings suggest that in murine "leprosy" infection, early immunological changes occur that enable the macrophages present in the granulomas to kill the infecting M . lepraemurium regardless of the eventual lepromatoid evolution of the granulomas . Lepromatoid granulomas in the mouse and lepromatous granulomas in man are equivalent structures in regard to their histology and bacteriology. J Allergy Clin Immunol, 1988 Aug, 82(2), 231 - 6 Domiciliary metaproterenol nebulization: a bacteriologic survey; Popa V et al.; We wanted to determine whether domiciliary jet nebulization (DJN) leads to contamination of the equipment with fungi or aerobic bacteria and, eventually, to respiratory colonization or pneumonia in daily users of the equipment . We surveyed from this standpoint 23 veterans 65 +/- 10.1 years of age, present or former smokers, treated with steroids more than 7 months in the year preceding the survey, and with FEV1/FVC of 42 +/- 11%; they all were daily users of the equipment, diluting the metaproterenol solution with nonbacteriostatic saline dispensed in multiple-dose bottles of 500 to 1000 ml (protocol 1 {P1}) . After this protocol was completed, the large saline bottles were replaced by 20 cc vials; 11/23 completed 1 year of this treatment (protocol 2 {P2}) . Equipment contamination was checked in all initial 23 patients after one-time nebulization in the laboratory with fresh material (protocol 3 {P3}) . We found that DJN leads to equipment contamination in 20/23 subjects of P1 and 3/11 subjects of p2; saline bottles and the nebulizer were the most frequently contaminated items (32/41 equipment items in P1 and 10/55 in P2) . The contamination was predominantly bacterial with oropharyngeal saprophytes (19 in p1, O in P2) or gram-negative bacilli (47 in P1, 8 in P2) . Bacterial growth was heavier in P1 than in P2 . During P3, three equipment items became contaminated in 3/23 subjects; the flora was oropharyngeal . No patient developed respiratory colonization or developed pneumonia during 9000 patient days of DJN.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1988 Aug, 26(8), 1600 - 3 Progress in culture and subculture of spheroplasts and fastidious acid-fast bacilli isolated from intestinal tissues; Markesich DC et al.; The efficiency of culture media was compared for the culture and subculture of very slowly growing acid-fast bacilli and spheroplast forms obtained from intestinal tissues of patients with Crohn's disease and ulcerative colitis and from controls without inflammatory bowel disease . Media were developed by modifying a nutrient broth medium based on veal infusion broth and yeast extract . We evaluated the effects of pH and the addition of Tween 80, Dubo oleic albumin complex, an extract from intestinal tissue from a patient with Crohn's disease, horse serum, sucrose, magnesium sulfate, ferrous ammonium sulfate, and sodium citrate . All media contained mycobactin J (2 micrograms/ml) . We developed a medium (MG3) which was highly successful in promoting the growth of very fastidious organisms and promoted reversion of spheroplasts to acid-fast rods . MG3 contained veal infusion broth, 1% yeast extract, 10% horse serum, 0.3 M sucrose, 0.2% MgSO4, 0.1% ferrous ammonium sulfate, 0.1% sodium citrate, and 2 mg of mycobactin J per liter . We were able to obtain quantities of organisms sufficient for examination of the organisms by molecular techniques . Successful cultivation of all isolates and reversion of spheroplasts to acid-fast forms encourage further studies of the possibility of a complex association of mycobacteria and Crohn's disease. Chest, 1988 Aug, 94(2), 316 - 20 Chest roentgenogram in pulmonary tuberculosis . New data on an old test; Barnes PF et al.; The utility of routine admission chest roentgenograms (CXRs) was evaluated in detecting pulmonary tuberculosis and the relationship between roentgenographic patterns and the likelihood of finding acid-fast bacilli (AFB) on sputum smear . Of 58 patients whose chief complaints were unrelated to pulmonary tuberculosis, the CXR suggested tuberculosis in 52 cases (90 percent) . In 45 cases, the emergency room physician failed to elicit the patient's respiratory symptoms and did not consider tuberculosis as a diagnostic possibility . In 18 individuals, the diagnosis was missed in the emergency room because of failure to obtain a CXR . Among patients whose roentgenograms showed cavitation or extensive alveolar infiltrate, sputum smears showed AFB in 98 percent of cases . If alveolar infiltrate was absent, or if the roentgenographic pattern was not that of adult reactivation disease, sputum smears revealed AFB in only one half of the cases . We conclude that routine admission CXRs are useful in hospitals serving populations where tuberculosis is still common, and the probability of detecting AFB on sputum smear is greatly influenced by the roentgenographic findings. Am J Med, 1988 Jul 25, 85(1A), 49 - 51 Survey of antibiotic susceptibility among gram-negative bacilli at a cancer hospital; Bodey GP et al.; A survey was conducted of the susceptibility of gram-negative bacilli to selected broad-spectrum antibiotics . The organisms were isolated from all patient specimens submitted to the routine microbiology laboratory during two three-month periods . Overall, the least resistance was observed against imipenem and ciprofloxacin . Considering all of the gram-negative bacilli, differences in susceptibilities to the other antibiotics (aztreonam, cefoperazone, ceftazidime, piperacillin) were minimal . Significant increases in resistance to some antibiotics occurred during the latter period. Am J Med, 1988 Jul 25, 85(1A), 21 - 30 Controlled trials of double beta-lactam therapy with cefoperazone plus piperacillin in febrile granulocytopenic patients; Winston DJ et al.; The efficacy and safety of double beta-lactam therapy with cefoperazone plus piperacillin in febrile granulocytopenic patients were compared with moxalactam plus piperacillin, ceftazidime plus piperacillin, and imipenem alone in two separate clinical trials . All patients also received prophylactic vitamin K . When National Committee for Clinical Laboratory Standards breakpoints for susceptibility were used, a greater proportion of pretherapy isolates of gram-negative aerobic bacilli and gram-positive organisms were found to be susceptible to cefoperazone (94 percent) and imipenem (91 percent) than to moxalactam (84 percent), ceftazidime (85 percent), or piperacillin (85 percent) . In trial I, the overall response rates for documented or possible infections were 78 percent (76 of 97 patients) for cefoperazone/piperacillin and 80 percent (72 of 90 patients) for moxalactam/piperacillin . In trial II, the overall response rates were 86 percent (25 of 29 patients) for cefoperazone/piperacillin, 74 percent (20 of 27 patients) for ceftazidime/piperacillin, and 72 percent (21 of 29 patients) for imipenem alone . There was no nephrotoxicity or hemorrhage related to the study drugs . Diarrhea was more frequent with each of the double beta-lactam regimens, whereas nausea and seizures were more common with imipenem given at a dosage of 1.0 g intravenously every six hours . Seizures occurred in three of 29 imipenem-treated patients but in none of 243 patients treated with the double beta-lactam regimens (p less than 0.001) . These results suggest that cefoperazone plus piperacillin provides adequate coverage for most common bacterial pathogens and is safe and effective therapy for febrile granulocytopenic patients. Am J Med Sci, 1988 Jul, 296(1), 69 - 70 Native valve endocarditis caused by dysgonic fermenter type 2 bacilli; Niefield S et al.; A chronic alcoholic who had casual contact with dogs developed subacute tricuspid endocarditis caused by the unusual gram-negative bacillus dysgonic fermenter type 2 (DF-2) . Despite recurrent pulmonary emboli, the patient had an apparent successful response to 6 weeks of penicillin therapy . Two weeks after discharge, he experienced congestive heart failure necessitating tricuspid valvulectomy . No evidence of active infection was found in tissue removed at surgery . Despite the achievement of a bacteriologic cure, surgery for residual valve damage is not uncommon in endocarditis, regardless of the microbial etiology . In this case, alcoholism was the only risk factor predisposing to infection presumably contracted from exposure to dogs. Chest, 1988 Jul, 94(1), 199 - 200 Broncho-aortic fistula secondary to pulmonary tuberculosis; Masjedi MR et al.; Tuberculous broncho-aortic fistula has not been reported, to our knowledge . This is a case report of a 60-year-old woman with massive hemoptysis secondary to a broncho-aortic fistula . The pathologic study of the pulmonary specimens showed tuberculous granulomas with caseous necrosis and tubercle bacilli in the pulmonary tissue and the fistulous area. Parazitologiia, 1988 Jul-Aug, 22(4), 321 - 8 {Hemolymph cells of fleas and their phagocytic activity}; Kozlov MP et al.; The present paper concerns 4 groups of haemolymph cells of fleas (proleukocytes, leukocytes, trophic cells and oenocytoids), results of observations on their phagocytic activity during parenteral infection of insects with bacteria, bacilli, and cells' response to the infection with Microsporidia. J Clin Microbiol, 1988 Jul, 26(7), 1395 - 7 Effect of egg yolk on growth of Mycobacterium tuberculosis in 7H12 liquid medium; Kononov Y et al.; Of 92 drug-resistant Mycobacterium tuberculosis strains isolated from sputum specimens, 86 showed growth in two types of 7H12 broth, one with egg yolk and the other without egg yolk . In addition, two strains grew only in plain 7H12 broth without yolk, and four others were recovered only in the medium supplemented with egg yolk . The radiometrically detected growth was higher in the presence of egg yolk, corresponding to a higher number of CFU per milliliter in these cultures . The improvement of growth in 7H12 broth supplemented with egg yolk was most noticeable in cultures isolated from sputum specimens having a low number of acid-fast bacilli in the smear and producing only a few colonies on solid media. Indian J Lepr, 1988 Jul, 60(3), 422 - 6 Filamentous phase in life cycle of M . leprae(?): a preliminary communication; Bhatia VN; Certain structures which indicate probable involvement of a filamentous phase in life cycle of M . leprae have been noted in preserved skin biopsy suspensions from lepromatous leprosy cases . These include (i) filaments with empty or pink round spaces within them (ii) conidia-like structures and (iii) membranes with acid fast bacilli . These structures were rare in the fresh material. Immunol Lett, 1988 Jul, 18(3), 201 - 4 Brain norepinephrine levels after BCG stimulation of the immune system; Barneoud P et al.; Brain norepinephrine, dopamine and serotonin levels were determined in right and left hemisphere from female C3H/He mice 13 days after their immune system was stimulated by an intraperitoneal injection of bacillus Calmette-Guerin (BCG) (10(7) bacilli/mouse) . Increased norepinephrine levels were observed in both hemispheres but significantly only in the right one . No concomitant variations in dopamine or serotonin levels were detected . Furthermore, norepinephrine levels in the right hemisphere appeared to be correlated with the ability of lymphocytes to proliferate after concanavalin A stimulation . The modulation of the immune system by the brain neocortex has been previously shown to be lateralized . Here we show that the information from the immune system towards the central nervous system also appears to be expressed in a lateralized manner. Proc Natl Acad Sci U S A, 1988 Jul, 85(14), 5210 - 4 Efficacy of a cell-mediated reaction to the purified protein derivative of tuberculin in the disposal of Mycobacterium leprae from human skin; Kaplan G et al.; The purpose of this study was to evaluate the effects of a delayed-type cell-mediated immune response to Mycobacterium tuberculosis antigen on the Mycobacterium leprae load in the skin of leprosy patients . Twelve patients with the lepromatous form of leprosy have been injected intradermally with 5 units of the purified protein derivative of tuberculin (PPD) . Ten individuals responded with areas of induration ranging from 12 to 21 mm in diameter, and two were unresponsive (less than 10 mm) . Twenty-one days thereafter, the injected and control sites were biopsied, and the histology, number of acid-fast bacilli, nature and phenotype of the emigrant cells, and ultrastructural characteristics of the lesions were evaluated . Eight of the 10 responding patients showed reductions in the number of acid-fast bacilli by factors ranging from 5 to 10,000 . Two responders and both nonresponders exhibited no discernible decline in the number of organisms . The reduction in bacillary load was correlated with an intense mononuclear cell infiltrate, the maintenance of a high CD4+ T-cell/CD8+ T-cell ratio, the formation of granulomata, and the extensive destruction of previously parasitized macrophages. Indian J Lepr, 1988 Jul, 60(3), 360 - 2 Ultrastructural studies of peripheral nerves in lepromatous leprosy patients; Kumar V et al.; Ultrathin sections of the peripheral nerves taken from three lepromatous leprosy patients (One untreated, other treated and third in ENL reaction) was examined in the electronmicroscope . In the untreated patient, solid M . leprae organism inside the schwann cell and the degeneration of schwann cell was seen . In contrast, the treated patient showed the degeneration of bacilli and myelinated fibres . However, the characteristics of cells in the ENL reaction showed close similarities with the untreated case. J Clin Immunol, 1988 Jul, 8(4), 234 - 43 Host defense against Mycobacterium-avium complex; Schnittman S et al.; Mycobacterium-avium complex (MAC) is an intracellular pathogen and the most common cause of widely disseminated bacterial infection in patients with the acquired immunodeficiency syndrome (AIDS) . MAC is infrequently seen in other immunocompromised adults, suggesting that the host defense defect allowing for MAC infection is relatively unique for AIDS . A system was developed for studying the immune response to MAC infection, utilizing MAC isolated from patients with AIDS and monocytes from normal controls and patients with AIDS . Phagocytosis, superoxide anion (SOA) production, and killing were measured . Monocytes from normal controls and AIDS patients were identical with respect to phagocytosis of MAC . In contrast, baseline SOA production was elevated in monocytes from patients compared to normal monocytes and was minimally augmented in response to either phorbol myristate acetate or MAC . Fourteen-day kinetic studies revealed in patients and controls a biphasic pattern with 50-99% killing of AIDS-derived MAC initially, followed always by a rapid outgrowth of surviving bacilli . Despite a modest enhancement of MAC killing by normal but not patients' monocytes pretreated with either recombinant interferon-gamma or recombinant tumor necrosis factor-alpha, outgrowth of MAC was always observed in both, typically faster in patients than in controls . Even monocytes in the presence of lymphocytes stimulated with interleukin-2 did not demonstrate enhanced MAC killing . In contrast, high-titered anti-MAC immune serum derived from a patient with polymyositis and disseminated MAC significantly enhanced the killing of MAC by monocytes from both AIDS patients and healthy controls and prevented their outgrowth . These findings suggest that the host defense defect allowing for MAC infection appears not to reside in the monocyte and that the in vitro lymphocyte functions examined in this study do not appear to play a major role . What role specific antibody plays in vivo in preventing disseminated MAC is uncertain, but the lack of such antibody may help explain the propensity for AIDS patients to develop systemic infection. Infect Immun, 1988 Jul, 56(7), 1692 - 7 Cytokine regulation of the intracellular growth of Mycobacterium paratuberculosis in bovine monocytes; Zurbrick BG et al.; In this study we examined the influence of various crude and recombinant cytokines on the ingestion and intracellular survival of Mycobacterium paratuberculosis within bovine monocytes and monocyte-derived macrophages . Cytokine pretreatment had little effect on the ingestion of M . paratuberculosis by bovine monocytes and macrophages . Monocytes that were continuously incubated with virus-induced crude bovine interferon (100 U) or recombinant bovine alpha interferon (100 U) significantly restricted the subsequent intracellular growth of M . paratuberculosis, as determined by microscopic counts of acid-fast bacilli and by recovery of CFU from lysed monocyte monolayers . In contrast to their effects on freshly adherent monocytes, these cytokines had little effect on the growth of M . paratuberculosis within monocyte-derived macrophages . In two separate experiments, we also observed inhibition of bacillary growth in monocytes treated with unpurified recombinant human granulocyte-macrophage colony-stimulating factor . Conversely, intracellular growth of M . paratuberculosis was enhanced in monocytes that were pretreated with culture supernatants from M . paratuberculosis-stimulated peripheral blood mononuclear cells obtained from an immunized calf . The growth-enhancing activity of these supernatants was labile at pH 2.0, suggesting a role for gamma interferon; however, subsequent experiments indicated that recombinant gamma interferon alone neither enhanced nor restricted intracellular bacillary growth . To determine the possible contributions of monocyte oxidative activity to cytokine-induced bacteriostasis, we compared the release of superoxide anion from cytokine-treated and control monocytes . No obvious relationship was observed between the release of superoxide anion and the subsequent intracellular fate of the bacilli. Int J Lepr Other Mycobact Dis, 1988 Jun, 56(2), 291 - 5 Lepromatous meningoencephalitis in the nine-banded armadillo (Dasypus novemcinctus); Job CK et al.; The brains from 10 nine-banded armadillos with lepromatous leprosy were studied histopathologically . All of them showed evidence of lepromatous meningitis . In two there was invasion by Mycobacterium leprae into the brain tissue, with neuronal cells and glial cells containing intracellular bacilli . To our knowledge, this is the first report of meningoencephalitis in a lepromatous nine-banded armadillo. Int J Lepr Other Mycobact Dis, 1988 Jun, 56(2), 238 - 42 Cataract surgery on lepro