Bacillus

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 leprosy patients; Suryawanshi N et al.; All patients who had cataract surgery at the Schieffelin Leprosy Research and Training Centre, Karigiri, India, between January 1979 and April 1985 were studied to find out the outcome of that surgery . These patients included 291 leprosy cases and 89 nonleprosy cases . Postoperative complications were slightly higher among leprosy patients compared to the nonleprosy cases . Visual recovery was marred by preoperative corneal opacities in some of the leprosy patients . Eyes with chronic insidious type of iridocyclitis did not produce any devastating results postoperatively . Patients whose skin smears were still positive for leprosy bacilli did not show any major complication . All leprosy patients should be offered the benefit of cataract surgery for restoring sight because blindness in leprosy would mean a double handicap if they are already suffering from insensitive, deformed hands and feet.

Eur J Epidemiol, 1988 Jun, 4(2), 231 - 4
The incubation time of relapses after treatment of multibacillary leprosy with rifampicin containing regimens; Pattyn SR et al.; In order to determine the duration of follow-up needed to evaluate the efficacy of short-course bactericidal regimens for multibacillary leprosy, information is needed on the incubation time of relapses after stopping treatment . Several groups of patients, who had been on rifampicin-containing regimens, were followed up for periods ranging from 4 to 10 years . Two groups of relapses were observed: early relapses occurring within 3.5 years after stopping treatment, with a median incubation time of 1 year and 10 months (upper limit of 95% confidence interval: 2 years); and late relapses occurring more than 3.5 years after stopping treatment, with a median incubation of 5 years . Early relapses are probably due to insufficient treatment, and late relapses to persisting bacilli or to reinfection . It is concluded that the efficacy of short-course RMP-containing therapeutic regimens can be evaluated by observing the occurrence of early relapses, 50% of which occur before 2 years after the end of therapy.

J Clin Pathol, 1988 Jun, 41(6), 687 - 90
Comparison of methods for isolating Mycobacterium avium-intracellulare from blood of patients with AIDS; Shanson DC et al.; A variety of blood culture media were compared to determine the optimal method for the isolation of Mycobacterium avium-intracellulare (MAI) from the blood of patients with AIDS . Simulated laboratory blood cultures and clinical blood cultures were tested . Glucose broth, Bactec aerobic medium, Kirschner's medium, and Bactec Middlebrook medium supported the growth of MAI . The Isolator system, a lysis centrifugation method, facilitated the most rapid isolation of MAI (p = 0.001) . The Bactec Middlebrook medium gave the most rapid detection rate (p = 0.001) as acid fast bacilli could be stained by the Ziehl-Neelson method before colonies were isolated in the Isolator system . The growth index readings did not reliably predict mycobacterial growth in the two radiometric media tested . Although several methods may be used to isolate MAI from blood, the most rapid and sensitive method is the Isolator system used in combination with the Bactec Middlebrook medium.

Arch Neurol, 1988 Jun, 45(6), 691 - 3
Mycobacterial meningomyelitis associated with human immunodeficiency virus infection; Woolsey RM et al.; A homosexual man, seropositive for human immunodeficiency virus, developed back and leg pain that evolved, over three weeks, into a T-10 anesthetic, areflexic paraplegia . Spinal fluid examination showed lymphocytosis, markedly elevated spinal fluid protein, and hypoglycorrhachia . A spinal cord biopsy specimen disclosed an intramedullary granuloma containing acid-fast bacilli . The patient was treated with antituberculous drugs and had no progression of neurologic deficit . He died, eight months after first becoming ill, of Klebsiella pyelonephritis and septicemia . Mycobacterial meningomyelitis is presently the only known acquired immunodeficiency syndrome-related myelopathy responsive to specific treatment.

Urology, 1988 Jun, 31(6 Suppl), 28 - 32
Aztreonam in treatment of intra-abdominal infections; Malangoni MA; Aztreonam is a monobactam antibiotic with a broad antimicrobial spectrum against Gram-negative facultative bacteria . It possesses many of the characteristics of antibiotics that are useful for the treatment of intra-abdominal infections . While this drug is effective against the Gram-negative enteric bacilli usually encountered in intra-abdominal infections, it is not practical as a single agent since anaerobic bacteria are not susceptible to aztreonam . The use of aztreonam avoids the nephrotoxicity and ototoxicity associated with aminoglycoside antibiotics . Its pharmacokinetic parameters allow administration 3 or 4 times daily, and it is less expensive than many alternative agents . Studies comparing aztreonam to tobramycin in patients who also received clindamycin for acute appendicitis note similar rates of success in both antibiotic treatment groups.

Diagn Microbiol Infect Dis, 1988 Jun, 10(2), 125 - 9
Legionella pneumophila: initial detection through evaluation of Giemsa-stained smears of a bronchial aspirate; Reitano M et al.; The presence of Legionella species in a bronchial aspirate was strongly suspected by the visualization on Giemsa-stained smears of slender violaceous intra- and extracellular bacilli despite the absence of fluorescence on smears stained with L . pneumophila serogroup 1 conjugate . Subsequently, cultures of the aspirate grew L . pneumophila reactive with serogroup 6 fluorescein-conjugated antibody.

Diagn Microbiol Infect Dis, 1988 Jun, 10(2), 67 - 73
Identification of Mycobacterium tuberculosis in sputum by direct inoculation of the BACTEC NAP vial; Stager CE et al.; The Mycobacterium tuberculosis complex (M . tuberculosis, M . bovis, and M . africanum) can be differentiated from mycobacteria other than M . tuberculosis (MOTT bacilli) with the BACTEC NAP test (Johnston Laboratories, Becton, Dickinson & Co., Towson, MD), by selectively inhibiting their growth with p-nitro-alpha-acetyl-amino-beta-hydroxypropriophenone (NAP) . The BACTEC NAP test is recommended for isolated mycobacterial cultures . In this report, a direct NAP test is performed by immediate inoculation of BACTEC NAP vials with processed sputum specimens that stain acid-fast positive . Seventy-six of 80 M . tuberculosis were correctly identified and all of the MOTT bacilli (nine M . avium complex and one M . kanasii) were correctly classified . The average time required for identification of M . tuberculosis with the direct BACTEC NAP test described here is more convenient than the recommended indirect test, and it is an accurate and rapid method to differentiate the M . tuberculosis complex from MOTT bacilli.

Mol Cell Probes, 1988 Jun, 2(2), 101 - 9
Fluorescence histochemical double staining for the localization of intracellular hydrolases and tubercle bacilli; Kumar P et al.; Fluorescence histochemical techniques are described to localize intracellular enzyme and tubercle bacilli in alveolar macrophages obtained from infected guinea pigs . The study demonstrated a double-staining technique using 4-methylumbelliferyl substrates for enzyme localization followed by auramine-O staining for intracellular tubercle bacilli . Upon enzyme substrate reaction, released 4-MU remains retained inside the cell and gives a green fluorescence, whereas tubercle bacilli give a yellow fluorescence of auramine staining . The technique is useful where a correlation of enzyme activity vs a presence of bacilli in vivo is required at the single cell level.

Proc Natl Acad Sci U S A, 1988 Jun, 85(12), 4267 - 70
Stress proteins are immune targets in leprosy and tuberculosis; Young D et al.; To understand the immune response to infection by tuberculosis and leprosy bacilli and to develop improved vaccines, the nature of antigens that are involved in humoral and cell-mediated immunity was investigated . We have determined that five immunodominant protein antigens under study are homologues of stress proteins . This finding and observations with other pathogens suggest that infectious agents may respond to the host environment by producing stress proteins and that these proteins can be important immune targets . We postulate that abundant and highly conserved stress proteins may have "immunoprophylactic" potential for a broad spectrum of human pathogens.

Gastroenterol Clin North Am, 1988 Jun, 17(2), 357 - 85
Diverticulitis; Pohlman T; Diverticulitis represents a spectrum of clinical entities ranging from minimal pericolitis in the adjacent mesentery to uncontrolled intra-abdominal sepsis and septic shock . The presentation most often described is left lower quadrant abdominal pain, fever, chills, and left lower quadrant tenderness associated with a mass . Unusual presentations occur when infection tracts to distant locations . Diverticulitis is a common cause of intra-abdominal sepsis associated with high morbidity and mortality . The pathogenesis of intra-abdominal sepsis is not well understood, but likely involves circulating host inflammatory mediators . The role of computed tomography in the early diagnosis of diverticulitis is increasing and supersedes barium enema in the assessment of the extracolonic extent of disease . Also, computed tomographic-directed percutaneous drainage of intra-abdominal abscesses is, in most cases, as effective as surgical drainage . Predictably, the micro-organisms involved are representatives from the commensal flora of the lower gastrointestinal tract . These bacteria are usually sensitive to a wide range of antimicrobial agents that are effective against facultative and obligate anaerobic gram-negative bacilli . Surgical intervention is reserved for those individuals who do not respond to therapy, or for generalized peritonitis, uncontrolled sepsis, free viscus perforation, and fistulas.

Acta Otolaryngol, 1988 May-Jun, 105(5-6), 494 - 9
Skin affection in rhinoscleroma . A clinical, histological and electron microscopic study on four patients; Gaafar HA et al.; Clinical, histological and electron microscopic studies were performed on 4 rhinoscleroma patients with concomitant skin lesions in the upper lip, dorsum of the nose and nasolacrymal sac area . The skin lesions were treated locally . One of the patients was followed up to 16 years . Histologically, the skin lesions showed downward prolongation of the rete pegs . Deep in the dermis, vacuolated Mikulicz cells surrounded by lymphocytes and plasma cells were found . By electron microscopy, numerous small vacuoles containing fine granular material were seen inside Mikulicz cells . A limited number of bacilli were found inside and outside these cells . Two clinical entities of rhinoscleroma are observed in Egypt, an active granulomatous type with possible extranasal extension, and a less active intranasal type with limited mucosal lesions . The skin lesions in rhinoscleroma were found to have an unpredictable course.

Am Surg, 1988 May, 54(5), 276 - 83
Synchronous bacterial and fungal septicemia . A marker for the critically ill surgical patient; Verghese A et al.; Mixed septicemia (synchronous fungal and bacterial septicemia) is an occasional, but often fatal occurrence in the critically ill patient . We reviewed 14 such cases at two hospitals . Twelve of 14 patients were in the surgical intensive care unit . Eleven patients had an average of 2.7 major surgical procedures (range 2 to 4); persistent post-operative peritoneal sepsis was common occurring in 9 patients . Bacteremia preceded mixed septicemia in 8 of 14 cases and gram negative enteric bacilli were the most common causes of bacteremia . Fungemia was due to Candida species in 13 of 14 patients and followed prolonged antibiotic therapy . The diagnosis of disseminated candidiasis was suspected during life in 13 patients and proven in six . Mixed septicemia is a marker for a distinct population of critically ill surgical patients with a high overall mortality (78% in this study) . Culture of both a fungal and bacterial pathogen in a blood culture, especially if preceded by bacteremia, should alert the physician to strongly suspect disseminated fungal infection and to commence appropriate treatment . Mortality is likely to remain high unless the underlying disease states can be rapidly corrected and infection controlled.

Am J Med, 1988 May, 84(5), 847 - 54
Comparison of norfloxacin with cotrimoxazole for infection prophylaxis in acute leukemia . The trade-off for reduced gram-negative sepsis; Bow EJ et al.; A total of 63 neutropenic patients receiving cytotoxic therapy for acute leukemia were randomly allocated to receive norfloxacin (400 mg every 12 hours) or cotrimoxazole (160/800 mg every 12 hours) to prevent bacterial infection . Compliance was more than 95 percent and no adverse effects attributable to the study drugs were observed . The overall incidence of febrile illness (67 percent) was similar between the groups; however, no gram-negative bacillary infections were observed in 31 norfloxacin recipients compared with four of 32 cotrimoxazole recipients . Furthermore, nine norfloxacin recipients had 17 gram-positive bacteremias compared with two in two cotrimoxazole recipients (p = 0.0034) . Norfloxacin was more effective than cotrimoxazole for preventing acquisition of aerobic gram-negative bacilli in surveillance cultures . Neither study drug allocation nor the presence of an indwelling central venous catheter influenced outcome among the 42 patients who subsequently received empiric systemic antibiotics for suspected infection . Although gram-positive infection remains an unsolved problem, norfloxacin appears to be a safe, effective, well-tolerated alternative to cotrimoxazole for preventing gram-negative infection in neutropenic patients with acute leukemia.

Urology, 1988 May, 31(5), 419 - 21
Tuberculous epididymo-orchitis; Koyama Y et al.; In the clinical course of epididymitis in a forty-four-year-old male patient, enlargement of ipsilateral testis developed which was difficult to distinguish clinically from testicular tumor . High inguinal orchiectomy was performed . Microscopic sections revealed many granulomas with caseous necrosis and giant cells . Tuberculous bacilli also were demonstrated in the histologic examination.

Am Rev Respir Dis, 1988 May, 137(5), 1141 - 6
Effectiveness of ofloxacin against Mycobacterium tuberculosis and Mycobacterium avium, and rifampin against M . tuberculosis in cultured human macrophages; Crowle AJ et al.; Ofloxacin (OFL) is a new broad-spectrum drug with potentially valuable antimycobacterial activity . It was tested for ability to inhibit virulent tubercle bacilli (TB) and virulent Mycobacterium avium in cultured human macrophages (MP) . The first-line antituberculosis drug rifampin (RMP) also was tested against TB in MP . The drugs were added to the MP cultures immediately after infection or 2 days later . Antimicrobial inhibition was measured by colony-forming-unit (cfu) counts of bacilli from lysed samples of the infected MP taken at zero, 4, and 7 days after infection . Drug inhibition of the bacteria in vitro in 7H9 broth also was measured . OFL showed the same minimal inhibitory concentration (MIC) of 1.25 micrograms/ml against TB in vitro and in MP . At 2 micrograms/ml or more it killed TB in vitro and in MP . It was equally effective in MP against initially nonmultiplying TB and MP-established TB, which were multiplying exponentially in the MP . OFL had the same MIC in vitro against M . avium but was ineffective against both M . avium in MP and M . avium isolated directly from MP at as much as 8 micrograms/ml . The MIC for RMP against TB in MP was 0.1 microgram/ml, and TB in vitro 0.02 microgram/ml . At 0.5 microgram/ml or greater, it killed TB in MP . RMP killed TB in MP rapidly, whereas OFL killed them slowly . These results confirm initial clinical evidence, as published by others, that OFL should be a useful antituberculosis drug . However, they suggest that it may not be very effective against MA infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagn Microbiol Infect Dis, 1988 May, 10(1), 41 - 8
Direct antimicrobial drug susceptibility testing of Mycobacterium tuberculosis by the radiometric method; Libonati JP et al.; Direct-drug-susceptibility tests were performed on clinical specimens positive for acid-fast bacilli by either Ziehl-Neelsen or fluorochrome staining . The results of conventional agar dilution (Vestal, 1975) and a modified radiometric (BACTEC) method were compared . A total of 580 smear-positive specimens were tested by the BACTEC method at three separate sites . Three hundred and seventy-seven of these were culture positive for M . tuberculosis, and 343 (91%) yielded acceptable direct-susceptibility-test results . We used the conventional method to determine that 343 of 519 smear-positive specimens were culture positive for M . tuberculosis, and 212 (62%) produced acceptable results within 3 wks . Conventional results were reported in 3-4 wks, while the time required to obtain results with the BACTEC method ranged from 5 to 21 days (average 11.5 days) . Results indicate that the radiometric method provides reportable results more frequently with time savings as compared to the conventional method.

Antibiot Khimioter, 1988 May, 33(5), 352 - 5
{Obtaining hybridomas producing monoclonal antibodies with different specificities against Mycobacterium tuberculosis of the human and bovine types}; Androsova MV et al.; A procedure for isolation of hybridomes producing monoclonal antibodies (McAB) to tubercle bacilli is described . Specificity of the McABs was studied with the solid phase radioimmune and immunoenzyme tests . Supernatant of tubercle bacilli destroyed with ultrasound was used as antigens . The McABs did not practically react with antigens of the tubercle bacilli atypical forms . Five ascitic monoclonal hybridomes were isolated . Four of them produced antibodies with selective specificity to antigens of bovine tubercle bacilli (M . bovis-8 and BCG) and one produced antibodies to antigens of human tubercle bacilli (H37Rv).

Am Rev Respir Dis, 1988 May, 137(5), 1147 - 50
Five-year follow-up of a clinical trial of three 6-month regimens of chemotherapy given intermittently in the continuation phase in the treatment of pulmonary tuberculosis . Singapore Tuberculosis Service/British Medical Research Council; Triple regimen of selective decontamination of the digestive tract et al.; Department of Surgery, Western Infirmary, GlasgowAll 324 patients admitted over sixteen months to a general intensive therapy unit (ITU) were prospectively studied to assess the effect of a novel prophylactic antibiotic regimen on the incidence of acquired infection . Consecutive control (161 patients) and test (163 patients) groups were analyzed . In the control group, antibiotic administration was determined by clinical and microbiological evidence of infection . In the test group, treatment consisted of a triple regimen of selective decontamination of the digestive tract (polymyxin E, tobramycin, and amphotericin B) administered throughout the ITU stay, systemic cefotaxime administered for the initial four days, and regular microbiological screening of multiple sites . The test group showed a striking and consistent reduction in colonisation of the digestive tract with aerobic gram-negative bacilli, and there was a substantial reduction in the incidence of acquired infection (24% to 10%) . Mortality in certain categories of patients was also reduced . There is now a considerable body of evidence to justify the more widespread use of this selective parenteral and enteral anti-sepsis regimen (SPEAR) in general intensive care practice.

J Rheumatol, 1988 Apr, 15(4), 659 - 62
Septic arthritis due to gram negative bacilli: older patients with good outcome; Newman ED et al.; Previous studies of gram negative bacillary septic arthritis conclude it is an uncommon disease of older patients with poor outcome, or of younger patients with good outcome . We reviewed 22 cases of gram negative bacillary septic arthritis in a rural population . The mean age was 61 years, symptoms were of short duration (6.5 days mean), and a chronic illness was frequently present (77%) . The knee was involved in 73% and E . coli was the usual causative organism (32%) . Antibiotics plus aspiration was a successful initial therapy . Overall survival was 95% and a good outcome was achieved in 68% . Gram negative bacillary septic arthritis affects older patients, and the outcome appears good.

Jpn J Med Sci Biol, 1988 Apr, 41(2), 37 - 47
An experimental model of chemotherapy on dormant tuberculous infection, with particular reference to rifampicin; Kondo E et al.; Mice were infected intravenously with a streptomycin (SM)-dependent strain of tubercle bacilli which had been starved of the antibiotic . The inoculum persisted in the spleen for a fairly long period, especially keeping almost the initial level of viable counts in the first few weeks . Isoniazid (INH) administration exerted little effect on such fate of the infection at a bactericidal dose to the same strain multiplying under the supply of SM . Rifampicin (RFP) was, however, highly effective in either case . Similar results were obtained in the corresponding in vitro experiments . The data suggest that this animal model is a convenient system for screening drugs effective on the dormant tuberculous infection.

Immunobiology, 1988 Apr, 177(1), 40 - 54
Infection with live mycobacteria inhibits in vitro detection of Ia antigen on macrophages; Mshana RN et al.; Both antigen-specific and non-specific anergy are common features of disseminated mycobacterial infections, and the pathogenesis of such anergy is as yet not fully understood . To date, most studies have focused on the efferent limb of the immune response, and no detailed information is available on the early macrophage-T cell interaction and its consequence on T cell clonal proliferation . To gain information on this crucial phase of mycobacteriosis, we have conducted studies to evaluate the effect of M . kansasii infection on Ia expression induced by T cell-derived lymphokine and have assessed whether such cells can adequately present either mycobacterial or allogeneic antigens to T cells . In vitro infection of mouse resident peritoneal macrophages with live but not heat-killed M . kansasii resulted in a significantly reduced percentage of cells expressing monoclonal antibody detectable Ia antigen following optimal stimulation with crude lymphokine preparations or recombinant mouse gamma interferon . In parallel experiments, macrophages infected with the mycobacteria were co-cultured with syngeneic in vivo M . kansasii sensitized non-adherent, nylon-wool purified lymph node cells, and lymphoproliferation was measured by {3H}thymidine incorporation . It was shown that in co-cultures with macrophages infected with live M . kansasii, the lymphocyte proliferation was marked even in very low infection ratios . In contrast, the response to heat-killed bacilli was dose dependent, reaching peak levels only in high infection ratios . The ability of infected macrophages to present allogeneic antigens was assessed using the mixed leukocyte reaction . Macrophages infected with heat-killed M . kansasii were able to induce a mixed leukocyte reaction similar to uninfected macrophages whereas macrophages infected with live M . kansasii were unable to stimulate allogeneic T cells . These findings may have implications on immunological disturbances often seen in mycobacterial infections, such as leprosy, in which there can be large numbers of non-toxic viable intracellular bacilli.

Rev Argent Microbiol, 1988 Apr-Jun, 20(2), 97 - 101
{Evaluation of four antigens for the detection of anti-Mycobacterium bovis antibodies by enzyme immunoassay}; Ritacco V et al.; An enzyme-linked immunosorbent assay (ELISA) for the diagnosis of bovine tuberculosis through the detection of specific seric antibodies has recently been developed in our laboratory . In order to assess its reproducibility and select the most adequate antigen, four bovine PPDs from different sources were evaluated in parallel: PPD M . bovis strain AN5, CEPANZO standard (CPZ), PPD M . bovis strain AN5, European Economic Community standard (EEC), PPD M . bovis strain AN5, prepared from non heated bacilli, killed by phenol (P) and PPD . M . bovis BCG strain prepared at the Pasteur Institute, Paris (BCG) . Sera from 22 healthy cattle from tuberculosis free area and 20 bacteriologically confirmed tuberculous animals were employed in simultaneous assays . Antibody mean and standard deviations from healthy cattle expressed as optical density (OD) values were 45 +/- 22 when CPZ was used as antigen, 24 +/- 10 with EEC, 103 +/- 56 with P and 56 +/- 20 with BCG . Mean O.D . from tuberculous cattle were 588 +/- 158, 510 +/- 234, 782 +/- 138 and 441 +/- 189 with antigens CPZ, EEC, P and BCG respectively . A close correlation was observed when results obtained with EEC and P were compared with that of CPZ (r: 0.97 and 0.94 respectively) . A lower specificity was achieved when BCG was used as antigen being also lower its correlation with the results obtained with CPZ (r: 0.87) . It is concluded that our ELISA would achieve similar sensitivity and specificity if CPZ, EEC and P were used as antigens . On the other hand, BCG would not be suitable for this assay.

Leber Magen Darm, 1988 Apr, 18(2), 97 - 8
{Thoracic dissecting aortic aneurysm . Contribution to the differential diagnosis of increased enzymes indicating cholestasis, fever and thoracic pain}; Eckhardt C et al.; A 68 years old female patient was admitted with thoracic pain and fever (40.0 degrees C) . A coronary heart disease was known . The liver was enlarged, the cholestatic enzymes elevated without bilirubinaemia . In the blood culture gram-negative bacilli was found . Our diagnosis: septic cholangitis, coronary ischemia . She was better by antibiotic therapy, the fever fell . Few days later she suddenly died . Autopsy demonstrated a serious arteriosclerosis of the aorta, an aneurysm on the aortic arc with chronic bleeding in the environmental tissue with inflammation and coronary arteriosclerosis . The liver was normal.

Biochem Biophys Res Commun, 1988 Mar 30, 151(3), 1074 - 80
Transfer of spores, bacteria and yeast into toluene containing phospholipids and low amounts of water: preservation of the bacterial respiratory chain; Darszon A et al.; A method that allows the transfer of spores, bacteria and yeasts into a ternary system composed of toluene, phospholipids and low amounts of water is described . Initially an emulsion is formed by sonication of cells suspended in water in presence of toluene and phospholipids . The emulsion formed was subsequently clarified by blowing N2 on its surface and transparency was achieved when the water content of the system was reduced to 1-3 microliter/ml of organic solvent . The cells in ternary systems exhibit a reduction of cell volume, but the general structure is preserved . About 1/10,000 bacilli or yeast were viable, but spores were viable after 30 days in the ternary system . Yeast cells transferred to the ternary system, and back to an all water media failed to show oxygen uptake . In contrast bacilli that remained in the ternary system for 2 days respired to 80% of their maximal capacity when returned to an aqueous media.

Eur J Biochem, 1988 Mar 15, 172(3), 579 - 84
Polyphthienoyl trehalose, glycolipids specific for virulent strains of the tubercle bacillus; Daffe M et al.; Phthienoic acids constitute a family of dextro-rotary odd-numbered unsaturated fatty acids isolated exclusively from virulent strains of human and bovine tubercle bacilli . In the bacterial cell they are not free and a search for their linked form in complex wall lipids of Mycobacterium tuberculosis (strain Canetti) showed that they esterified trehalose . Structural elucidation of the major phthienoyl trehalose showed the occurrence of five acyl residues located at 2, 2', 3', 4 and 6' positions of trehalose . The acyl substituents were mainly 2,4,6-trimethyl tetracos-2-enoic acid (C27 phthienoic acid) accompanied by its homologs . In addition to these branched fatty acids, straight-chain C16 and C18 acyls composed about 20% of the substituents . The proposed structure is a new one, both for the mycobacterial-specific glycolipid and for the substituted positions on trehalose . Other minor acyl trehaloses were detected in M . tuberculosis (strain Canetti), differing from the major component by the occurrence of an additional hydroxy fatty acid (3-hydroxy-2,4,6-trimethyl tetracosanoic acid) or by the number of acyl substituents . The major glycolipid presented a weak activity in vitro on mitochondrial oxidative phosphorylation . These glycolipids and phthienoic acids could serve as virulence indicators.

JAMA, 1988 Mar 4, 259(9), 1347 - 52
Cat-scratch disease . Isolation and culture of the bacterial agent; English CK et al.; A gram-negative bacterium or its cell wall-defective variants were isolated from lymph nodes of ten patients with cat-scratch disease . Cultured bacteria were morphologically identical to vegetative and wall-defective forms seen in human tissues . Three of seven patients with recent cat-scratch disease had fourfold or greater rises in antibody titer against the cultured bacteria; the remaining four patients had maximum titers of 1:32 to 1:128 . Rabbit antiserum to cultured bacilli reacted in immunoperoxidase stains with vegetative and wall-defective cat-scratch disease bacilli in lymph node, skin, or conjunctiva and with vegetative or wall-defective bacteria isolated from ten patients . Vegetative bacteria produced lesions in the skin of an armadillo identical to early lesions in human skin . Vegetative bacteria were recovered from the lesions in the armadillo.

Endoscopy, 1988 Mar, 20(2), 62 - 5
Colonoscopic diagnosis and medical treatment of ten patients with colonic tuberculosis; Ferentzi CV et al.; Ten patients with tuberculous enterocolitis were diagnosed colonoscopically . In four, the diagnosis was confirmed by positive acid fast stain or the presence of caseating granuloma in colonic biopsy material or ileal washings . In one other patient a cervical lymph gland revealed acid-fast bacilli . He was the only patient with extraintestinal disease, indicating that primary tuberculous colitis is probably more common than secondary in Saudi Arabia . In the other five patients the colonoscopic diagnosis was confirmed by a complete response to antituberculous triple therapy . Six patients had hypertrophic, two ulcerohypertrophic and two widespread ulcerative lesions . Colonoscopy with biopsies has definite advantages over barium enema in diagnosis . After thus excluding malignancy, Crohn's disease remains the most important differential diagnosis . A ten-week therapeutic trial of antituberculous treatment is recommended in patients from high-risk populations with a typical history and colonoscopic picture to avoid the morbidity and mortality of diagnostic laparotomy.

Vet Pathol, 1988 Mar, 25(2), 131 - 7
Role of M cells and macrophages in the entrance of Mycobacterium paratuberculosis into domes of ileal Peyer's patches in calves; Momotani E et al.; Ligated ileal loops of calves were inoculated with live and heat-killed Mycobacterium paratuberculosis and were examined by light and electron microscopy . At 5 hours after inoculation, acid-fast bacilli were in subepithelial macrophages, but not in M cells covering domes . At 20 hours, more than 50 acid-fast bacilli per cross section were in subepithelial macrophages in domes . Both living and heat-killed bacilli passed into domes . Addition of anti-M . paratuberculosis bovine serum to the inoculum enhanced entry of bacteria into domes . By electron microscopy, intact bacilli with electron-transparent zones (peribacillary spaces) were in the supranuclear cytoplasm of M cells at 20 hours . M cells also contained vacuoles, including electron-dense material interpreted as degraded bacilli . Subepithelial and intraepithelial macrophages contained bacilli and degraded bacterial material in phagosomes . These results suggest that calf ileal M cells take up bacilli, and that subepithelial and intraepithelial macrophages secondarily accept bacilli or bacterial debris which are expelled from M cells.

Am J Med, 1988 Mar, 84(3 Pt 2), 597 - 602
Treatment of pneumonia in patients at risk of infection with gram-negative bacilli; McGehee JL et al.; Patients with a history of chronic debilitating disease due to a variety of causes are known to be at risk for infection with coliform gram-negative bacilli when they present with community-acquired pneumonia . Empiric treatment with broad-spectrum parenteral antibiotics is often begun in such patients pending the result of blood and other cultures . The optimal duration of broad-spectrum empiric therapy in such patients when cultures fail to reveal a specific pathogen is unknown . Review was made of the charts of 131 patients with community-acquired pneumonia admitted to the hospital and treated with broad-spectrum parenteral antibiotics in whom a specific pathogen was never isolated . Overall, 89 percent of these patients were cured without complication or relapse . Patients receiving broad-spectrum therapy for four days or less due to rapid clinical improvement had a successful outcome in 95 percent of cases . It is concluded that broad-spectrum parenteral antibiotic therapy can safely be abbreviated provided response to therapy is prompt.

Int J Lepr Other Mycobact Dis, 1988 Mar, 56(1), 36 - 44
Vaccination of human volunteers with heat-killed M . leprae: local responses in relation to the interpretation of the lepromin reaction; Gill HK et al.; The early (Fernandez) and late (Mitsuda) lepromin reactions were closely examined in a group of healthy, BCG-vaccinated individuals who were given four doses of a heat-killed, armadillo-derived vaccine, i.e., 1.5 X 10(7), 5 X 10(7), 1.5 X 10(8), and 5 X 10(8) bacilli . There was a clear dose-response relationship for both the early and late reactions with no leveling of the responses within the range of doses examined . While the early response was negative in most of the volunteers, the late response was positive in all of the volunteers . No association was found between the early lepromin test and the pre-vaccination skin test to PPD . There was also no association between the early lepromin test and the pre-vaccination skin test response to a soluble Mycobacterium leprae antigenic preparation (MLSA) in general, but there was a good correlation between these two parameters at the highest vaccine dose . The late lepromin response showed no association with either the prevaccination or post-vaccination skin test response to PPD . However, there was a significant correlation between the late lepromin response and the post-vaccination skin test response to MLSA . In general, no association could be found between the in vivo skin tests and the in vitro lymphocyte transformation test (LTT) . Thus, the lepromin test is essentially a vaccination which elicits a specific response to M . leprae antigens provided that the dose of armadillo lepromin given is higher than 5 X 10(7) . Therefore, it is unsuitable as a diagnostic test for leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)

Urology, 1988 Mar, 31(3 Suppl), 20 - 5
BCG (RIVM) versus mitomycin intravesical therapy in superficial bladder cancer . First results of randomized prospective trial; DeBruyne FM et al.; This study presents the preliminary results of a randomized prospective two-arm study in which bacillus Calmette-Guerin (BCG) RIVM, a Dutch BCG preparation, is compared with mitomycin C (MMC) in patients with primary or recurrent superficial bladder tumors, including carcinoma in situ (CIS) . Therapeutic regimens were as follows: after complete transurethral resection of all visible tumors, BCG RIVM (1 x 10(9) bacilli in 50 mL saline) was instilled once a week for six consecutive weeks, and mitomycin C (30 mg in 50 mL saline) was administered once a week for one month (weeks 1 to 4) and thereafter once a month for a total of six months . Reported are the incidence of side effects in 165 patients and the recurrence rate of tumors in 308 patients after a follow-up period of twelve months . Drug-induced, or chemical cystitis was observed in 13 (16.7%) of 78 BCG-treated patients and in 12 (13.8%) of 87 MMC-treated patients . In the same groups bacterial cystitis occurred in 17 (21.8%) patients and in 16 (18.4%) patients, respectively . In the BCG-treated group (N = 148), 44 (29.8%) had recurrent tumors, while in the MMC-treated group (N = 160), 40 (25.0%) had a recurrence . The recurrence rate for BCG-treated patients was 0.33; the recurrence rate for MMC-treated patients was 0.29 (P = 0.560, not significant) . These preliminary data demonstrated no statistically significant difference between the two arms with regard to toxicity and recurrence of tumors.

Infect Immun, 1988 Mar, 56(3), 660 - 4
Recombinant interleukin-2 limits the replication of Mycobacterium lepraemurium and Mycobacterium bovis BCG in mice; Jeevan A et al.; BALB/c mice were infected with Mycobacterium lepraemurium in the footpad or with Mycobacterium bovis BCG intravenously with 5 x 10(7) bacilli . Recombinant interleukin-2 (IL-2) was injected intraperitoneally as a single dose (20,000 U), as a single course of five injections (400 U each), or as a 6-month course starting 3 days after the M . lepraemurium infection . BCG-infected mice received a single dose (1,000 U) or five daily injections of 100 or 1,000 U each . IL-2 significantly reduced the total bacterial counts in the footpad, lymph nodes, and liver of M . lepraemurium-infected mice (50 to 85%) by 6 months and viable counts in the spleen (30 to 50%) by 60 days after BCG infection . The courses of IL-2 started at 60 days were more effective than those started at 3 days after M . lepraemurium infection (P less than 0.05 to 0.001), and for BCG, 100 U of IL-2 was better than 1,000 U (P less than 0.05 to 0.01) . These results indicate that IL-2 limits mycobacterial infections in mice and raise the question of its possible use in humans.

Tubercle, 1988 Mar, 69(1), 57 - 61
Extension of pulmonary tuberculosis after fibreoptic bronchoscopy; Rimmer J et al.; Two cases are described in which the diagnosis of pulmonary tuberculosis was suspected on both clinical and radiological grounds . Sputum smear and culture were negative for acid fast bacilli . Consequently a bronchoscopy and bronchial washings from the affected lobe were undertaken . While this procedure achieved a positive diagnosis of pulmonary tuberculosis, it also resulted in a significant extension of the disease.

Tubercle, 1988 Mar, 69(1), 15 - 25
Effects of isoniazid and of ceforanide against virulent tubercle bacilli in cultured human macrophages; Crowle AJ et al.; Isoniazid (INH) is said to inhibit tubercle bacilli equally well in vivo and in vitro, and to be mycobactericidal . Ceforanide (CEF) can inhibit tubercle bacilli in vitro but has been found ineffective clinically . These two drugs were tested against virulent tubercle bacilli in cultured human macrophages (MP), partly to compare the results with clinical experience, and partly for a better understanding of antituberculosis activities of these drugs in human beings . INH had the same minimal inhibitory concentration (MIC) against tubercle bacilli in MP as in 7H9 broth cultures . It killed multiplying bacilli in MP but not nonmultiplying bacilli, even at 100 times MIC . It killed both multiplying and nonmultiplying bacilli in broth cultures . It interfered with its own effectiveness against intra-MP bacilli by preventing nonmultiplying bacilli from beginning to multiply and thus become susceptible to killing . These findings help explain why this demonstrably mycobactericidal drug produces relapses of tuberculosis when used alone . It was confirmed that CEF is able to inhibit growth in broth cultures (MIC = 10 micrograms/ml) . However, it was not effective against either multiplying or nonmultiplying bacilli in MP at concentrations up to 50 micrograms/ml . These results with the drugs INH and CEF support the good record of correlation between the human MP model of tuberculosis and clinical experience in antituberculosis chemotherapy.

Ann Inst Pasteur Microbiol, 1988 Mar-Apr, 139(2), 213 - 23
Limited in vitro multiplication of Mycobacterium leprae; Dhople AM et al.; The inability to cultivate Mycobacterium leprae in vitro has been a major bottleneck in leprosy research . There have been numerous reports on successful in vitro cultivation of this organism, but these reports could not be confirmed by others in the field . Hence, in vitro multiplication of M . leprae was evaluated in various culture media . Only 2 media supported limited multiplication of M . leprae . One medium was used previously by one of the authors (AMD) for in vitro growth of M . lepraemurium and the other was a conditioned medium used for growth of mouse dorsal root ganglion . Growth was evaluated by 3 biochemical parameters: bacterial ATP, DNA and 3H-thymidine uptake . All 3 measurements revealed a 4-6-fold increase in cell biomass after 16 weeks of incubation at 34 degrees C . The harvested bacilli demonstrated a few of the important properties of M . leprae, including growth in mouse footpads . However, subcultures of these in-vitro-grown cells in the respective media could not be achieved . By the end of 12 weeks, the bacilli lost all intracellular ATP and the ability to incorporate 3H-thymidine; they also failed to multiply in mouse footpads.

Am J Prev Med, 1988 Mar-Apr, 4(2), 102 - 9
Tuberculosis prevention: cost-effectiveness analysis of isoniazid chemoprophylaxis; Rose DN et al.; Isoniazid chemoprophylaxis is not recommended for all persons infected with tubercle bacilli . Because of the small but significant risk of isoniazid hepatotoxicity, chemoprophylaxis is reserved for only those at the highest risk of tuberculosis activation . To evaluate this policy, we performed a cost-effectiveness analysis of isoniazid chemoprophylaxis for two populations with positive tuberculin skin tests: recent tuberculin converters, who are at high risk for activation, and older tuberculin reactors, who have a low risk for activation and for whom chemoprophylaxis is not now recommended . The cost-effectiveness ratios found were stable, despite wide variations in model assumptions and probability estimates . For high-risk tuberculin reactors, chemoprophylaxis resulted in net medical care monetary savings, extended life expectancy, and fewer fatal illnesses . For low-risk tuberculin reactors, chemoprophylaxis resulted in positive, but small, health effects . Because the cost to gain these positive effects were also small, the resulting cost-effectiveness ratios were reasonable and in the realm of accepted prevention strategies: $12,625 to gain one year of life and $35,011 to avert one death . These findings suggest that the current policy is too restrictive and that many in the large population of low-risk tuberculin reactors should be considered for isoniazid chemoprophylaxis.

Int J Lepr Other Mycobact Dis, 1988 Mar, 56(1), 27 - 35
Immunogenic "subunit" of the ICRC antileprosy vaccine; Chirmule NB et al.; The administration of a vaccine containing ICRC bacilli, which is currently undergoing clinical trials in India, induces persistent lepromin conversion in lepromatous leprosy (LL) patients and lepromin-negative healthy subjects, with "upgrading" of tissue response in the former . A sonicate of ICRC bacilli, when subjected to gel-filtration chromatography using high-pressure liquid chromatography (HPLC), yields a high molecular weight glycolipoprotein (PP-I) with an apparent molecular weight of 10(6) daltons . PP-I, which brings about lepromin conversion in lepromin-negative healthy subjects, is a major immunogen of the organism, and carries epitopes for both B and T cells . A similar high molecular weight glycolipoprotein (PP-I Mycobacterium leprae) has been isolated from the sonicate of M . leprae . The two PP-I fractions exhibit a close antigenic relatedness at both B- and T-cell levels . However, they differ in their chemical composition and carry different charges . PP-I of ICRC is not only a good immunogen . Its high lipid content provides the necessary built-in adjuvant that would make it a good candidate for a "subunit" antileprosy vaccine . Also, since it carries epitopes for both B and T cells, PP-I ICRC could be used for "molecular engineering" to obtain molecules which selectively stimulate T-cell immunity which is the dominant host defense against M . leprae.

CMAJ, 1988 Mar 1, 138(5), 431 - 4
Superficial mycobacterial lymphadenitis in Saskatchewan; Martin T et al.; A total of 43 bacteriologically verified cases of superficial mycobacterial lymphadenitis were reported in Saskatchewan between 1981 and 1986; 35 (81%) were due to Mycobacterium tuberculosis . Among the eight cases (19%) due to nontuberculous mycobacteria the agent most frequently isolated was M . avium-intracellulare . Five additional cases were smear-positive and culture-negative . Direct smears of node tissue or aspirate were positive for acid-fast bacilli in 7 (88%) of the 8 cases of nontuberculous mycobacterial lymphadenitis but in only 16 (46%) of the 35 cases due to M . tuberculosis . Superficial tuberculous lymphadenitis was most frequent in female North American Indian or Asian-born adults and most commonly involved the cervical nodes . Nontuberculous mycobacterial lymphadenitis was most frequent in female white children, and most commonly involved the submandibular nodes . The cases of both tuberculous and nontuberculous mycobacterial lymphadenitis were spread throughout the province . There was an urban concentration of cases of tuberculous lymphadenitis in those of Asian origin . It is important to distinguish between superficial mycobacterial lymphadenitis due to M . tuberculosis and that due to nontuberculous mycobacteria for treatment and management purposes.

Int J Lepr Other Mycobact Dis, 1988 Mar, 56(1), 1 - 9
Pyrazinamide as a part of combination therapy for BL and LL patients--a preliminary report; Katoch K et al.; Pyrazinamide in a dose of 1500 mg was given to 63 borderline lepromatous (BL) and lepromatous (LL) leprosy patients on different drug regimens for the initial 2 months of therapy . Fifty-one BL and LL patients were put on the same drug regimens without pyrazinamide . There was a rapid and good clinical improvement in the patients in both of the groups . At the end of 2 years, the patients who received pyrazinamide had a morphological index (MI) of zero as compared to those patients who did not receive pyrazinamide, some of whom still had solidly staining bacilli . One out of 20 (5%) scrotal (smooth muscle) biopsies of the patients who received pyrazinamide had growth in the mouse foot pad as compared to 9 out of 38 (23.7%) smooth muscle biopsies of the patients who did not receive pyrazinamide . At the end of 5 years, the patients who received pyrazinamide had slightly better results compared with the non-pyrazinamide group . Pyrazinamide appears to have some effect against persisters in multibacillary leprosy . A well-controlled, randomized trial with longer duration of pyrazinamide therapy in a larger group of patients needs to be carried out to unequivocally determine the exact role of pyrazinamide in leprosy.

Am J Trop Med Hyg, 1988 Mar, 38(2), 391 - 2
Mycobacterium ulcerans infections in Papua New Guinea: correlation of clinical, histological, and microbiologic features; Igo JD et al.; Biopsy material from 46 cases clinically diagnosed as Mycobacterium ulcerans infection was studied . The disease was found to be most frequent in East Sepik Province, and in the first decade of life . In these 46 cases the histological features were characteristic and acid-fast bacilli were seen in tissue sections.

N Z Med J, 1988 Feb 10, 101(839), 45 - 9
Contact screening procedures for tuberculosis in Auckland; Karalus NC; A five year audit of tuberculosis notifications for the three Auckland health districts revealed that 10.7% of notifications were the result of contact screening procedures . Most notifications from this source were children (73.2%) up to 16 years of age . By far the greatest yield from contact screening procedures was among contact of patients with infectious pulmonary tuberculosis (whose sputum is smear positive on direct microscopy): 78.8% of cases found by contact procedures were contacts of these infectious patients . The yield was particularly high for children who were close contacts of these cases: 23.8% of such children were considered to be infected by tubercle bacilli compared with only 1.1% of children who were casual contacts of these infectious cases . Few adults were found by contact procedures because: (a) only those with pulmonary disease were found, whereas among children all those who had been infected, the majority of whom had not developed tuberculous disease (so-called primary occult tuberculosis) were found, and (b) many adult contacts of smear positive pulmonary index cases were not followed with chest radiographs for long enough: only one half had six months of surveillance . By restricting contact screening procedures to contacts at highest risk the workload could be substantially reduced with minimal reduction in the yield of new cases.

Antibiot Khimioter, 1988 Feb, 33(2), 120 - 4
{Sensitivity of clinical strains of facultatively anaerobic bacteria to antimicrobial drugs}; Bazhenov LG et al.; Six hundred and sixty five samples of clinical materials from patients with various pyoinflammatory diseases were tested for obligatory anaerobes . Anaerobes were detected in 148 samples which amounted to 22.3 per cent of the total number of the samples and to 33.2 per cent of the samples with microbial growth . A total of 171 strains of obligatory anaerobes were isolated . Among them 58.5, 24.5, 16.4 and 0.6 per cent were nonsporulating gramnegative bacilli, grampositive cocci, grampositive bacilli and gramnegative cocci respectively . Sensitivity of the isolated anaerobes was tested with the disk diffusion method . The most active drugs against the tested strains were: nitroxoline, rifampicin, metronidasole, erythromycin, carbenicillin and cefotaxim (4.2, 4.5, 9.3, 10.6, 11.5 and 11.7 per cent of the resistant strains respectively) . Gentamicin, polymyxin M, novobiocin and cefazoline were the least active drugs (94.6, 78.9, 65.4 and 50.0 per cent of the resistant strains respectively) . Metronidasole, levomycetin, nitroxolin, rifampicin and furazolidone showed the highest activity against bacteroids of the fragilis group (0, 0, 0, 8 and 12.5 per cent of the resistant strains respectively) while gentamicin, polymyxin M, cefazolin, oxacillin, novobiocin and penicillin showed the lowest activity (100, 100, 100, 100, 87.0 and 66.7 per cent of the resistant strains respectively).

Aust Vet J, 1988 Feb, 65(2), 43 - 6
Clinical and pathological observations on goats experimentally infected with Pseudomonas pseudomallei; Thomas AD et al.; The effects in goats of the subcutaneous injection of varying doses of Pseudomonas pseudomallei (90 to 500,000 bacilli) suspended in normal saline are described . High doses (greater than or equal to 500 bacilli) caused acute, fatal infections . Lower doses (90 to 225 bacilli) caused acute or chronic disease when infection became established . However, 11 of 18 goats injected with the lower doses of bacilli showed no sign of infection on clinical or bacteriological examination . Response to antibiotic therapy with long acting tetracycline and chloramphenicol was minimal . Goats surviving the initial phase of infection tended to overcome the disease with a corresponding increase in the number of abscesses that were sterile at necropsy . In infected goats, clinical signs included undulating fever, wasting, anorexia, paresis of the hind legs, severe mastitis and abortion . At necropsy, abscesses were found predominantly in the spleen, lungs, subcutaneous injection site and its draining lymph node.

Am Rev Respir Dis, 1988 Feb, 137(2), 265 - 72
Prevention of nosocomial pneumonia using topical and parenteral antimicrobial agents; Johanson WG Jr et al.; The efficacy of antimicrobial agents applied topically in the oropharynx and trachea with and without intravenous antibiotics in preventing bacterial pneumonias during prolonged (7 to 10 days) mechanical ventilation was studied in 35 baboons, 30 of which had acute lung injury induced by either oleic acid or hyperoxia . In 12 animals receiving no antibiotics, only topical application of polymyxin B (PB), or only intravenous penicillin and gentamicin (IV PCN/GM), moderate or severe pneumonia was found in 81% of lobes examined at necropsy; no lobes were sterile . Pneumonias were polymicrobial in the absence of antibiotics, due to PCN-sensitive organisms in the topical PB group, and due to gram-negative bacilli in the IV PCN/GM group . Combinations of topical PB or GM or both plus IV PCN were highly efficacious in preventing pneumonia in 23 animals as only 15% of the lobes contained moderate to severe pneumonia and 52% of lobes were sterile . In these groups, histologically evident pneumonias were associated with low concentrations of bacteria in lung tissue, principally gram-negative bacilli resistant to the topical agent being used . Resistance to PB appeared to be solely due to selection of intrinsically resistant species, whereas resistance to GM may have developed through additional mechanisms as well . Although this approach to pneumonia prevention is clearly efficacious in this animal model, clinical studies are needed to define the frequency and significance of microbial resistance in human subjects.

Am Rev Respir Dis, 1988 Feb, 137(2), 259 - 64
Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation; Johanson WG Jr et al.; Cultures of tracheal secretions, bronchoalveolar lavage (BAL), protected specimen brushes (PSB), and direct lung aspirates were compared with cultures of lung homogenates and histologic findings in 35 baboons after 7 to 10 days of intubation and mechanical ventilation . Six animals received no antibiotics, while the remainder were treated with a variety of prophylactic regimens of intravenous and topical agents . Bacterial contamination at each culture site was expressed as a "bacterial index" (BI), obtained as the sum of the logarithmic concentrations of individual species . In the absence of antibiotics, pneumonias occurred in all animals and were polymicrobial; 56% of organisms in lung tissue were members of the normal upper respiratory tract flora, while 44% were gram-negative bacilli with a mean total bacterial index of 13.94/g . Lobar tissue BI values greater than 6.0/g were found in 77% of lobes containing pneumonias judged by histologic criteria to be moderate or severe in extent, whereas only 7% of lobes with lesser inflammatory changes had similar BI values . The BI values of BAL were linearly related to tissue values, whether the BAL was performed of the same lobe cultured or a different lobe . BAL recovered 74% of all species present in lung tissue compared to 41% by PSB and 56% for needle aspirates . False positive specimens were found with similar frequency with these 3 procedures . Tracheal aspirates revealed 78% of organisms found in lung tissue, but 14 of 35 (40%) of species isolated were not present in lung tissue . BAL provides the best reflection of the lung's bacterial burden, both quantitatively and qualitatively, in the setting of prolonged intubation and ventilation.

J Allergy Clin Immunol, 1988 Feb, 81(2), 391 - 400
Experimental hypersensitivity pneumonitis in the mouse: histologic and immunologic features and their modulation with cyclosporin A; Takizawa H et al.; A murine model of hypersensitivity pneumonitis (HP) was established with transnasally administered Thermoactinomyces vulgaris (Tv) bacilli . Bronchoalveolar lavage (BAL) of experimental animals revealed marked increase in the total cell, lymphocyte, and macrophage numbers; the findings were similar to those in human HP . The BAL lymphocytes were mostly Thy 1.2 positive . Lyt-1 positive cells predominated Lyt-2 positive cells . Anti-Tv IgG antibodies and delayed-type hypersensitivity footpad reactions against Tv were detected in animals with HP . Cyclosporin A (CyA), a potent immunosuppressive drug, had marked effects on the development of HP in this model . When CyA was administered throughout the course of Tv inoculations, the granulomatous pneumonitis was markedly suppressed, and an increase in BAL lymphocytes, Thy 1.2 positive cells, was suppressed . When CyA was administered only during the first half period of the Tv treatment, suppression of the disease was minimal; when CyA was administered in the latter half, both the HP lesions and the increase in BAL cell lymphocyte numbers were significantly suppressed . These results indicate that a series of transnasal administration of Tv in mice may provide a good model for human HP.

Microbiologia, 1988 Feb, 4(1), 55 - 9
Characterization of an hospital disseminated plasmid encoding resistance to gentamicin and other antimicrobial agents; Rivera MJ et al.; A preliminary report has shown the existence of an endemic R plasmid in the University Hospital of Zaragoza . The results presented in this paper demonstrate the dissemination of a new 73 kilobases plasmid into multiple strains and species of gram-negative bacilli . This transferable plasmid belongs to Incompatibility group P and mediates resistance to ampicillin, tetracycline, gentamicin, kanamycin, streptomycin, chloramphenicol and sulfamethoxazole, synthesizing the aminoglycoside-modifying enzymes 3-acetyltransferase, 3'phosphotransferase, and 3"nucleotidyltransferase, and a TEM-1 beta-lactamase . These results and the previous findings show that a family of gentamicin-resistance plasmids exists among the gram-negative bacteria in the University Hospital . Resistance to gentamicin in all these plasmids is associated with the formation of 3-N-acetyltransferases.

Cancer Detect Prev, 1988, 11(3-6), 173 - 89
Collagen fiber formation and proliferation as a mechanism of cancer prevention and regression induced by extract from Mycobacterium tuberculosis: correlation between clinical observation and animal experiments; Kimoto T et al.; Administration of polysaccharides extracted from human Mycobacterium tuberculosis bacilli, Aoyama B strain (SSM) produced regression of breast cancer in 2 women . Biopsies of tumor nodules from these patients revealed intense proliferation of collagen fibers from the stromal cells . SSM apparently promoted the proliferation and maturation of collagen fibers from the stromal cells and matrix destroyed by tumor infiltration . Transplantation of human tumor cell lines into athymic mice resulted in the formation of collagen fibers surrounding the cancer cells . SSM promoted the proliferation and maturation of collagen fibers encasing the tumor cells . The intensity of collagen fiber formation varied with the kind of cancer cells used . The degree of proliferation of collagen fibers correlated with the antitumor effects of SSM . There was hardly any migration of lymphocytes, monocytes, and macrophages in the affected sites . It is interpreted that SSM stimulates the proliferation and maturation of collagen fibers in the host as a major mechanism of its antitumor property . When examined by circular dichroism this proliferation was found to be dependent upon changes in the molecular structure of the substances which make up the cell membrane . Fibronectin was presumed to be important among these substances.

Pathology, 1988 Jan, 20(1), 74 - 6
Capnocytophaga species: a cause of amniotic fluid infection and preterm labour; McDonald H et al.; Subclinical amniotic fluid infection and subsequent preterm labour may occur with intact membranes . We report two cases of subclinical amniotic fluid infection with intact membranes presenting in preterm labour . Capnocytophaga species, fastidious Gram-negative bacilli normally found in oral flora, were isolated in pure culture from amniotic fluid obtained by transabdominal amniocentesis . The distinctive microbiological features and spectrum of infections associated with Capnocytophaga species, and the importance of recognition of subclinical amniotic fluid infection as a cause of preterm labour, are discussed.

J Infect, 1988 Jan, 16(1), 61 - 4
Tuberculosis presenting as laryngeal stridor in a child; Elias-Jones AC et al.; A three and a half-year-old boy developed stridor after insertion of grommets for bilateral secretory otitis media . Despite treatment with steroids systemically and locally, antibiotics and an antihistamine, the stridor worsened . Microlaryngotracheobronchoscopy (MLB) demonstrated laryngeal granulations, in which, by auramine and Ziehl-Neelsen staining, acid-fast bacilli were seen, and from which subsequently Mycobacterium tuberculosis grew in culture . Following the MLB the child became comatosed and a clinical diagnosis of tuberculosis involving the central nervous system was made . Despite quadruple antituberculous chemotherapy he died 8 days later . A Mantoux test was negative and a chest radiograph was normal . Acid-fast bacilli were not demonstrated on repeated examinations of cerebrospinal fluid, nor were they grown ante mortem or post mortem from samples of cerebrospinal fluid.

Arch Dermatol Res, 1988, 280(1), 18 - 22
Relationship between macrophage infiltration and epidermopoiesis in delayed-type hypersensitivity; Tanaka T et al.; The relationship between epidermopoiesis and macrophage infiltration was studied in delayed-type hypersensitivity (DTH) skin lesions in guinea pigs that had been sensitized with heat-killed tubercle bacilli or bovine serum albumin (BSA) . Macrophages were identified with acid-phosphatase and nonspecific esterase stains, and the epidermal proliferative response was studied at DTH challenge sites by autoradiography . The number of macrophages in the sensitized animals was higher than that in the nonsensitized animals 48-72 h following challenge injections, when labelling indices were also elevated in the former group . Soluble factor(s) from cultured macrophages transiently enhanced the DNA synthesis of epidermal cells in cultures and in the sites injected with the factor(s) . These results suggest that macrophages retained in the DTH lesion may play a role in an acceleration of epidermal proliferation, thus leading to acanthosis and lichenification.

J Biol Stand, 1988 Jan, 16(1), 15 - 26
The stability and immunogenicity of a dispersed-grown freeze-dried Pasteur BCG vaccine; Gheorghiu M et al.; The level of antituberculous immunity seems to be related to the number of memory T cells induced . This may vary as a function of the multiplication and persistence of BCG in host tissues . The most important requirements for a BCG vaccine are, therefore, the immunogenicity of the strain, the high proportion of live to dead bacilli, and adequate dispersion and low levels of soluble antigens . The surface-grown Pasteur BCG vaccine contains a very high proportion of bacilli killed by ball-milling and freeze-drying . It also contains clumps and soluble antigens, all factors influencing cell-mediated immune processes and viability control . Therefore, several batches of vaccine were prepared on an industrial scale using one of the most immunogenic strains (French 1173 P2) and grown as dispersed bacilli by a modified cell type culture method . This method provided fully viable, well-dispersed vaccines which have a viability and heat stability superior to that of the classical surface-grown BCG . The immunogenicity was checked by multiplication and persistence in mouse organs and the skin reactivity and tuberculin hypersensitivity in guinea-pigs showed results comparable to those obtained with classical vaccine . Small-scale tests in children showed superior immunogenicity of the dispersed as opposed to the classical vaccine and there was no suppurative adenitis.

Ann Fr Anesth Reanim, 1988, 7(1), 26 - 30
{Secondary lung diseases in patients with nasotracheal intubation . Role of nosocomial sinusitis}; Meyer P et al.; Nosocomial pneumonia is a frequent infectious complication in ICU patients . All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study . Diagnosis was confirmed via CT-scan views and transnasal sinus puncture . In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement . Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates . In four cases, a polymicrobial sinusitis was found with a single organism predominant . This predominant germ was always found in bronchial aspirate . Recovery from pneumonia was obtained only after sinus drainage . Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics . One patient required surgical maxillary sinus drainage after failure of medical management . The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses . Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation . Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

J Clin Pathol, 1988 Jan, 41(1), 93 - 6
Tuberculous lymphadenitis associated with human immunodeficiency virus (HIV) in Uganda; Nambuya A et al.; Sixteen adults presented with lymphadenopathy which was tuberculous on biopsy; they were all seropositive for human immunodeficiency virus (HIV-1), but none had the clinical criteria of the acquired immunodeficiency syndrome (AIDS) . The biopsy specimen showed caseating tuberculosis, with scanty or no visible acid fast bacilli in seven cases; the remaining nine had a poor cellular reactivity with numerous bacilli . Antituberculous chemotherapy for two months reduced the lymphadenopathy . Two patients subsequently developed AIDS . Mycobacterial cultures were not performed, but the infection was almost certainly Mycobacterium tuberculosis . The space-time clustering of tuberculous lymphadenitis now seen in Kampala, and the unusual non-reactive histopathology, are typical of the impairment of cellular immunity induced by HIV infectionPIP: Tuberculosis is not among the infections currently included in the clinical case description of AIDS . However, tuberculous lymphadenitis is emerging as an increasingly common concomitant infection associated with HIV-1 seropositivity in Africa . 16 HIV-positive patients presenting at Mulago Hospital, Kampala, in 1986, with lymphadenopathy were studied . Lymph node biopsies were done on all 16, but only 7 of the histopathologic specimens showed a normal immune response to tubercle bacilli . The remaining 9 showed numerous bacilli but absent or weak cellular immune response . All patients responded to standard antituberculosis drug therapy; 2 patients developed clinical AIDS . Since HIV seropositivity seems to predispose to nontypical tuberculosis, it is recommended that in future cultures be done on tuberculous tissues from HIV-positive patients in Africa .

Int Arch Allergy Appl Immunol, 1988, 86(1), 19 - 27
Antigenic profile of ICRC bacilli with special reference to isolation of immunogenic subunit; Chirmule NB et al.; A vaccine containing ICRC bacilli induces persistent immune conversion in lepromatous leprosy (LL) patients and lepromin-negative healthy subjects, in association with upgrading of the tissue responses in the former . With an idea to isolate the immunogenic 'subunit(s)', antigenicity of ICRC sonicate and its fractions were tested, with reference to both B- and T-cell responses . A very high molecular weight glycolipoprotein, named PP-I with an apparent molecular weight of 1,000,000, has been isolated using gel permeation high performance liquid chromatography (HPLC) . PP-I, which focussed as a single band at pH 5 in an LKB isoelectric focussing column, quantitatively interacted with 80% of the circulating antibodies in pooled LL sera, and also induced a late (3 weeks) Mitsuda-type skin response which shows excellent correlation with host immunity against Mycobacterium leprae . These observations suggest that PP-I is a complex bifunctional antigen containing epitopes for both B and T cells . The PP-I fraction of ICRC and a similar high molecular weight HPLC fraction of M . leprae produced a line of identity against rabbit anti-ICRC serum in Ouchterlony gel diffusion and gave comparable skin responses in healthy volunteers in leprosy endemic areas . The data indicate that the PP-I fractions from the two organisms are antigenically closely related . Preliminary studies in human volunteers showed that administration of PP-I of ICRC resulted in immune conversion in lepromin-negative healthy subjects . PP-I thus appears to be the appropriate immunogen that could be used in preparation of a 'subunit' antileprosy vaccine.

Acta Cytol, 1988 Jan-Feb, 32(1), 109 - 12
Postoperative changes in vaginal smears after vaginal reconstruction with a free skin graft; Takashina T et al.; Surgical vaginal reconstruction was performed by a free skin graft in two patients without a vagina . The postoperative changes in vaginal smears collected from the artificial vaginas were observed for about two years . Marked operation-induced inflammatory changes were observed until the second postoperative month . After the third postoperative month, the background became relatively clear . Cyanophilic and eosinophilic superficial cells, intermediate cells and Doderlein bacilli were observed occasionally in addition to keratotic cells . Six to 12 months after surgery, the vaginal smears showed little abnormality, except for the presence of keratotic cells . The changes in the vaginal smears after the third month show that the artificial vaginal epithelium changed cytologically to an almost normal vaginal mucosa that, although not histologically complete, responded to hormones . The presence of Doderlein bacilli suggests that the regional environment of the artificial vagina was almost the same as that of the normal vagina.

J Med Microbiol, 1988 Jan, 25(1), 13 - 5
Rifampicin-resistant strains of Mycobacterium leprae may have reduced virulence; McDermott-Lancaster RD et al.; A strain of Mycobacterium leprae resistant to rifampicin (RMP) failed to infect normal mice when injected into the foot pads (FP) at a dose of 10 or 100 bacilli/FP, although it could be maintained by serial passage in mice by the use of inocula of 10(4) bacilli/FP; normal mice can be infected by RMP-sensitive M . leprae at a dose of 10 bacilli/FP . By contrast, nude (athymic) mice could be infected with an inoculum of 10 bacilli/FP of the RMP-resistant strain . It is suggested that the strain concerned possessed reduced virulence for normal mice, and the implications of this for the probability of occurrence of human disease caused by RMP-resistant strains of M . leprae are discussed.

Invest Ophthalmol Vis Sci, 1988 Jan, 29(1), 140 - 5
Corneal changes in nine-banded armadillos with leprosy; Malaty R et al.; Leprosy is the third leading cause of blindness worldwide; however, little is known about the ocular changes that occur during the disease process . We have studied the eyes of two nine-banded armadillos with experimental Mycobacterium leprae infection by light and electron microscopy . Both animals had been inoculated intracutaneously, one 5 years and the other 2 years previously . Light microscopy revealed invasion by acid-fast bacilli which were seen in keratocytes and mononuclear phagocytes in all layers of the corneal stroma . In both animals, large macrophage granulomas were observed in the deep stroma, which was vascularized . Acid-fast bacilli were also were found in macrophages and vascular endothelial cells . By electron microscopy, numerous bacilli were found in the keratocytes, macrophages, and Schwann cells of myelinated and unmyelinated axons, and in the endothelial cells of blood vessels . The localization of M . leprae and the presence of inflammatory cells in the ocular tissue of both animals suggest that the bacilli reach the eye by the neural and/or vascular route . One animal showed much more extensive disease and bacillary yield than the other, indicating that ocular involvement may be independent of the generalized infection . Further studies of early ocular involvement in the armadillo and other animals could help to clarify the pathogenesis of this potentially blinding infection.

Drugs, 1988, 35 Suppl 2, 22 - 8
Emergence of resistance during beta-lactam therapy of gram-negative infections . Bacterial mechanisms and medical responses; Pechere JC; Some Gram-negative, non-fastidious bacilli, although classified as susceptible by conventional susceptibility testing methods, become resistant during therapy with the newer beta-lactam compounds . Emergence of resistance results primarily from the selection of resistant clones pre-existing within the susceptible bacterial populations . Most of the resistant clones produce large amounts of beta-lactamases which inhibit the beta-lactam antibiotics by hydrolysis, rather than by binding . In addition, resistant clones can limit the penetration of beta-lactam molecules through the outer membrane by a decreased expression of their porins . Less commonly, when beta-lactamase activity together with alteration of the permeability barrier does not prevent the access of the antibiotic molecules to their target, altered penicillin-binding proteins (PBPs) can produce resistance . However, the risk of resistance emerging during therapy varies with the beta-lactam drug administered . Some compounds such as cefpirome, BMY 28142, SCH 34343, or imipenem appear to be associated with a low risk . In addition, emergence of resistance can be reduced by using higher dosages of beta-lactam agents, or by combining them with other drugs such as aminoglycosides or quinolones.

Diagn Cytopathol, 1988, 4(2), 99 - 105
Nasal cytology in allergic processes and other syndromes caused by hyperreactivity; Rivasi F et al.; The spontaneous nasal secretions from about 128 patients with the symptomatic triad of rhinorrhea, sneezing, and nasal obstruction were studied . The cytological examination consisted of a morphological evaluation and a semiquantitative evaluation . Noncellular and nonliving presences in the smears have been considered, including mucus, Charcot-Layden crystals, and pollen grains, as well as fungi and bacilli . We found a net increase in eosinophils, goblet cells, and cellular debris in secretions of atopic patients . Pollen grains and vegetative fragments were present in the nasal smears of pollinosis . The presence of fungi was observed in five cases of allergic rhinopathy . The exfoliative cytology represents a valuable means for the differential diagnosis of rhinitis . In particular, the presence of noncellular elements has value regarding rhinocytology.

Dermatologica, 1988, 177(4), 212 - 7
Histoid leprosy: a prospective diagnostic study in 38 patients; Sehgal VN et al.; Histoid leprosy is a fascinating expression of multibacillary leprosy, the incidence of which was 3.6% . It was seen predominantly in males of the younger age group, who were on inadequate and irregular dosage of diaminodiphenyl sulfone . Papules, cutaneous and/or subcutaneous nodules and plaques appearing over apparently normal skin were its exquisite prospective clinical features . It was invariably supported by enormous, uniformly solid staining discrete bacilli from the lesions, in contrast to their virtual absence from the surrounding normal-appearing skin . Encapsulated tumorous mass, formed primarily by spindle-shaped histocytes, displayed either in intertwining, criss-cross or whorled fashion in haematoxylin-eosin-stained sections, were supplementary . The morphology of acid-fast bacilli was, however, similar to skin-slit smears.

Ann Chir Gynaecol, 1988, 77(1), 37 - 40
Hyperbaric oxygen in the treatment of clostridial gas gangrene; Hirn M et al.; Thirty-two cases with clostridial gas gangrene were treated during the years 1971-87 in the Department of Surgery, Turku University Central Hospital . The presumptive diagnosis was made on the basis of the clinical appearance of the patient and presence of gram-positive bacilli on a smear . Each patient underwent surgical debridement, antibiotic therapy and hyperbaric oxygen treatment . Seventeen cases had diffuse spreading myonecrosis, 11 of whom survived . Fifteen patients developed clostridial cellulitis with toxicity, 12 survived . Thus the over-all mortality was 28.1% . All those patients who died had been transferred from other hospitals of the country and were already moribund on arrival . Twenty-two infections developed postoperatively, in 6 cases trauma was the antedecent cause and 4 were spontaneous infections . None of the patients with a posttraumatic infection died . The most common underlying disorders included arteriosclerosis, diabetes mellitus, malignancy and Buerger's disease . The addition of hyperbaric oxygenation to the treatment of gas gangrene--although strictly adjunctive to surgery, antibiotics and supportive therapy--has dramatically changed the surgical approach to treatment . Early diagnosis remains essential . Patient survival can be achieved if the disease is recognized early and appropriate therapy applied promptly.

Cathet Cardiovasc Diagn, 1988, 15(2), 92 - 4
New nonsurgical technique for multiple pericardial biopsies; Endrys J et al.; We report a new, nonsurgical technique for obtaining multiple pericardial biopsies in patients with pericardial effusion . A short catheter is introduced by the Seldinger technique under fluoroscopy through the subxiphoid approach . The pericardial fluid is aspirated and the catheter replaced by an 8F teflon sheath with a curved tip . A bioptome is inserted through the sheath, and air is allowed to enter the pericardium . This method outlines the parietal percardium . The curved sheath directs the bioptome to the left or right wall . Eighteen consecutive patients had an average of eight pieces of pericardium removed . On histological examination, three patients had malignancy . Six had tuberculous granuloma, and mycobacterium tuberculosis was cultured from all six tissue specimens but only once from the fluid . Tissue smears showed acid fast bacilli in four out of six, whereas the fluid was negative in all . The biopsy yielded diagnostic information in nine out of ten patients with a thickened pericardium . There were no complications.

Med Microbiol Immunol (Berl), 1988, 177(5), 255 - 63
Effect of protein and zinc deficiencies on vaccine efficacy in guinea pigs following pulmonary infection with Listeria; Coghlan LG et al.; Specific pathogen-free guinea pigs were maintained for 3 weeks on purified diets containing 30% protein (ovalbumin) and 50 ppm added zinc (Control-C), 10% protein and 50 ppm added zinc (low protein-LP), or 30% protein and no added zinc (low zinc-LZ) . Half of the animals in each diet group were vaccinated intraperitoneally with 2.5 x 10(3) viable Listeria monocytogenes organisms after 8 days of diet treatment . Ten days later, all animals received an aerosol challenge of 250 L . monocytogenes organisms and were killed 4 days later . Both zinc and protein deficiency resulted in animals that were growth retarded as compared to controls . Specific nutrient effects were observed as significant reductions in total serum proteins (LP group) and plasma zinc concentrations (LZ group) . In vaccinated guinea pigs, both protein and zinc deprivation resulted in significant impairment of delayed-type hypersensitivity (DTH) responses following the intradermal injection of listeria antigen . Diet did not exert a measurable impact on the response of nonvaccinated guinea pigs to pulmonary listeriosis . Prior vaccination allowed both malnourished groups to control the challenge infection successfully as measured by significant reductions in viable bacilli recovered from the lung, spleen and hilar lymph nodes . The diet and vaccine effect varied depending on the tissue examined . Thus, although both protein and zinc deficiencies resulted in loss of peripheral antigen-specific T lymphocyte function (DTH), vaccine efficacy was not impaired.

Cornea, 1988, 7(3), 218 - 22
Ocular Capnocytophaga infection in an edentulous, immunocompetent host; Ormerod LD et al.; Severe microbial keratitis developed in a 74-year-old women receiving long-term corticosteroids . Corneal smears revealed slender, fusiform gram-negative bacilli, but the lesion continued to worsen despite intensive antibiotic treatment . After several days, Capnocytophaga sputigena was identified on culture . Specific antimicrobial therapy was instituted, supplemented with corneal cryotherapy . There was gradual clinical improvement . However, a sterile corneal melt led to the late loss of the eye . Although Capnocytophaga are gingival organisms and usually implicated as opportunists in severely ill, neutropenic patients with oral ulcerations, our patient was edentulous and without systemic immunosuppression . An increased awareness of Capnocytophaga is justified because of their widespread antibiotic resistance, capnophilic cultural requirements, and unusual microscopic and cultural morphology.

Curr Clin Top Infect Dis, 1988, 9, 173 - 84
Choices of new penicillins and cephalosporins in the DRG era; Rahal JJ; Several new penicillins and cephalosporins have provided important advances in the therapy of infections caused by gram-negative aerobic bacilli . Older agents, alone or in combination, possess equivalent or greater activity against gram-positive and anaerobic organisms and most community-acquired gram-negative enteric pathogens . Thus, newer agents are useful primarily for the treatment of highly resistant hospital-acquired gram-negative infections . Financial pressures created by the DRG era may favor their broader application, thus creating further resistance by selection or induction . However, prudent use of these agents for selected serious infections or for individuals threatened by aminoglycoside toxicity will yield the most durable cost-effective results.

Eur J Cancer Clin Oncol, 1988, 24 Suppl 1, S15 - 23
Prophylaxis of infection in bone marrow transplants; Winston DJ et al.; Bone marrow transplants experience severe immuno-deficiency as a consequence of pretransplant radiation and chemotherapy, transient granulocytopenia before marrow engraftment, and post-transplant prevention and treatment of graft-versus-host disease with immuno-suppressive agents . During periods of granulocytopenia, chemoprophylaxis with the oral fluorinated quinolones can prevent colonization and infection with gram-negative bacilli, is better tolerated than oral non-absorbable antibiotics or trimethoprim-sulfamethoxazole and is more cost-effective than laminar-air-flow isolation or prophylactic granulocyte transfusions . Antifungal prophylaxis with oral nystatin, ketoconazole or amphotericin B, however, has not been consistently effective; empiric intravenous amphotericin B therapy is still the most reliable way to prevent fatal fungal infections . Following marrow engraftment, cytomegalovirus infection and interstitial pneumonia can be prevented in cytomegalovirus-seronegative patients by the use of cytomegalovirus-seronegative blood products and cytomegalovirus immune globulin . In cytomegalovirus-seropositive patients, prophylactic DHPG (ganciclovir) is currently being evaluated in a controlled clinical trial . Herpes simplex and varicella-zoster infections can be treated effectively with intravenous acyclovir, but routine acyclovir prophylaxis is not cost-effective . Trimethoprim-sulfamethoxazole is used for prophylaxis of Pneumocystis carinii pneumonia and may be continued in patients with chronic graft-versus-host disease for prevention of late post-transplant bacterial infections.

J Clin Microbiol, 1988 Jan, 26(1), 18 - 21
Oxidation of palmitic acid by Mycobacterium leprae in an axenic medium; Franzblau SG; The ability of Mycobacterium leprae to oxidize palmitic acid during incubation in an axenic medium was studied . By using a Buddemeyer-type detection system, partially purified nude-mouse-derived M . leprae was found to produce 14CO2 from 14C-labeled palmitic acid in a linear fashion for at least 1 week . Procedures known to remove residual host tissue did not diminish the rate of 14CO2 evolution, indicating that bacterial metabolism was being measured . Palmitate oxidation was temperature sensitive, with an apparent optimum of 33 degrees C, but pH insensitive . Bacilli exposed to a variety of antileprosy drugs for 1 or 2 weeks displayed significantly reduced rates of 14CO2 evolution upon subsequent addition of 14C-labeled palmitic acid . This activity could be readily detected with 10(6) bacilli, thus indicating its potential for use in clinical susceptibility testing.

AJNR Am J Neuroradiol, 1988 Jan-Feb, 9(1), 121 - 4
Focal tuberculous cerebritis; Jinkins JR; Five cases of focal tuberculous cerebritis, seen over a period of 10 years, revealed unique clinicoradiologic patterns that differentiate these lesions from other forms of cerebral tuberculosis . Histologically, the process consists of microgranulomata, a lymphocytic infiltrate, Langhans' giant cells, epithelioid cells, and variable evidence of rare tubercle bacilli . The relatively poor clinical outcome in this series indicates the importance of timely recognition of this disease so that proper treatment can be instituted as early as possible in an effort to arrest the underlying inflammatory reaction with a resulting minimum neurologic insult . Intense focal gyral enhancement on CT and a corresponding palisading gyral blush on angiography are invariably observed radiologically.

Trans R Soc Trop Med Hyg, 1988, 82(3), 492 - 4
Demonstration of acid-fast bacilli in skin biopsies from indeterminate leprosy cases; Alvarez-Mendoza A et al.; Because the correct diagnosis of indeterminate leprosy (IL) requires the finding of acid-fast bacilli in skin lesions from clinically and histopathologically suggestive cases, it is necessary to develop a reliable method for this purpose . This paper presents a simple procedure, available to every general laboratory, which consists in obtaining 2 suspensions: SI, by mincing and grinding the tissue in phosphate-buffered saline; and SII, after treating SI with NaOH solution and digesting with trypsin . In 22 IL skin biopsies, bacilli were directly observed in only 3 with the Ziehl-Neelsen (ZN) stain; and with the peroxidase-antiperoxidase method it was impossible to differentiate between nonspecific precipitate and true positive reactions . In contrast, 18 positive results from the same 22 samples were obtained when both SI and SII were evaluated with ZN stain . The logarithmic bacterial index was also increased in at least 7 cases.

Ann Otolaryngol Chir Cervicofac, 1988, 105(7), 549 - 52
{Nosocomial sinusitis in an intensive care unit . Role of nasotracheal intubation}; Levy C et al.; Hospital infectious sinusitis resulting from nasotracheal intubation is common . A prospective study was undertaken between October 1986 and January 1988 of 46 patients who had undergone nasotracheal intubation . CT scan revealed sinusitis in 43 cases with sinus puncture proving the existence of bacterial sinusitis in 36 cases . Gram negative bacilli predominated . In 21 cases the existence of a complication (chest infection and/or septicemia) raised the possibility of the role played by sinusitis in their etiology . The prevalence of gram negative bacilli sinusitis in patients with a nasotracheal tube is felt to require the following from the 8th day onwards: a CT scan to detect the existence of sinusitis, sinus puncture for bacteriological identification of the organism.

Indian J Lepr, 1988 Jan, 60(1), 90 - 2
Primary drug resistance to both rifampicin and dapsone in a paucibacillary leprosy patient; Koranne RV et al.; A thirty-one year old male patient was diagnosed and treated for a pure or better primary neuritic case of leprosy with dapsone (100 mg daily for 2 years) and rifampicin (600 mg daily for 6 months) . From the very outset, the patient did not show any improvement; on the top of it, he subsequently, developed a cutaneous patch, which on histopathological examination, revealed classical features of BT leprosy . Acid-fast bacilli were absent both in skin slit smear and histologic section . A primary resistance to both dapsone and rifampicin, even in paucibacillary patient, is speculated.

Crit Rev Microbiol, 1988, 16(1), 15 - 36
The bioenergetics of alkalophilic bacilli; Krulwich TA et al.; A summary, cum speculation, of the major bioenergetic characteristics of alkalophilic bacilli is presented in Figure 5 . Further progress will depend heavily on the purification and characterization of the relevant proteins that catalyze the ion fluxes and on the development of much more potent genetic approaches to the outstanding issues of this interesting group of bacteria.

Rev Argent Microbiol, 1988 Jan-Mar, 20(1), 26 - 35
{Characterization of experimental infection with Mycobacterium lepraemurium in 2 strains of mice}; Roggero E et al.; A model of experimental leprosy in two strains of mice, namely CBA/J and CBi, has been developed based on: 1) the histological examination of a granuloma in the hind foot pad 200 days after inoculation of 0.30 microliter of Mycobacterium lepraemurium (6 x 10(8) MLm/ml); 2) the assessment of T lymphocytes in the granuloma identified by the alpha-naphthyl acetate method for esterase, and c) dissemination of the infection . The histological findings in the low resistance CBA/J strain included positive acid fast bacilli vacuolated cells, without lymphocytic infiltration, scarce number of T lymphocytes and a generalized and important dissemination, similarly to the one observed in human lepromatous leprosy . The histological findings in the hind foot pad granuloma of 30-40 per cent of the medium to high resistance CBi strain, consisted of vacuolated cells and lymphocytic infiltration, a large number of T cells and a scarce dissemination, similar to the human borderline leprosy . Both strains present a different susceptibility to a unique challenge with the mycobacterium which could be useful to disentangle the immunogenetic components involved, by means of appropriate selection and crosses . Furthermore, it could be of interest to perform immunoprotection assays in CBi mice, which might have some bearing on the development of a vaccine in human leprosy.

Lymphokine Res, 1988 Summer, 7(2), 129 - 40
Recombinant interleukin-2 limits the replication of Mycobacterium lepraemurium and Mycobacterium bovis BCG in mice; Jeevan A et al.; BALB/c mice were infected with Mycobacterium lepraemurium (MLM) in the foot pad or with M . bovis BCG intravenously with 5 x 10(7) bacilli . Recombinant interleukin-2 (IL-2) was injected intraperitoneally as a single dose (20,000 u), single course of 5 injections (400 u each) or 6 monthly courses starting 3 days or 60 days after the MLM infection . BCG infected mice received a single dose (1000 u) or 5 daily injections of 100 or 1000 u each . IL-2 significantly reduced the total bacterial counts in the footpad, lymph node and liver of MLM infected mice (50-85%) by 6 months and viable counts in the spleen (30-50%) by 60 days after BCG infection . The courses of IL-2 started at 60 days were more effective than at 3 days after MLM infection (P less than 0.05-0.001) and in the case of BCG, 100 u of IL-2 was better than 1000 u (P less than 0.05-0.01) . These results indicate that IL-2 limits mycobacterial infections in mice, and raise the question of its possible use in humans.

Cancer Immunol Immunother, 1988, 26(2), 153 - 60
Induction by an immunogenic immunomodulating agent of nonspecific T cell suppression of lymphocyte responsiveness in MLR but not of antibody production; Reuben C et al.; Spleen cells derived from BALB/c mice that had been repeatedly immunized with the methanol extraction residue (MER) fraction of tubercle bacilli exhibited a depressed capacity to act as responder cells in allogeneic and syngeneic mixed lymphocyte reactions (MLR) . Previously reported studies revealed that such spleen cells are also defective in the in vitro generation of antibodies . In order to determine the nature of the cells responsible for the depressed MLR reactivity, purified populations of splenic macrophages, B lymphocytes, T lymphocytes originating from normal and from MER-immunized mice, and cell culture supernatants were added to MLR mixtures consisting of normal mouse splenocytes . Macrophages originating from MER-immunized mice and their culture supernatants exerted a significantly higher suppressive effect on MLR than that of corresponding preparations from normal mice . Splenic T cells originating from MER-immunized mice and their supernatants also significantly suppressed the MLR response . However, the same T cell populations that were inhibitory in MLR failed to suppress the in vitro generation of antibodies against sheep red blood cells in the presence of either MER or 2-mercaptoethanol . These and previously reported findings indicate that a nonspecific immunomodulating agent, MER, can, under certain conditions of treatment, elicit the induction of nonspecific suppressor T cells for MLR but not for antibody production, and, accordingly, can inhibit cellular and humoral immunological responsiveness by different mechanisms.

Clin Ther, 1988, 10(5), 487 - 515
Comparative in vitro activity of imipenem and 15 other antimicrobial agents against clinically important aerobic and anaerobic bacteria; Goldstein EJ et al.; The comparative susceptibility of over 400 strains of aerobic and anaerobic pathogens, isolated from clinical specimens in late 1987 and early 1988, to imipenem and 15 other antimicrobial agents was studied using a uniform broth microdilution technique recommended by the National Committee for Clinical Laboratory Standards . Imipenem had the widest spectrum of activity and was consistently the most active agent tested . It was active against aerobic gram-positive cocci, aerobic gram-negative bacilli, and anaerobic bacteria.

J Leukoc Biol, 1988 Jan, 43(1), 60 - 6
Defective activation of granuloma macrophages from Mycobacterium leprae-infected nude mice; Sibley LD et al.; We have previously demonstrated that granuloma macrophages from the foot pads of Mycobacterium leprae-infected nude mice are functionally normal despite heavy intracellular burdens of bacilli . However, unlike peritoneal macrophages, these macrophages fail to restrict the intracellular growth of Toxoplasma gondii when stimulated with recombinant murine gamma interferon (Mu IFN-gamma) and thus appear defective in their response to macrophage-activating factor(s) . In further characterizing this defect we have examined tumoristatic capacity, superoxide radical formation, and expression of la antigens on granuloma macrophages before and after treatment with Mu IFN-gamma . By all three criteria, M . leprae-burdened granuloma macrophages failed to become activated by doses of Mu IFN-gamma that readily activate peritoneal macrophages from M . leprae-infected nude mice or normal Balb/c mice . M . leprae-infected granuloma macrophages produced elevated levels of prostaglandin E2 (PGE2) in vitro, which was suppressed by indomethacin . However, the inhibition of PGE2 production for 48 hr in vitro did not restore normal responses to Mu IFN-gamma.

Indian J Lepr, 1988 Jan, 60(1), 13 - 6
Auramine staining in detecting small number of bacilli in skin smears; Bhatia VN et al.; Auramine staining has been compared with Ziehl-Neelsen's staining of M . leprae in skin smear slide . The auramine method was found to be more sensitive than Ziehl-Neelsen's method and may be useful in detecting small number of M . leprae in skin smears . The inter-observer variance was minimal with auramine staining.

Eur J Immunol, 1988 Jan, 18(1), 59 - 66
Mycobacteria-reactive Lyt-2+ T cell lines; De Libero G et al.; The biological activities of mycobacteria-reactive Lyt-2+ T cells were characterized in vitro . T cells from mice immunized with killed Mycobacterium tuberculosis or viable M . bovis were restimulated in vitro and cloned under limiting dilution conditions . Several L3T4-Lyt-2+ T cell lines, some of them KJ16+, were established . These T cell lines were capable of lysing mycobacteria-primed macrophages in an antigen-specific way . The cytolytic activity of some T cell lines was found to be class I restricted, whereas others showed antigen-specific killing in the absence of apparent H-2 restriction . Several T cell lines produced interferon-gamma after appropriate stimulation . Furthermore, these T cell lines could induce tuberculostatic macrophage capacities by apparently two different mechanisms, namely by secretion of lymphokines (most probably interferon-gamma) and by direct cell contact . We conclude that CD8 T cells with antigen-specific cytolytic potential are generated during tuberculosis and that these T cells are involved in the immune response to tubercle bacilli.

S Afr Med J, 1987 Dec 19, 72(12), 878 - 81
Pleuropericardial effusions in children with non-Hodgkin's lymphoma . A report of 2 cases; Schraader EB et al.; Two children with non-Hodgkin's lymphoma (NHL) who presented with pleuropericardial effusions are reported on . Pericardial effusions are very unusual in children with mediastinal nodal NHL . In the first patient, who presented with a pleural effusion and pericardial tamponade, the diagnosis of NHL was obscured by a false-positive report of acid-fast bacilli in the pleural fluid . The second patient presented with a pleural effusion and a pericardial effusion with superior vena cava obstruction . Rapid filling of the serous cavities was a striking feature in both cases . Cytological and biochemical investigation of the pleural fluid and pleural biopsy are of limited diagnostic value . Pleuropericardial effusions in NHL are reviewed . The patients have been in disease-free remission for 18 and 16 months respectively.

Mayo Clin Proc, 1987 Dec, 62(12), 1129 - 36
Antituberculous agents; Van Scoy RE et al.; Antituberculous agents have radically improved the prognosis of patients with active tuberculosis . Generally, 6-month and 9-month regimens have been successful, and surgical therapy is rarely necessary . Extrapulmonary tuberculosis should be managed with the drug regimens outlined for pulmonary tuberculosis . The major cause of therapeutic failure is poor compliance of the patient in taking the medication regularly . The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobial agents used . When treatment failure is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated . A single drug should never be added to a failing regimen . For prophylaxis, isoniazid, given for 6 to 12 months, is effective in most cases.

J Bacteriol, 1987 Dec, 169(12), 5423 - 8
Facile autoplast generation and transformation in Bacillus thuringiensis subsp . kurstaki; Crawford IT et al.; We describe a method for maximizing the rate of conversion of Bacillus thuringiensis subsp . kurstaki vegetative cells to osmotically fragile forms in the absence of exogenously added enzymes . Optimal generation of autoplasts occurred in 50 mM sodium acetate buffer (pH 7.0) at 37 degrees C with 10% (wt/vol) polyethylene glycol as an osmotic stabilizer . The maximum autolytic rate resulted in a conversion of greater than 90% of bacilli to spherical autoplasts in 6 min . Autoplasts regained bacillary morphology upon plating on DM3-G regeneration medium, with reversion frequencies ranging from 1.2 x 10(-1) to 5.3 x 10(-3) . The autoplasts could efficiently take up exogenously added plasmid DNA . The presence of plasmids was verified by Southern hybridization analysis.

Tubercle, 1987 Dec, 68(4), 255 - 60
The course of fever during treatment of pulmonary tuberculosis; Barnes PF et al.; We studied 161 patients with pulmonary tuberculosis: 55 (34%) were afebrile and 106 (66%) were febrile at presentation . Febrile patients were younger and more symptomatic than afebrile individuals . Fever was also associated with a higher incidence of lymphopenia, hyponatraemia, hypoalbuminaemia and many acid-fast bacilli on sputum smear . Most patients were treated with isoniazid, rifampicin and pyrazinamide . Of 83 individuals who became afebrile while in hospital, 74 (89%) did so within a week and 77 (93%) in 2 weeks . Prolonged fever was associated with alcoholism, anaemia, hyponatraemia and hypoalbuminaemia . A therapeutic trial of antituberculosis drugs may be more useful than has been previously thought, since in most patients the temperature falls to normal within 2 weeks.

No Shinkei Geka, 1987 Dec, 15(12), 1345 - 50
{Tuberculoma and tuberculous meningitis mimicking metastatic brain tumor and meningeal carcinomatosis--case report}; Morimoto T et al.; A 45-year-old man was well until February 1986, when he experienced gait disturbance and psychiatric symptoms . On February 11 he fell down several times and developed generalized convulsion on the following day . He was admitted to a hospital in a delirious condition . The chest X-ray film showed infiltration in the left upper lobe, but computed tomographic (CT) scan of the head revealed no abnormality . Cerebrospinal fluid obtained by lumbar puncture contained 155 cells/mm3, all of which were lymphocytes, and protein and glucose concentrations were 372 mg/dl and 68 mg/dl respectively . In spite of negative smear tests of sputum and cerebrospinal fluid for tubercle bacilli he was administered antituberculosis drugs on the suspicion of pulmonary tuberculosis and tuberculous meningitis . His level of consciousness gradually returned to normal but the follow-up CT scans showed a low density area with contrast enhancement in the right thalamus and obliteration of the right quadrigeminal cistern which was also enhanced with contrast medium . He was transferred to our hospital on March 28 for further evaluation . On admission to our hospital he was alert and oriented, his pupils were equal and reactive to light and he had mild left hemiparesis, left hyperreflexia and left hemihypesthesia . Cell count of the cerebrospinal fluid was 243/mm3, 90% of which were lymphocytes and protein and glucose contents were 340 mg/dl and 42 mg/dl respectively . Both smear and culture of the cerebrospinal fluid were negative for tubercle bacilli and other organisms . Cytological examination of the cerebrospinal fluid demonstrated clusters of cells of various sizes with high N/C ratio which suggested these cells were malignant.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Otolaryngol, 1987 Dec, 12(6), 455 - 9
The clinical significance of the gastro-oral pathway of intestinal bacteria after head and neck cancer surgery; Swift AC et al.; Intestinal aerobic gram-negative bacilli (IAGB) are considered to be important in the pathogenesis of wound infection following major head and neck surgery . These micro-organisms have been shown to originate endogenously from the stomach, in spite of broad spectrum chemoprophylaxis . We have attempted to interrupt this gastro-oral pathway by instilling an antiseptic (40% ethanol) into the stomach after surgery . We studied 16 patients who were randomly allocated to an 'alcohol' or control group . Alcohol was administered to 8 patients regularly via the nasogastric tube until the 5th postoperative day . The mouth, tracheostomy site and gastric aspirates were sampled on the 1st, 5th, and 10th days after surgery . No patients had IAGB grown from the mouth before surgery, but after surgery coliforms were prolific in all sites in both patient groups, and the administration of alcohol did not have any noticeable affect . However, even though coliforms were ubiquitous during the recovery period, wound complications were few, and their importance in the pathogenesis of wound sepsis is reconsidered.

Lab Anim Sci, 1987 Dec, 37(6), 757 - 64
Microbial dysbiosis in rabbit mucoid enteropathy; Lelkes L et al.; The cecal contents of normal rabbits and rabbits with mucoid enteropathy (ME) were examined microscopically . Rabbits with ME consistently had dramatic cecal dysbiosis characterized by a loss of protozoa, large metachromatic bacilli and other gram-positive organisms and an increase in the size and stain retention of gram-negative organisms . Experimentally induced cecal hyperacidity in fistulated rabbits produced dysbiosis similar to that observed in natural cases of ME . Cecal pH measurements in normal young and adult rabbits revealed that pH values consistently were lower in young rabbits and frequently were low enough to induce microbial changes . Spontaneous cecal hyperacidity in young rabbits, therefore, appears to account for the cecal distention and diarrhea seen initially in ME . Late manifestations such as mucus hypersecretion and impaction, on the other hand, appear to be the result of specific microbial factors which develop when dysbiosis persists . The gradual change in the dysbiotic flora to one which closely resembles that of the normal rabbit colon appears to be the stimulus that permits these late manifestations to develop.

Pathol Biol (Paris), 1987 Dec, 35(10 Pt 2), 1370 - 6
Effects of antibiotics on bacterial structure and their pathogenicity; Lorian V et al.; Subinhibitory concentrations of beta-lactam antibiotics as well as some other antibacterial agents alter the ultrastructure of bacteria . The separation of replicated genomes of Gram positive cocci is inhibited, and results in clusters of as many as 30 organisms held together by thick cross walls . The separation of the replicated genomes of Gram negative bacilli is also inhibited and results in the formation filaments . These altered forms of bacteria usually exhibit lower pathogenicity than their respective normal counterparts such as; decreased adherence to epithelial cells, higher susceptibility to phagocytosis and decreased output of bacterial enzymes . Contrary to common belief, subinhibitory concentrations do not generate a significant increase in bacterial resistance to the respective drug.

Int J Lepr Other Mycobact Dis, 1987 Dec, 55(4), 680 - 4
Appearance of a methoxy mycolate-like component by the acid methanolysis of Mycobacterium leprae; Datta AK et al.; It has been reported that Mycobacterium leprae contains two types of mycolic acid, namely, alpha- and keto-mycolic acids, thus it is taxonomically similar to M . bovis BCG . However, there was some controversy about the presence of methoxy mycolic acid which was observed in small amounts only in the case of experimentally infected (W45) armadillo-derived M . leprae . To investigate this fact, mycolic acids were extracted from the cell-wall structure of M . leprae and characterized using chromatographic techniques . The results showed the appearance of a methoxy mycolate-like component for both purified bacilli and infected human skin tissue materials . However, this appearance occurred only when the acid methanolysis procedure was followed for the release of mycolic acids from these bacilli . No such component appeared on the chromatogram when the alkaline methanolysis procedure was followed . Nevertheless, the consistent presence of this methoxy mycolate-like component by acid methanolysis is an important finding which has to be kept in mind while identifying this pathogen when using chromatographic techniques.

Int J Lepr Other Mycobact Dis, 1987 Dec, 55(4), 672 - 9
Primary and secondary dapsone resistance of M . leprae in Martinique, Guadeloupe, New Caledonia, Tahiti, Senegal, and Paris between 1980 and 1985; Guelpa-Lauras CC et al.; Primary and secondary dapsone resistance were studied among lepromatous patients living in Martinique, Guadeloupe, New Caledonia, Tahiti, Senegal, and Paris . Four hundred fifteen biopsies were taken from clinically active and bacteriologically positive (bacterial index greater than 2) patients in the 6-year period of 1980-1985 . Among these, 280 biopsies that contained 5 x 10(4) acid-fast bacilli per ml with a morphological index of at least 0.10 were inoculated into the mouse foot pad, and 229 harbored infective Mycobacterium leprae . Among the 129 infective M . leprae isolated from new cases, 54% had some degree of dapsone resistance, a low degree being prominent in all cases . Among the 100 infective M . leprae isolated from relapsed cases, 79% had a high or an intermediate degree of dapsone resistance . The annual incidence of secondary dapsone resistance was estimated to be about 0.55% in Guadeloupe.

Int J Lepr Other Mycobact Dis, 1987 Dec, 55(4), 657 - 66
Effects of ICRC antileprosy vaccine in healthy subjects; Chaturvedi RM et al.; Long-term effects of the administration of the ICRC antileprosy vaccine in healthy subjects have been investigated both in household contacts of leprosy patients and noncontacts in a general population . Each volunteer received a dose of vaccine containing either 0.5 x 10(9) or 1.7 x 10(7) bacilli intradermally . The vaccine induces a dose-dependent lepromin conversion in negative subjects at 8 weeks after vaccination . One year later, the conversion rates are more than 90% in both high- and low-dose groups . Lepromin conversion is stable for at least 3 years . When administered to the lepromin-positive contacts, the vaccine induces a statistically significant increase in intensity of the reaction at 6 months . During the 3-year observation period, the subjects have remained healthy and no untoward effects, including any neurological lesions, have been observed . There has also been no change in the circulating level of antibodies against the phenolic glycolipid-I antigen of Mycobacterium leprae as a result of vaccination . The vaccine thus induces not only stable immunity but is safe and, being given as a single injection, has a high acceptability . Its field trials will begin soon.

Immunology, 1987 Dec, 62(4), 587 - 91
The Ity/Lsh/Bcg gene significantly affects mouse resistance to Mycobacterium lepraemurium; Brown IN et al.; Mouse resistance to infection with Mycobacterium lepraemurium was measured by counting the total number of intact acid-fast bacilli in the spleen 8 weeks after i.v . injection of a standard inoculation . The effect of Ityr on resistance to M . lepraemurium was confirmed and the results extended to two Ityr strains of mice, A and C57L, not previously tested . Resistance to M . lepraemurium was also examined in the F1, backcross and F2 generations of BALB/c X CBA crosses, and in the congenic strain B10.LLshr that is Ityr . In all experiments the results were consistent with the view that resistance to M . lepraemurium is significantly affected by a gene close to or identical to the Ity/Lsh/Bcg gene on mouse chromosome 1 . Sex had a marked effect on resistance to M . lepraemurium, so that the males of some genetically resistant strains were almost as susceptible as some genetically susceptible females.

Infect Immun, 1987 Dec, 55(12), 2945 - 50
Inhibition by 1,25(OH)2-vitamin D3 of the multiplication of virulent tubercle bacilli in cultured human macrophages; Crowle AJ et al.; Historically, sunlight has seemed to fortify antituberculosis resistance . Evidence is presented here suggesting a role for vitamin D in this effect . The active metabolite of this photosynthesized vitamin, 1,25-dihydroxy-vitamin D3 (1,25D), promotes maturation and activation of human monocytes and macrophages (MPs) . Therefore, it was tested for ability to protect MPs against virulent tubercle bacilli . MPs were derived by 7-day culture from blood monocytes, infected with the bacilli, and exposed to 1,25D in several regimens . Their inhibition of bacilli was measured by lysing samples of the cultures at 0, 4, and 7 days after infection and making bacillary CFU counts from serial dilutions of the lysates . 1,25D enabled MPs to slow or stop bacillary replication . Autologous serum supported the 1,25D-induced protection because the vitamin was not effective in medium supplemented with a serum substitute and was less effective in a heterologous AB serum than in autologous serum . The protection developed rapidly and could be induced even when 1,25D was added 3 days after infection . A concentration on the order of 4 micrograms/ml was needed for protection by the regimens used in these experiments . That is considerably higher than normal circulating concentrations of 1,25D but could be reached in infectious granulomas, because MPs can make 1,25D from precursor 25-hydroxyvitamin D3 . The precursor circulates at levels 10(3) higher than those of 1,25D and is directly influenced by dietary intake or photosynthetic production of vitamin D . These results identify 1,25D as an immunomodulator which can reproducibly activate human MPs to express tuberculoimmunity . They connect vitamin D, sunlight, and tuberculoimmunity and suggest that vitamin D should be considered a vital factor in the practical control of tuberculosis.

Int J Lepr Other Mycobact Dis, 1987 Dec, 55(4), 646 - 50
Immunosuppression and cellular immunity reactions in leprosy patients treated with a mixture of Mycobacterium leprae and BCG; Rada EM et al.; Suppressor reactivity was studied in a group of leprosy patients before and after immunotherapy with a mixture of Mycobacterium leprae and BCG . The treatment increases the responses in lymphocyte transformation tests to levels which are comparable to those observed in BT-TT patients and reduces suppressor activity . The soluble extract of M . leprae appears to be more sensitive than purified intact bacilli in the lymphocyte transformation tests, but this preparation did not induce suppressor reactivity with the regularity observed when using a Dharmendra preparation.

Am Rev Respir Dis, 1987 Dec, 136(6), 1339 - 42
Five-year follow-up of a controlled trial of five 6-month regimens of chemotherapy for pulmonary tuberculosis . Hong Kong Chest Service/British Medical Research Council; Polyarteritis nodosa of the epididymis in a patient with Whipple's disease; Department of Medicine, UCLA School of MedicineThe case of a 55-year-old white male who developed necrotizing arteritis localized to the superior pole of the epididymis is presented . He had a history of Whipple's disease and euthyroid Graves' disease . Histopathologic section of an extratesticular mass showed a necrotizing vasculitis with giant cells; periodic acid Schiff stain for Whipple "bacilli" was negative . The combination of rare diseases in our patient suggests the possibility of a common infectious or immune etiology, perhaps mediated via circulating immune complexes.

N Engl J Med, 1987 Nov 26, 317(22), 1376 - 82
Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers . The role of gastric colonization; Driks MR et al.; Gram-negative nosocomial pneumonia may result from retrograde colonization of the pharynx from the stomach, and this may be more likely when the gastric pH is relatively high . We studied the rate of nosocomial pneumonia among 130 patients given mechanical ventilation in an intensive care unit who were receiving as prophylaxis for stress ulcer either sucralfate (n = 61), which does not raise gastric pH, or conventional treatment with antacids, histamine type 2 (H2) blockers, or both (n = 69) . At the time of randomization to treatment, the two groups were similar in age, underlying diseases, and severity of acute illness . Patients in the sucralfate group had a higher proportion of gastric aspirates with a pH less than or equal to 4 (P less than 0.001) and significantly lower concentrations of gram-negative bacilli (P less than 0.05) in gastric aspirates, pharyngeal swabs, and tracheal aspirates than did patients in the antacid-H2-blocker group . The rate of pneumonia was twice as high in the antacid-H2 group as in the sucralfate group (95 percent confidence interval, 0.89 to 4.58; P = 0.11) . Gram-negative bacilli were isolated more frequently from the tracheal aspirates of patients with pneumonia who were receiving antacids or H2 blockers . Mortality rates were 1.6 times higher in the antacid-H2 group than in the sucralfate group (95 percent confidence interval, 0.99 to 2.50; P = 0.07) . Although our results fell just short of statistical significance when they were analyzed according to intention to treat, they suggest that agents that elevate gastric pH increase the risk of nosocomial pneumonia in patients receiving ventilation by favoring gastric colonization with gram-negative bacilli . We conclude that in patients receiving mechanical ventilation, the use of a prophylactic agent against stress-ulcer bleeding that preserves the natural gastric acid barrier against bacterial overgrowth may be preferable to antacids and H2 blockers.

Infect Immun, 1987 Nov, 55(11), 2689 - 94
Role of anaerobic flora in the translocation of aerobic and facultatively anaerobic intestinal bacteria; Wells CL et al.; It is thought that the normal enteric microflora acts not only to prevent intestinal colonization but also to prevent subsequent systemic dissemination of ingested, potentially pathogenic bacteria . To determine the relative roles of specific components of the intestinal bacterial flora in bacterial translocation out of the gut, mice were given various antimicrobial agents to selectively eliminate specific groups of intestinal bacteria . The cecal flora and the translocating bacteria in mesenteric lymph nodes were monitored both before and after oral inoculation with antibiotic-resistant Escherichia coli C25 . Orally administered streptomycin selectively eliminated cecal facultative gram-negative bacilli, orally administered bacitracin-streptomycin eliminated all cecal bacterial species except low numbers of aerobic sporeformers, and parenterally administered metronidazole selectively eliminated cecal anaerobic bacteria . Compared with control mice, only metronidazole-treated mice had significantly increased rates of dissemination of intestinal bacteria into mesenteric lymph nodes, indicating that the exclusive absence of anaerobic bacteria facilitated the translocation of the intestinal facultative bacteria . In a parallel experiment with streptomycin-resistant E . coli C25 as a marker, parallel results were obtained . Metronidazole increased the translocation of the marker strain and the indigenous strains of intestinal bacteria . Thus, anaerobes appeared to play a key role in confining indigenous bacteria to the gut . However, intestinal colonization and translocation of E . coli C25 occurred most readily after bacitracin-streptomycin treatment, suggesting that in addition to anaerobic bacteria, other bacterial groups may play a role in limiting the intestinal colonization and extraintestinal dissemination of E . coli C25.

Infect Control, 1987 Nov, 8(11), 465 - 73
Confounding and the analysis of multiple variables in hospital epidemiology; Freeman J et al.; Most information in hospital epidemiology comes from observational studies of hospitalized patients rather than planned experiments, and in such observational studies the characteristics of study patients may vary widely, even within a single hospital . Any comparison between hospital populations will usually contain additional, unintended contrasts among patients with varying degrees of health . Adult patients, for example, may have vastly different underlying diseases, and infants may be of substantially different birth weights . We used both underlying disease and birth weight as indices of the basic severity of illness in order to adjust for confounding by differences in underlying disease in reanalyses of several published studies . We give an example in which differing birth weights among groups of infants compared artifactually double the apparent effect of nosocomial infections as a cause of mortality, and another example in which differing degrees of severity of underlying illness artifactually halve the apparent effect of appropriate antibiotics in preventing death from bacteremia with gram-negative bacilli . We describe simple intuitive methods based on stratification, adapted from chronic disease epidemiology, to remove confounding effects during analyses.

J Infect, 1987 Nov, 15(3), 237 - 42
Selenomonas bacteraemia--case report and review of the literature; Pomeroy C et al.; Selenomonas species are crescent shaped Gram-negative bacilli with a characteristic tuft of flagella located on the concave surface . They are normally found in human gingiva or the rumen of herbivores . The first case of Selenomonas bacteraemia to be reported in a patient immunocompromised by malignant disease is described and the two previously reported cases of Selenomonas bacteraemia as reviewed . The importance of careful anaerobic culturing to recover the organism and special diagnostic techniques to classify the bacteria as Selenomonas species are emphasised . These organisms may cause serious human disease including bacteraemia.

Schweiz Med Wochenschr, 1987 Oct 10, 117(41), 1596 - 7
{Open tuberculosis with radiologically negative cavity findings}; Muhlberger F et al.; Non-cavernous bacillary tuberculosis is observed with relatively increasing frequency nowadays . Most patients affected have very few or no symptoms, and radiographs usually show circumscribed lesions . The essential feature is the low infection risk due to the small number of bacilli excreted.

J Antimicrob Chemother, 1987 Oct, 20(4), 477 - 88
The antibiotic sensitivity of the Bacteroides fragilis group in the United Kingdom; Fox AR et al.; Eight hundred and sixty-two cultures of penicillin-resistant anaerobic Gram-negative bacilli collected from 14 centres in the United Kingdom were identified . Six hundred and fifty-one were members of the Bacteroides fragilis group, and their sensitivity to 14 antibiotics was determined by a microtitre method . Among the beta-lactams, moderate resistance to ampicillin (MIC greater than or equal to 8 mg/l) was common, (B . ovatus 100%, B . thetaiotaomicron 95%, B . fragilis 76%, B . distasonis 50%, B . vulgatus 25%) but high-level resistance (MIC greater than 128 mg/l) was uncommon (B . fragilis 4%, B . ovatus 4%, B . vulgatus 3%) . In B . fragilis, moderate resistance to other beta-lactams was less common (cefoxitin 16%, mezlocillin 13% and cefotetan 7%), though in most non-B . fragilis species, higher numbers were moderately resistant . High level resistance to these three beta-lactams was rare . Resistance to penems (MIC greater than 4 mg/l) was not detected . All isolates of B . fragilis tested were sensitive to 16 mg/l of ciprofloxacin and ofloxacin, and 68% and 81% of isolates were sensitive to less than 4 mg/l, but one isolate of B . uniformis and one of B . thetaiotaomicron proved highly resistant . Clindamycin resistance was uncommon (1% of B . fragilis and 10% other B . fragilis group isolates were resistant to 2 mg/l clindamycin) with isolates resistant to clindamycin often also resistant to erythromycin . Tetracycline resistance was common in all species and occurred in 40% of isolates . Resistance to chloramphenicol, metronidazole or rifampicin was not detected . Significant differences were observed between the sensitivity of B . fragilis and other members of the B . fragilis group to mezlocillin, cefotetan, cefoxitin and the quinolones . There was no clear trend towards higher resistance in any one area of the country.

South Med J, 1987 Oct, 80(10), 1249 - 53
Cause of death in systemic lupus erythematosus: a pattern based on age at onset; Harisdangkul V et al.; We reviewed the causes of death in 50 patients treated for systemic lupus erythematosus at the University of Mississippi Medical Center between 1973 and 1985 . Two groups of patients could be distinguished based on the age at onset but not on the duration of disease . Younger patients more often died of active renal disease an infectious complications, while older patients died of other organ involvement, inactive renal disease, and miscellaneous causes . Common causes of infection were gram-positive cocci and gram-negative bacilli . Atherosclerotic cardiovascular disease was an infrequent cause of death, and no patients died of malignancy . Patients who died had more multisystemic involvement, with serositis and renal, central nervous system, and hematologic manifestations than patients who were alive at last follow-up.

Indian J Lepr, 1987 Oct-Dec, 59(4), 399 - 404
Indeterminate leprosy: a clinical and histopathological evaluation; Paksoy N; 27 histologically confirmed indeterminate leprosy cases were evaluated clinically and histopathologically at the SLR & TC, Karigiri, South India in 1985 . The main clinical finding was a single or multiple (up to 3) patches . This was found in 25 (92%) of 27 cases . 2 cases only showed an area of anaesthesia without any skin lesion . Loss of sensation was present in 22 cases (81%) . Histologically all cases (100%) showed lymphohistiocytic infiltration around the dermal structures and around/in the dermal nerves . AF bacilli were found in 17 cases (63%) . They were detected most commonly in cellular infiltrate in the dermis (7 cases, 26%) and secondly in the dermal nerves (5 cases, 14%) . Careful search and deeper sections increased the chance of detecting bacilli . Criteria for histological diagnosis were also discussed.

Indian J Lepr, 1987 Oct-Dec, 59(4), 390 - 2
Mast cells in histoid lepromatous lesions; Kumar R; Ten patients with histoid lesions among the lepromatous leprosy cases, of both sexes in the age group of 35-65 years, were included in this study . Skin biopsy from the nodule with surrounding healthy skin of histoid lesion was taken . The biopsies were fixed in susa solution and processed for light microscopy . 5-7 mu thick sections were cut and stained with haematoxylin and eosin, Toludine blue and Fite faraco . Observations were made on the dermis to locate the mast cells and bacilli . Proliferation of mast cells and their degranulation was seen in the histoid nodule as compared to surrounding normal healthy skin where the cells were mainly intact . The study further investigates the role of mast cells in the histopathogenesis of the disease.

Ann Acad Med Singapore, 1987 Oct, 16(4), 655 - 7
Histoid leprosy in Singapore; Giam YC et al.; Histoid leprosy is a rare variant of lepromatous leprosy . This is the first documented case of histoid leprosy in Singapore . The patient was diagnosed as borderline leprosy in 1973, remained untreated and progressed to lepromatous leprosy . The characteristic histoid lesions were firm pruriginous nodules on the dorsum of his feet . The histology showed a pseudocapsulated tumour with fibroblasts and histiocytes filled with lepra bacilli . Electron microscopy showed fibroblasts, macrophages with bacilli and plasmacytoid cells with active endoplasmic reticulum . He was found to be dapsone-resistant and the lesions cleared with clorphazimine . Immunological defects were not detected.

Br J Exp Pathol, 1987 Oct, 68(5), 733 - 41
Localization and retention of mycobacterial antigen in lymph nodes of leprosy patients; Barros U et al.; Although leprosy, a chronic disease caused by M . leprae, primarily affects skin and peripheral nerves, pathological changes and granulomas have been observed in lymph nodes which are: (a) present in tuberculoid lymph nodes in the absence of acid-fact bacilli and (b) persistent in lepromatous patients even after prolonged treatment . We detected substantial amounts of mycobacterial antigen in 16 leprous lymph nodes using anti-BCG by the peroxidase anti-peroxidase method . The load and distribution of antigen varied along the spectrum and with the duration of treatment . Tuberculoid and long-term treated lepromatous lymph nodes had a similar distribution of antigen in clusters of cells giving a 'speckled' appearance . The untreated lepromatous had a 'diffuse' staining of antigen in foamy histiocytes whereas lepromatous lesions with a lower bacillary load had a mixed pattern of 'diffuse' and 'speckled' . Antigen was also detected in a number of plasma cells along the spectrum but predominantly in lepromatous lymph nodes . Our observations indicate that: (a) antigen exists in lymph nodes despite prolonged chemotherapy which may be responsible for the persistent granuloma and (b) antigen is not confined to any particular anatomical compartment of the lymph node.

Genetika, 1987 Oct, 23(10), 1741 - 8
{Advances in gene engineering of microorganisms}; Debabov VG; A novel branch of national economy--biotechnology is being developed, based on genetic engineering . The construction of strains using the methods of molecular cloning has led to-date to creation of new biotechnological processes . Further advance in biotechnology would be mainly promoted by the possibilities of application of gene engineering to reorganization of industrially important microorganisms . These are bacilli employed for production of vitamins, enzymes, insecticides; streptomycetes--the producers of antibiotics; yeasts applied in bakery industry, in production of fodder proteins; pseudomonads which will be helpful in development of effective biological means for protection of environment, etc . So, vector molecules based on plasmids and phages have been constructed for best-studied representatives of industrial microorganisms, the methods of introduction into the cell of hybrid DNA molecules worked out, the problems of optimization of foreign gene expression being currently solved.

Int J Dermatol, 1987 Oct, 26(8), 521 - 6
An appraisal of epidemiologic, clinical, bacteriologic, histopathologic, and immunologic parameters in cutaneous tuberculosis; Sehgal VN et al.; Cutaneous tuberculosis incidence was recorded as 0.15% . Of the 42 patients, 23 had scrofuloderma, 17 lupus vulgaris, and 2 tuberculosis verrucosa cutis . Both men and women were affected by the disease in the second and third decades . Its duration was variable . An affirmative family history was elicited in five scrofuloderma patients . The clinical expression largely conformed to the ritual text . Variation in Mantoux test positivity was unremarkable . The disparity in the demonstration of bacilli in the smear and tissue sections was, however, quite apparent in scrofuloderma . The correlation of different parameters indicates a continuous spectrum, formed at one end by lupus vulgaris, and at another by scrofuloderma . A moderate to strongly positive Mantoux text, enormous lymphocytes in the granuloma, absence of tubercle bacilli, negative culture, and an apparently normal immunoprofile were features of lupus vulgaris; whereas scrofuloderma had a moderately positive Mantoux test, lesser number of lymphocytes in the granuloma, large number of bacilli in tissue smear and/or tissue section, raised levels of immunoglobulins, and a grossly lowered C3 levels . The other variants probably occupy a position in between.

Acta Leprol, 1987 Oct-Dec, 5(4), 265 - 70
The leprosy bacillus: a microbe-dependent microbe; Kato L; Since the discovery of the leprosy bacillus, cultivable mycobacteria were regularly found in lepratic tissues of humans and armadillos . Unpublished data indicate that Professor Hugo Preisz isolated and collected several cultures of unidentified cultivable strains of mycobacteria from leprosy sufferers . Recent findings suggest that Mycobacterium leprae is a microbe-dependent, mycobactin-deficient microorganism . The author proposes the concept that secondary mycobacteria found in leprosy cases are ethilogical cofactors in the pathogenesis of leprosy . Since secondary mycobacteria are rich in mycobactin, it is suggested that they provide the essential mycobactin for growth multiplication and virulence for the mycobactin deficient leprosy bacilli . The implications of this concept are discussed.

Indian J Lepr, 1987 Oct-Dec, 59(4), 386 - 9
Auramine staining in histopathology sections; Bhatia VN et al.; Auramine staining was done on 65 histopathological sections from different types of treated leprosy cases which were negative by Fite-Farraco stain . All the sections except one showed auramine positive organisms . The organisms were mostly coccoid except in BL/LL cases where beaded bacilli could be seen.

J Ethnopharmacol, 1987 Sep-Oct, 21(1), 75 - 84
Structure and chemotherapeutical activity of a polyisoprenylated benzophenone from the stem bark of Garcinia huillensis; Bakana P et al.; The stem bark of Garcinia huillensis grown in Zaire and used in central-African traditional medicine has been subjected to a bioassay-guided fractionation . The chemotherapeutically active petroleum ether extract afforded fatty acids, aliphatic alcohols, triterpenes and a polyisoprenylated benzophenone, which was identified as garcinol, also named camboginol . This compound has been shown to exhibit chemotherapeutical activity gram-positive and gram-negative cocci, mycobacteria and fungi . On the other hand garcinol has been found to be inactive against gram-negative enteric bacilli, yeasts and viruses.

Infect Immun, 1987 Sep, 55(9), 2006 - 16
In vivo killing and degradation of Mycobacterium aurum within mouse peritoneal macrophages; Silva MT et al.; We studied the in vivo killing and degradation of Mycobacterium aurum, a nonpathogenic, acid-fast bacillus, within macrophages after inoculation into the peritoneal cavity of CD-1 mice . The degradative process could be divided in five successive steps that were characterized on ultrastructural and cytochemical grounds and the relative contributions of which were determined by quantitative electron microscopy of samples taken at different times . The main ultrastructural alterations observed during the degradative process were ribosome disaggregation, coagulation of the cytoplasmic matrix, and change in the membrane profile from asymmetric to symmetric, with loss of the polysaccharide components from the outer layer, followed by membrane solubilization and intracellular clearing, followed by digestion of the innermost (peptidoglycan) layer of the cell wall, and at the end of the process, disorganization and collapse of the remaining layers of the cell wall . The correlation between viability and morphology indicated that the first ultrastructural signs of viability loss are cytoplasmic coagulation, change in the membrane geometry, and disappearance of ribosomes . The labeling of lysosomes of peritoneal macrophages with ferritin or by the cytochemical demonstration of inorganic trimetaphosphatase showed that fusion of lysosomes with phagosomes containing mycobacteria occurs in the phagocytes in the mouse peritoneal cavity and is already extensive as soon as 1 h after the inoculation of the bacilli.

J Cataract Refract Surg, 1987 Sep, 13(5), 498 - 510
Localized endophthalmitis: a newly described cause of the so-called toxic lens syndrome; Piest KL et al.; We report five cases of post-extracapsular cataract extraction infection in which subsequent pathologic analyses identified the organisms and found the infection to be localized or confined to the lens capsular sac . The most common offending organisms were gram-positive pleomorphic bacilli . In one case, we were able to identify the bacteria as Propionibacterium acnes . We designate this condition a localized endophthalmitis . It should be considered any time a persistent, smoldering, postoperative inflammation occurs, and in the differential diagnosis of phacoanaphylactic endophthalmitis . The condition itself is not new, but undoubtedly many such cases have gone unrecognized or have been misdiagnosed as the so-called toxic lens syndrome . In localized endophthalmitis, a clinically visible inflammatory process may occur even when multiple diagnostic taps are negative, although when the cases first appeared, the surgeons were not aware of the entity and anaerobic cultures were not always obtained . A negative tap may be explained by the fact that metabolic products from the organisms are released from the bag into the anterior segment and vitreous . A synergistic reaction may occur between these organisms and retained lens cortical remnants that may cause or exacerbate a hypersensitivity reaction . The condition may be worsened by Nd:YAG capsulotomy . The pathogenesis of localized endophthalmitis has nothing to do with the type of intraocular lens fixation (lens capsular sac or ciliary sulcus); rather, the simple presence of a capsular sac after extracapsular cataract extraction is the prerequisite for the clinical condition.

Antibiot Med Biotekhnol, 1987 Sep, 32(9), 696 - 700
{Effectiveness of soluble rifampicin in combination with other antibacterial preparations in treating disseminated destructive pulmonary tuberculosis in an experiment}; Bondarev IM et al.; Efficacy of a new rifampicin dosage form developed at the All-Union Research Institute of Antibiotics was studied on dogs with extensive destructive tuberculosis of the lungs . Intracavernous instillation and rapid intravenous administration (RIA) of the drug in combination with 10 per cent solution of isoniazid and intramuscular administration of streptomycin were used . Intracavernous instillation of rifampicin in combination with 10 per cent solution of isoniazid was performed under the control of an x-ray unit with an image converter tube or with the developed administration procedure through an indwelling catheter . Intracavernous administration of the drugs was alternated with their RIA: either one-stage administration of the antibiotic in daily half doses to each cavern followed by RIA every second day or RIA of a daily half dose in the morning followed by intracavernous instillation of the second half dose to one cavern in 5-6 hours and the second half dose to the other cavern on the next day . Intracavernous instillation of rifampicin in combination with isoniazid together with their RIA in treatment of extensive destructive tuberculosis of the lungs provided 100 per cent elimination of tubercle bacilli in the internal organs of all the dogs and closing of the caverns with cicatrization in 70 per cent of the dogs and formation of microcavities in 30 per cent of the dogs within 30 days.

Clin Chest Med, 1987 Sep, 8(3), 455 - 66
Bacterial colonization: pathogenesis and clinical significance; Palmer LB; Bacterial colonization of the respiratory tract frequently precedes the onset of serious invasive infection . It is increasingly evident that the risk for colonization is greatest in patients with serious underlying illness . These patients have been shown to have increased bacterial binding to their respiratory mucosa . In addition to the patients' own predisposition to infection, many of our medical interventions may further compromise the respiratory tract host defenses and permit successful bacterial growth . Methods for prevention of bacterial colonization have not been very successful to date . Although methods to decrease the introduction of exogenous bacteria to patients have been developed, problems persist with the patients' endogenous enteric gram-negative bacilli . It is hoped that increased understanding of bacterial-mucosal interactions will lead to new therapeutic strategies to prevent bacterial invasion of the respiratory tract.

Clin Chest Med, 1987 Sep, 8(3), 339 - 58
Host defense impairments that may lead to respiratory infections; Reynolds HY; Host defense mechanisms spaced along the respiratory tree and in the alveolar spaces effectively remove or contend with micro-organisms that enter the airways, so serious lung infections occur rarely in healthy people . Special circumstances, such as virgin exposure to a virulent microbe or a large innoculum of a pathogen, can result in illness, but usually routine surveillance host defenses are protective and suffice to keep colonizing airway flora in check . When pneumonia develops or recurrent sinopulmonary infection exists, however, some element of the normal defense apparatus may have failed or is inadequate . This review highlights several components of the apparatus, that is immunoglobulins IgG and IgA and the interaction of alveolar macrophages and lymphocytes, and examines deficiencies in their function that may result in infection . Along the conducting airways, poor mucociliary clearance and/or deficiencies in certain IgG subclass antibodies or destruction of IgA may predispose to sinopulmonary infections; these may be a manifestation of a hereditary disease . In pneumonia the alveolar macrophage is positioned as the central cell which must respond in several directions . This scavenger phagocyte first intercepts the microbe and either can kill or contain it or must call in some other phagocytic cell or inflammatory mediator(s) for assistance . Opsonic antibodies (IgG) and other nonimmune opsonins (complement and surfactant or fibronectin fragments) facilitate phagocytosis, but an absence of antibody may permit infection to develop with encapsulated bacteria (pneumococcus) . Insufficient bone marrow reserves of PMNs or a paucity of chemotactic factors to attract them into the alveoli is a situation that may permit gram-negative bacilli and fungal organisms to flourish . Inability of immune T-lymphocytes to energize macrophages, through soluble cellular mediators that provide cell-mediated immunity and activation, makes containment of certain intracellular microbes impossible for these phagocytes (Legionella or mycobacteria) . Likewise, concomitant infection of macrophages with viruses (human immunodeficiency virus, and cytomegalovirus or herpes viruses) plus an excessive T-lymphocyte suppressor cell influence may make P . carinii and common bacterial and fungal organisms difficult to contain in the lungs of AIDS patients . Consideration about what the lung host deficiency might be can make therapy more specific through immunization to develop special antibodies, replacement of certain immunoglobulins (IgG subclasses), or selective administration of cell mediators (gamma-interferon or interleukins).

Int J Lepr Other Mycobact Dis, 1987 Sep, 55(3), 515 - 20
An ultrastructural study of dermal nerves in early human leprosy; Chandi SM et al.; Skin biopsies from the cutaneous lesions of seven patients with indeterminate, BT, BL, and LL leprosy of less than 1 year's duration were examined by light and electron microscopy . Inflammatory cells, which marked the location of Mycobacterium leprae in bacilliferous cases (BL and LL) were most frequently and consistently found in relation to dermal blood vessels, neurovascular bundles, nerves, arrector pili muscles, and skin adnexa . The number of bacilli and inflammatory cells in the epineurium was in great excess of those in the perineurium and endoneurium . Perineurial infiltration by lymphocytes and bacillated macrophages was seen to occur through gaps between the constituent cells of a loosened and sometimes proliferated perineurium . Bacillation of Schwann cells and associated inflammation in the endoneurium was minimal . M . leprae were identified in endothelial cells, arrector pili muscles, macrophages and Schwann cells . At this stage, inflammatory destruction of nerve fibers was not encountered . It is concluded that M . leprae which are extruded from the circulation into the epineurium (or perineurium) may be carried in inflammatory cells across the perineurium which is loosened and rendered permeable to inflammatory cells as a consequence of chronic inflammation in the adjacent epineurium . This is suggested as a very probable route for M . leprae to enter nerves.

Int J Lepr Other Mycobact Dis, 1987 Sep, 55(3), 450 - 3
Primary visceral virchowian (lepromatous) hanseniasis; Azulay RD; A case of primary visceral virchowian hanseniasis is presented . The onset and symptoms of the disease made one think that it was a lymphoma because of the severe enlargement of the liver, spleen, and lymph nodes . Biopsies of the liver, lymph nodes, and bone marrow revealed virchowian infiltration with acid-fast bacilli and globi . The skin was free of lesions and negative to bacilli, and there were no neural symptoms.

Clin Lab Med, 1987 Sep, 7(3), 513 - 29
Monitoring aminoglycoside therapy; Mullins RE et al.; The aminoglycoside antibiotics are indispensible therapeutic agents; however, a high incidence of toxic effects mandates that they be used with caution . In many patients, careful monitoring of serum concentrations is required . Because of their chemical characteristics, aminoglycosides are given parenterally except in certain well-defined clinical situations such as bowel preparation prior to surgery . The drugs act by interfering with microbial protein synthesis and are uniformly bactericidal . Plasmid-mediated resistance remains a problem, particularly in the hospital environment . Aminoglycosides find their most frequent use in infections caused by aerobic gram-negative bacilli . The pharmacokinetics have been well characterized, and an appropriate dosage regimen can be selected to achieve peak bactericidal levels while maintaining trough concentrations low enough to minimize toxicity . Monitoring of serum aminoglycoside concentrations is essential in many types of patients, such as those having compromised renal function, those receiving a maximum dose of the drug, the obese, the elderly, and patients with cystic fibrosis . Close cooperation between the clinical laboratory and all groups involved in the patient's care is necessary to make maximum clinical use of drug monitoring information.

CMAJ, 1987 Sep 1, 137(5), 397 - 403
Changes in endogenous microflora among febrile granulocytopenic patients receiving empiric antibiotic therapy: implications for fungal superinfection; Bow EJ et al.; The ecologic effect of empiric systemic antibiotic therapy on the endogenous microflora was evaluated in 83 febrile granulocytopenic patients with cancer who were randomly allocated to receive moxalactam plus ticarcillin (45 patients) or tobramycin plus ticarcillin (38 patients) for suspected infection . Serial surveillance cultures of the nasal passages, oropharynx and feces performed twice a week showed that patients who received the former regimen had higher elimination rates and significantly lower acquisition rates (p = 0.027) for aerobic gram-negative bacilli than did patients who received the latter regimen . However, therapy with moxalactam plus ticarcillin also resulted in significantly higher acquisition rates for yeasts (p = 0.004) . This was associated with a significantly higher fungal superinfection rate among these patients than among those who received tobramycin plus ticarcillin (40% v . 16%) (p less than 0.05) . Moxalactam plus ticarcillin therapy created a greater microbial ecologic vacuum by the elimination of intestinal anaerobes, which, in turn, permitted fungal colonization and an increased risk of superinfection . Our results support the recommendation that an antipseudomonal penicillin plus an aminoglycoside be selected as empiric therapy for suspected infection in febrile granulocytopenic patients with cancer . Such a regimen would spare the anaerobic intestinal microflora, thereby reducing the risk of fungal colonization and infection.

J Hosp Infect, 1987 Sep, 10(2), 204 - 8
Contamination of small-volume medication nebulizers and its association with oropharyngeal colonization; Botman MJ et al.; The effect of the use of small-volume medication nebulizers on oropharyngeal colonization with potentially pathogenic Gram-negative bacilli was investigated in 95 patients with respiratory disease, of whom 54 used nebulizers and 41 were controls . Inhalation therapy had a significant effect on colonization, with a relative risk of more than four . Age over 60 years also showed a significant association with colonization . One-third of the nebulizers sampled were contaminated, 71% with Gram-negative bacilli . A direct route of contamination could be demonstrated in 28% of the patients . Medication nebulizers should be thoroughly cleaned after use and stored dry between patients.

Afr J Med Med Sci, 1987 Sep, 16(3), 123 - 32
Tuberculin sensitivity in tuberculosis; Onwubalili JK; Seven of twenty-eight (25%) patients with untreated tuberculosis had skin induration of less than 6 mm to one tuberculin unit (TU), and 3 (11%) to 10 TU PPD . Among twenty-four patients with lung disease, there were no detectable differences in radiological extent of disease between reactors and non-reactors to low-dose tuberculin . However, non-reactors were significantly more malnourished (P less than 0.02), excreted more bacilli (P less than 0.02) and took longer for sputum sterilization during chemotherapy (P less than 0.01) . Early skin reactions (6-8 h) occurred in fourteen of twenty-four (58%) patients, but in none of twenty-four matched healthy controls (P less than 0.0001); the proportions giving delayed (48-72 h) reactions were similar . Although the patients had larger delayed reactions as a group (P = 0.04), this would not have been of value in making the diagnosis . Repeat tuberculin testing of subjects had a booster effect, but did not induce hypersensitivity in initially healthy non-reactors . All nutritional abnoalities observed in the patients, except arm muscle circumference and serum albumin, reverted to normal during chemotherapy, concomitant with clinical improvement and an increase in dermal reactivity to tuberculin . Antigen overload may lead to both skin anergy and undernutrition . The accelerated tuberculin skin reaction could offer a practical and specific, although not particularly sensitive, method of aiding the diagnosis of active tuberculosis.

J Gen Microbiol, 1987 Sep, 133 ( Pt 9), 2523 - 9
Comparative 16S rRNA oligonucleotide analyses and murein types of round-spore-forming bacilli and non-spore-forming relatives; Stackebrandt E et al.; The phylogenetic incoherency of the genus Bacillus as presently described is demonstrated by analysis of both published and new data from comparative 16S rRNA cataloguing of nine Bacillus species and a number of related non-Bacillus taxa, i.e . Caryophanon latum, Filibacter limicola and Planococcus citreus . While the ellipsoidal-spore-forming bacilli, e.g . B . subtilis and allied species, formed a coherent cluster, the round-spore-forming bacilli showed a higher degree of relationship to the non-spore-forming organisms than these bacilli show among each other . Thus B . sphaericus clustered with C . latum, B . globisporus grouped with F . limicola, B . pasteurii with Sporosarcina ureae, and 'B . aminovorans' with P . citreus, respectively . These organisms formed two related subclusters which, in their phylogenetic depth, are comparable to that of the B . subtilis subline . With the exception of 'B . aminovorans', the 16S rRNA phylogeny was entirely consistent with the distribution of murein types . Even more distantly related to and grouping outside the main Bacillus cluster was B . stearothermophilus, which displayed a moderate relationship to Thermoactinomyces vulgaris . Taxonomic problems arising from the new insights into the intrageneric relationships of Bacillus are discussed.

Eur J Clin Microbiol, 1987 Aug, 6(4), 395 - 401
Serological evaluation of the outer membrane protein complexes of five saccharolytic intestinal Bacteroides species; Marshall R et al.; The purpose of this investigation was to develop a serological procedure for rapid identification of the following five Bacteroides species: Bacteroides distasonis, Bacteroides fragilis, Bacteroides ovatus, Bacteroides uniformis, and Bacteroides vulgatus . The outer membrane fractions were assayed using SDS-polyacrylamide slab gel electrophoretic techniques . The species-specific protein band from each species as well as the group-specific protein were purified and used to develop an indirect enzyme-linked immunosorbent assay to detect the species-specific and group-specific protein from the outer membrane of five reference species . The sensitivity and specificity of the procedure were evaluated by indirect ELISA methodology using 506 clinical isolates of organisms in this group, ten other species of anaerobic gram-negative bacilli, and three species of aerobic gram-negative bacilli . Each species evaluated yielded unique outer membrane protein patterns, suggesting the potential for development of a rapid, species-specific diagnostic procedure.

Am J Gastroenterol, 1987 Aug, 82(8), 769 - 72
Primary gastric tuberculosis: a case report and literature review; Subei I et al.; Gastric tuberculosis is a rare entity; it usually occurs secondary to another lesion(s), mainly in the lungs . Only a few cases of primary gastric tuberculosis have been reported in the literature . Most commonly, gastric tuberculosis lesion(s) is located in the lesser curvature of the antrum and prepylorus, so the clinical picture is similar to that of peptic ulcer, in addition to the constitutional symptoms seen in tuberculosis in general . We report a case of a young man presented with abdominal pain acute gastric outlet obstruction due to a large mass in the lesser curvature of the antrum and the pylorus . The histological examination revealed caseating granuloma with the presence of acid-fast bacilli . Partial gastrectomy with Bilroth II reconstruction was performed and the patient was put on antituberculosis medications . There was no evidence of the tuberculous lesion anywhere else . Patient's follow-up observation in the clinic was uneventful.

Int Ophthalmol, 1987 Aug, 10(4), 235 - 40
Tuberculous panophthalmitis associated with drug abuse; Menezo JL et al.; Tuberculous endophthalmitis is a rare condition not described to date in association with intravenous drug abuse . Characteristics such as the lack of proven tuberculous disease in other organs and intense progression towards panophthalmitis make this case all the more interesting . The histopathological diagnosis is based on the identification of acid-alcohol resistant bacilli, and typical granuloma lesions with focal caseosis in stained sections.

South Med J, 1987 Aug, 80(8), 1060 - 1
Nontuberculous mycobacterial skin infection resembling lepromatous leprosy; Love GL; A leg ulcer in a 52-year-old renal transplant patient yielded foamy histiocytes containing acid-fast bacilli subsequently identified as a Runyon group III Mycobacterium . Skin infection with these organisms is unusual, and the histologic appearance in this case suggested lepromatous leprosy.

Jikken Dobutsu, 1987 Jul, 36(3), 277 - 80
{Occurrence of granulomatous appendicitis in rabbits}; Fujiwara H et al.; Granulomatous appendicitis was observed in all of the 45 Japanese white rabbits examined . Histologically, multiple microgranulomas were accompanied with foreign body giant cells and focal calcifications in lymph nodules of appendix . Foreign body giant cells contained hair coat and larvae of Passalurus ambiguus . In addition, the sacculus rotundus and mesenteric lymph nodes were affected with the same lesions . PAS- and Gram- positive bacilli were phagocytized in the microgranulomas and macrophages . They were also stained positively with the immunoperoxidase method for the auto-sera of rabbits . Isolation of these bacilli in pure culture has not yet been accomplished . The occurrence of granulomatous lesions due to tuberculosis, pseudotuberculosis, tularemia and actinomycosis seems unlikely in the present cases because none of these organisms nor characteristic lesions were detected . It was suggested that the Gram-positive bacilli appeared to play a role in granulomatous appendicitis.

J Wildl Dis, 1987 Jul, 23(3), 391 - 5
Mycobacteriosis in cultured striped bass from California; Hedrick RP et al.; Striped bass (Morone saxatilis) juveniles raised in an intensive culture system had chronic mortality resulting from infections with Mycobacterium marinum . Approximately one-half of a population of 900 yearlings succumbed to the disease and 80% of those remaining were infected . The bacteria were isolated on Petrignani's medium after 7 days at 25 C and subcultures grew at temperatures from 20 to 37 C . The disease was characterized by systemic nodular lesions in all major organs . Older tubercles contained numerous acid-fast bacilli . Chemotherapy by feeding rifampin (6 mg/100 g of food for 60 days) was not an effective treatment . Subclinical mycobacteriosis in adult striped bass may be the source for vertical transmission to their progeny.

J Infect Dis, 1987 Jul, 156(1), 99 - 106
Capnocytophaga species: increased resistance of clinical isolates to serum bactericidal action; Wilson ME et al.; Capnocytophaga, a newly recognized genus of capnophilic gram-negative bacilli, is part of the normal oral flora . The capacity of Capnocytophaga to cause sepsis and local infections in both immunocompromised and nonimmunocompromised hosts has been documented . Given the recognition that serum resistance may contribute to the virulence of some gram-negative bacteria, we attempted to define the serum sensitivity of clinical isolates of Capnocytophaga from blood and other sites of infection . Whereas nine of nine isolates from human subgingival plaque showed greater than 95% loss of viability under standardized assay conditions, nonoral isolates exhibited variable serum sensitivity . Six of six isolates from blood showed considerable serum resistance (mean survival, 59.7% +/- 38.3%; range, 14.4%-113.3%) . Comparison of the electrophoretic mobilities of lipopolysaccharides (LPSs) from sensitive and resistant strains revealed reduced LPS heterogeneity and lower apparent molecular weight among serum-resistant strains . Thus, serum resistance, possibly influenced by LPS structure, may be an important factor contributing to the pathogenic potential of Capnocytophaga spp.

Infect Immun, 1987 Jul, 55(7), 1588 - 93
Ingestion and intracellular growth of Mycobacterium paratuberculosis within bovine blood monocytes and monocyte-derived macrophages; Zurbrick BG et al.; Cellular immunity is thought to be of major importance in resistance to infection with Mycobacterium paratuberculosis, the causative agent of Johne's disease of ruminants . The results of this study clarify the influence of bovine mononuclear phagocyte maturation on the ingestion and intracellular survival of M . paratuberculosis in vitro . Optimal phagocytosis of M . paratuberculosis by cultured bovine blood monocytes and monocyte-derived macrophages required the presence of 5 to 20% serum; few bacilli were phagocytized in the absence of serum . Monocyte-derived macrophages consistently demonstrated greater phagocytosis of M . paratuberculosis than did freshly adherent monocytes . Ingested M . paratuberculosis multiplied approximately 200 to 250% over a 7-day incubation period within bovine monocytes and monocyte-derived macrophages, as determined by microscopic counts of acid-fast-stained monocyte monolayers and by plate counts of viable organisms . These findings suggest that resident macrophages and recently emigrated blood monocytes within the intestinal mucosa may have considerable ability to ingest M . paratuberculosis, but they are unlikely to kill or markedly restrict the intracellular growth of the ingested bacilli . The ability of these mononuclear phagocytes to provide an intracellular niche for the growth of M . paratuberculosis and the immune response that eventually develops are likely to be important components in the development of the granulomatous lesions that are characteristic of Johne's disease.

Antibiot Med Biotekhnol, 1987 Jul, 32(7), 538 - 41
{Protective function of the peptide antibiotics of bacilli}; Lukin AA; The modern status of the biological role of peptide antibiotics in vital activity of bacilli is discussed . The published data and the original findings of the author and his coworkers are analyzed from the viewpoint of two hypothesis: regulator and protective . It is shown that at present there is no solid basis for considering antibiotics as positive regulators of sporulation in organisms producing them . Synthesis of antibiotics is thought to be a manifestation of a certain stage in ontogenetic development of bacilli and is associated with production of extracellular enzymes . The enzymes are conjectured to perform in nature hydrolysis of exogenic substrates and thus create nutrient medium for vegetative cell division of antibiotic-producing organisms . The author suggests that the main biological function of peptide antibiotics produced by bacilli is protection of their environment from other microorganisms.

J Antimicrob Chemother, 1987 Jul, 20(1), 95 - 107
A prospective randomized trial of ceftazidime versus cefazolin/tobramycin in the treatment of hospitalized patients with pneumonia; Mandell LA et al.; Ceftazidime and cefazolin/tobramycin were compared in the treatment of hospitalized patients with pneumonia . Iv doses 8-hourly were: ceftazidime--2 g, cefazolin--1.5 g, tobramycin--1.7 mg/kg . For patients with pseudomonas infection randomized to cefazolin/tobramycin, ticarcillin (3 g iv 4-hourly) was used instead of cefazolin . One hundred and ten of 129 patients were evaluable (ceftazidime = 52, cefazolin/tobramycin = 58) . Seventy five cases (68%) had documented pathogens of which 81% were aerobic Gram-negative bacilli . Analysis of clinical response showed no difference in overall results (P = 0.77), or separate outcomes: cured (P = 0.85), improved (P = 0.62), failed (P = 0.53), or relapsed (P = 0.50) . No differences in bacteriological response were noted either: eradication (P greater than 0.10), elimination with recurrence (P greater than 0.10), persistence (P greater than 0.10) . The incidence of enterococcal and fungal colonization and superinfection was the same for both regimens . There was a greater incidence of Coombs' test positivity with ceftazidime (P less than 0.01) but greater nephrotoxicity with cefazolin/tobramycin (P less than 0.02) . Ceftazidime appears to be as efficacious as cefazolin/tobramycin in the treatment of hospitalized patients with pneumonia, and is less nephrotoxic.

Pediatr Infect Dis J, 1987 Jul, 6(7), 678 - 81
Laryngeal tuberculosis in childhood; du Plessis A et al.; Laryngeal tuberculosis is an extremely rare condition in childhood, although probably less so in the underdeveloped world . We have described two cases treated concurrently in our wards . The first case showed features of a pharyngopalatotonsillar membrane, an exquisitely painful edematous pharynx and larynx and was initially sputum-negative for acid-fast bacilli . This presentation fits the hematogenous form of disease and stresses that: laryngeal tuberculosis is not confined to cases of far advanced pulmonary tuberculosis; tuberculosis should enter the differential diagnosis of pharyngeal, tonsillar and palatal lesions (especially membranoulcerative lesions); and there is a common association between laryngeal and abdominal tuberculosis . Her treatment included a 1-month course of steroids and to date (12 months after onset) she shows no signs of complications . The edematous form of laryngeal tuberculosis may be yet another indication for the use of steroids in tuberculosis . Our second patient presented with prolonged chest symptoms, initial positive sputum for acid-fast bacilli and localized granulomatous laryngeal disease, features of far advanced "adult" disease and bronchogenic laryngeal spread . Laryngeal tuberculosis usually responds rapidly to antituberculosis chemotherapy . This was clinically and endoscopically confirmed in both our cases.

Hum Pathol, 1987 Jul, 18(7), 701 - 8
Mycobacterial antigen detection by immunohistochemistry in pulmonary tuberculosis; Humphrey DM et al.; A preliminary diagnosis of tuberculosis can be established by the detection of acid-fast bacilli (AFB) and confirmed by culture of the microorganism . To evaluate an alternative method of diagnosis, the distribution of mycobacterial antigens in lung tissue specimens was characterized by an indirect peroxidase-antiperoxidase method and was compared to the detection of AFB by Ziehl-Neelsen stain . Histologic specimens were obtained from 59 hospital patients . Of nine patients with mycobacterial disease, seven had antigen detected in tissue . In two patients with tuberculous pneumonia, the distribution of mycobacterial antigens was approximately the same as that of AFB . In contrast, in four patients with caseating pulmonary granulomas, clumps of mycobacterial antigens were demonstrated in necrotic areas of the granulomas where there were few or no AFB . In one patient with Mycobacterium intracellulare infection, cross-reactive antigens stained weakly . Antigen was not found in tissue from two patients; one had miliary lung granulomas, and the second had mediastinal lymph node granulomas . Mycobacterial antigens were not detected in specimens from 50 control patients with nonmycobacterial diseases . On the basis of this study of 59 cases, immunohistochemical detection of microbial antigens appears to be useful for establishing the mycobacterial etiology of caseating pulmonary granulomas.

Am J Epidemiol, 1987 Jul, 126(1), 38 - 43
Hepatitis B virus replication and tuberculin reactivity: studies in Alaska; McGlynn KA et al.; In a previous study in 1982-1984 of southeast Asian refugees in Philadelphia, the authors found that hepatitis B virus carriers who reacted to a tuberculin (purified protein derivative (PPD)) skin test were more likely to be negative for the hepatitis B e antigen (HBeAg) than carriers who did not react to PPD . Because it was not known whether the PPD reactivity was due to natural infection or vaccination with bacille Calmette-Guerin (BCG), the authors conducted a further study in 1985 in Alaskan Native hepatitis B carriers, a group not vaccinated with BCG . The inverse association of HBeAg and PPD reactivity was confirmed across all age groups and was similar in magnitude to that observed in the refugee population . The host response to tubercle bacilli may inhibit the replication of hepatitis B virus . If the host response to BCG is similar, BCG vaccination may be of therapeutic value in chronic hepatitis B infection.

Rev Infect Dis, 1987 Jul-Aug, 9 Suppl 4, S386 - 90
Role of fibronectin in the pathogenesis of gram-negative bacillary pneumonia; Woods DE; Because the pharyngeal flora may be an important determinant of the etiology of pneumonia, the presence of gram-negative bacilli in the oropharynx might be expected to be a prelude to pneumonia due to these organisms . Colonization of the upper respiratory tract by gram-negative bacilli is correlated with adherence of gram-negative bacilli to epithelial cells . Increased adherence is associated with a loss of fibronectin from the surface of oral epithelial cells, which presumably occurs as a result of the action of secretory proteases that denude cells of fibronectin . Thus, fibronectin may be described as a modulator of the composition of the oral flora . It seems more likely that the level of protease activity or the determinants that control the level of protease activity are the true modulators of the composition of the oral flora . The delineation of these determinants should lead to a greater understanding of the pathogenesis of gram-negative bacillary pneumonia.

Eur J Respir Dis, 1987 Jul, 71(1), 37 - 41
IgG antibody level to mycobacterial glycoprotein in pulmonary tuberculosis by ELISA; Kato K et al.; Sera from patients with active pulmonary tuberculosis and sera from appropriate control individuals were assayed for IgG, IgA and IgM antibodies against glycoprotein from tubercle bacilli by an enzyme-linked immunosorbent assay . The mean antibody levels in IgG and IgA were significantly higher in the tuberculosis patients than in the controls . By measuring IgG antibody, this assay may provide a diagnostic tool to distinguish patients with active pulmonary tuberculosis from patients with other pulmonary disease.

Acta Cytol, 1987 Jul-Aug, 31(4), 460 - 3
Pulmonary cytology in tuberculosis; Tani EM et al.; A review was made of 138 sputa, 4 bronchial washings and 4 bronchial aspirates from 64 patients with pulmonary tuberculosis . The cytologic findings that may indicate granulomatous involvement were epithelioid cells, giant cells, lymphocytes and a necrotic background . Cell-block preparations stained by the Ziehl-Neelsen technique gave a positivity for acid-fast bacilli similar to that of bacterioscopy . This study emphasizes the potential diagnostic value of inflammatory alterations, even when the main objective of pulmonary cytology is the diagnosis of neoplasia; the finding of epithelioid cells and giant cells in a necrotic background may indicate a specific granulomatous involvement.

Histol Histopathol, 1987 Jul, 2(3), 307 - 12
Ultrastructural study of granulomatous tissue in tonsillar malakoplakia; Vitellaro-Zuccarello L et al.; The ultrastructural study carried out in a case of tonsillar malakoplakia confirmed that granulomatous lesions consisted mainly of macrophages containing peculiar calcified inclusions (Michaelis-Gutmann bodies) considered pathognomonic for the disease . Moreover macrophages frequently contained ingested Gram-negative bacilli and presented aspects of mitochondrial degeneration and autophagy . These latter features were probably the consequence of bacterial infection rather than the expression of primary cellular defects, as the clinical evolution of this case of malakoplakia did not support the existence of generalized macrophage alterations.

Histol Histopathol, 1987 Jul, 2(3), 217 - 22
An ultrastructural examination of murine alveolar macrophages following intranasal administration of propionibacterium acnes; Hightower JA et al.; Light and electron microscopic analysis of murine lungs or isolated pulmonary cells was performed three days after intranasal administration of the bacterial immunostimulant, Propionibacterium acnes (P . acnes) . Our observations indicated that pulmonary alveolar and airway macrophages (PAMs) were the only cells with P . acnes bacilli in their cytoplasm . Bacilli were not observed in pulmonary interstitial macrophages, granulocytes, lymphocytes or pulmonary parenchymal cells such as type I and type II pneumocytes . Because of the morphological heterogeneity of PAMs observed in control and experimental animals, it was not possible from these studies to be certain about the relative abundance or complexity of lysosomes, endoplasmic reticulum, Golgi and other organelles in the two groups . However, we noted that it was not uncommon to observe in the same PAM, profiles of P . acnes and a well developed Golgi complex and endoplasmic reticulum . These P . acnes--associated morphological alterations occurred at a time when functional activities (e.g., phagocytosis, cytostasis) of PAMs were enhanced.

J Am Acad Dermatol, 1987 Jul, 17(1), 1 - 13
Leprosy: new insight into an ancient disease; Modlin RL et al.; Patients with leprosy may be classified into two clinical and histopathologic categories . At one end of the spectrum, patients with tuberculoid leprosy have few skin lesions in which organisms can rarely be identified . At the other end of the spectrum, patients with lepromatous leprosy have numerous skin lesions containing myriad bacilli . Because immunologic resistance is associated with this spectrum, the study of leprosy provides a unique opportunity to gain insight into immunoregulatory mechanisms in man . In addition, serodiagnosis to identify early cases and prevention by vaccination are areas of active research . For patient care, a network of Regional Hansen's Disease Centers has been established under the sponsorship of the National Program for Hansen's Disease, Carville, LA . Because the patients are often poor, their receipt of care and medication without cost helps to ameliorate at least one of the burdens imposed by this potentially devastating illness . The program central office may be called at 800-642-2477.

FEBS Lett, 1987 Jun 22, 218(1), 131 - 4
An enzyme catalyzing the liberation of N-acetylglucosamine from N-acetylglucosaminyl pyrophosphorylpolyprenol in Bacillus polymyxa membranes; Murazumi N et al.; A novel enzyme which specifically hydrolyzes N-acetylglucosaminyl pyrophosphorylpolyprenol to liberate N-acetylglucosamine was found in membranes of Bacillus polymyxa AHU 1385 . The enzyme seems to be inactive toward alpha-N-acetylglucosaminyl phosphorylundecaprenol, beta-N-acetylglucosaminyl phosphorylundecaprenol, N-acetylglucosamine 1-phosphate, N-acetylglucosamine 1-pyrophosphate, or UDP-N-acetylglucosamine . Much lower activities of the same enzyme were also found in membranes of several other strains of Bacilli.

Pharm Weekbl Sci, 1987 Jun 19, 9(3), 172 - 8
The influence of gamma-irradiation upon the chemical and biological properties of insulin; Salemink PJ et al.; Partially purified insulin preparations of bovine and porcine origin, were subjected to gamma-irradiation with doses ranging from 1.0 up to 25 kGy (0.1-2.5 Mrad) at 0 degrees C or ambient temperature . The susceptibility of insulin to the irradiation was determined by chromatography, electrophoresis and assay of the biological activity . The sterilizing effect of the gamma-irradiation was investigated for Bacillus pumilus as well as for artificial mixtures of lactose and several bacilli . It is concluded that the sterilizing dose for the investigated insulins was greater than or equal to 2.2 kGy . At doses up to 25 kGy at 0 degree C no specific radiolytic products were detectable, whereas the biological activity was fully retained . The content of dimers and the content of related peptides appeared to increase gradually with the irradiation dose absorbed . No effects of long-term storage could be demonstrated on biological and chemical properties of insulin after 2.2, 4.5 and 7.5 kGy.

Q J Med, 1987 Jun, 63(242), 517 - 22
A prospective study of hepatic tuberculosis in 41 black patients; Maharaj B et al.; Forty-one black patients aged 21 to 75 years with hepatic tuberculosis diagnosed at liver biopsy were studied prospectively . The liver varied in size and consistency and was tender in 44 per cent of patients . Abdominal symptoms, weight loss, pyrexia, hepatomegaly, splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and 27 per cent of patients respectively . Twenty-two per cent of chest radiographs were normal . Liver function tests were of little diagnostic value and hepatic imaging techniques often gave normal results . Acid-fast bacilli, caseation and coexistent liver disease were detected in 59, 51 and 37 per cent of patients respectively . Since there was no consistent clinical pattern a high index of suspicion is necessary if this disease is to be detected in communities in which tuberculosis is endemic . In patients with unexplained hepatomegaly or hepatosplenomegaly or pyrexia of unknown origin liver biopsy provides the only means of making this diagnosis.

Tubercle, 1987 Jun, 68(2), 93 - 103
A study of the use of maternity and child welfare clinics in case-finding for pulmonary tuberculosis in Kenya; Aluoch JA et al.; This investigation is the seventh in a series of case-finding studies in Kenya . It explores the potential value of questioning mothers attending maternity and child welfare (M & CW) clinics to identify tuberculosis suspects (individuals aged 6 years or more with a cough for 1 month or more or hemoptysis) living in their households . The study was carried out in all the eight M & CW clinics in two divisions (populations 86,000 and 112,000) of two different districts . The mothers were asked to give a standard letter, which explained the possible importance of a chronic cough, to each suspect they identified and invited the suspect to attend the district hospital chest clinic . Each suspect attending the clinic was entered in a special register and two sputum specimens were collected . For those who failed to attend, the specimens were collected at a home visit . Of the total of 342 suspects living in the two study areas who were registered at the M & CW clinics during 1 year, 261 were identified by the mothers but 19 denied having received the standard letter . The remaining 81 had not been identified by mothers but had attended the M & CW clinics on their own initiative . Of the 242 suspects who received the letter, 89 (39%) attended the hospital chest clinic, 74% within a week of the letter being issued from the M & CW clinic . The main reasons given for not attending the hospital chest clinic by the remaining suspects were financial or because their cough had improved or disappeared . Sputum was collected from 238 suspects and examined bacteriologically: in six (2.5%) it was positive for tubercle bacilli on smear and culture and in a further two (0.8%) the sputum was positive on culture only . Of those attending the hospital chest clinic 2.9% were smear- and culture-positive and 4.7% were culture positive . This method of case-finding has yielded disappointing results, for only 4% of the estimated annual incidence of smear-positive cases was detected.

Tubercle, 1987 Jun, 68(2), 119 - 25
The immune response in two populations of wild badgers naturally infected with bovine tubercle bacilli; Mahmood KH et al.; This study describes the immune responses of two defined badger populations; one from East Sussex and another from Staffordshire . The mean in vitro lymphoproliferative response, of all infected badgers from both areas, to Glaxo BCG, was significantly greater than that of healthy animals . The infected badgers had significantly higher antibody levels against mycobacterial antigens, especially New Tuberculin, than did the healthy animals . All the healthy and tuberculous badgers from the Staffordshire area were invariably unreactive to the various preparations used for skin-testing . However, in the East Sussex area, positive reactions were obtained in 10 out of 37 healthy and 7 out of 10 infected animals . This is the first account of positive skin tests in free living badgers . These results support the concept that badgers infected with bovine tubercle bacilli pass through an immunological spectrum throughout much of which they are unlikely to be important sources of infection . In the early stages, tubercle bacilli are excreted from infected wounds, whereas in the later stages, failure of cell-mediated immunity results in excretion of tubercle bacilli from other sites and the badger becomes a potent source of infection.

Vaccine, 1987 Jun, 5(2), 109 - 14
Absorption of Mycobacterium bovis BCG administered by the oral route; Mortatti RC et al.; The action of gastric and duodenal juices on BCG as well as on its absorption and its distribution in the organs after intragastric administration in mice were studied . A significant decrease in BCG oxygen uptake and a moderate loss of viability were found after 2 h treatment with gastric juice . Using duodenal juice, a marked decrease of respiration and a notable fall in viability were observed . Labelling of BCG with carbon-14 was accomplished using {14C}glycerol as a precursor of mycobacterial lipids . Similar levels of radioactivity were recovered in organs of mice 24 h after intragastric administration of 14C-BCG, sonicated 14C-BCG and {14C}glycerol . The level of 14C-BCG remained stable from 6 to 24 days, while sonicated 14C-BCG and {14C}glycerol defined a biological decay process . Studies of biological decay from the small intestine and liver indicated that the absorptive process started rapidly and reached its highest level at 24 h, declining thereafter according to the complexity of the material given to mice . However, living bacilli were not cultured from organs of mice given single doses of unlabelled BCG . Therefore, judging from the above data it may be concluded that the majority of BCG bacilli absorbed intact were not alive.

Int J Lepr Other Mycobact Dis, 1987 Jun, 55(2), 338 - 44
S-100 protein and immunoperoxidase technique as an aid in the histopathologic diagnosis of leprosy; Fleury RN et al.; The histopathologic diagnosis of leprosy in the tuberculoid type (TL) and in the indeterminate group (IL) may be difficult and frequently unfeasible . The detection of the impairment of cutaneous nerve branches by the inflammatory reaction may permit the diagnosis of TL over other skin granulomas . In an attempt to overcome these diagnostic difficulties in the lesions with no bacilli and without obvious damage to nerve branches, we utilized the immunoperoxidase technique with S-100 protein as the nerve marker . Two groups were selected: Patients (group 1) with TL confirmed by the presence of bacilli, and patients (group 2) with a clinical diagnosis of TL not confirmed by histopathology . The slides treated by S-100 in group 2 showed that 8 cases (9 total) were confirmed to have TL on the basis of the nerve alteration observed by the immunoperoxidase technique . These data obtained in the present studies show that use of the immunoperoxidase technique for the detection of S-100 protein to visualize peripheral nerves represents an efficient auxiliary aid in the diagnosis of leprosy.

Int J Lepr Other Mycobact Dis, 1987 Jun, 55(2), 316 - 21
Comparison of radiometric macrophage assay and fluorescein diacetate/ethidium bromide staining for evaluation of M . leprae viability; Harshan KV et al.; Earlier studies from our laboratory reported that a radiometric Mycobacterium leprae resident macrophage assay was a useful in vitro indicator of bacillary viability with good correlation with the established mouse foot pad model . The present study compares our assay with the recently described fluorescein diacetate/ethidium bromide (FDA/EB) method . M . leprae extracted from the dermal lesions of 73 bacilliferous leprosy patients were tested concurrently by both techniques . Good correlation (r = 0.52, p less than 0.001) was found between the radiometric assay evaluating DNA synthesis and the FDA/EB staining reflecting the presence of active esterase enzyme . In addition, the utility of the FDA/EB staining in the monitoring of therapy was established . Twenty-two patients treated for greater than 1 year showed lower numbers of green fluorescing bacilli when compared to 19 untreated or short-term-treated individuals.

Schweiz Med Wochenschr, 1987 May 9, 117(19), 707 - 11
{Use of antibiotics for the prevention of bacterial pneumonia in surgical intensive care units}; Baumgartner JD et al.; Bacterial pneumonia is responsible for high mortality in surgical intensive care patients which is partly attributable to a high incidence of gram-negative bacillary pneumonia . In these patients alterations to epithelial cell surfaces promote colonization of the oropharynx by gram-negative bacilli . The alterations are directly related to the severity of the patients' underlying disease and not to the hospital environment . Prospective studies on prophylactic administration of antibiotics to decrease the incidence of nosocomial pneumonia are reviewed . In these studies antibiotic have been administered either locally in the respiratory tract or systemically by the i.v . route . In both cases a moderate decrease in the incidence of pneumonia was observed, but selection of resistant bacteria occurred . Pneumonia appearing despite antibiotic prophylaxis was difficult to treat and had a high mortality . Therefore, local or intravenous antibiotic administration for routine prophylaxis of pneumonia seems to do more harm than good in patients from intensive care units.

Life Sci, 1987 May 4, 40(18), 1769 - 75
Occurrence of a barbiturate-inducible catalytically self-sufficient 119,000 dalton cytochrome P-450 monooxygenase in bacilli; Fulco AJ et al.; In a recent publication (Narhi, L.O . and Fulco, A.J.{1986} J . Biol . Chem . 261, 7160-7169) we described the characterization of a catalytically self-sufficient 119,000 Dalton cytochrome P-450 fatty acid monooxygenase (P-450BM-3) induced by barbiturates in Bacillus megaterium ATCC 14581 . We have now examined cell-free preparations from 12 distinct strains of B . megaterium and from one or two strains each of B . alvei, B . brevis, B . cereus, B . licheniformis, B . macerans, B . pumilis and B . subtilis for the presence of this inducible enzyme . Using Western blot analyses in combination with assays for fatty acid hydroxylase activity and cytochrome P-450, we were able to show that 11 of the 12 B . megaterium strains contained not only a strongly pentobarbital-inducible fatty acid monooxygenase identical to or polymorphic with P-450BM-3 but also significant levels of two smaller P-450 cytochromes that were the same as or similar to cytochromes P-450BM-1 and P-450BM-2 originally found in ATCC 14581 . Unlike the 119,000 Dalton P-450, however, the two smaller P-450s were generally easily detectable in cultures grown to stationary phase in the absence of barbiturates and, with some exceptions, were not strongly induced by pentobarbital . None of the non-megaterium species of Bacillus tested exhibited significant levels of either fatty acid monooxygenase activity or cytochrome P-450 . The one strain of B . megaterium that lacked inducible P-450BM-3 was also negative for BM-1 and BM-2 . However, this strain (ATCC 13368) did contain a small but significant level of another P-450 cytochrome that others have identified as the oxygenase component of a steroid 15-beta-hydroxylase system . Our evidence suggests that the BM series of P-450 cytochromes is encoded by chromosomal (rather than by plasmid) DNA.

Gastroenterology, 1987 May, 92(5 Pt 1), 1127 - 32
Terminal ileitis associated with Mycobacterium avium-intracellulare infection in a homosexual man with acquired immune deficiency syndrome; Schneebaum CW et al.; A 38-yr-old homosexual man developed fever, diarrhea, and weight loss . An upper gastrointestinal examination revealed terminal ileitis, and stains of stool revealed acid-fast bacilli that were subsequently identified as Mycobacterium avium-intracellulare . Antimycobacterial therapy was associated with weight gain and loss of fever and diarrhea . Several months later, cutaneous Kaposi's sarcoma was observed . When the patient developed strictures in the terminal ileum, a surgical resection was performed . Numerous granulomas and acid-fast bacilli, later identified as M . avium-intracellulare, were present in the resected terminal ileum . This report demonstrates that infection of the terminal ileum with M . avium-intracellulare in a patient with acquired immune deficiency syndrome can present with a clinical and radiologic picture resembling Crohn's disease . It also demonstrates symptomatic improvement of this infection temporally related to the administration of antimycobacterial therapy and the ability of an acquired immune deficiency syndrome patient to tolerate major abdominal surgery.

Diagn Microbiol Infect Dis, 1987 May, 7(1), 69 - 72
Comparison of RapID-ANA and Minitek with a conventional method for biochemical identification of anaerobes; Hussain Z et al.; Two micromethods for the identification of anaerobes, one requiring growth (Minitek) and one nongrowth dependent (RapID-ANA), were compared with a conventional identification culture system . For 222 clinical isolates, RapID-ANA agreed with PRAS in 187 (84%) and Minitek agreed for only 170 strains (76%) . Both systems identified common isolates well, but encountered some difficulty in identifying less common clostridia and Gram-negative bacilli . Although adequate for most strains, the results from both systems should be interpreted with caution, particularly for less frequently isolated species.

Indian J Lepr, 1987 Apr-Jun, 59(2), 191 - 3
Epithelioid and polygonal cells in histoid leprosy; Porichha D et al.; Salient histological features of 36 histoid leprosy were presented . Usual features like whorls and interlacing bundles of spindle cells, histoid habitus of the bacilli were noticed in all the cases . Pseudocapsule was present in 6 cases . Circumscribed islets of epithelioid cells were seen in the deeper part of the granuloma in 5 cases . Acid-fast bacilli were absent or rare in these cells . Polygonal, foamy macrophages were found in 12 cases . Presence of epithelioid and polygonal cells in histoid leprosy is rare and its significance needs to be explored.

Indian J Lepr, 1987 Apr-Jun, 59(2), 171 - 7
Alkaline phosphatase activity in peripheral nerves and endothelial cell cultures in leprosy; Mehta L et al.; Alkaline phosphatase activity in leprosy nerves was studied . The activity was mainly in blood vessels and was maximum in healthy nerves . Low levels were seen in crush injury . In leprosy lower levels were in BT than LL cases . Endothelial cells (in vitro) released alkpase when infected with live bacilli only . No response was observed with heat killed bacilli.

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