Zentralbl Bakteriol Mikrobiol Hyg {A}, 1987 Apr, 264(1-2), 167 - 77 Effect of culture medium on morphology and virulence of Legionella pneumophila serogroup 1; Nowicki M et al.; In a preliminary study, the preparation of a modified charcoal yeast extract by predialysis of yeast extract (CDYE) allowed us to obtain short non filamentous forms of Legionella pneumophila ser 1 (Philadelphia) found to be more virulent in the chick embryo than the long forms grown on conventional media . We confirmed these findings in guinea pigs inoculated by either intraperitoneal injection or aerosol inhalation . LD50s were calculated using the method of Reed and Muench . Survival curves were established using Liddell's method . If for chick embryo the most virulent organisms were those derived from yolk sac culture, organisms grown on CDYE agar were more virulent than those grown on the other media . There was a significant positive correlation between the mean length of the bacilli and the log 10 of the LD50 (r = 0.96; 0.02 less than p less than 0.05) . For guinea pigs by either intraperitoneal injection or inhalation we confirmed that the bacteria cultured on CDYE were more virulent than those grown on other solid media . Thus for the guinea pig inoculated intraperitoneally, the LD50s of the CDYE and BCYE cultures were 1.4 X 10(7) and greater than 3 X 10(9) CFU, respectively . The mortality of guinea pigs inoculated by aerosol with CDYE cultures was significantly higher than that of guinea pigs infected with BCYE cultures using suspensions of 10(8) and 10(9) CFU/ml (p less than 0.01) and 10(10) CFU/ml (p less than 0.05). Anal Biochem, 1987 Apr, 162(1), 18 - 23 A rapid chemical procedure for isolation and purification of chromosomal DNA from gram-negative bacilli; Beji A et al.; A rapid and simple method for preparing chromosomal DNA from gram-negative bacilli is presented . It is based on the alkaline (NaOH 0.03 M) lysis of cell walls . The resulting emulsion is purified by proteinase K (0.625 mg/g of wet wt), SDS, and the deproteinizing agent (chloroform isoamyl alcohol) . The purity, molecular nature, and yield of DNA obtained by the present method are compared with those of DNA extracted by Marmur's procedure and a Marmur's modified procedure . We have developed and standardized this original method to isolate double-stranded DNA, free of proteins and RNA contamination and with a significantly higher yield of DNA than the two other methods . This procedure is particularly useful for strains with low growth and can be applied in every field concerned with DNA analysis. J Wildl Dis, 1987 Apr, 23(2), 220 - 4 Leprosy in armadillos (Dasypus novemcinctus) from Texas; Clark KA et al.; Tissue sections from 237 nine-banded armadillos (Dasypus novemcinctus) from 51 central Texas counties were examined microscopically for acid-fast bacilli and/or lesions of leprosy . Neither were found . A review of the literature relative to the incidence of leprosy from armadillos in Texas indicates that residents of counties along the Texas Gulf Coast may be at risk of contracting leprosy by handling infected armadillos or their tissues. Int J Dermatol, 1987 Apr, 26(3), 181 - 4 Skin granulomas due to Mycobacterium gordonae; Gengoux P et al.; A 38-year-old woman presented with small, ulcerated, red or bluish nodules on the right hand, clinically resembling mycobacterial granulomas; these appeared a few months after a bite by a rat, while the patient was collecting frogs in a pond in the Belgian Ardennes . The histopathologic picture was compatible with a diagnosis of mycobacterial infection and rare acid-fast bacilli could be found . Repeated bacteriologic investigations were performed and these led to the identification of a strain displaying characteristics of Mycobacterium gordonae . The skin condition responded well to rifampicin (300 mg/day) within 6 months. Epidemiol Infect, 1987 Apr, 98(2), 155 - 63 The immunological consequences of challenge with bovine tubercle bacilli in badgers (Meles meles); Mahmood KH et al.; Optimal conditions were determined for performing antibody measurements (ELISA), lymphocyte transformation tests and, to some extent, skin tests in badgers . These parameters, together with the bacteriological and pathological studies reported previously (Pritchard et al . 1987), were used to follow the course of intradermal and intratracheal challenge of badgers with bovine tubercle bacilli . Two challenge doses were used for each route of infection and two animals received each dose . None of the four animals challenged by the intratracheal method showed any evidence of infection, suggesting that adult badgers may have some resistance to challenge by this method . All four animals challenged intradermally developed lesion of tuberculosis . Immunologically the disease passed through three phases . There was an early phase in which lymphocyte transformation to whole BCG steadily and significantly increased, and skin tests to tuberculin became positive but there was little change in antibody levels . This was followed by an intermediate phase of variable skin responses, fluctuating lymphocyte transformation and significant increase in antibody levels . The final phase, which was only seen in two animals with extensive disease, was associated with changing skin reactions and falling lymphocyte responses, together with a sudden increase in antibody levels . This paper presents the first formal evidence of cell-mediated immunity to tuberculosis in the badger, which may delay onset and prolong the survival of challenged animals. Pathology, 1987 Apr, 19(2), 186 - 92 Rationale for the histological spectrum of tuberculosis . A basis for classification; Ridley DS et al.; There is need to re-appraise the cellular response to Mycobacterium tuberculosis . Histological analysis of 54 untreated patients with established disease demonstrated a continuous spectrum of tissue responses in which six groups correlated with evidence of resistance to bacterial multiplication . A predominance of cases in the two middle groups (82%) signified an immunological equilibrium in middle grade resistant patients that is absent in related diseases such as leprosy and cutaneous leishmaniasis . The dominant feature was necrosis, which increased progressively across the spectrum . Its form varied from minimal fibrinoid change, through fine eosinophilic necrosis, to basophilic necrosis characterized by neutrophil karyorrhexis, and finally to an almost acellular lesion with many bacilli . Cytological differentiation of the granuloma was of subsidiary significance, mature epithelioid cells being found only in high resistant cases . No correlation was found for the number of lymphocytes . This classification is thought to be an accurate reflection of the immune state in relation to antigenic load . It raises a hitherto unconsidered possibility that "caseation", a loosely applied macroscopic term, may embrace immunologically distinct states . The classification of multiple lesions was consistent . Histology offers a promising basis for further immunopathological investigation. Acta Leprol, 1987 Apr-Jun, 5(2), 125 - 31 Histoid leprosy--a histopathological reapparel; Sehgal VN et al.; Twenty three clinically diagnosed histoid leprosy patients were subjected to histopathological and histochemical investigations . The histopathological features were comprise of a well-formed lesion surrounded by a pseudocapsule . In addition, a free, midly eosinophilic, uninvolved sub-epidermal zone, and variously arranged spindle-shaped histiocytes were noted in the lesion . Polygonal and foamy histiocytes were also sited in a few sections . The lesion also had a large number of solid staining acid-fast lepra bacilli . The latter might have stimulated a peculiar histiocytic tissue response almost identical to that seen in histiocytoma(cutis) but for the absence of haemosidrin and lipids. Jpn J Antibiot, 1987 Apr, 40(4), 711 - 26 {Clinical trial of forphenicinol for the lung infection with Mycobacterium avium, Mycobacterium intracellulare complex}; Ishibashi T et al.; Clinical evaluation of forphenicinol, a low molecular weight immunomodulator, in patients with Mycobacterium avium, Mycobacterium intracellulare complex pulmonary infections has been conducted in a multicenter trial participated by 9 institutions in Kyushu during a period of 12 months from July 1982 to August 1983 . Forphenicinol was administered for 6 months without changing the regimen of antituberculous drugs used previously . The following results were obtained . 1 . Ten out of 33 eligible patients were evaluated as showing good responses; In 5 of them, elimination of M . avium, M . intracellulare complex from sputum was observed . In the other 5 patients, number of bacilli excreted was decreased significantly after treatment . 2 . All of the cases with good responses were those which were simultaneously administered with antituberculous drugs . 3 . Patients with thick-walled cavities, following cured tuberculosis, which was superimposed with M . avium, M . intracellulare complex, were poorly responded to forphenicinol . 4 . Side effects were observed in 3 out of 41 patients; 1 case each with fever, abdominal distension and anorexia . No abnormalities in laboratory test values were observed. J Wildl Dis, 1987 Apr, 23(2), 318 - 20 Listeriosis in an immature black buck antelope (Antilope cervicapra); Webb DM et al.; A 10-week-old, black buck antelope calf, from the Mesker Park Zoo in Evansville, Indiana was found dead without observed signs of illness . Necropsy disclosed disseminated ecchymoses on the pericardium, diaphragm, intestines, and renal capsules and more extensive hemorrhage in the muscles of the hindquarters . There were numerous, 1 mm, pale foci on the capsular and cut surfaces of the liver and spleen which, on microscopic examination, were necrotic foci containing variable numbers of neutrophils and mononuclear leukocytes with numerous, short, Gram-positive, cocco-bacilli at the periphery . Listeria monocytogenes was isolated from the liver . Septicemia is the most common form of listeriosis in non-domestic ruminants . Listeriosis should be suspected when unexpected deaths are accompanied by multifocal necrotizing hepatitis and splenitis, myocarditis, and disseminated hemorrhage. J Trauma, 1987 Apr, 27(4), 357 - 64 The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients; Stoutenbeek CP et al.; The incidence of respiratory tract infections was determined in 59 multiple trauma patients requiring prolonged intensive care (greater than 5 days) and receiving no antibiotic prophylaxis . Early pneumonia (less than 48 hr) with S . aureus, S . pneumoniae, and/or H . influenzae was found in 44% of patients . Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by pneumonia occurred in 12 patients (20%) . The overall incidence of respiratory tract infections was 59% . In a prospective open trial three prophylactic antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable antibiotics (polymyxin E 400 mg, tobramycin 320 mg, amphotericin B 2,000 mg/day) . No difference in infection rate was found . Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an ointment containing 2% of the same antibiotics . Secondary colonization and infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p less than 0.001) . The incidence of early (Gram-positive) infections, however, was unchanged . Another group of 63 patients was treated with systemic antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination . The incidence of early pneumonia was significantly reduced (p less than 0.001) . Five patients (8%) developed an infection . Superinfections were not observed. J Infect Dis, 1987 Mar, 155(3), 390 - 402 Systemic cat scratch disease: report of 23 patients with prolonged or recurrent severe bacterial infection; Margileth AM et al.; Over a seven-year period, we identified 23 patients who had prolonged or recurrent, severe, systemic, cat-scratch disease (CSD) . Compared with the usual, benign course in 1,038 patients with typical CSD, the course in these 23 patients included prolonged (two or more weeks) morbidity (fever, malaise, fatigue, myalgia, arthralgia, skin eruptions, weight loss, and splenomegaly) . Five patients with systemic CSD had either neuroretinitis, pleurisy, arthralgia or arthritis, splenic abscesses, and mediastinal masses or enlarged nodes of the head of the pancreas . Recurrent CSD in two of three adults was confirmed by finding typical CSD bacilli in lymph nodes removed during separate episodes . The majority of patients were adult males, and all patients recovered completely without sequelae . Histopathologic studies of five skin and 18 lymph node biopsy specimens were diagnostic . CSD bacilli were detected in lymph nodes from 15 patients and in the primary skin lesions of four patients . CSD bacilli were found in both skin and lymph nodes of three patients. J Clin Microbiol, 1987 Mar, 25(3), 546 - 50 Evaluation of the AutoMicrobic system for susceptibility testing of aminoglycosides and gram-negative bacilli; Hindler JA et al.; The AutoMicrobic system (AMS; Vitek Systems, Inc., Hazelwood, Mo.) was compared with a reference broth microdilution MIC method to determine the accuracy and reproducibility of aminoglycoside susceptibility testing of gram-negative bacilli . Stock clinical isolates (n = 176) which demonstrated resistance to at least one aminoglycoside, extended-spectrum penicillin, or broad-spectrum cephalosporin (or a combination) were selected for this study . Isolates with moderate susceptibility to the aminoglycosides were also included . Of these isolates, 116 were either resistant or moderately susceptible to one or more of amikacin, gentamicin, netilmicin, and tobramycin . When AMS MIC results for 704 antimicrobial agent-organism combinations were compared with parallel microdilution MIC results, exact agreement (AMS MIC = reference MIC) rates were: amikacin, 71.6%; gentamicin, 71.6%; netilmicin, 83.0%; and tobramycin, 69.3% . Agreement rates within +/- 1 log2 dilution were: amikacin, 96.0%; gentamicin, 93.8%; netilmicin, 97.2%; and tobramycin, 96.0% . When National Committee for Clinical Laboratory Standards criteria were used to qualitatively evaluate performance, the overall agreement rates were: amikacin, 100.0%; gentamicin, 99.4%; netilmicin, 98.9%; and tobramycin, 99.4% . There were only four very major discrepancies, which represented 0.6% of the tests performed, and there were no major discrepancies . The percentages of minor discrepancies were: amikacin, 9.6%; gentamicin, 14.2%; netilmicin, 11.9%; and tobramycin, 10.8% . Of the overall average of 11.6% minor discrepancies, 9.7% occurred even though the AMS MIC was within +/- 1 log2 dilution of the reference MIC . The intralaboratory reproducibility ranged from 93.3 to 100% for the four drugs examined . With this challenge group of gram-negative bacilli, the AMS generated aminoglycoside MIC results that were comparable to those obtained by a reference broth microdilution method. J Clin Microbiol, 1987 Mar, 25(3), 488 - 90 Gram-negative bacilli as nontransient flora on the hands of hospital personnel; Guenthner SH et al.; The possibility that gram-negative bacilli (GNB) are part of the nontransient flora on hands was examined by using a broth rinse technique to detect low titers of GNB after a hygienic hand wash with soap and water . A total of 100 nurses who had direct patient contact and 40 controls without patient contact had a similar rate of recovery of GNB (46 and 55%, respectively) . GNB persisted on the hands of 10 nurses throughout five successive hand washes with soap and water . Hand cultures were obtained daily from 12 nurses before and after a work shift in a surgical intensive care unit . GNB were recovered from 57% of individuals before patient contact and from only 24% after the work shift . Nontransient GNB on the hands of hospital personnel are a potential reservoir for hospital strains, and patient contact is not an obvious source for the acquisition of nontransient GNB. Diagn Cytopathol, 1987 Mar, 3(1), 13 - 6 Fine-needle aspiration cytology diagnosis of tuberculosis; Rajwanshi A et al.; Fine-needle aspiration cytology of lymph nodes and extranodal swellings in 160 cases showed granulomatous reaction with or without caseation necrosis in 83% . The material was acellular or predominantly composed of necrotic material, polymorphs, and lymphocytes in 17% . The age of the patient ranged from 1.5 to 72 yr . The male to female ratio was 1:1.3 . Acid-fast bacilli (AFB) could be demonstrated in 40.6% of cases . In cases associated with cellular reaction and necrosis . AFB positivity was 50.0%, while it was 66.7% in cases with acellular necrotic material. Int J Lepr Other Mycobact Dis, 1987 Mar, 55(1), 99 - 108 Events surrounding the recognition of Mycobacterium leprae in nerves; Ridley MJ et al.; Histological examination and immunocytochemistry of Schwann cells, macrophages, and mycobacterial antigen were used to study 48 nerves of untreated patients with leprosy . None of the patients was in reaction clinically, but microreactions, involving small clusters of Schwann cells and macrophages in all cases except LL, were marked by progressive degradation of acid-fast bacilli (AFB) . This was thought to be the response to the recognition of mycobacterial antigen . In the first phase, the disintegration of one or more Schwann cells caused the release of AFB, accompanied by subacute inflammation . In the second phase, as edema and cellular infiltration subsided, the necrosis of Schwann cells was replaced by granuloma formation, mycobacterial antigen being in a soluble form . Myelinated cells harbored few degraded AFB, and there was evidence that antigen-associated myelin hastened the death of Schwann cells . Only then did antigen become immunologically detectable to induce an inflammatory response whose clearance and resolution was impeded by the restraint on cellular movement due to the structure of neural tissue . These developments were sporadic but continuous . AFB and antigen released by disintegrating Schwann cells were ingested by regenerating Schwann cells and by macrophages, producing a self-perpetuating cycle which might involve either small areas or the greater part of a fascicle, and could conceivably progress to a generalized reaction. Int J Lepr Other Mycobact Dis, 1987 Mar, 55(1), 70 - 7 Activities of pefloxacin and ciprofloxacin against Mycobacterium leprae in the mouse; Guelpa-Lauras CC et al.; Because ciprofloxacin and pefloxacin are fluoroquinolones active against many mycobacterial species, both drugs were tested against Mycobacterium leprae in the mouse foot-pad system . Preliminary pharmacokinetic studies in the mouse showed that after a single oral dose of 150 mg/kg ciprofloxacin the peak serum concentration was 3.6 micrograms/ml, and after 50 mg/kg or 150 mg/kg pefloxacin peak serum concentrations were, respectively, 9.2 micrograms/ml and 16.9 micrograms/ml, the half-lives for serum elimination being about 2 hr for both drugs . The activity of daily 50 mg/kg and 150 mg/kg ciprofloxacin and pefloxacin against M . leprae was then tested in mice infected with 5 X 10(3) M . leprae . The growth of M . leprae was not prevented in mice treated continuously with either 50 mg/kg or 150 mg/kg ciprofloxacin, indicating that this drug had no or a limited bacteriostatic effect at the dosages used . In mice treated continuously with 50 mg/kg pefloxacin, growth of M . leprae was not prevented, but at monthly harvests the number of bacilli in the foot pads remained less than those of control mice (p less than 0.05) . No growth of M . leprae occurred in mice treated continuously with 150 mg/kg pefloxacin . In mice treated for only 3 months with daily 150 mg/kg pefloxacin, the growth-delay that followed the stopping of the drug was 126 days, suggesting that approximately 99% of the M . leprae were killed . The pharmacokinetics of pefloxacin being more favorable in man than in the mouse, pefloxacin appears a possible drug for the chemotherapy of leprosy. Int J Lepr Other Mycobact Dis, 1987 Mar, 55(1), 30 - 5 In vitro proliferation of lymphocytes from human volunteers vaccinated with armadillo-derived, killed M . leprae; Gill HK et al.; A killed, armadillo-derived Mycobacterium leprae vaccine was examined for its ability to induce cell-mediated responsiveness in purified protein derivative (PPD)-positive volunteers residing in a nonendemic country using the lymphocyte transformation test (LTT) . A marked increase in the proliferative responses to a M . leprae-soluble antigen preparation was observed in the two groups which were vaccinated with the highest doses of the vaccine, i.e., 1.5 X 10(8) and 5 X 10(8) bacilli . This increase was observed in both groups 3 months after vaccination, and persisted for the study period of 1 year . The in vitro proliferative responses to whole bacilli, of both armadillo and human origin, showed a similar but smaller increase 3 months after vaccination . Some enhancement of responses to cross-reactive antigens, such as PPD, and to unrelated antigens such as streptokinase-streptodornase, tetanus toxoid and diphtheria toxoid, was also observed . Thus, the LTT revealed that while the killed M . leprae vaccine induced a specific cell-mediated response to M . leprae, it was also responsible for a nonspecific immune-enhancement effect in healthy volunteers. Infect Immun, 1987 Mar, 55(3), 680 - 5 Intracellular fate of Mycobacterium leprae in normal and activated mouse macrophages; Sibley LD et al.; Mycobacterium leprae replicates within mononuclear phagocytes, reaching enormous numbers in the macrophage-rich granulomas of lepromatous leprosy . To examine the capability of macrophages to digest M . leprae, we studied the intracellular fate of M . leprae organisms in normal and activated mouse macrophages by using the electron-dense secondary lysosome tracer Thoria Sol . Intracellular M . leprae organisms, surrounded by a characteristic electron-transparent zone, were contained within phagosomal vacuoles of macrophages cultured in vitro for 1 to 6 days . In normal macrophages, a majority of phagosomes containing freshly isolated live M . leprae cells resisted fusion with Thoria Sol-labeled lysosomes . The extent of fusion was not significantly affected by pretreatment of M . leprae with human patient serum high in specific immunoglobulin G and M antibodies . In contrast, a majority of phagosomes containing gamma-irradiated M . leprae cells underwent lysosome fusion in normal macrophages . In addition, increased phagolysosome fusion was observed with live M . leprae-containing phagosomes in macrophages activated with gamma interferon . Increased fusion was associated with an increase in the number of fragmented and damaged bacilli, suggesting that increased digestion followed fusion . This study indicates that activated macrophages may have an increased capacity for clearance of normally resistant M . leprae. Tubercle, 1987 Mar, 68(1), 3 - 17 Virulence for guinea pigs of tubercle bacilli isolated from the sputum of participants in the BCG trial, Chingleput District, South India; Prabhakar R et al.; This study, conducted in Madras, India and in Madison, Wisconsin, USA, was concerned with the virulence of isolates of Mycobacterium tuberculosis obtained from the sputum of individuals living in the Chingleput district of south India . The following results were obtained . 1 . The findings of Mitchison with respect to the predominance of low virulence for guinea pigs among isolates from persons living Madras, were confirmed on isolates from the sputum of residents of the Chingleput district . 2 . A high correlation was found between the log10 number of tubercle bacilli recovered from the spleen of guinea pigs infected intramuscularly with 1.0 mg of tubercle bacilli and the root index of virulence . 3 . A high correlation was found between the log10 number of tubercle bacilli recovered from the spleen of guinea pigs infected intramuscularly with 1.0 mg of tubercle bacilli and the number recovered from the spleen of guinea pigs infected by the respiratory route with 5-10 tubercle bacilli . 4 . Relatively low correlations were found between RIV and the susceptibility of isolates to thiophene-2 carboxylic acid hydrazide or to hydrogen peroxide. Proc Natl Acad Sci U S A, 1987 Mar, 84(6), 1679 - 83 Genes for the major protein antigens of Mycobacterium tuberculosis: the etiologic agents of tuberculosis and leprosy share an immunodominant antigen; Husson RN et al.; Mycobacterium tuberculosis genes encoding immunologically relevant proteins were isolated by systematically screening a lambda gt11 recombinant DNA expression library with a collection of murine monoclonal antibodies directed against protein antigens of this pathogen . These antibodies, previously characterized by a World Health Organization workshop on monoclonal antibodies against mycobacteria, were used to isolate DNA sequences encoding five major protein antigens of this pathogen . To evaluate the extent of crossreactivity between these M . tuberculosis antigens and antigens of Mycobacterium leprae, recombinant antigens were probed with monoclonal antibodies directed against the protein antigens of these bacilli . One of the antigens, a 65-kDa protein, has determinants common to M . tuberculosis and M . leprae . We find not only that this antigen is recognized by mouse monoclonal antibodies but that it is the major protein recognized by anti-M . tuberculosis rabbit sera . The 65-kDa proteins of M . tuberculosis and M . leprae appear to play a role in the humoral and cell-mediated immune response to these pathogens. J Bacteriol, 1987 Mar, 169(3), 1182 - 91 Regulation of spo0H, an early sporulation gene in bacilli; Dubnau EJ et al.; The construction of lacZ fusions in frame with the spo0H gene of Bacillus licheniformis enabled us to study the expression of this gene under various growth conditions and in various genetic backgrounds . spo0H was expressed during vegetative growth, but the levels increased during early stationary phase and then decreased several hours later . Expression of the gene was not repressed by glucose, but was induced by decoyinine, an inhibitor of guanine nucleotide biosynthesis, which can induce sporulation . Of those tested, the only spo0 gene required for the expression of spo0H was spo0A, and this requirement was eliminated by the abrB mutation, a partial suppressor of spo0A function . spo0H-lacZ expression was much higher in a strain with a deletion in the spo0H gene. Int J Lepr Other Mycobact Dis, 1987 Mar, 55(1), 63 - 9 Suppressor T cells for delayed-type hypersensitivity in susceptible mice infected with Mycobacterium lepraemurium; Richard L et al.; Spleen cells from immunodepressed C3H mice, i.e., mice inoculated intravenously 4 months earlier with 1 X 10(7) Mycobacterium lepraemurium (Mlm) bacilli, were separated into different populations, and the T-cell-enriched population was treated further with gamma-irradiation or specific anti-Lyt antibodies plus complement . The cell populations obtained were then adoptively transferred to normal and Mlm-sensitized syngeneic mice in order to investigate whether or not suppressor cells regulate the delayed-type hypersensitivity (DTH) reaction to specific antigens . A radiosensitive cell population expressing the Lyt 1+, 2+ phenotype had the capacity to depress the induction (afferent phase) of DTH reaction . In contrast, a radioresistant cell population expressing the Lyt 1+, 2- phenotype possessed the capacity to depress the expression (efferent phase) of the cutaneous reaction . Thus, distinct populations of suppressor cells, each regulating a different phase of DTH, are induced in the spleen of Mlm-infected mice. J Hosp Infect, 1987 Mar, 9(2), 151 - 7 Potential hazard from spray cleaning of floors in hospital wards; Medcraft JW et al.; The potential hazard from using contaminated spray cleaning fluid to clean hospital floors was investigated . Eight of 10 sprays in daily hospital use failed the 'in-use' test of Kelsey & Maures . Contamination was due to Gram-negative bacilli, mainly Pseudomonas spp . An experiment showed that freshly diluted cleaning fluid in a new spray container became contaminated in 6 days, although the route of contamination of the fluid is not clear . Air samples and samples from bedding collected during spray cleaning with contaminated fluid showed the presence of Pseudomonas spp . Use of freshly diluted cleaning fluid and daily cleaning of spray containers is recommended. Int J Lepr Other Mycobact Dis, 1987 Mar, 55(1), 83 - 7 Orientation staining for the demonstration of Mycobacterium leprae in semithin sections; Luderschmidt C; In Spurr-embedded biopsies for ultrastructural examinations, Mycobacterium leprae hardly differed from the surrounding tissues using the staining technique of Richardson . Also, the usual histological staining methods of Ziehl-Neelsen and Fite did not achieve positive results for the determination of M . leprae . Therefore, we applied the methylene blue-borax and basic fuchsin technique for the demonstration of the bacilli in plastic-embedded tissue of 11 patients suffering from Hansen's disease . In every patient the diagnosis was confirmed by histological examination of skin biopsies . Portions of the biopsies of nine patients were then fixed in glutaraldehyde and osmium tetroxide and embedded according to Spurr . In the other two cases, the material was first fixed in 10% Formalin and embedded in paraffin . After cutting 3-micron sections for routine histological examination, the remaining material was prepared adequately for ultrastructural examination . Using the methylene blue-borax and basic fuchsin technique, the semithin sections of plastic-embedded material presented a considerably more differentiated picture than other comparable methods . M . leprae located in foamy cells or in the tissue stained violet . These findings were corroborated in subsequent electron-microscopic examinations . The semithin sections thus prepared allow, through the clear demonstration of the microorganisms, a precise demarcation of the ultrathin area. Presse Med, 1987 Feb 21, 16(6), 295 - 8 {Post-neurosurgical purulent meningitis . 31 cases}; Chauveau D et al.; Thirty-one cases of post neurosurgical bacterial meningitis from one center were reviewed to determine their promoting factors and responsible organisms . Most cases occurred after a protracted operation (6 hours on average) . 26% cases were related to a primary cutaneous infection . 58% organisms were Gram negative bacilli . The course of meningitis was often complicated or prolonged due to a scalp decubitus ulcer or cerebrospinal fluid leakage . Vancomycin is often requested during staphylococcal meningitis . Third generation cephalosporins have low MIC against many Gram negative bacilli and should be used . Pefloxacin, a new quinolone, may be valuable . Treatment of scalp wound infection is often requested. J Mol Biol, 1987 Feb 20, 193(4), 803 - 13 Electrostatic effects on modification of charged groups in the active site cleft of subtilisin by protein engineering; Russell AJ et al.; The dielectric constant in the active site cleft of subtilisin from Bacillus amyloliquefaciens has been probed by mutating charged residues on the rim and measuring the effect on the pKa value of the active site histidine (His64) by kinetics . Mutation of a negatively charged surface residue, which is 12 to 13 A from His64, to an uncharged one Asp----Ser99) lowers the pKa of the histidine by up to 0.4 unit at low ionic strength (0.005 to 0.01 M) . This corresponds to an apparent dielectric constant of about 40 to 50 between Asp99 and His64 . The mutation is in an external loop that is known to tolerate a serine at position 99 from homologies with subtilisins from other bacilli . The environment between His64 and Asp99 is predominantly protein . Another charged residue that is at a similar distance from His64 (14 to 15 A) and is also in an external loop that is known to tolerate a serine residue is Glu156, at the opposite side of the active site . There is only water in a direct line between His64 and Glu156 . Mutation of Glu----Ser156 also lowers the pKa of His64 by up to 0.4 unit at low ionic strength . This change again corresponds to an apparent dielectric constant of about 40 to 50 . The pKa values were determined from the pH dependence of kcat/KM for the hydrolysis of peptide substrates, with a precision of typically +/- 0.02 unit . The following suggests that the changes in pKa are real and not artefacts of experimental conditions: Hill plots of the data for pKa determination have gradients (h) of -1.00(+/- 0.02), showing that there are negligible systematic deviations from theoretical ionization curves involving a monobasic acid: the pH dependence for the hydrolysis of two different substrates (succinyl-L-alanyl-L-alanyl-L-prolyl-L-phenylalanyl p-nitroanilide and benzoyl-L-valyl-L-glycyl-L-arginyl p-nitroanilide) gives identical results so that the pKa is independent of substrate; the pH dependence is unaffected by changing the concentration of enzyme, so that aggregation is not affecting the results; the shift in pKa is masked by high ionic strength, as expected qualitatively for ionic shielding of electrostatic interactions. Infect Immun, 1987 Feb, 55(2), 320 - 8 Selective pressures and lipopolysaccharide subunits as determinants of resistance of clinical isolates of gram-negative bacilli to human serum; Porat R et al.; Differences in molecular composition of lipopolysaccharides (LPS) between serum-sensitive (S) clinical isolates of Escherichia coli and serum-resistant (R) clones derived by serial passage in serum were demonstrated to determine sensitivity or resistance to killing by normal human serum (NHS) . LPS from R clones had a greater proportion of higher-molecular-weight, more highly O-antigen-substituted subunits than LPS from their serum S parents . Utilization of a liposomal model with inserted LPS simulating bacterial cell walls established LPS as the site of serum bactericidal action . Liposomes containing S LPS were lysed, while liposomes containing R LPS were unaffected by NHS . R and S LPS were fractionated into higher (F1)- and lower (F2)-molecular-weight fractions . Liposomes containing R LPS or the F1 fraction of S and R LPS were not lysed by serum . Liposomes containing the F2 fraction of S or R LPS were lysed by serum analogous to that observed with liposomes containing intact S LPS . These findings establish LPS to be one site of serum bactericidal activity and demonstrate that the higher-molecular-weight, highly O-antigen-substituted LPS subunits mediate resistance to killing by NHS. Crit Care Med, 1987 Feb, 15(2), 99 - 102 Preventing lower airway colonization and infection in mechanically ventilated patients; van Uffelen R et al.; We report the results of a prophylactic regime designed to prevent endogenous colonization and infection of the lower airways by Gram-negative bacilli . The 27 study patients spent an average of 30 days (range 11 to 84) in the respiratory ICU, during which time they were on mechanical ventilation . Within 3 days of application of 2% polymyxin E and tobramycin in an adhesive paste to the buccal mucosa, the oral cavity of each patient was free of Gram-negative bacilli, and subsequently, no patient developed tracheal aspirates containing Gram-negative bacilli, and no study patient developed nosocomial pneumonia. Am J Infect Control, 1987 Feb, 15(1), 7 - 15 Trends in infections and antibiotic usage in a community hospital; Larsen RA et al.; The results of a physician-performed prevalence survey of infections and antibiotic use at the Salt Lake City LDS Hospital in 1984 were compared with results of surveys done in 1971 and 1979 . The hospital census and length of stay declined in successive surveys, contributing to the changes observed . Community-acquired infections were more prevalent in 1984 than in the previous surveys, whereas hospital-acquired infections were seen with similar frequencies . Among hospital-acquired infections, lower respiratory tract and soft-tissue infections were more prevalent in 1984 . Gram-negative bacilli accounted for 34% of hospital-acquired infections in 1984 versus rates of 60% or more found in the 1970s . Although the overall prevalences of antibiotic use were similar in the three surveys, the proportion attributed to cephalosporins increased from 17.5% (1971) to 49.2% (1979) and 59.1% (1984) . Antibiotic prophylaxis was less frequent in 1984 (14.4%) than in 1979 (24.1%) and reversed the trend found after 1971 (11.0%) . Despite extensive educational efforts since the prevalence survey of 1979, perioperative antibiotics were used for durations longer than 48 hours after surgery in 43% of the patients receiving such prophylaxis in 1984 . The LDS Hospital has adopted a restrictive antibiotic formulary in part as a result of the present survey. Am J Clin Pathol, 1987 Feb, 87(2), 272 - 5 Comparison of an agar slide blood culture device with Bactec 6B for the detection of bacteremia; Berger SA et al.; Each of 1,018 blood culture specimens was inoculated into Bactec 6B (Johnston Laboratories, Towson, MD) and a biphasic blood culture system that incorporates internal removable agar dip slides (Hylab) . Ninety clinically significant pathogens were recovered: 66 from both systems, 14 from Bactec only, and 10 from Hylab only . The mean incubation times to positive of the two systems did not differ when data were examined for gram-negative bacilli, gram-positive cocci, total isolates, and contaminants (P greater than 0.05) . Contamination rates were also comparable: Bactec 5.4%, Hylab 7.3% (P greater than 0.05) . The Hylab system may offer a practical alternative to Bactec 6B. Geriatrics, 1987 Feb, 42(2), 61 - 4, 67, 70 Newer antibiotics: their place in geriatric care . Part II; Gleckman RA et al.; The pharmaceutical industry has addressed the problem of combating infections caused by gram-negative aerobic bacilli with the development of newer penicillins and a novel class of antibiotics known as the carbapenems . These compounds represent the culmination of years of research designed to overcome bacterial resistance mediated by inactivating enzymes, called beta-lactamases . These latter enzymes, contained within the gram-negative aerobic bacilli, have the capacity to hydrolyze select penicillins to inactive derivatives . We outline the therapeutic indications and limitations of these newer antibiotics. Hinyokika Kiyo, 1987 Feb, 33(2), 289 - 93 {Study of levels of latamoxef in prostatic tissue and bladder mucosal tissue}; Nakata Y et al.; The concentration of Latamoxef (LMOX) in the serum, prostatic tissue and bladder mucosal tissue of 20 patients with benign prostatic hypertrophy and bladder cancer was measured after intravenous infusion of 1 g or 2 g of LMOX . Serum, prostatic tissue and bladder mucosal tissue levels of LMOX responded satisfactorily to the dose of LMOX . The bladder mucosal tissue level was higher than the prostatic tissue levels . Judging from the inhibitory concentration of LMOX (MIC 80), the concentration was sufficiently effective against infections caused by gram-negative, gram-positive and anaerobic bacilli. J Immunol, 1987 Feb 1, 138(3), 927 - 31 Human T cell clones recognize two abundant Mycobacterium tuberculosis protein antigens expressed in Escherichia coli; Oftung F et al.; Human T cells reactive to Mycobacterium tuberculosis were cloned from peripheral blood mononuclear cells (PBMC) of four tuberculosis patients by using whole irradiated bacilli as the in vitro stimulatory agent . Twenty-two T cell clones (CD4+) were tested for their reactivity to 12 different mycobacterial species and showed a distribution from limited to broad cross-reactivity . These T cell clones were also tested for their reactivity to three abundant M . tuberculosis proteins of 65, 19, and 14 kD, each expressed from recombinant DNA in Escherichia coli . The three proteins were expressed from DNA clones that were previously isolated from a lambda gt11 genomic DNA library of M . tuberculosis by using monoclonal antibodies directed against this pathogen . A T cell clone from one patient was stimulated by an E . coli lysate containing the 65 kD antigen, and a T cell clone from a second patient was stimulated by an E . coli lysate containing the 19 kD antigen in an in vitro proliferation assay . Both T cell clones showed very limited cross-reactivity when tested against other mycobacteria . We conclude that some patients with tuberculosis exhibit a T cell response to the 65 and 19 kD M . tuberculosis proteins defined by these isolated genes. J Immunol, 1987 Jan 15, 138(2), 570 - 4 T cell defect in lepromatous leprosy is reversible in vitro in the absence of exogenous growth factors; Mohagheghpour N et al.; T lymphocytes from patients with lepromatous leprosy (LL) characteristically fail to respond to Mycobacterium leprae . This specific immunologic defect is thought to contribute to the aggressive clinical course that typifies patients with LL . We report that although fresh CD4+ (helper) T cells from most LL patients are specifically unresponsive to M . leprae, after culture in medium alone for 48 hr the same cells respond to M . leprae antigens . The recovery of T cell function is specific for M . leprae, occurs at the level of responder CD4+ T cells, and is not affected by monocytes or CD8+ (suppressor) T cells . Recovery of T cell reactivity is blocked by the presence of M . leprae bacilli in the preculture medium . These findings indicate that despite the apparent specific anergy seen in patients with LL, the T cells of most LL patients can respond to M . leprae . Their failure to do so, in vivo, may be due to the persistence of antigen, which renders antigen-reactive T cells nonresponsive either directly or via activation of CD4+ suppressor cells. Am J Hosp Pharm, 1987 Jan, 44(1), 95 - 101 Institution-specific versus published in vitro antimicrobial susceptibility data in making formulary decisions; Franson TR et al.; The results of susceptibility testing of 549 isolates of gram-negative organisms to 17 antimicrobial agents were compared with published reports of the sensitivity of those organisms to those agents . All gram-negative bacilli isolated from cultures obtained from hospitalized patients during a three-month period were preserved for antimicrobial sensitivity testing . Standard Kirby-Bauer disk diffusion susceptibility tests were performed using 17 broad-spectrum antimicrobial agents that either were included in the hospital formulary or were being considered for inclusion . Organisms were recorded as being sensitive or resistant to each drug, and the results were compared with the published results of in vitro sensitivity studies . When the results of actual antimicrobial sensitivity testing varied from published results, the discordant results were assigned a ranking of 1 to 4 based on the percentage difference . In 34 of 77 drug-organism pairs tested, the results of susceptibility testing differed by more than 10% cumulative susceptibility from published values; 26 of these represented instances in which the results of actual testing were at least 10% less than published values . For seven of the antimicrobial agents that were being considered for inclusion in the hospital formulary, results indicating unexpectedly suboptimal activity against institutional pathogens were a determinant in eliminating the agents from further consideration . In vitro testing of antimicrobial susceptibility of local pathogens can be a better method of predicting the susceptibility of such pathogens to new antimicrobial agents than relying on published susceptibility data . Pharmacy and therapeutics committees should consider testing prevalent institutional pathogens for susceptibility to all antimicrobial agents that are proposed additions to the formulary. Am J Public Health, 1987 Jan, 77(1), 29 - 32 Tuberculosis risk among migrant farm workers on the Delmarva peninsula; Jacobson ML et al.; A survey was conducted to ascertain the risk of tuberculosis (TB) among migrant farm workers on the Delmarva peninsula . Relevant histories were obtained from 842 migrants; a total of 709 skin tests were completed, and 239 sputum specimens were examined for acid-fast bacilli (AFB) and culture . No cases of infectious tuberculosis were ascertained by history or AFB examination . One sputum culture was positive for M . tuberculosis and 13 were positive for various species of nontuberculous mycobacteria . Thirty-seven per cent of migrants tested had significant skin test reactions of 10 mm or more . Reaction rates for men were 41 per cent and for women 25 per cent . Age specific rates ranged from 14 per cent in children aged 5-14 to 54 per cent for ages 45-54 . Rates for the principal national/ethnic groups were Haitians 55 per cent, Mexicans 36 per cent, US Blacks 29 per cent and US-born Latinos 20 per cent . Based on these results and other information currently available, it is recommended that current Centers for Disease Control (CDC) recommendations for TB prophylaxis continue to be applied for migrant workers, but that mass screening by skin testing in camp populations not be emphasized . Other recommendations focus on: case finding of active disease, improving continuity and follow-up, increasing coordination among involved agencies, and actively supporting improved economic and living conditions for migrant farm workers. Acta Neurochir (Wien), 1987, 88(3-4), 109 - 15 Intracranial tuberculomas: diagnosis and management; Naim-Ur-Rahman; Experience with fifteen consecutive cases of intracranial tuberculomas, treated between 1981 and 1986, is summarized . Histological confirmation was obtained in twelve patients, and acid fast bacilli (AFB) were found in and cultured from the excised lesions and biopsy specimens in nine patients . Difficulties in diagnosis are discussed . A plan of management combining the operative treatment and medical therapy of the tuberculomas is outlined . The value of computerized tomography in the diagnosis and management of these patients is emphasized. Cornea, 1987, 6(3), 175 - 80 Mycobacterium avium-intracellulare corneal ulcer; Knapp A et al.; A healthy 28-year-old man developed a slowly progressive corneal ulcer 21 months after an episode of corneal trauma . Acid-fast bacilli were identified in corneal scrapings, and the causative organism was identified as Mycobacterium avium-intracellulare . Medical treatment with topical amikacin and oral rifampin was ineffective, and a therapeutic penetrating keratoplasty was necessary to cure the infection . To the best of our knowledge, this is only the second reported case of a corneal infection caused by a slow-growing nontuberculous mycobacterium (Runyon groups I, II, and III) and the first caused by M . avium-intracellulare . Slowly growing nontuberculous mycobacteria should be considered among those organisms that cause corneal infection, especially in cases characterized by a protracted course and lack of response to conventional antimicrobial therapy. Rev Mal Respir, 1987, 4(3), 133 - 5 {Pulmonary infection caused by a rare mycobacterium, Mycobacterium malmoënse}; Denis C et al.; The present case report is on a patient treated for tubercle in 1949 by an artificial pneumothorax . Thirty three years after the initial illness some radiological changes occurred suggesting a recurrence, especially as a bacteriological examination showed the presence of acid-alcohol fast bacilli on direct smear . Triple therapy (Isoniazid, Rifampicin, Streptomycin) was then prescribed, and was followed by a radiological improvement, even though the sputum remained positive . After multiple seedings, it was possible to isolate from 11 tubes and 2 expectorations a rare strain of mycobacterium: mycobacterium malmoense . The present observation seems to be the first indisputable French case of infection by this bacterium . From the opportunity presented by this observation the bacteriological characteristic of this mycobacterium, as well as the clinic aspects of the infection are discussed. Rev Mal Respir, 1987, 4(2), 69 - 74 {BCG vaccination in France}; Grosset J et al.; First used in 1921 and obligatory since 1950, BCG vaccination is a part of the classical arsenal in the struggle against tuberculosis in France . The progressive reduction in the incidence of tuberculosis leads one to wonder what to expect now and in the future, so much so that the degree of protection conferred by BCG is continually discussed . In animal experiments, BCG vaccination is efficacious but there is no absolute protection conferred . In man, the results of 9 prospective studies performed with control groups have thrice shown an 80% protection, thrice a 30% protection and thrice no protection (in the case of studies from Southern India) . On the grounds that there were large differences in the methodology of the 9 studies and that the best methodology was found in the 3 studies which showed good protective efficacy of BCG, it is justifiable to consider that the protection conferred against tuberculosis by a correct BCG vaccination is of the order of 80% and lasts 15 years (direct effect of BCG) . Equally, a similar protection has been observed in numerous retrospective studies . But it is not accompanied by a reduction in the transmission of tuberculous bacilli in the population vaccinated with BCG . Since one does not observe any reduction in the incidence of tuberculosis in non-vaccinated subjects who live in contact with the vaccinated population (indirect effect of BCG).(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Infect Dis, 1987, 19(1), 77 - 83 Childhood lymphadenitis in a harsh northern climate due to atypical mycobacteria; Gill MJ et al.; Between 1979 and 1983, 16 patients under 15 years of age living within 480 km of Edmonton, Alberta (latitude 53 degrees 34' N) were seen with cervical lymphadenitis caused by atypical mycobacteria . During this period only 4 cases of cervical lymphadenitis from Mycobacterium tuberculosis occurred in the same age and geographical grouping . Young children age 1-4 years accounted for most cases (14/16) . The onset showed no seasonal preponderance and the nodal enlargement was either asymptomatic (8/16) or associated with only minor systemic symptoms . M . avium intracellulare scrofulaceum (6 cases) or M . avium intracellulare (4 cases) were identified on cultures from the infected node . In the remaining cases characteristic histopathology and acid fast bacilli were seen on biopsy specimens but no organisms could be cultured . Surgery was employed in all cases either for diagnosis or for therapy . This series demonstrates that atypical mycobacteria may cause childhood lymphadenitis throughout the year in a harsh inland Northern climate . The etiological pathogen can be difficult to culture but complete surgical excision of the infected node is usually curative. Ann Intern Med, 1987 Jan, 106(1), 7 - 11 Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin; Dekker AW et al.; Fifty-six patients receiving remission induction treatment for acute leukemia were studied in a randomized trial comparing ciprofloxacin with trimethoprim-sulfamethoxazole plus colistin for prevention of infections . Both groups received amphotericin B for antifungal prophylaxis . Six major infections occurred in 28 patients receiving ciprofloxacin, and 11 major infections occurred in 28 patients receiving trimethoprim-sulfamethoxazole plus colistin . No infections caused by gram-negative bacilli were seen in the ciprofloxacin group (p less than 0.02) . Ciprofloxacin prevented colonization with resistant gram-negative bacilli, but 12 resistant colonizing strains were isolated from 10 patients receiving trimethoprim-sulfamethoxazole plus colistin (p less than 0.01) . Ciprofloxacin was better tolerated: 23 of 28 patients were highly compliant to the drug, compared with 15 of 28 patients in the trimethoprim-sulfamethoxazole group (p less than 0.05) . These results suggest that ciprofloxacin is a promising drug for the prevention of infection in patients with granulocytopenia. Neurochirurgie, 1987, 33(6), 482 - 6 {Suboccipital Pott's disease}; Stecken J et al.; A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis . The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass . CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels . Chest-X ray showed one tuberculous lesion at the right apex . The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive . An antituberculous trichemotherapy was started . After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar . Each one for a 5 month period . One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography . A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%) . The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates . The removal of abscess is discussed. Rev Pneumol Clin, 1987, 43(6), 327 - 33 {Pulmonary tuberculosis and cutaneous anergy to tuberculin}; Vandevenne A et al.; A negative tuberculin test in a bacilliferous subject is an apparently paradoxical situation, since the first penetration of tubercle bacilli into the human body is known to induce hypersensitivity to tuberculin and to enhance cellular immunity . These two facets of cutaneous reaction are most probably related to lymphocyte populations of two different phenotypes . The authors found that 21% of skin tests were negative in patients carrying tubercle bacilli, with a higher frequency in elderly people and in subjects with low serum albumin levels and/or biochemical hepatic alterations . Helped by the literature, they are wondering about the significance and possible mechanisms of this situation. Drugs Exp Clin Res, 1987, 13(9), 589 - 93 New trends in paediatric antibiotic therapy; Principi N; Recently many new antibiotics have been marketed for use in paediatrics . Most of them offer no real advantage in comparison to older drugs and their prescription is questionable, particularly because they are highly expensive . Only a few have a number of special characteristics which permit in certain patients a significant improvement of antibiotic therapy . Among these there are some third-generation cephalosporins such as ceftazidime and cefsulodin, aztreonam and the new macrolides . Ceftazidime and cefsulodin are highly active, particularly against Pseudomonas spp., thus offering new therapeutic possibilities in life-threatening infections due to these bacteria . Aztreonam is the first monobactam and has a spectrum of activity limited to the aerobic Gram-negative bacilli . Its indications are therefore very similar to those of the aminoglycosides but its use seems to be safer because it has none of the important side-effects of those drugs . Alone or in combination, it may become the drug of choice to treat children with infection due to Gram-negative bacteria . New macrolides are active against erythromycin-resistant bacteria, have a lower risk of gastrointestinal side-effects and have no interference with concomitant administered drugs such as theophylline . Therefore they may be used with higher compliance and better efficacy, especially in the areas where erythromycin-resistant Gram-positive strains are increasingly evident. Acta Neurochir (Wien), 1987, 88(1-2), 26 - 33 Atypical forms of spinal tuberculosis; Naim-Ur-Rahman et al.; Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described . All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control . None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies . These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the involvement of a single vertebral body; and, those without bony involvement . The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach . Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach . Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases. Cancer Detect Prev Suppl, 1987, 1, 165 - 72 Difficulty in establishing diagnosis from lung biopsies and bronchial washing analysis in children with leukemia following bone marrow transplantation; Miale T et al.; Three children developed severe respiratory distress at days +12, +11, and +11 following allogeneic bone marrow transplantation from donors . The first child was a 13-year-old Hispanic boy transplanted in relapse of Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) . At day -14, a bronchial washing done for a streaky pulmonary infiltrate was negative for acid-fast bacilli . Miliary tuberculosis was discovered at postmortem examination . A second child, transplanted in remission of null-cell ALL, developed severe hypoxia and hypercarbia on day +11 but recovered fully following prolonged mechanical ventilation . An open-lung biopsy showed a pattern of nonspecific, diffuse alveolar damage compatible with respiratory distress syndrome . The third child was transplanted in remission of B-cell ALL and developed fatal fungal and cytomegalovirus pneumonia on day +12 . In these latter two cases, it is likely that open-lung biopsy would have missed the diagnosis because of the uneven pulmonary involvement and multiple etiologies observed . All three children received cyclosporine, granulocyte transfusions, and multiple antimicrobials, including amphotericin B . Hyperfractioned total-body irradiation with lung shielding was used in the latter two patients. ORL J Otorhinolaryngol Relat Spec, 1987, 49(4), 214 - 7 Experimental inoculation of Klebsiella rhinoscleromatis bacilli in albino mice; Toppozada H et al.; 72 albino mice were intranasally inoculated with Klebsiella rhinoscleromatis suspension with or without the addition of hog mucin . Scleroma-like lesions developed in their lungs more frequently with hog mucin . A liver affection was detected only in 1 animal . K . rhinoscleromatis organisms were recovered from the lung lesions . A possible potentiating effect of hog mucin is discussed. Trans R Soc Trop Med Hyg, 1987, 81(2), 179 - 82 Infection and disease due to the environmental mycobacteria; Grange JM; Saprophytic mycobacteria are widely distributed in the environment and contact between them and man is unavoidable . Immunologically effective contact is responsible for cross-reactivity to tuberculin and there is increasing evidence that it also profoundly affects the nature of subsequent responses to BCG vaccination and to infection by the tubercle and leprosy bacilli . Some environmental mycobacteria occasionally cause overt disease . Two species, Mycobacterium ulcerans and M . marinum, cause characteristic named diseases: Buruli ulcer and swimming pool granuloma respectively . Other species cause pulmonary and non-pulmonary lesions that resemble those of tuberculosis . Disease often, but not always, occurs in individuals with predisposing factors such as damaged lungs or immunosuppressive disorders including AIDS . Diagnosis rests on the isolation and identification of the causative species and treatment is based on antituberculous therapy for extended periods or combinations of various other drugs . In contrast to tuberculosis, the incidence of these diseases appears to be on the increase in the Western world and they merit serious consideration. Microbios, 1987, 49(200-201), 183 - 8 Beta-lactamase synthesis in Mycobacterium leprae; Prabhakaran K et al.; Beta-lactam antibiotics are not active against Mycobacterium leprae . The enzyme beta-lactamase mediates the most common form of bacterial resistance to penicillins and cephalosporins . Cell-free extracts of purified suspensions of M . leprae were examined for beta-lactamase . The bacteria were prepared from the tissues of experimentally-infected nine-banded armadillos . Most of the suspensions were inactive . However, the bacteria obtained from the tissues of armadillos treated with penicillin G benzathine (bicillin) 6 months or more prior to sacrifice had beta-lactamase . If the organisms had been exposed to the antibiotic only for a few days, they were negative . Attempts to induce beta-lactamase in the bacteria in vitro did not succeed . Interestingly M . leprae separated from untreated armadillos, infected with the bacilli derived from treated animals contained the enzyme activity . Apparently, the M . leprae genome contains the operon for beta-lactamase, and once it is stimulated to express the enzyme, it continues to do so, even after the inducer is withdrawn. Ter Arkh, 1987, 59(3), 97 - 9 {Detection of pulmonary tuberculosis in adolescents in institutions of the general medical network and efficacy of its treatment}; Firsova VA et al.; Altogether 100 adolescents with TB detected on referral to general medical institutions were followed up . 30 patients with a clear-cut TB clinicoroentgenological pictures were referred to special hospitals . The rest 70 adolescents were followed up in general outpatients departments . The chief method of prehospital diagnosis verification was inefficacy of previous antiinflammatory therapy . 51 patients were not examined for tuberculosis (tuberculin test, chest x-ray, sputum investigation for tubercle bacilli, phthisiologist's consultation, etc.) . Clinical evaluation showed that 47% had had previous contacts with tuberculosis patients, 33% demonstrated hyperergic sensitivity to tuberculin, in 21% the disease coincided with intensification of tuberculin reactions, 55% isolated tubercle bacilli . Initiated antituberculosis therapy alleviated the disease course in most of the patients . However, late diagnosis resulted in the formation of noticeable residual changes in a considerable proportion of patients . The results obtained indicate the necessity of close contacts between antituberculosis service and general health service to improve the effectiveness of adolescents therapy. Exp Clin Immunogenet, 1987, 4(1), 17 - 26 Genetically controlled phagocytic activity of macrophages and MHC-restricted T-cell proliferative response correlate with the resistance against MLM infection in mice; Saito N et al.; The immune responsiveness to MLM bacilli is investigated using secondary T-cell proliferative response to sol . MLM in B10 mice with macrophages from various B10 congenic strains of mice . The results show that T cells of B10 mice are able to respond with macrophages from B10 or B10A(5R) mice, but not with those from B10A, B10A(4R), and B10BR mice . In addition, the proliferative response to sol . MLM of B10 spleen cells was suppressed by adding an anti-I-Ab monoclonal antibody into the culture . Thus, the results indicate that the immune response to sol . MLM is restricted by I-Ab gene products . In terms of the weight of lepromas, and of the number of MLM bacilli in the spleen and liver, B10A, B10A(4R), and B10BR mice appeared to be susceptible to MLM bacilli (low responders) . The macrophages obtained from the low-responder mice had a significantly lower phagocytic activity than those from high-responder mice (r = 0.967) . The high-responder mice were inversely associated with the weight of lepromas (r = 0.731) . These results suggest that the high phagocytic activity of B10 or B10A(5R) macrophages triggers an effective antigen presentation to helper T cells being restricted by I-Ab molecules, which could account for the immune resistance to MLM bacilli in B10 or B10A(5R) mice. Clin Exp Immunol, 1987 Jan, 67(1), 51 - 4 A single cell assay for the study of gamma-interferon formation in leprosy patients; Lindh J et al.; The number of gamma-interferon producing cells in the peripheral blood of leprosy (LL and BT) patients and controls was studied by the reversed protein A plaque assay before and after exposure in vitro to Mycobacterium leprae bacilli and Epstein-Barr virus (EBV) . The level of spontaneous gamma-interferon production was significantly higher in BT patients compared to LL patients and controls . Mycobacterium leprae induced a specific gamma-interferon response in lymphocytes from BT patients and from healthy contacts whereas in LL patients and non-exposed controls the response was low or non-existing . There were no significant differences in the gamma-interferon response to EBV between the above groups. Acta Neuropathol (Berl), 1987, 73(4), 387 - 92 Demonstration of Mycobacterium leprae antigen in nerves of tuberculoid leprosy; Barros U et al.; Twenty nerve biopsies of tuberculoid leprosy patients who showed no acid-fast bacilli in their skin smears or in tissue biopsies, were stained for mycobacterial antigens using anti-bacille Calmette-Guerin (BCG) by the peroxidase-antiperoxidase method . Adjacent parts of some of these nerves were examined for the presence of osmiophilic bacilli under the transmission electron microscope . Eight of the 20 nerves were both clinically and histologically uninvolved . All the 20 involved nerves showed presence of antigen located, mainly intracellularly, in the cytoplasm of epithelioid cells and to a lesser degree in Schwann, endothelial and plasma cells . A few nerves with caseated nerve abscesses showed clusters of antigen deposits in both the caseous mass as well as the wall of the abscess . In six of the nine nerves processed for electron microscopy, electron-dense bacilli were noted within the cytoplasm of Schwann cells but not within the infiltrating cells . The uninvolved nerves showed neither antigen deposits nor osmiophilic bacilli despite fine ultrastructural changes . Our observations indicate that (a) the specificity of the immune response in paucibacillary nerve lesions is probably against bacterial components . (b) There is a differing antigen handling by Schwann cell and the inflammatory epithelioid cell . (c) Plasma cells may play a role in presenting antigen . (d) Mycobacterium leprae may be acting as an adjuvant in causing damage to uninvolved nerves at distal sites. Acta Cytol, 1987 Jan-Feb, 31(1), 17 - 9 Acid-fast bacilli in aspiration smears from tuberculous lymph nodes . An analysis of 255 cases; Metre MS et al.; An analysis of fine needle aspiration (FNA) smears from 255 patients with tuberculous lymphadenopathy was done . The aspirates were either purulent, cheesy or mixed with blood . A total of 56.4% of all cases aspirated showed acid-fast bacilli . Of the cases in which purulent material was aspirated, 66% were positive for acid-fast bacilli . These findings stress the importance of doing Ziehl-Neelsen staining in smears of all cases suspected of being tuberculous in etiology, particularly when purulent material is aspirated. Presse Med, 1986 Dec 20, 15(46), 2336 - 8 {Indications for piperacillin in pediatrics}; May T et al.; The clinical activity of piperacillin was evaluated in 34 children (mean age: 8 years) presenting with severe infection (septicaemia, meningitis, bronchopneumonia, pyelonephritis) . A bacteriological diagnosis was established in 24 cases . The mean duration of treatment was 11 days, and the mean dose 220 mg/kg/day administered in three injections . In 25 cases piperacillin was combined with another antibiotic, usually an aminoglycoside (20 cases) . Clinical cure or improvement was obtained in 29 children (85%) . Treatment was well tolerated, with only 2 cases of moderate blood eosinophilia . In view of these results the authors suggest that piperacillin could be used in children in two circumstances: severe infections caused by Gram-negative cocci or bacilli in children with cystic fibrosis or neutropenia, and against infections contracted in intensive care units, or in children with febrile leucopenia, combined with an aminoglycoside in the absence of, or pending bacteriological results. N Engl J Med, 1986 Dec 18, 315(25), 1570 - 5 Exogenous reinfection with tuberculosis in a shelter for the homeless; Nardell E et al.; We investigated an outbreak of tuberculosis in a large shelter for the homeless to assess the role of exogenous reinfection as opposed to reactivation of endogenous infection as the cause of secondary tuberculosis in this population . Exogenous reinfection is considered relatively unimportant in the United States and other developed countries . Of 49 shelter-related cases, 22 had cultures resistant to both isoniazid and streptomycin and of the same phage type, indicating recent transmission originating with a single index patient . The probable index patient had a 10-year history of isoniazid and streptomycin resistance--an uncommon pattern at the shelter during the three years preceding the outbreak . In 4 of the 22 cases, the patient had previously had documented tuberculosis infection or disease . These reinfected patients had extensive lung cavitation and numerous acid-fast bacilli on sputum smears--features associated with contagiousness . In contrast, patients with tuberculosis for the first time (primary tuberculosis) are usually less contagious . We conclude that exogenous reinfection may have been an important factor leading to highly contagious secondary cases and an acceleration of the usual pattern of tuberculosis transmission in this highly susceptible population. Am J Ophthalmol, 1986 Dec 15, 102(6), 733 - 9 Chronic Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation; Meisler DM et al.; We studied six cases of chronic, indolent intraocular inflammation that occurred after extracapsular cataract extraction and posterior chamber intraocular lens implantation . The inflammation was characterized by a delayed onset, and in three cases had the clinical appearance of a granulomatous iridocyclitis . Cultures of intraocular specimens obtained from six eyes yielded Propionibacterium; five yielded P . acnes . Pleomorphic gram-positive bacilli consistent with Propionibacterium were identified in cytologic or histopathologic studies in four of the six culture-positive cases . After surgical and medical therapy, the inflammation resolved . Postoperative Propionibacterium endophthalmitis may masquerade as a chronic iridocyclitis. Trop Geogr Med, 1986 Dec, 38(4), 425 - 8 Intracranial tuberculoma: case report and review of the literature; Al-Nozha M et al.; A case of multiple intracranial tuberculomas with miliary lesions of the lungs is reported . Atypical clinical presentation; non-specific computed tomographic findings showed large intracranial masses producing a midline shift and progressive neurological deficit necessitating excision of the symptomatic mass . Acid fast bacilli were found in the excised lesion and cultured from biopsy specimens. Dig Dis Sci, 1986 Dec, 31(12), 1351 - 60 Experimental disease in infant goats induced by a Mycobacterium isolated from a patient with Crohn's disease . A preliminary report; Van Kruiningen HJ et al.; Pilot studies were done to assess the pathogenicity of a Mycobacterium which had been recovered from the diseased ileum of a patient with Crohn's disease . In four separate studies, pairs of infant goats served as subjects . One of each pair received an oral inoculum of freshly harvested Mycobacterium species strain Linda suspended in cream . A littermate or stablemate which received only cream served as control . Necropsies were done at three, five, six, and 10 months postinoculation . Each of the four inoculated animals developed segmental granulomatous disease of the ileum or ileum and more proximal segments of small intestine, and regional lymph nodes . The earliest lesion occurred in Peyer's patches of the ileum and consisted of granulomatous clusters of epithelioid cells and giant cells, without caseation, which often occurred in a mantle of lymphocytes between the germinal centers and the muscularis mucosae . Nine of 10 such granulomas were free of acid-fast bacilli . In more advanced lesions, there was confluence of granulomas and ulceration of the mucosal surface . Two of the four inoculated animals also had lymphocytic lymphangitis in affected segments . Although the Mycobacterium Linda was recovered from intestinal segments of all four animals, acid-fast bacteria were not demonstrable in the intestines in two of them . Control animals remained free of lesions and acid-fast bacilli and were negative by bacteriologic culture . The Mycobacterium species strain Linda represents an enteric pathogen capable of inducing granulomas of the distal small intestine of susceptible species . The lesions produced have distinct similarities to those occurring in Crohn's disease. Dis Colon Rectum, 1986 Dec, 29(12), 891 - 5 The value of colonoscopy in schistosomal, tuberculous, and amebic colitis . Two-year experience; Radhakrishnan S et al.; Forty-six patients were diagnosed as having schistosomal, tuberculous, or amebic colitis over a two-year period using colonoscopy and biopsy . Both schistosomal and tuberculous colitis could be diagnosed by characteristic endoscopic and histologic features in the majority of cases . Colonoscopy provided the added advantage of endoscopic polypectomy at the diagnostic session itself . The yield of granulomas in tuberculous lesions was 100 percent, although acid-fast bacilli could not be recovered from any . The endoscopic picture of amebic colitis often resembles that of inflammatory bowel disease; hence endoscopic biopsies are of paramount importance in establishing a correct diagnosis, especially in developing countries where both diseases exist with considerable frequency. Semin Respir Infect, 1986 Dec, 1(4), 220 - 9 Drug-resistant tuberculosis; Goble M; Management of drug-resistant tuberculosis (TB) is challenging . In areas with high prevalence of drug-resistant TB, we recommend starting all patients with active TB on the standard four or five drug regimens . For patients with acquired drug resistance due to prior inadequate therapy, we advocate thorough evaluation of history and drug susceptibility followed by individualized regimens of at least three drugs . Drugs are most effective if the patient has never received them before and if the patient's tubercle bacilli are susceptible to them in vitro . Retreatment regimens are of long duration and often there are adverse drug reactions . These factors must be put into perspective because options for alternate therapy may be limited . Compliance must be assured. Tubercle, 1986 Dec, 67(4), 295 - 302 Mycobacterium tuberculosis infection in the acquired immunodeficiency syndrome . A review of 14 patients; Duncanson FP et al.; The clinical findings in 13 drug abusers and one homosexual man with tuberculosis and the acquired immunodeficiency syndrome (AIDS) from New York City are described . Tuberculosis preceded the diagnosis of AIDS in nine of the 14 patients by a mean of 7 months and occurred within the same month in the remaining five . The presence of thrush, generalised lymphadenopathy, lymphopenia, cutaneous anergy and chest radiographs showing hilar adenopathy and/or lower lobe infiltrates was common among the patients in whom tuberculosis preceded AIDS . Eight of our patients had extra-pulmonary tuberculosis, six had disseminated tuberculosis and five had tuberculous lymphadenitis . Cultures of tissue biopsies may be positive for Mycobacterium tuberculosis despite the absence of acid fast bacilli or granulomas on microscopic examination . Tuberculosis generally responded to chemotherapy, but the majority of patients died from opportunist infections. Int J Lepr Other Mycobact Dis, 1986 Dec, 54(4), 584 - 95 Identification of cat leprosy bacillus grown in mice; Mori T et al.; Cat leprosy bacilli passaged in mice could be isolated on 1% Ogawa yolk medium . The isolated cat leprosy bacilli which were cultivated successively four times on 1% Ogawa yolk medium produced a leproma in mice . All characteristics of the isolated cat leprosy bacillus were the same as isolated murine leprosy bacillus, as follows: slow grower, light yellowish-white rough colony, production of much coproporphyrin on the medium, heat-resistant catalase negative, heat-resistant phosphatase negative, arylsulfatase negative, niacin negative, hydrolysis of Tween 80 negative, urease negative, nicotinamidase positive, pyrazinamidase positive, cytochrome b1 at 560 nm positive, cytochrome a2 at 630 nm positive, and cytochrome c at 550 nm negative . Cats are susceptible to both cat and murine leprosy bacilli; the bacilli produced a leproma in a newborn cat at 3 to 4 months and in an adult cat at 2 months after inoculation . Many globi of acid-fast bacilli (AFB) were observed in the histopathological sections and the smear preparations of the newborn cat's lepromas, especially in the necrotic areas of the lepromas . Many AFB and polymorphonuclear leukocytes were seen in the histopathological sections and the smear preparations of the adult cat's lepromas . These lepromas formed ulcers by autolysis and healed or absorbed without ulcer formation over the course of months . Large lepromas remained for a long time without ulcer formation and caseation in some cats . Secondary infections with cat and murine leprosy bacilli were done respectively to the right and left femoral subcutaneous regions of newborn cats carrying primary lepromas . After one month, granulomas in which many AFB were observed were produced in both infection sites . Cats are susceptible to infection with cat and murine leprosy bacilli; however, the bacilli did not invade progressively to internal organs or other subcutaneous areas . Cat leprosy bacilli which were passaged in the mouse are identical to murine leprosy bacilli. Int J Lepr Other Mycobact Dis, 1986 Dec, 54(4), 540 - 4 Selection of sites for slit skin smears in untreated and treated leprosy patients; Kumar B et al.; A total of 1000 slit-skin smears were taken from multiple sites (both ear lobules, right elbow, dorsal aspect of middle phalanx of the left finger, and dorsum of middle phalanx of the right foot) from 558 leprosy patients . There were 319 sets (1595 smears) from untreated patients and 681 sets (3405 smears) from the treated group . The duration of treatment varied from 6 months (multidrug therapy) to 7 years (dapsone monotherapy) . The ear lobules gave significantly higher values for the bacterial index (BI) compared to toes and fingers in the untreated group . The morphological index (MI) was also significantly higher from the ear lobules compared to toes, elbows, and fingers . In five patients from the untreated group, bacilli were found in some other sites when the earlobes did not reveal any . In the treated group, all sites yielded similar BI and MI values, the figures being lowest from elbows and toes but not different statistically . In 20 long-treated patients, bacilli were detected at sites other than the ear lobules . In 28 patients, sites other than the ear lobules gave a higher MI and in 20 patients, solid bacilli were seen at sites other than the ear lobules. J Antimicrob Chemother, 1986 Dec, 18 Suppl E, 9 - 13 Mechanisms by which imipenem may overcome resistance in gram-negative bacilli; Williams RJ et al.; Imipenem is one of the carbapenem class of new beta-lactam antibiotics . It is a potent antibacterial with a broad spectrum of activity . Against Gram-negative rods, it appears to be able to circumvent the classical resistance mechanisms by way of its high affinity for PBP 2 and its good penetration of the cell wall . Imipenem is stable to hydrolysis by the common plasmid-mediated beta-lactamases and is a potent inducer of, but stable to the action of, chromosomal beta-lactamases. Geriatrics, 1986 Dec, 41(12), 51 - 5 Newer antibiotics: their place in geriatric care . Part I; Gleckman RA et al.; The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli . Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy. Semin Respir Infect, 1986 Dec, 1(4), 262 - 4 Studies of antituberculosis chemotherapy with an in vitro model of human tuberculosis; Crowle AJ; Testing new drugs or drug combinations for activity against tuberculosis is highly problematic: Clinical therapy trials are expensive and time-consuming; animal trial results may not be applicable to humans; and simple in vitro testing on culture medium excludes a vital component of the natural infection, namely the macrophage . Described here is a technique to treat with chemotherapy human macrophages that have been infected ex vivo with tubercle bacilli . Briefly discussed are the results of treating such infected phagocytes with a variety of agents: Streptomycin, ethambutol, pyrazinamide, isoniazid, and ceforanide . Interesting parallels between the macrophage-model results and observed clinical phenomena are noted . This model appears to have considerable potential for evaluating drug activity against tubercle bacilli, nontuberculous mycobacteria, and, perhaps, other intracellular parasites. Tubercle, 1986 Dec, 67(4), 261 - 7 Virulence of tubercle bacilli isolated from patients with tuberculosis in Bangalore, India; Naganathan N et al.; This is a study of the virulence of cultures of Mycobacterium tuberculosis isolated from pulmonary and extrapulmonary forms of tuberculosis in patients living in or near Bangalore, India . The findings are as follows: 1 . The percentage of cultures recovered from cases of pulmonary tuberculosis in Bangalore classified as being of low, moderate, and high virulence, was the same as that reported by Mitchison et al., in 1960 for isolates obtained from patients in Madras, India . 2 . The distribution of the root index of virulence (RIV) of isolates from patients living in the city of Bangalore was significantly different (p less than 0.05) from that of isolates from patients living in rural Bangalore . 3 . Even though the number of cultures classified as high virulent was significantly greater in isolates from patients with tuberculosis meningitis compared with those from patients with pulmonary tuberculosis, the data show that 36% of the isolates from the meningitis group were classified as low virulent. Int J Lepr Other Mycobact Dis, 1986 Dec, 54(4), 545 - 55 Separate antigenic determinants on cell wall associated carbohydrate antigens of Mycobacterium leprae defined with monoclonal antibodies; Britton WJ et al.; Monoclonal antibodies (Mabs) raised against Mycobacterium leprae sonicate defined two different determinants on related, cell-wall-associated, carbohydrate antigens common to M . leprae, M . bovis (BCG), and M . tuberculosis . Antigen inhibition ELISA and antigen capture assays demonstrated that the two antigens were present in a cell-wall fraction, M . leprae resonicate . There was species variation in the distribution of the antigens; the 4.5-6 kD antigen was more abundant in M . tuberculosis and M . bovis, while the 30-40 kD antigen was more concentrated in M . leprae preparations . Although both were present in the cell wall, only determinants on the 30-40 kD antigen were accessible on intact bacilli . The results from capture assays and Mab affinity chromatography with both L9 and L4 indicated that the 4.5-6 kD antigen was probably a fragment of the larger molecule . Both antigens are significant immunogens in the human B-cell response to M . leprae. J Clin Microbiol, 1986 Dec, 24(6), 1102 - 3 Acid-fast bacilli in sputum: a case of Legionella micdadei pneumonia; Hilton E et al.; Legionella micdadei has been implicated as a cause of nosocomial pneumonia . There are no reports of L . micdadei pneumonia diagnosed by acid-fast stain of expectorated sputum . We report a case of L . micdadei pneumonia in which expectorated sputum harbored acid-fast bacteria that reacted specifically with fluorescent antiserum to L . micdadei, confirmed by culture . In a patient at risk for nosocomial infection, the differential diagnosis of a positive sputum stain for acid-fast bacilli should include L . micdadei in addition to mycobacteria . Therapy for L . micdadei infection should be considered pending confirmation of the diagnosis. J Am Vet Med Assoc, 1986 Nov 15, 189(10), 1336 - 7 Disseminated tuberculosis caused by Mycobacterium avium in a cat; Drolet R; A 5-year-old neutered male Siamese cat was examined by a veterinarian because of a recent decrease in appetite and a large lymph node in the left mandibular area . Clinical findings included fever, icterus, leukopenia, and progressive anemia . Despite various treatments, the cat died approximately 3 weeks after initial examination . The main necropsy findings included necrotizing and granulomatous lymphadenitis of the left mandibular lymph node, multifocal necrotizing hepatitis, and interstitial pneumonia . Acid-fast bacilli were detected in lesions of the mandibular lymph node, liver, lung, spleen, and bone marrow . Mycobacterium avium was isolated from the liver . Avian tuberculosis in cats has been reported rarely. Am J Clin Pathol, 1986 Nov, 86(5), 619 - 23 Evaluation of four anti-microbic susceptibility testing systems for gram-negative bacilli; Peterson EM et al.; A total of 200 clinical isolates were assayed by five anti-microbic susceptibility testing systems . Two frozen minimal inhibitory concentration (MIC) systems (MicroScan and Pasco), an automated MIC system (AMS, Vitek Systems), and the standard disk diffusion were compared with a reference broth dilution method . Organisms tested included 100 resistant clinical stock strains and 100 fresh random clinical isolates . Overall, there were 1,600 anti-microbic-organism combinations analyzed . The Pasco and MicroScan systems had no major discrepancies, the AMS system had seven, and the disk diffusion two . The number of very major discrepancies were as follows: AMS, 11; disk diffusion, 9; MicroScan, 5; Pasco, 2 . Of the total 36 major or very major discrepancies in the study, 33% (12 of 36) were with an aminoglycoside and 44% (16 of 36) occurred with a second-generation cephalosporin, of which 10 of 16 were with cefamandole . Overall, there was a greater than 98.8% essential agreement with all systems compared with the reference method. J Clin Microbiol, 1986 Nov, 24(5), 812 - 21 Comparison of 15 laboratory and patient-derived strains of Mycobacterium avium for ability to infect and multiply in cultured human macrophages; Crowle AJ et al.; Mycobacterium avium is a cause of nontuberculous chronic granulomatous infections which is attracting increased attention as a frequent opportunistic pathogen in acquired immunodeficiency syndrome . Some important aspects of its human pathogenicity were investigated by using cultured human macrophages infected with it . The uptake and replication of various strains of M . avium in the macrophages could be measured by CFU counts of the bacteria in samples of lysed, sonicated macrophages . Microscopic counts of acid-fast bacilli were not useful because the bacteria multiplying in the macrophages were usually not acid fast . Electron microscopy showed the intracellular bacilli to multiply by transverse fission, to be surrounded in individual vacuoles by a broad electronlucent zone, and to have thinner cell walls than extracellularly grown M . avium . Fifteen strains, including examples of serovars 1, 2, 4, 8, and 9, were studied for uptake and rate of replication in cultured macrophages from three normal subjects . The strains were isolates from patients with nontuberculous granulomatous infection, acquired immunodeficiency syndrome, or unrelated problems, or they were laboratory reference cultures . There were no differences among them in phagocytosis, but there were differences in intracellular replication . Laboratory strains tended to be avirulent, that is, they did not replicate in the macrophages . Patient isolates usually were virulent and could be compared for virulence by intracellular replication rates . Virulence correlated with flat, transparent bacterial colony morphology on nutrient agar but not with serovar or kind of patient from whom the bacteria were isolated . However, among strains of transparent colony morphology there were wide differences in virulence . A virulent bacilli generally produced domed, opalescent colonies on nutrient agar . A virulent bacilli predominated in populations of M . avium conditioned to growth in bacteriologic culture medium . Bacilli of virulent colony morphology predominated in populations passaged through cultured macrophages . The model described here presents a new approach to the investigation of the pathogenicity of M . avium for human subjects and may be more patient relevant than animal models. Ann Inst Pasteur Microbiol, 1986 Nov-Dec, 137B(3), 239 - 57 The electron-transparent zone in phagocytized Mycobacterium avium and other mycobacteria: formation, persistence and role in bacterial survival; Frehel C et al.; After phagocytosis by bone-marrow macrophages, Mycobacterium avium was surrounded by a thick electron-transparent zone (ETZ) . The use of various fixation and embedding procedures showed that ETZ did not seem to be an artifactual structure . A quantitative assessment of ETZ frequency was performed at different times after infection of macrophages with SmD and SmT colony variants of M . avium . For SmT-variant-infected macrophages, a higher percentage of ETZ+ bacilli paralleled a higher percentage of intact bacilli than was the case for SmD-infected macrophages . Macrophages were also infected with bacteria killed with UV or gamma rays, H2O2, heat or glutaraldehyde . About 50% of bacilli killed with any of these treatments were found ETZ+ instead of 80-85% with live bacteria . Unlike live bacilli, for which the percentage of ETZ frequency remained stable throughout incubation time, ETZ frequency for killed bacilli decreased with time . ETZ assessment performed on M . tuberculosis H37 Rv for comparison showed that, despite a very low ETZ frequency (8-15%), the percentage of intact bacteria was identical to that observed with M . avium . In contrast, three rapidly growing non-pathogenic species (M . smegmatis, M . phlei and M . fallax) presented a low ETZ frequency after phagocytosis and were rapidly degraded . The process of ETZ formation and its role in bacterial survival are discussed. J Gen Microbiol, 1986 Nov, 132 ( Pt 11), 3137 - 46 A numerical taxonomic study of anaerobic gram-negative bacilli classified as Bacteroides ureolyticus isolated from patients with non-gonococcal urethritis; Fontaine EA et al.; A numerical taxonomic study of 64 strains of anaerobic Gram-negative bacilli isolated from men with non-gonococcal urethritis, two unclassified laboratory strains of 'corroding bacilli', and 12 other strains of anaerobic Gram-negative bacilli, including nine received as anaerobic curved rods and three as 'Bacteroides corrodens' (B . ureolyticus), isolated from women with bacterial vaginosis, was undertaken . Seventeen reference anaerobic strains belonging to the genera Bacteroides, Fusobacterium, Mobiluncus, Mitsuokella and Wolinella were included . Morphological, biochemical and physiological characteristics were examined in 103 tests . The resemblance between the 95 strains was calculated using the SSM, SJ and DP coefficients for cluster analyses based on the UPGMA method . All three approaches gave similar groupings, and the estimated average probability of test error was 2.46% . The strains fell into 10 phenons . The unclassified strains from men and three from women with lower genital-tract infections, and the laboratory strains of 'corroding bacilli' clustered in one phenon with the reference strains of B . ureolyticus, indicating that they correspond to B . ureolyticus . The other unclassified strains of anaerobic curved rods clustered as a distinct phenon . They correspond to species of the newly described genus Mobiluncus . The taxonomic data and the compilation of diagnostic tables serve as a useful guide for the laboratory identification of clinical isolates regarded as B . ureolyticus. Rev Infect Dis, 1986 Nov-Dec, 8 Suppl 5, S487 - 95 An overview of the response of bacteria to beta-lactam antibiotics; Greenwood D; A great variety exists in the ways bacteria respond to beta-lactam antibiotics . The responses of gram-positive cocci and gram-negative bacilli are fundamentally different, and beta-lactam antibiotics vary widely in their ability to penetrate to the target proteins, to bind to those proteins, and to withstand hydrolysis by enzymes that the organism may possess . Continuous turbidimetric monitoring offers a simple means by which the response of bacterial cultures can be followed in undisturbed test conditions . Microscopy of the cultures permits the turbidimetric record to be related to morphologic changes elicited by the antibiotic . Such studies reveal that cephalosporins can often evoke a transient response in bacteria that are completely unaffected by penicillins; beta-lactamase inhibitors appear to be more effective when they build on such a partial response. Rev Infect Dis, 1986 Nov-Dec, 8 Suppl 5, S482 - 6 Role of beta-lactamases in the resistance of gram-negative bacilli to beta-lactam antibiotics; Acar JF et al.; Few studies in animal models or humans have been performed to prove that the mechanism of resistance to beta-lactam antibiotics in the presence of beta-lactamases is similar in vivo and in vitro . In vivo, it seems likely that different parameters will influence each other: the penetration of the antibiotic into the site of infection; the stability of the drug; and the organism responsible for the infection, which affects the type and amount of beta-lactamase released into the environment . In vitro, the different enzymatic parameters responsible for the inactivation of various compounds have been well defined . However, overall resistance to beta-lactams in the presence of beta-lactamase may also be influenced by the function of the outer membrane in gram-negative bacteria. Am Rev Respir Dis, 1986 Nov, 134(5), 1052 - 5 Inhibition by pyrazinamide of tubercle bacilli within cultured human macrophages; Crowle AJ et al.; Pyrazinamide (PZA) is a unique antituberculosis drug because it is effective in vivo but not in mediums commonly used to culture tubercle bacilli . Consequently, it was employed to test the validity of an in vitro macrophage model of human tuberculosis for value as a correlate of clinical events . The drug was as active in the macrophage model as it was clinically, inhibiting virulent tubercle bacilli at concentrations at 20 micrograms/ml or higher . By contrast, it was ineffective in 7H9 bacteriologic culture medium, even at concentrations as high as 2,560 micrograms/ml . It could be either bacteriostatic or bactericidal against intramacrophage tubercle bacilli, depending on its concentration, the donor of the macrophages, and the length of exposure of the infected macrophages to the drug . The data presented suggest that the clinical effectiveness of PZA is determined by a complicated self-modulating sequence of interactions between it, tubercle bacilli, and host macrophages . Specific evidence was found that tubercle bacilli may replicate within human macrophages in non-acid-fast form, thus indicating that colony-forming unit counts are inherently more accurate than acid-fast bacilli counts in these experiments, and also suggesting that important changes in bacillary cell wall composition may occur among tubercle bacilli within infected human macrophages. Immunology, 1986 Nov, 59(3), 333 - 8 Activation of macrophages to inhibit proliferation of Mycobacterium tuberculosis: comparison of the effects of recombinant gamma-interferon on human monocytes and murine peritoneal macrophages; Rook GA et al.; When cultured in 20% heat-inactivated human serum, human monocytes from seven donors were not on average significantly different from non-activated murine peritoneal cells (cultured simultaneously and in an identical manner) in their ability to inhibit BCG and, when calculated relative to growth of bacilli in the same medium without macrophages, to enhance the growth of Mycobacterium tuberculosis . Recombinant gamma-interferon caused marked inhibition of virulent M . tuberculosis by murine (BALB/c) peritoneal macrophages . This effect was seen, whether the cells were cultured in 10% fetal calf serum or in 20% heat-inactivated normal human serum, with or without the addition of iron supplements . However, unlike murine cells, the addition of crude lymphokine or recombinant gamma-interferon to human monocytes caused only weak inhibition of M . tuberculosis, and in some instances, gamma-interferon caused enhancement of growth of the bacilli . Monocytes were only slightly more effective if precultured for 4-8 days before the addition of the activating stimulus . This relative failure to develop anti-mycobacterial mechanisms occurred in spite of the activation of the cells as shown by a massive increase in reduction of nitro-blue tetrazolium inducible by phorbol myristate acetate. Can J Surg, 1986 Nov, 29(6), 451 - 2 Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature; Gallinger S et al.; Local hepatic tuberculosis is an unusual form of extrapulmonary tuberculosis . The authors describe the case of a 39-year-old woman with this disease who posed diagnostic difficulties . She presented with abdominal pain, minimal constitutional symptoms, hepatomegaly and radiologic findings of a focal hepatic lesion . Laparotomy was required for diagnosis . A literature review revealed that most individuals with local hepatic tuberculosis have fever, night sweats and weight loss . Hepatomegaly is often the only abnormal physical sign . Minimally elevated serum bilirubin and alkaline phosphatase levels are common . Ultrasonography and computerized tomography will demonstrate a lobulated, hypoechoic liver mass . Definitive diagnosis requires demonstration of acid-fast bacilli in biopsy material obtained by percutaneous techniques or at laparotomy . Cultures of the diseased liver are usually negative . Antituberculous drug therapy appears to be the preferred method of treatment. J Hosp Infect, 1986 Nov, 8(3), 248 - 56 Toewebs as a source of gram-negative bacilli; Noble WC et al.; The prevalence of Gram-negative bacilli on the toewebs was 8% in normal students, 24% in hospital outpatients with suspected Tinea pedis, 41% in industrial workers wearing protective clothing and 58% in coal miners . Prevalence was greatest in those exposed to wet working conditions . In miners, the presence of Gram-negative bacilli was related to symptoms of itching/soreness and cracking/fissuring, and was negatively related to malodour, but this latter trend was reversed in outpatients and in industrial workers . The feet are a source of many 'enteric' and 'environmental' bacilli and could contribute to infection elsewhere than in the toewebs themselves. Cell Immunol, 1986 Oct 15, 102(2), 273 - 86 Bacillary growth, interleukin 2 production defect, and specific antibody secretion governed by different genetical factors in mice infected subcutaneously with Mycobacterium lepraemurium; Hoffenbach A et al.; Different mouse strains were infected subcutaneously in the footpad with 10(7) Mycobacterium lepraemurium (MLM) . At various stages of the infection, the number of acid-fast bacilli (AFB) in different organs, spleen cell interleukin 2 production, and specific IgM and IgG serum antibodies to MLM sonicate were assessed . Strains were separable into two distinct groups depending on the number of AFB recovered from the different organs, without any obvious influence of the Bcg gene . Thus C57BL/6, DBA/2, (C57BL/6 X DBA/2)F1 and C3H/Pas mice belonged to the high resistance group and DBA/1, BALB/c, and CBA strains to the low resistance group . Interleukin 2 production was depressed only in C57BL/6 and C3H/Pas mice . Anti-MLM antibody response also markedly varied according to strains, in terms of antibody titers, Ig class distribution, and species specificity, but with a different genetic pattern from that observed for MLM growth control. Nature, 1986 Oct 30-Nov 5, 323(6091), 816 - 9 Antiviral effects of recombinant tumour necrosis factor in vitro; Mestan J et al.; Tumour necrosis factor (TNF) was first described as a factor in the serum of mice injected with tubercle bacilli (BCG) and several days later with lipopolysaccharide (LPS) . The gene encoding TNF has recently been cloned and pure recombinant human TNF is now available . TNF is known for its in vivo antitumour effect and in vitro cytotoxicity on certain transformed cell lines . Similarities in amino acid sequence and biological activity to lymphotoxin and cachectin have been reported, and very recently a growth-factor-like activity on diploid fibroblasts was observed . There is no similarity between these proteins and interferons (IFNs), which are also induced during in vivo induction of TNF . Here we describe the antiviral activity of pure recombinant human TNF in a typical in vitro antiviral assay which we discovered while investigating the possible role of TNF as an inducer of IFN. Jpn J Antibiot, 1986 Oct, 39(10), 2803 - 10 {A study of serum levels of cefoperazone sodium and its movement to myocardial tissue}; Abe T et al.; After introduction of anesthesia to 19 patients requiring cardiac surgery, cefoperazone sodium (CPZ) 1 g was administered intravenously and its movement to serum, pericardial fluid and tissue of the right auricle was studied . The serum CPZ level was 75.68 micrograms/ml and 59.77 micrograms/ml at 60 and 120 minutes after administration, respectively, and the biological half-life time was 2.54 hours . Lengths of time to achieve peak concentrations of CPZ in pericardial fluid and right auricle tissue after administration were both approximately 1 hour . The drug level in myocardial tissue was 14.52 micrograms/g after 240 minutes . Level of CPZ in myocardial tissue was maintained, even after 240 minutes, sufficiently higher than MIC80 of the drug against Gram-negative bacilli which may be responsible for many infections . No side effects were observed in any case examined. Arch Pathol Lab Med, 1986 Oct, 110(10), 965 - 6 Tuberculous esophagitis with erosion into aortic aneurysm; Chase RA et al.; An 87-year-old woman with a known atherosclerotic thoracic aneurysm died suddenly from a massive esophageal hemorrhage . Prior to death, tuberculous esophagitis was diagnosed by biopsy . At autopsy, a fistulous tract was found extending from the esophagus to the aortic aneurysm; this fistula proved to be the site of fatal hemorrhage . The tract was surrounded by a granulomatous inflammatory reaction, in which acid-fast bacilli were found . To our knowledge, this is the first reported case of tuberculous esophagitis extending to an aortic aneurysm resulting in hemorrhage and death. Chest, 1986 Oct, 90(4), 542 - 5 Tuberculosis in non-Haitian patients with acquired immunodeficiency syndrome; Louie E et al.; From Jan 1, 1981 to Oct 31, 1984, 24 of 280 (8.6 percent) patients with acquired immunodeficiency syndrome (AIDS) had tuberculosis . No patient with both AIDS and tuberculosis was Haitian . In 15 patients, tuberculosis was diagnosed prior to or concomitant with the diagnosis of AIDS . Twelve patients (50 percent) had Mycobacterium tuberculosis grown from at least one extrapulmonary site . Although the clinical presentation was variable, no patient had cavitary and only one had apical disease . Histologic examination of lung and transbronchial biopsy specimens usually did not reveal acid-fast bacilli or granulomas . Seventeen patients were treated and all showed clinical improvement . Tuberculosis was infrequent but not rare in our patients and often preceded the diagnosis of AIDS . Despite the fact that many of these patients had both severe and extrapulmonary disease, they appeared to respond well to treatment. Indian J Lepr, 1986 Oct-Dec, 58(4), 567 - 75 Histo-functional status of kidney in leprosy; Nigam P et al.; A study of 64 cases of leprosy (44 lepromatous and 20 nonlepromatous) revealed that the duration of the disease has a significant relationship with renal involvement (chi 2 = 16.9, P less than 0.001) . Proteineuria, microscopic haematuria, granular and hyaline casts are mainly seen in lepromatous cases and specially with lepra reaction (100%) while few of the non-lepromatous (2%) cases may show these abnormalities . Impaired renal functions are mostly observed in lepromatous leprosy (62.9%) specially those with lepra reaction (100%) while 2% nonlepromatous cases have these impaired renal functions . Histo-pathological studies revealed non-specific changes in 44.4% of cases and those of chronic pyelonephritis in 15.5% of the cases . Renal amyloidosis is less common occurrence (4.4%) . The specific lesion, that is 'leproma kidney', is rare and seen in one patient only . Acid fast bacilli could not be seen in any of the kidney tissue . It is therefore, concluded that the renal involvement in the form of inflammatory lesions and non-specific changes in the glomeruli and tubules are very common in lepromatous leprosy specially during the reactive phase. Indian J Lepr, 1986 Oct-Dec, 58(4), 543 - 8 A comparative study of the efficacy of WHO and IAL multidrug therapy regimens for leprosy--an in-vivo and in-vitro study; Revankar CR et al.; In the absence of definite evidence on utility of intensive therapy with rifampicin in multibacillary leprosy cases, a laboratory based investigation was undertaken basically to compare the efficacy of WHO and IAL regimens . In each group 4 untreated BL-LL patients were included and their skin biopsies were subjected for viability test both in vitro and in vivo systems . A consistant fall in BI with good clinical improvement was observed in both the groups . However good viability was maintained till about third pulse dose in WHO group whereas under IAL group rapid fall in viability was observed after intensive phase . Viable bacilli were seen even after 12,15,18 and 24 doses in both groups . These findings question the need for additional 21 doses of rifampicin in IAL schedule . However such studies are to be repeated on larger samples. Hum Pathol, 1986 Oct, 17(10), 1072 - 4 Mycobacterial coronary arteritis in a heart transplant recipient; Tuder RM et al.; A case of mycobacterial vasculitis in a chronically rejected transplanted heart is described . The coronary arteries were the only vessels involved by mycobacteria, although the patient had a generalized infection . The process of chronic rejection, with persistent injury to the intimal vascular lining of a transplanted organ, may lead to defects in the endothelial cell barrier and thus facilitate infiltration of a vessel wall by acid-fast bacilli. Acta Leprol, 1986 Oct-Dec, 4(4), 445 - 6 {Efficacy of combined treatments comprising 6 months' administration of rifampicin in multibacillary leprosy}; Pattyn SR et al.; Ten patients infected with mouse proven DDS-resistant bacilli were treated with the following combined regimen: RMP 600 2/7 6 months, ETH 500 7/7 6 months and DDS 100 7/7 12 months . Follow up was for 27-54 months, without relapses . Added to patients from previous study (Int . J . Lepr . 1984, 52, 297-303) the 95% confidence limit decreases from 12 to 9%. Histopathology, 1986 Oct, 10(10), 1015 - 21 Use of silver staining (dieterlé's stain) in the diagnosis of cat scratch disease; Korbi S et al.; Lymph node involvement in cat scratch disease is characterized by a granulomatous lymphadenitis with micro-abscesses . Recently, it has been shown that the possible aetiological agent is a micro-organism which stains with some silver stains . In this study 60 lymph nodes were studied from 60 patients, us