Bacillus

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, using a modified Dieterle's stain . In 40 cases (66%) rod-shaped bacilli with rounded extremities were observed . They were negative both with the Gram and Ziehl-Neelsen stains . Since such micro-organisms were demonstrated in the majority of the nodes examined, it can be concluded that silver stains are appropriate for the diagnosis of this condition.

J Biol Chem, 1986 Sep 15, 261(26), 12345 - 51
Structure and antigenicity of the phosphorylated lipopolysaccharide antigens from the leprosy and tubercle bacilli; Hunter SW et al.; A family of major arabinose- and mannose-containing phosphorylated lipopolysaccharides was isolated from Mycobacterium leprae and Mycobacterium tuberculosis . The only antigenic member of the family, lipoarabinomannan (LAM)-B, was purified by anion exchange and gel filtration chromatography in detergent and recovered in large quantities (15 mg/g of bacteria) . It yielded a broad diffuse band on polyacrylamide gel electrophoresis but appeared homogeneous by this criterion and gel filtration . Besides arabinose and mannose, it contained glycerol and a polyol phosphate and was acylated by lactate, succinate, palmitate, and 10-methyloctadecanoate . The phosphate was released by alkalinolysis and identified by thin layer chromatography and gas chromatography-mass spectrometry as myoinositol 1-phosphate . Thus, the group-specific "arabinomannan" of the genus Mycobacterium in the native state is acylated, contains the substituents of phosphatidylinositol, and is apparently membrane associated . LAM-B is one of the dominant immunogens of the leprosy bacillus reacting readily with antibodies from lepromatous leprosy patients and monoclonal antibodies in plate and nitrocellulose enzyme-linked immunosorbent assay and on electrophoretic immunoblots . It is immunologically cross-reactive with a like product from M . tuberculosis . LAM-B is clearly the pervasive "glycoprotein" antigen of the leprosy bacillus and may be the long sought lipoteichoic acid-like polymer of Mycobacterium with a role in cell wall physiology, macrophage recognition, and perhaps an involvement in cross-protective immunity.

Diagn Microbiol Infect Dis, 1986 Sep, 5(3), 269 - 72
In vitro activities of 17 antimicrobial agents against the formate/fumarate-requiring, anaerobic gram-negative bacilli; Johnson CC et al.; The in vitro activities of 17 antimicrobial agents were evaluated against 46 clinical isolates of formate/fumarate-requiring anaerobic gram-negative bacilli . Strains of Bacteroides ureolyticus (23) were almost uniformly susceptible to the tested antimicrobials, whereas strains of Bacteroides gracilis (18) showed some striking resistance with penicillin active against only 67%, the cephalosporins active against 67%-89%, and clindamycin active against 67% . Although few strains of Wolinella species/C . concisus (5) were available for testing, these isolates tended to be more resistant than B . ureolyticus but less resistant than B . gracilis.

Am Surg, 1986 Sep, 52(9), 467 - 71
A randomized controlled trial of moxalactam versus clindamycin/tobramycin in the treatment of mixed anaerobic/aerobic infections; Joshi M et al.; Many infections are due to mixtures of facultative gram-negative bacilli and anaerobic bacteria . Moxalactam, a semisynthetic beta lactam antibiotic, is active against a wide range of anaerobic organisms, including most strains of Bacteroides fragilis, as well as many aerobic gram-negative bacilli . We performed a prospective, randomized controlled trial comparing moxalactam alone with the regimen of clindamycin and tobramycin for treatment of mixed aerobic/anaerobic infections . One hundred and six patients with presumed mixed infections were randomized to the study groups . The resultant groups were clinically and microbiologically comparable . The effectiveness of treatment was similar with both antibiotic regimens . Five of 25 patients tested in the moxalactam group had a prolongation of their prothrombin time and one of them developed clinically important bleeding . Two of the 23 patients tested in the clindamycin/tobramycin group had a prolonged prothrombin time with no bleeding . Decreases in hematocrit which could be "probably" or "possibly" related to antimicrobial use were seen in 6 of 48 moxalactam patients and none of 50 clindamycin/tobramycin patients (P = .03) . Moxalactam, a potent antimicrobial for both anaerobic and aerobic organisms, demonstrated effectiveness in treating mixed anaerobic/aerobic infections similar to clindamycin/tobramycin but was associated with clinically important decreases in hematocrit.

Int J Lepr Other Mycobact Dis, 1986 Sep, 54(3), 446 - 52
Restored pathogenicity of attenuated Mycobacterium lepraemurium in mice; Nomaguchi H et al.; The ability of Mycobacterium lepraemurium (Mlm) to adhere to A31 cells in culture decreased with the number of passages of the bacilli on Ogawa egg-yolk medium . Pathogenic Mlm consistently grew in tissue culture cells but growth was not seen with attenuated Mlm isolated from a smooth colony . After prolonged incubation, attenuated Mlm became adapted to tissue culture growth . The pathogenicity of the attenuated bacilli was restored partially by the adaptation to tissue culture cells and restored almost completely by passage in mice . After restoration of pathogenicity by these methods, the Mlm formed rough-type colonies on Ogawa egg-yolk medium although the colonies were not completely of the rough type . Attenuated Mlm did not interfere with the growth of in vivo-derived Mlm in tissue culture or in mice.

Int J Lepr Other Mycobact Dis, 1986 Sep, 54(3), 437 - 45
Adoptive transfer of tolerance induced by ICRC bacilli against Mycobacterium leprae in mice; Jeevan A et al.; ICRC bacilli, the cultivable leprosy-derived mycobacteria, isolated from lepromatous nodules of leprosy patients were found to be immunogenic in BALB/c mice at a dose of 2 X 10(7) acid-fast bacilli when injected by the intradermal (i.d.) route . The sensitization to lepromin and ICRC antigens was measured by the foot pad enlargement (FPE) method . The same dose of bacilli when injected by intravenous (i.v.), intraperitoneal, and subcutaneous routes induced immune tolerance in mice as indicated by reduction in the FPE to the test antigens . The spleen cells obtained after i.v . injection of ICRC bacilli/Mycobacterium leprae after adoptive transfer brought about suppression of delayed-type hypersensitivity in sensitized as well as nonsensitized recipients, indicating production of suppressor cells after i.v . injection . Similarly, the tolerance induced by i.v . injection of M . leprae in mice could be partially converted to immunity by i.d . sensitization with live BCG and two strains of ICRC bacilli (C-44 and C-75).

Semin Respir Infect, 1986 Sep, 1(3), 145 - 50
Gram-negative bacterial pneumonia in the immunocompromised host; Pennington JE; Gram-negative bacillary pneumonia is common in all groups of iatrogenically immunosuppressed patients . Mortalities are directly proportional to the degree of neutropenia . Those at particular risk for gram-negative pneumonia are neutropenic patients, patients residing in the hospital setting for prolonged periods, and patients in postoperative periods (eg, organ transplant recipients) . The most frequent pathogenesis for pneumonia appears to be airway colonization with gram-negative bacilli, followed by lowe respiratory tract infection . Thus, attention to infection control measures and surveillance culture data is important . Because sputum production is scant or absent, and blood cultures positive in only 30% to 40% of patients, it is often difficult to identify specific etiologic agents . If bacterial pneumonia is suspected in the immunocompromised host, empiric antibiotic coverage should include drugs active against all common aerobic gram-negative bacilli (including P aeruginosa), plus S aureus . Most advocate a beta-lactam plus aminoglycoside combination . Adjunctive treatment with granulocyte transfusions should be reserved for patients not responding to traditional regimens . Immune therapy or prophylaxis has not been fully evaluated for the immunocompromised patient population.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Sep, 262(3), 321 - 34
Action of colistin (polymyxin E) on the lytic cycle of the mycobacteriophage D29 in Mycobacterium tuberculosis; David HL et al.; The antibiotic colistin (polymyxin E) inhibited the lytic cycle of the mycobacteriophage D29 in the tubercle bacilli, but not the D29 adsorption . The protein and nucleic acid synthesis in D29-infected bacteria were not affected significantly . The inhibitory activity was reversed by washing off the antibiotic, and by addition of Ca++, but not in media made iso-osmotic by addition of NaCl or sucrose . Transmission electron microscopy revealed an asymmetric to symmetric transition in the staining profile of the cytoplasmic membrane . Though no mature phage particles were ever observed in colistin-treated, D29-infected tubercle bacilli, loosely arranged aggregates resembling phage proheads were occasionally found . Judging from the above data, it was concluded that colistin inhibited D29 lytic cycle by causing molecular displacements in the inner leaflet of the cytoplasmic membrane, and consequently, the binding sites for D29 structural proteins were not available.

Thorax, 1986 Sep, 41(9), 681 - 4
Rapid diagnosis of sputum negative miliary tuberculosis using the flexible fibreoptic bronchoscope; Willcox PA et al.; Acid fast bacilli are seldom identified by direct staining of sputum smears in patients with miliary tuberculosis, so that delays in diagnosis are common . We report 41 patients with miliary tuberculosis who had negative sputum smears and who underwent bronchoscopy, bronchial brushing, and transbronchial biopsy . In two patients the procedure was repeated . A definitive diagnosis was obtained from bronchoscopy in 34 patients (83%) . Bronchial brushings yielded Mycobacterium tuberculosis in 24 of 42 bronchoscopies (57%), 13 from direct smear and a further 11 from culture only . Transbronchial biopsies were diagnostic in 30 of 41 procedures (73%), 28 from histological appearances, one from direct smear of the biopsy specimen, and another exclusively from culture . A rapid diagnosis was established in most patients (27/34), either by direct smear of brushings or biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and histological examination (8) . The diagnosis was confirmed later in a further seven patients by culture of brushings or specimens; in five of these non-caseating granulomas were initially found by histological examination . Fibreoptic bronchoscopy is a valuable technique for rapidly establishing the diagnosis of miliary tuberculosis.

J Appl Bacteriol, 1986 Sep, 61(3), 247 - 51
Bactericidal activity of alkaline glutaraldehyde solution against a number of atypical mycobacterial species; Collins FM; The mycobactericidal activity of 2% alkaline glutaraldehyde solution was determined using standardized suspensions of 10 species of atypical mycobacteria and compared with that for virulent Mycobacterium tuberculosis . Suspensions of M . avium, M . intracellulare and M . gordonae were more resistant to disinfection by the glutaraldehyde than were virulent tubercle bacilli while M . kansasii, M . scrofulaceum and M . szulgae were somewhat more susceptible . Mycobacterium marinum, M . smegmatis and M . fortuitum were highly sensitive to the disinfectant action of the alkaline glutaraldehyde solution . This variation in sensitivity shown by apparently closely related strains of mycobacteria to this disinfectant has important practical implications.

Tubercle, 1986 Sep, 67(3), 179 - 88
The Birmingham Tuberculosis Drug Resistance Register, 1956-1983; Thomas HE et al.; The findings of the Birmingham Drug Resistance Register are recorded for the years 1956-83 . In native born patients initial drug resistance was common up to 1969, but few new cases were discovered after 1970 . In the immigrant population a peak of male discoveries was noted in 1968 and a peak of female discoveries in 1979, probably due to immigration patterns . In the native born, single drug resistance was the more common pattern; no initial isoniazid resistance has been detected in this group since 1970 . The immigrant patients showed a higher proportion of initial multiple drug resistance . The proportion of culture positive respiratory tuberculosis from which drug resistant bacilli were isolated is given for the years 1976-1983 . For native born males this was 1%, for native born females 0.6%, for immigrant males 5.1% and for immigrant females 6.5% . The detections of acquired drug resistance were high in 1956, but since 1970 have fallen to low levels, as has the pool of chronic excretors of drug resistant tubercle bacilli.

Int J Lepr Other Mycobact Dis, 1986 Sep, 54(3), 403 - 8
Viability of Mycobacterium leprae: a comparison of morphological index and fluorescent staining techniques in slit-skin smears and M . leprae suspensions; Odinsen O et al.; In a comparison of the estimation of Mycobacterium leprae viability by morphology and the fluorescent vital dyes FDA/EB and R123/EB, the latter techniques were more satisfactory using suspensions and slit-skin smears of M . leprae bacilli . Both FDA/EB and R123/EB seem to more accurately reflect viability after freeze/thaw cycles and heating, and are able to detect lower percentages of viable bacilli . In addition, the fluorescent vital dye techniques are both simple and less open to subjective interpretation than the conventional estimation of the morphological index.

Gastroenterol Jpn, 1986 Aug, 21(4), 325 - 35
Functional morphology of microfold cells (M cells) in Peyer's patches--phagocytosis and transport of BCG by M cells into rabbit Peyer's patches; Fujimura Y; Suspensions of BCG (32-80 X 10(7) viable bacilli/ml) were injected into constricted loops of ileum containing a Peyer's patch from non-immunized young adult rabbits after laparotomy under anesthesia . Light microscopically (rhodamine B-auramine double staining, Ziehl-Neelsen staining), many mycobacteria were observed adhering to the surface of follicle-associated epithelium (FAE) and in phagocytes that had migrated within FAE and to deep lymphoid follicles . Electron microscopically in 1-hour post inoculated specimens, the bacteria were found adhering specifically to M cells, and the microfolds of the M cells were seen to stretch like tentacles toward the bacteria to catch them . The bacteria were recognized in the large vesicle of the cytoplasm of the M cells . The bacteria phagocytized by the M cells were found in the intercellular space between M cells and columnar cells . The bacteria were also seen in macrophages enfolded by the M cells as well as in macrophages below the FAE . In this experiment, BCG were found to have been phagocytized only by M cells, and none were found in absorptive cells . It was verified that M cells are the first entrance through which BCG invade the host and that they are transported from M cells to macrophages of the epithelium.

J Med Microbiol, 1986 Aug, 22(1), 69 - 77
An investigation of the spread of gentamicin resistance in a district general hospital; Fisher GM et al.; A cluster of infections caused by gentamicin-resistant gram-negative bacilli in a District General Hospital was investigated . The plasmids coding for gentamicin resistance in the infecting organisms and in isolates obtained from the ward environment and from the faeces of patients and staff were characterised . Six plasmids encoding gentamicin resistance were recognised amongst the organisms causing infection . Two of the plasmids were found in different serotypes of the same species and one plasmid was found in different genera . Three of the plasmids present in the organisms causing the infections were also present in the inanimate environment or in the bowel flora of patients and these also were found in different serotypes of the same species and in different genera.

Antimicrob Agents Chemother, 1986 Aug, 30(2), 211 - 4
Imipenem-cilastatin as initial therapy for febrile cancer patients; Bodey GP et al.; Imipenem-cilastatin was used to treat 79 febrile episodes in 71 cancer patients, most of whom had neutropenia . The overall response rate was 67%, and 76% of the 45 documented infections responded . The response rates for septicemias and pneumonias were 79 and 62%, respectively . Only 1 of the 17 infections caused by gram-negative bacilli failed to respond to this therapy . The most common side effects were skin rash, nausea, and diarrhea . Eight superinfections were detected during therapy.

Acta Pathol Microbiol Immunol Scand {B}, 1986 Aug, 94(4), 257 - 63
Immunoadsorbent-purified antibodies in the study of antigenic relatedness of outer membrane proteins of enteric bacilli; Henriksen AZ et al.; Immunoadsorbent chromatography was used for purification of antibodies to E . coli 055 outer membrane proteins . Antibodies to the 33.5 kD and 7.5 kD proteins were eluted when rabbit antisera were applied to an epoxy-activated Sepharose 6B column to which the outer membrane was coupled in the presence of dioxane . ELISA coats prepared with sonicated bacteria showed binding of the eluted antibodies with strains of all of seven different species of the enteric bacilli, but not with other Gram-negative bacilli or cocci, or with Gram-positive cocci; immunoblot analysis of transblots of SDS-PAGE-separated bacteria showed that antibodies to both of the 33.5 kD and 7.5 kD E . coli outer membrane proteins cross-reacted with the enteric bacilli of different species . Both of the anti-33.5 kD and -7.5 kD antibodies were bound by intact E . coli 055 cells, but more efficiently by sonically disrupted or heat-treated bacteria . The results show that affinity-purified anti-OM antibodies were useful for the study of the antigenic relatedness of E . coli OM proteins with proteins of other bacteria.

J Natl Cancer Inst, 1986 Aug, 77(2), 441 - 7
Importance of Lyt 1+ T-cells in the antitumor activity of an immunomodulator, SSM, extracted from human-type Tubercle bacilli; Suzuki F et al.; An arabinomannan lipid extracted from Mycobacterium tuberculosis strain Aoyama B (SSM) is an immunopotentiating agent with interferon-inducing and antitumor activities . In the present study, the possible role(s) of various immunocompetent cells on the antitumor effect of SSM was investigated in mice bearing syngeneic (RL male 1 leukemia) and allogeneic (Ehrlich carcinoma) ascites tumors . When Thy 1+ T-cells were depleted from tumor-bearing mice by the administration of monoclonal anti-Thy 1.2 antibody, the protective effect of SSM was eliminated . However, when macrophage (M phi) and natural killer (NK) cell activities were depleted by treatment with M phi blockers (trypan blue and carrageenan) or a blocker for NK cells (anti-asialo GM1 antiserum), no alteration of the antitumor activity of SSM was observed . Therefore, T-lymphocytes, but not M phi or NK cells, were required for the expression of the antitumor efficacy of SSM . The antitumor activity of SSM was also abrogated by Lyt 1+ T-cells being depleted by treatment with monoclonal anti-Lyt 1.2 antibody, whereas the administration of monoclonal anti-Lyt 2.2 antibody had no effect on the antitumor activity . Independent of M phi, NK cells, or Lyt 2+ T-cells, Lyt 1+ T-lymphocytes appear to play an important role in the expression of the antitumor effects of SSM.

J Immunol, 1986 Aug 1, 137(3), 983 - 7
Effect of recombinant interferon-gamma on hydrogen peroxide-releasing capacity of monocyte-derived macrophages from patients with lepromatous leprosy; Kaplan G et al.; Monocyte-derived macrophages from 14 patients with lepromatous leprosy respond to rIFN-gamma with an enhanced secretion of H2O2 in a fashion similar to that of cells obtained from normal donors . The activation is not dependent on the cutaneous bacterial index, the length of treatment, or the stage and activity of the disease . H2O2 release can be triggered in these cells both by phorbol myristate acetate and by intact irradiated Mycobacterium leprae . Uptake of M . leprae by both normal donors' and patients' macrophages is proportional to the number of bacilli added . Prior ingestion of M . leprae does not interfere with the ability of macrophages to respond to IFN-gamma by the production of oxygen intermediates . We conclude that the immune defect in lepromatous leprosy probably results from a lack of response to M . leprae by the patients' T cells rather than an inability of mononuclear phagocytes to respond to IFN-gamma.

Clin Exp Immunol, 1986 Aug, 65(2), 253 - 9
Epidermal keratinocyte Ia expression, Langerhans cell hyperplasia and lymphocytic infiltration in skin lesions of leprosy; Rea TH et al.; Epidermal changes, Ia expression on keratinocytes, Langerhans cell hyperplasia and lymphocyte infiltration were sought in skin lesions of leprosy: 15 borderline tuberculoid (BT), six borderline lepromatous (BL), 17 lepromatous (LL), 13 erythema nodosum leprosum (ENL), six Lucio reactions and nine reversal reactions . All three changes were well developed in BT and reversal reactions . ENL showed well developed keratinocyte Ia and Langerhans cell hyperplasia, but little lymphocytic infiltration . LL and Lucio tissues had some Langerhans cell hyperplasia but little or no keratinocyte Ia or lymphocytic infiltration . BL tissues were so diverse as to suggest two distinct subgroups . These findings are consistent with the hypothesis that keratinocyte Ia expression is an immunohistological sign of a cell-mediated immune (CMI) response . However, the Ia keratinocyte expression found in BL and ENL tissues appears contrary to the undifferentiated macrophages and numerous bacilli found in the lesions . Thus, if a sign of CMI, keratinocyte Ia expression is not a measure of the effectiveness of the response.

Am J Med, 1986 Jul 28, 81(1A), 11 - 26
Infection in cancer patients . A continuing association; Bodey GP; Infection remains a major complication in patients with malignant disease . There are many factors predisposing to infection in this patient population, including local factors due to the tumor, specific deficiencies in host defense mechanisms due to certain malignant processes, and deficiencies in host defense mechanisms secondary to cancer chemotherapy . Neutropenia is probably the most important factor predisposing to infection in cancer patients . These patients require prompt broad-spectrum antibiotic therapy when fever develops . The majority of infections occurring in this patient population are caused by gram-negative bacilli and cure rates usually are between 65 and 75 percent . The most important prognostic factor is whether or not the neutrophil count recovers during the course of infection . Fungal infections have increased in frequency in neutropenic patients and often present as fevers of unknown origin . Increasingly, neutropenic patients are receiving antifungal agents as empiric therapy for persistent fever that fails to respond to antibacterial antibiotics . The most critical factor in recovery from fungal infection is remission of the underlying malignant disease.

Nature, 1986 Jul 31-Aug 6, 322(6078), 459 - 61
Genetically restricted suppressor T-cell clones derived from lepromatous leprosy lesions; Modlin RL et al.; Leprosy is a spectral disease in which immune responses to Mycobacterium leprae correlate with the clinical, bacteriological and histopathological manifestations of disease, so study of its pathology provides insights into immunoregulatory mechanisms in man . At the tuberculoid pole, patients have few lesions in the skin which contain rare organisms and are able to mount strong cell-mediated immune responses to M . leprae antigens . In contrast, at the lepromatous pole, patients have disseminated skin lesions containing large numbers of acid-fast bacilli and are selectively unresponsive to antigens of M . leprae . M . leprae-induced suppressor cells derived from peripheral blood have been reported to be active in vitro, yet their in vivo significance has remained unclear . Because the focal point of the immune response to M . leprae is the skin lesion consisting of lymphocytes and macrophages, we have recently developed methods for isolating lymphocytes from skin biopsies of leprosy patients . We report here that two T8 clones derived from lepromatous leprosy skin biopsies, in the presence of lepromin, suppress concanavalin A (Con-A) responses both of peripheral blood mononuclear cells and of T4 clones in an HLA-D (HLA, histocompatibility locus antigen)-restricted manner . Moreover, these T8 clones suppressed responses of HLA-D-matched, but not HLA-D-mismatched antigen-responsive T4 clones to M . leprae antigens, indicating that T-cell suppression is major histocompatibility complex (MHC)-restricted at some level in man.

N Engl J Med, 1986 Jul 3, 315(1), 6 - 15
Local and systemic effects of intradermal recombinant interferon-gamma in patients with lepromatous leprosy; Nathan CF et al.; Evidence that interferon-gamma may be a physiologic macrophage-activating factor, and that macrophage activation may be defective in lepromatous leprosy, led us to test the effects of intradermal injection of low doses of recombinant interferon-gamma in six patients with this disease . Interferon-gamma, 1 or 10 micrograms, was administered daily by jet gun for three days into a single cutaneous lesion . A biopsy specimen was taken from the injection site on the sixth study day and compared with specimens obtained previously from a site where no injection had been made or where excipient alone had been injected in the same way as the interferon . Interferon-gamma elicited local effects similar to certain features of delayed-type hypersensitivity reactions or tuberculoid leprosy, including induration, T-cell and monocyte infiltration, keratinocyte proliferation, diminution of epidermal Langerhans cells, and dermal and epidermal cell HLA-DR (Ia) antigen expression . At some of the sites of interferon-gamma injection, there was also an apparent decrease in acid-fast bacilli . Before treatment, monocytes from patients with lepromatous leprosy released 48 percent as much hydrogen peroxide as did monocytes from controls in response to phorbol myristate acetate, and 36 percent as much as those from controls in response to Mycobacterium leprae . When recombinant interferon-gamma was injected, these responses became normal . No toxic effects were observed . These observations suggest that interferon-gamma can mediate certain manifestations of delayed-type hypersensitivity or cell-mediated immunity in vivo, and that recombinant interferon-gamma should be tested for possible therapeutic effects in certain nonviral infectious diseases.

Am Rev Respir Dis, 1986 Jul, 134(1), 12 - 6
Incidence, site, and outcome of infections in patients with the adult respiratory distress syndrome; Seidenfeld JJ et al.; Bacterial infection in the adult respiratory distress syndrome (ARDS) is associated with the occurrence of multiple organ failures and death . We studied 108 infections in 129 patients with ARDS and evaluated the organisms responsible, the body sites involved, and the outcomes of therapy . Gram-negative bacilli represented 57% of the microbial pathogens and gram-positive cocci 36% . Only 7% of infections were caused by other organisms (fungi, viruses, Pneumocystis, Legionella) . Gram-negative organisms were more common in the lung, abdomen, and pleura . Bacteremia was more common in abdominal infections (11 of 17, 67%) than in infections at other sites (18 of 65, 28%), (p less than 0.01); ;9 patients were bacteremic from clinically undetected sites . Ten of 17 (59%) patients with abdominal infections survived compared with 7 of 56 (13%) patients with lung infections (p less than 0.001) . A retrospective review of in vitro organism susceptibility and the antibiotics administered revealed that the patients who received adequate antibiotic therapy did not have a higher survival rate (20 of 69, 29%) than those who received inadequate antibiotic therapy (3 of 13, 23%) . These data suggest that further investigation of infections in patients with ARDS is required and that emphasis should be placed on pathogenesis, prevention, and host responses.

Indian J Lepr, 1986 Jul-Sep, 58(3), 373 - 6
Sciatic nerve in experimental leprosy; Vaishnavi C et al.; Swiss albino mice were inoculated with Mycobacterium leprae obtained from untreated lepromatous patients . Histopathological study of sciatic nerves showed no abnormality . However a few free acid fast bacilli (AFB) were detected in the sciatic nerves taken from the inoculated limbs during the early stages of infection, suggesting the nerve-fibre route of travel as seen in humans in experimental leprosy, too.

Crit Care Clin, 1986 Jul, 2(3), 471 - 95
The interaction of infection and the adult respiratory distress syndrome; Niederman MS et al.; Infection, particularly that involving the respiratory tract, is commonly seen in the patient with ARDS . It can be either an etiologic factor leading to the syndrome or a complicating factor leading to a high likelihood of mortality . Pneumonia develops in up to 70% of individuals with ARDS, and when present, converts the syndrome to its most severe and mortal form . In addition, when systemic injury coexists with any type of infection, ARDS will develop with an increased frequency . Nosocomial pneumonia results when upper and lower respiratory tract defenses fail and these sites are overwhelmed by bacteria . Colonization of the oropharynx and tracheobronchial tree, both of which are common in critically ill patients, precedes the development of pneumonia . In the patient with ARDS, all levels of host antibacterial defenses may be impaired, thus accounting for the high incidence of both colonization and pneumonia . These impairments result from the acute lung injury itself, coexisting systemic illnesses, therapeutic interventions, and acquired malnutrition . Once pneumonia develops in the course of acute lung injury, diagnosis is exceedingly difficult and potentially inaccurate . With proper application of the protected specimen brush, inserted bronchoscopically, diagnostic accuracy may improve . Therapy must be undertaken early and with agents directed at likely pathogens, particularly P . aeruginosa and other gram-negative bacilli . In the future, preventive efforts against pneumonia may be effective for the ARDS patient . Strategies that may be effective include hyperalimentation, judicious use of all pharmacotherapy, active and passive antibacterial vaccines, airway microenvironment manipulation, and the use of aerosolized antibiotics.

J Appl Bacteriol, 1986 Jul, 61(1), 87 - 93
Kinetics of the tuberculocidal response by alkaline glutaraldehyde in solution and on an inert surface; Collins FM; Single cell suspensions of BCG and Mycobacterium tuberculosis were exposed to 2% alkaline glutaraldehyde solution (pH 8.0) and the rate of kill measured at intervals up to 30 min . Residual glutaraldehyde was neutralized with freshly prepared 1% sodium bisulphite . The rate of kill was directly proportional to the temperature and independent of the inoculum size whether the organism was tested in suspension or attached to an inert surface . Glutaraldehyde was slightly more bactericidal for the virulent M . tuberculosis than for the attenuated BCG . A substantial proportion of the mycobacterial population on an inert surface floated off during its exposure to the glutaraldehyde solution but the 'floaters' were killed at an equivalent rate to the attached bacilli . Complete sterility of a standardized suspension of M . tuberculosis could not be achieved within the 10 min period specified by the tuberculocidal assay, although it was usually attained within 20 min.

Am Rev Respir Dis, 1986 Jul, 134(1), 44 - 8
Natural mycobacteriostatic activity in human monocyte-derived adherent cells; Douvas GS et al.; The effects of human monocyte maturity on the replication of virulent Mycobacterium tuberculosis were examined . Mycobacteria grew readily in freshly isolated, adherent peripheral blood monocytes and in monocyte-derived macrophages obtained after 7 days in culture, as measured by counts of acid-fast bacilli and colony-forming units . Monocytes cultured for only 3 days before infection, however, were less permissive for the mycobacteria than either uncultured or 7-day cells . The association between the low permissiveness of 3-day cells and superoxide production was examined . Mycobacteria induced only a slight increase in superoxide production during the first 60 min of infection in uncultured and in 3-day cells, and no increase in cells cultured for 7 days before infection . Freshly isolated adherent cells produced small amounts of superoxide in response to phorbol myristate acetate (PMA) stimulation, but PMA-induced superoxide production increased steadily for 7 days . Mycobacteria had no effect on superoxide production by PMA-stimulated adherent cells . These results suggest that the suppressive activity of the 3-day cells is not associated with the production of increased amounts of reactive oxygen species.

Am J Med, 1986 Jun 30, 80(6B), 44 - 7
Have the new beta-lactams rendered the aminoglycosides obsolete for the treatment of serious nosocomial infections?
Moellering RC Jr.
Hospital-acquired infections are often due to multi-resistant gram-negative bacilli . When treating these infections, the physician must use potent antibiotics that have broad spectrums of activity . Aminoglycosidic aminocyclitols and the newer beta-lactam antibiotics are particularly valuable in the management of hospital-acquired infections . This article discusses the role of both classes of antibiotics in this setting.

Am J Med, 1986 Jun 30, 80(6B), 71 - 5
Control of emergence of multi-resistant gram-negative bacilli by exclusive use of amikacin; Ruiz-Palacios GM et al.; Results of a three-year prospective study of amikacin as the only aminoglycoside used at the Instituto Nacional de la Nutricion "Salvador Zubiran" are presented . During the initial three-month baseline period, resistance to amikacin, gentamicin, and tobramycin among 870 gram-negative bacterial isolates was 3.2 percent, 17.4 percent, and 11.2 percent, respectively . In this period, the overall consumption of aminoglycosides was 69 percent for gentamicin, 30.5 percent for amikacin, and 0.5 percent for tobramycin . In the following period of exclusive amikacin use, sensitivity patterns of 9,344 gram-negative strains isolated over three years were recorded . During this period, amikacin constituted 99.3 percent of all aminoglycosides used . The percentage of gentamicin-resistant gram-negative strains declined to 7.4 percent (p less than 0.0001), whereas the percentage of amikacin-resistant strains did not change significantly . Quarterly trend analysis of aminoglycoside-resistant strains also demonstrated a significant decrease in gentamicin resistance (p less than 0.005) and an overall steady state of amikacin resistance . It is concluded that the exclusive use of amikacin was not accompanied by a significant increase in amikacin resistance during a three-year period, and may even lead to a decrease in resistance to gentamicin and tobramycin among most gram-negative organisms.

Tubercle, 1986 Jun, 67(2), 109 - 18
The effect of exposure of hospital employees to patients with tuberculosis on dermal reactivity to four new tuberculins; Grange JM et al.; An early (6-8 h) erythematous response to Purified Protein Derivative and to sonicate antigens (new tuberculins) prepared from Mycobacterium tuberculosis, M . vaccae, M . scrofulaceum, and M . leprae occurred much more frequently amongst hospital employees exposed to patients with tuberculosis than amongst factory workers . Biopsies taken from the skin test sites at 48 h revealed a more intense inflammatory cell infiltrate in response to PPD and the sonicate of M . tuberculosis, but not to the antigens of the other mycobacteria, amongst the hospital employees thus indicating a degree of specificity . The early response appears to be directed towards species specific antigens, but not, apparently, to the same as those that elicit the 48 h reactions . The hospital employees also had higher peripheral blood B-cell counts and total IgG levels, suggestive of an adjuvant effect . It is postulated that the early reaction results from repeated exposure to tubercle bacilli and the possible nature of the reaction is discussed.

Q J Med, 1986 Jun, 59(230), 599 - 610
Acute respiratory distress related to chemotherapy of advanced pulmonary tuberculosis: a study of two cases and review of the literature; Onwubalili JK et al.; Two patients with non-miliary pulmonary tuberculosis developed a syndrome resembling adult respiratory distress following initiation of drug treatment . They were studied clinically and with a representative range of in vitro and in vivo tests of immune function . Both were alcoholic, malnourished and presented with radiologically widespread, smear-positive disease and lymphocytopenia . One had cutaneous anergy in vivo and profound reduction on mononuclear cell proliferative and interferon responses to tuberculoprotein (PPD) in vitro; the other patient, who died two weeks after starting treatment, had relatively normal values for these measures of cell-mediated immunity . In both cases there was a progressive increase during treatment, in peripheral blood lymphocyte counts, skin reactions and in vitro cellular responses to PPD, and a sudden rise in ESR at the time of their deterioration . We propose that the reactions may represent local manifestations of heightened delayed hypersensitivity, mounted by increasing numbers of 'resuscitated' lymphocytes against immunogenic cell wall substances released from dying tubercle bacilli in patients whose level of cellular immunity is being enhanced as a result of chemotherapy . The likelihood of an acute respiratory reaction during treatment may therefore depend on the bacillary load, the extent of lung disease present, and its severity may be related to the pre-treatment immune status of the patient.

Pathol Res Pract, 1986 Jun, 181(3), 344 - 8
Angiocentric pulmonary granulomas in tuberculosis; Ojeda VJ et al.; An open-lung biopsy performed in a 15-year-old girl because of left sided pulmonary nodules revealed striking angiocentric necrotising granulomas . No acid fast bacilli (AFB) were cultured or demonstrated in tissue sections, however, the diagnosis of tuberculosis was suggested . Anti-tuberculous therapy resulted in both clinical and radiological cure within 12 months . The differential diagnosis of this type of lesion should include pulmonary tuberculosis as well as the non-infective angiocentric granulomas such as lymphomatoid granulomatosis and has major therapeutic implications.

Chest, 1986 Jun, 89(6), 822 - 7
Late exudative complications of collapse therapy for pulmonary tuberculosis; Schmid FG et al.; In a retrospective study of 15 patients who were treated with collapse therapy for pulmonary tuberculosis on an average 30 years previously, we found 16 instances of exudation in the residual pocket: four were sterile and without fistula, ten had bronchial fistulae, one had an esophageal fistula, and one was a tuberculous empyema without fistula . Among the 11 exudations with bronchial or esophageal fistulae, none contained tubercle bacilli, six were infected with pyogenic microorganisms, and five remained sterile . In 12 cases, the diagnosis was suggested by chest x-ray film . Four of nine exudates which remained sterile and three of the seven infected ones could be stabilized by conservative measures; the others required a decortication, sometimes with parenchymal resection . This study shows that in late exudative complications of old collapse therapy, an initial conservative treatment can be curative in about 45 percent of the cases.

Am J Gastroenterol, 1986 Jun, 81(6), 428 - 31
Nonspecific jejunitis--a challenging problem in children; Sharma AK et al.; An acute enteric infection with the pathological feature of a severe necrotising jejunitis is an uncommon condition which mainly affects young people . It is characterized by severe abdominal pain of acute onset, copious bilious vomiting, and foul smelling loose stools containing blood . Exploration revealed varying degree of ischemic changes in the small bowel (mainly the upper jejunum) ranging from mucosal ulceration to frank gangrene of the bowel . The exact etiology is not known; the condition may be due to toxins produced by gram-negative bacilli or due to a localized allergic reaction . The disease had a progressive but self-limiting course . Mortality is around 40% and considerable morbidity continuing for 2-3 wk . Presentation bears similarity to Darmbrand of Germany, Pig-bel of New Guinea, and ischemic enteritis of Thailand.

J Trop Med Hyg, 1986 Jun, 89(3), 143 - 8
Human pulmonary infections with bovine and atypical mycobacteria in Lagos, Nigeria; Idigbe EO et al.; A total of 2784 cases with persistent symptoms of lower respiratory tract infections were seen in four of the chest clinics in Lagos between January and June of 1983 . Of these, 668 were randomly selected and screened for pulmonary tuberculosis . Repeated sputum samples from the 668 patients were cultured on Lowenstein-Jenseen slopes and 102 pure mycobacterial isolates were obtained . The isolates were differentiated into tubercle bacilli, bovine or atypical mycobacteria on the basis of results obtained from nine identification tests . Of the 102 mycobacterial isolates obtained, 87 (85%) were identified as Mycobacterium tuberculosis, four (4%) as M . bovis and 11 (11%) as atypical mycobacteria . Among this atypical group, six were classified as M . avium, four as M . kansasii and one as M . fortuitum . The study showed the involvement of bovine and atypical mycobacteria in pulmonary infections in Lagos . Tuberculosis-like diseases produced by some of the atypical group are resistant to most of the conventionally used anti-tuberculosis drugs . The need for adequate bacteriological analysis in current-day diagnosis and treatment of pulmonary tuberculosis is therefore highlighted since the 11 atypical cases seen in this study would otherwise have been diagnosed and treated as cases of classical tuberculosis.

J Clin Pathol, 1986 Jun, 39(6), 666 - 71
Kit systems for identifying gram negative aerobic bacilli: report of the Welsh Standing Specialist Advisory Working Group in Microbiology; Bennett CH et al.; Under the auspices of the Welsh Standing Specialist Advisory Working Group in Microbiology (WMG) 10 clinical microbiology laboratories in Wales undertook a collaborative study to assess 10 commercial kits for the identification of aerobic Gram negative bacilli . In excess of 1000 such strains were examined in parallel with each kit system . Accuracy, reproducibility of accuracy, and reproducibility alone were assessed, together with the cost effectiveness of the kits used . A ranking order of kit performance based on the above variables was drawn up.

Liver, 1986 Jun, 6(3), 158 - 66
Pathologic features of the liver in acquired immune deficiency syndrome (AIDS); Nakanuma Y et al.; The livers of 26 adult males with acquired immune deficiency syndrome (AIDS) were reviewed . The occurrence of portal tracts with diminished lymphocytes, probably reflecting generalized exhaustion of the lymphoid system, was a characteristic morphologic change, and was found in all cases . Kupffer cell hyperplasia was also a frequent finding and probably reflected generalized infection(s) . Punched-out clusters of foamy histiocytes filled with acid-fast bacilli, typical for infection with Mycobacterium avium intracellulare (MAC), were found in three patients . In addition, MAC was cultured from two livers without the foamy histiocytic changes . Chronic viral hepatitis (three cases) and deposition of polarizable materials (one case) in the liver might be related to unusual habits of patients with AIDS . In conclusion, livers from patients with AIDS disclosed several kinds of lesions reflecting underlying or associated conditions in AIDS, but these did not contribute to the cause of death in our patients.

Jpn J Antibiot, 1986 Jun, 39(6), 1555 - 64
{Fundamental and clinical studies on imipenem/cilastatin sodium in the field of obstetrics and gynecology}; Lin BL et al.; Fundamental and clinical studies on imipenem/cilastatin sodium (MK-0787/MK-0791) were carried out and the following results were obtained . Concentrations of MK-0787 in plasma and uterine tissues were determined at 30 minutes to 390 minutes after the completion of an intravenous drip infusion of 500 mg/500 mg of MK-0787/MK-0791 sodium . Levels of MK-0787 in oviduct, ovary, endometrium, myometrium, uterine cervix and portio vaginalis were 5.1, 5.3, 4.2, 6.6, 5.2 micrograms/g and 6.0 micrograms/g, respectively, at 30 minutes after the completion of the infusion . These levels far exceeded the MICs of MK-0787 against major pathogens (Gram-negative rods and anaerobic bacilli) most often isolated in the field of obstetrics and gynecology . MK-0787/MK-0791 was administered by intravenous drip infusion to 11 patients, including 4 with pelvic peritonitis, 4 with adnexitis and one each with peritonitis, tubo-ovarian abscess, and endometritis, at a dose of 1 g/1 g-1.5 g/1.5 g per day for a period of 4 to 9 days . Clinical response was excellent in 2 and good in 9 . No adverse reactions or abnormal laboratory findings were observed in any of the patients.

Tubercle, 1986 Jun, 67(2), 119 - 24
Drug-resistant tuberculosis in Sierra Leone; Gibson J; Culture and sensitivity tests were performed on tubercle bacilli from patients with tuberculosis attending a provincial general hospital in Sierra Leone, who appeared clinically to have drug-resistant infections . Amongst the general intake of patients from 1978 to 1984 there was a 10.5% incidence of isoniazid resistance, with 7.7% of patients having strains resistant to both streptomycin and isoniazid, 1.3% resistant to rifampicin, and 0.8% resistant to ethambutol . Multiple drug resistance was more frequent than single drug resistance . This high incidence is largely due to inadequate and irregular supplies of first line drugs.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Jun, (6), 29 - 33
{Glutamine synthetase content and immunochemical analysis of different strains of Bordetella pertussis}; Samsonova VS et al.; In this investigation 3 groups of strains isolated from pertussis patients have been studied: typical (group 1), atypical in their cultural properties (group 2), unidentified Gram-negative bacilli agglutinated by pertussis and parapertussis antitoxins (group 3) . Besides, B . pertussis cultures, obtained by subculturing 2 museum strains and 2 newly isolated strains on synthetic casein-charcoal agar with subinhibiting doses of antibiotics or specific immune sera added, have been studied . As indicated by the results of this study, strains belonging to groups 1 and 2 contain glutamine synthetase, while in strains of group 3 this enzyme is absent . In immunoelectrophoresis strains of group 3 have been found to contain not a single antigen similar to the antigens of strains belonging to groups 1 and 2 . Electrophoresis in polyacrylamide gel has revealed to differences in the protein spectrum of the strains of these 3 groups . The investigation has shown that the determination of glutamine synthetase and immunoelectrophoresis can be used for the differentiation of B . pertussis from similar Gram-negative bacilli . B . pertussis strains, changed as the result of experiments with antibiotics and specific immune sera, have also been shown to retain their antigenic composition and protein spectrum and to have no essential difference in the content of glutamine synthetase.

Am J Med, 1986 May 30, 80(5C), 79 - 84
Empiric antimicrobial therapy with aztreonam or ceftazidime in gram-negative septicemia; Lagast H et al.; In an open, comparative study, 225 patients with severe underlying diseases and suspected gram-negative bacillary septicemia were randomly assigned to receive aztreonam or ceftazidime empirically, 2 g intravenously three times daily . Twenty-five patients in the aztreonam group and 22 in the ceftazidime group had blood cultures that grew aerobic gram-negative bacilli and were evaluable for response to therapy . All pathogenic strains were sensitive to treatment . In the aztreonam group, 22 (88 percent) patients had cures, three (12 percent) had failures, and seven (28 percent) had development of superinfections (five were caused by gram-positive cocci and two by fungi) . In the ceftazidime group, 18 (82 percent) patients had cures, one had improvement, three (14 percent) had failures, and three had superinfections . The median peak serum bactericidal activity was 1:2,048 after aztreonam administration and 1:512 after ceftazidime administration . Failures were not related to resistant strains or to low serum bactericidal activity.

J Urol, 1986 May, 135(5), 916 - 9
Histological parameters and pitfalls in the interpretation of bladder biopsies in bacillus Calmette-Guerin treatment of superficial bladder cancer; Lage JM et al.; We report the morphological effects of intravesical bacillus Calmette-Guerin therapy on early post-treatment biopsies of the bladder in 39 patients with superficial transitional cell carcinoma (stage Ta, T1 or Tis) of the bladder . Although submucosal granulomatous inflammation in bladder biopsies of patients receiving intravesical bacillus Calmette-Guerin treatment has been described previously, a complete morphological description of the early effects of bacillus Calmette-Guerin on all bladder layers and the prostatic urethra has not been reported . In the majority of cases the superficial epithelium was eroded and the edematous submucosa contained noncaseating granulomas with a surrounding lymphoplasmocytic and eosinophilic infiltrate . Langhans' giant cells occasionally were found, and acid-fast bacilli were demonstrated only rarely by special stains in the 6-week post-treatment biopsy . In some cases the prostatic urethra and muscle bundles contained noncaseating granulomas . Features distinguishing epithelial atypia resulting from bacillus Calmette-Guerin treatment and superficial cancer include the presence of epithelial maturation, preserved nuclear/cytoplasmic ratio, smooth nuclear contours and lack of nuclear pleomorphism, nucleoli or cytomegaly.

J Clin Microbiol, 1986 May, 23(5), 920 - 3
Identification of oxidase-positive, glucose-negative, motile species of nonfermentative bacilli; Pickett MJ et al.; Motile and glucose-negative nonfermentative bacilli are difficult to identify by commonly used procedures . We found eight features (reduction of nitrate and nitrite, acidification of fructose, and alkalinization of acetamide, arginine, histidine, saccharate, and urea) that identified 83% of 143 strains . These, along with additional biochemical tests, effected identification of 93% of the strains . Hence, only a minority of these strains required examination by microscopy (for type of flagellation and presence of inclusion bodies) for complete identification.

Am Rev Respir Dis, 1986 May, 133(5), 861 - 5
The diagnosis of gram-negative bacillary pneumonia in an animal model using a competitive ELISA technique to detect the presence of lipid A; Campbell GD et al.; Gram-negative bacillary pneumonias represent a major problem in hospitalized patients . A major research interest has been towards the development of rapid and accurate diagnostic procedures for these infections . An ELISA procedure for the detection of lipid A in pulmonary lavage fluid has been developed . Using the quantitation of lipid A, an antigen common to all clinically important gram-negative bacilli, as a marker for gram-negative bacilli, the presence or absence of pneumonia caused by these organisms could be demonstrated in laboratory animals . Additionally, by quantitating the lipid A associated with the lavageable pulmonary cell population, a measure of bacterial lung clearance could be obtained.

Am J Surg Pathol, 1986 May, 10(5), 317 - 22
Granulomatous infection mimicking bronchocentric granulomatosis; Myers JL et al.; Four examples of granulomatous infection with histologic features indistinguishable from bronchocentric granulomatosis are presented . Lung biopsies in all cases showed necrotizing granulomatous inflammation confined to the conducting airways . No patient had a history of asthma, however, and eosinophils were not numerous in the biopsy specimens . Rare organisms were identified in special stains in three cases, including acid-fast bacilli in two and histoplasma in one; cultures grew Mycobacterium avium-intracellulare in one and Histoplasma capsulatum in another . Special stains and cultures were negative in one patient and the correct diagnosis of blastomycosis was established only after biopsy of a soft tissue mass 3 months following the lung biopsy . Exclusive peribronchial localization of granulomas can occur in infections and may cause confusion with bronchocentric granulomatosis . In non-asthmatic patients without tissue manifestations of allergy, therefore, the diagnosis of bronchocentric granulomatosis should be made rarely, if ever, and only after an infectious etiology has been carefully excluded.

Am J Med, 1986 May, 80(5), 891 - 6
Disseminated atypical mycobacterial infection in patients with hairy cell leukemia; Bennett C et al.; Disseminated atypical mycobacterial infections developed in nine of 186 patients with hairy cell leukemia who were seen over 10 years at the University of Chicago Hospital . Clinically, these patients had symptoms of fever and chills; an infiltrate was usually present on chest radiography . Invasive diagnostic studies, including thoracotomy and laparotomy, were necessary for confirmation of the diagnosis of atypical mycobacteria infection . Confirmatory culture specimens were obtained from lymph nodes, liver, and splenic tissue . Six patients had infections with Mycobacterium kansasii; two with M . avium-intracellulare; and one with M . chelonei . Treatment with multiple anti-tuberculosis drugs was initiated either empirically (six patients); after obtaining pathologic evidence of granuloma or acid-fast bacilli (two patients); or after obtaining a positive culture result (one patient) . Five of the nine patients survived the infection and continued taking anti-tuberculosis drugs for total periods of nine months to two years . Awareness of the association between hairy cell leukemia and atypical mycobacteria infection, with early consideration of invasive diagnostic studies, as well as empiric anti-tuberculosis therapy, may prolong the survival time for many patients with hairy cell leukemia.

Pathol Biol (Paris), 1986 May, 34(5), 339 - 41
{Diffusion of aztreonam in the tissues and biological fluids of the female genital tract}; Berthelot G et al.; Diffusion of aztreonam into female genital tract tissues was investigated . After a single IV injection of 1 g, aztreonam was assayed in uterine tissue, uterine tube tissue and peritoneal fluid in 15 patients undergoing coelioscopy or hysterectomy . In addition, to evaluate placental transfer of aztreonam, maternal blood, amniotic fluid and cord blood samples were collected in five women undergoing cesarean section . Concentrations of aztreonam were determined using a microbiologic method . Mean concentrations 1 to 2 hours after administration of the drug were 11 to 25 micrograms/g in the endometrium and uterine tube tissue and 18 to 30 micrograms/g in the myometrium . Concentrations in peritoneal fluid samples were lower, ranging from 4.7 micrograms/ml (0.5 h) to 16 micrograms/ml (1 to 2 hours after the injection) . The ratio of tissue concentrations to serum concentrations found at the same time, expressed as a percentage, ranged from 50 to greater than or equal 100% . Placental transfer of aztreonam proved comparable to that of other recently studied beta-lactams: the amniotic fluid/maternal blood and cord blood/maternal blood ratios ranged from 27 to 33% thirty minutes after administration of the antibiotic . No adverse effects were recorded in the offspring . These results indicate that diffusion of aztreonam into female genital tract tissues is good, producing concentrations capable of preventing or curing gynecologic and obstetrical infections caused by Gram negative bacilli.

Int J Dermatol, 1986 May, 25(4), 245 - 8
Preliminary study of a Mycobacterium leprae bacterin vaccine in a human volunteer population in a nonendemic area; Millikan LE et al.; Seventeen volunteers who had never resided in areas with significant transmission of leprosy (Hansen's disease) were inoculated intradermally with 1.5 X 10(8) killed, purified armadillo-derived Mycobacterium leprae in a standardized preparation being tested for possible vaccine use . The peak of local skin responses, consisting of induration with or without ulceration similar to the post-lepromin Mitsuda reaction, occurred between the 21st and 28th days after injection . The maximum mean induration diameter was 17.2 mm, the minimum, 6.1 mm . Sera tested with the ELISA technique revealed no humoral response to either the sonicated bacilli, M . leprae-specific phenolic glycolipid I antigen, or three semi-synthetic analogues reactive with lepromatous patients' sera . The dose of M . leprae inoculated appeared to be safe and without unacceptable reactions at the injection site . One volunteer developed a generalized skin rash parallel to the local reaction, but the relationship of the former to the inoculation was unclear.

Hepatology, 1986 May-Jun, 6(3), 495 - 501
Adult liver transplantation: an analysis of the early causes of death in 40 consecutive cases; Cuervas-Mons V et al.; One hundred twenty-nine adult patients who received an orthotopic liver transplantation and survived at least 24 hr after surgery were evaluated . During the period of follow-up, 48 of the 129 patients (37%) died . Only 40 of these 48 patients died at our institution and were included in this study . Seventeen of the 40 deaths (42.5%) occurred during the first month after orthotopic liver transplantation and 30 of the 40 deaths (75%) occurred during the first 60 days post-orthotopic liver transplantation . Death was related to infection in 21 cases (52.5%), to multiorgan failure in 8 (20%) and to uncontrollable rejection in 3 (7.6%) . The remaining eight deaths (20%) were attributed to a variety of other causes . Eleven of the 21 deaths related to infection (52%) occurred during the first month after orthotopic liver transplantation . Bacterial sepsis was the leading cause of death and accounted for 17 of the 21 deaths (81%) in which infection was present at the time of death . The most frequently isolated bacteria were Pseudomonas and other enteric Gram-negative bacilli . Three patients had complete occlusion of the hepatic artery of the grafted liver . Six patients developed massive infarction of the liver despite patent vascular anastomoses . Histological signs of rejection were seen in 9 of the 31 patients autopsied (29%), but in only 3 of these (9.6%) was rejection the principal cause of death . The biliary anastomoses were patent in all 31 cases examined at autopsy.

J Med Microbiol, 1986 May, 21(3), 215 - 8
Rapid identification of gram-negative bacilli from blood cultures; Stevens M et al.; Blood-culture broths showing macroscopic or radiometric evidence of growth of gram-negative bacilli were examined by a rapid automated bacterial identification system . A differential centrifugation technique was developed to prepare suitable inocula . The identification results obtained were confirmed by the API 20E method, with single colonies of the strains isolated 24 h later . Of 90 organisms tested, seven did not give the same identification by the two systems . With the rapid automated technique a presumptive identification of gram-negative bacilli can be made 24 h earlier than by more conventional methods.

Neurosurgery, 1986 May, 18(5), 604 - 10
Mycobacterium tuberculosis meningitis: a report of twelve cases and a literature review; Clark WC et al.; Twelve recent cases of Mycobacterium tuberculosis meningitis were presented, and the literature was reviewed . There are no particularly new or unique therapies or approaches to the management of this most serious disease . The major obstacle to successful diagnosis and treatment of tuberculous meningitis continues to be a lack of clinical suspicion of its presence . As illustrated in the cases presented, it has been our experience that patients already moribund or nonresponsive do not respond, regardless of the intervention undertaken . The most sensitive and economical method of detecting M . tuberculosis in the CSF may be LPA . However, this has not yet been widely validated or accepted . Larger volumes of CSF should be sent to the laboratory for testing and centifuged to about 5x concentrations before both acid-fast bacilli staining and culture are attempted . If tuberculous meningitis is suspected, three-drug therapy can be started immediately without jeopardizing subsequent culture confirmation of the presence of the TB bacillus . In addition, these patients must be followed closely to detect hydrocephalus at the earliest possible moment . When patients fail to respond to appropriate antituberculosis and pressure-reducing therapy, hydrocephalus should be actively sought by either CT or radioisotope cisternography . Although the decision to proceed to ventricular drainage or shunting must be individually made in adult patients with infection-related hydrocephalus, we agree with others that surgical intervention should be considered early and should be performed if the level of consciousness deteriorates, intracranial pressure increases, or ventricular enlargement or enhancing basal exudates are identified on CT.

Am Rev Respir Dis, 1986 May, 133(5), 779 - 83
Long-term follow-up of a clinical trial of six-month and four-month regimens of chemotherapy in the treatment of pulmonary tuberculosis . Singapore Tuberculosis Service/British Medical Research Council.
{Fulminant gram-negative (CDC-dysgonic-fermenter 2) septicemia in a splenectomized patient}
Yersin B, Aubert J, Bille J, Perret C.

In a 43-year-old woman admitted because of fever and high cardiac output shock, disseminated intravascular coagulation with purpura was present . The peripheral blood smear revealed the presence of intraleukocytic elongated bacilli, but growth of bacteria (further identified as DF2) in the blood cultures was detected only two weeks after admission . Despite intensive therapy with hemodynamic and respiratory support, associated with broad spectrum antibiotherapy, the patient died on the third day of hospitalisation . The past medical history of the patient revealed splenectomy for Hodgkin's disease 4 years previously, but no recent dog bite.

Ann Acad Med Singapore, 1986 Apr, 15(2), 221 - 6
Spontaneous bacterial peritonitis in cirrhotics: clinical and ascitic fluid findings; Kachintorn U et al.; During a two-year period, 30 patients with spontaneous bacterial peritonitis were documented . All patients had ascites and 70% were alcoholic cirrhosis . Fever and abdominal pain were the most frequent presenting manifestations (96.66% and 76.66% respectively) . Triads of fever, abdominal pain and rebound tenderness were found in 40% . A third had hepatic encephalopathy and decreased bowel sound . Ascitic fluid was transudate . Positive ascitic fluid culture and blood culture were obtained in 40% and 59% respectively, and three quarters were due to gram negative enteric bacilli . There was no significant statistic correlation among the result of ascitic fluid gram's stain and ascitic fluid culture, and of ascitic fluid culture and blood culture . The clinical and laboratory findings of patients with positive and negative ascitic fluid culture were similar . Significant increased mortality was found in patients who had hepatic encephalopathy, hypotension, increased bilirubin level and serum creatinine . The over all mortality was 33.33% . We recommend abdominal paracentesis in every cirrhotic patients with ascites who were admitted into hospital.

Aust N Z J Med, 1986 Apr, 16(2), 224 - 5
Mycobacterium gastri peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis; Linton IM et al.; This report documents a case of peritonitis due to Mycobacterium gastri in a 28 year old woman on continuous ambulatory peritoneal dialysis . She presented with persistent abdominal pain and clear peritoneal drainage fluid which contained increased numbers of lymphocytes . The diagnosis was made by identification of acid-fast bacilli in peritoneal fluid and within a peritoneal biopsy specimen, and culture of Mycobacterium gastri from peritoneal fluid . Treatment with rifampicin and ethambutol and removal of the Tenckhoff catheter has proved effective . The case highlights the importance of searching for slow growing organisms in apparently 'aseptic' peritonitis in peritoneal dialysis patients.

Mem Inst Oswaldo Cruz, 1986 Apr-Jun, 81(2), 149 - 54
{Influence of BCG in the control of humoral deficiency induced by mastocytoma p-815}; Brascher HM et al.; Viable BCG bacilli, in a lipid emulsion, inoculated intravenously, were capable of reverting the profound humoral immunosuppression induced in adult DBA/2 mice by the mastocytoma P-815 . BCG increased not only the number of hemolytic plaque forming cells, but also the serum titers of hemagglutinating IgM antibodies . However, no blocking effect was detected on normal tumor progression.

J Biol Stand, 1986 Apr, 14(2), 143 - 52
Comparison in sensitized and unsensitized guinea-pigs of tuberculin PPDs RT 23 and PPD-M by skin tests and lymphocyte stimulation tests . Effect of immunization time; Haslov K et al.; The biological activities of tuberculin PPD RT 23 and the International Standard for Purified Protein Derivative of Mammalian Tuberculin (PPD-M) were compared in sensitized and unsensitized guinea-pigs by skin tests and lymphocyte stimulation (LS) tests . Estimates of relative potency (RP) from skin test results were dependent on the dose level, on the immunogen used, and, in guinea-pigs immunized with killed tubercle bacilli in oil, also on the immunization time . Relative potency estimates from LS results were dependent on the source of the lymphocytes and were different from estimates obtained from skin tests . Lymphocyte stimulation dose-response curves for the tuberculins were qualitatively different . In contrast to RT 23, PPD-M gave rise to non-specific skin reaction in unsensitized guinea-pigs . Both tuberculins were mitogenic to lymph node lymphocytes isolated from unsensitized guinea-pigs, PPD-M being the more mitogenic of the two tuberculins . The present results confirm that qualitatively different tuberculins cannot be unambiguously calibrated in identical terms and thus emphasize that the uncritical use of (international) standards should be avoided in tuberculin calibration.

Eur J Clin Microbiol, 1986 Apr, 5(2), 152 - 5
Radiometric diagnosis of mycobacteria; Laszlo A et al.; The aim of this study was to determine the impact of recently developed rapid radiometric techniques on the clinical diagnostic operations of a reference laboratory for mycobacteria . Selective inhibition by rho-nitro-alpha-acetylamino-beta-hydroxypropiophenone was used to rapidly screen submitted cultures for identification of mycobacterial species other than Mycobacterium tuberculosis . The radiometric drug susceptibility test was applied only to those cultures presumptively identified as belonging to the Mycobacterium tuberculosis complex . All referred cultures were tested without additional subculture . The results showed that non-pigmented mycobacteria other than Mycobacterium tuberculosis can be screened with about 99% reliability, most of them within 24 hours . Unnecessary drug susceptibility testing of mycobacteria other than tubercle bacilli can be avoided at an early stage, thus shortening the average reporting time of the Mycobacterium tuberculosis complex to nine days following the receipt of the cultures . Ways of limiting erroneous reporting are discussed.

Med Trop (Mars), 1986 Apr-Jun, 46(2), 161 - 8
{Staining of Mycobacterium leprae: comparison between the Lapeyssonnie and Causse technic on the one hand and Thelep's technic on the other in the evaluation of the bacteriological index}; Baquillon G et al.; In the present review, two staining techniques have been compared to evaluate bacteriological index: the Lapeyssonnie and Causse's technique, used in french speaking Africa, and the one recommended by the O.M.S . scientific panel on chemotherapy of leprosy, Thelep . It appears that the former facilitates the finding of a greater number of bacilli . More efficient, it is also easier and faster than the latter one and, consequently, more adapted to logistic constraints attached to the fight against endemic leprosy in Africa.

Arch Inst Pasteur Tunis, 1986 Mar, 63(1), 101 - 10
{Live oral typhoid vaccine Ty 21 a . An original method of manufacturing and distribution}; Huet M; Oral immunization against typhoid using Ty 21 a strain did not meet the anticipated success . This vaccine is too expensive for countries which actually need immunization . The suitable form of the vaccine is not yet clearly defined . Our proposal therefore is to give up freeze-drying and to use fresh suspended live bacilli . We have established that this form is stable enough (at least one week at + 4 degrees C) to allow necessary controls and good dispatch . More, the colonization of digestive tract should be easier when the vaccine is given as a liquid than as capsules with a dry content.

Tubercle, 1986 Mar, 67(1), 17 - 29
Three chemotherapy studies of tuberculous meningitis in children; Ramachandran P et al.; Chemotherapy studies were undertaken in 180 patients with tuberculous meningitis . They were treated for 12 months with 1 of 3 regimens: the first consisted of streptomycin, isoniazid and rifampicin daily for the first 2 months, followed by ethambutol plus isoniazid for 10 months; in the second, pyrazinamide was added for the first 2 months, and in the third, rifampicin was reduced to twice weekly in the first 2 months . Steroids were prescribed for all the patients in the initial weeks of treatment . Approximately 50% of the patients were aged less than 3 years . On admission, 13% of the patients were classified as stage I, 77% as stage II and 9% as stage III . Cerebrospinal fluid (CSF) culture results were available for all the 180 patients and M . tuberculosis was isolated in 59 (33%) . CSF smear results for acid fast bacilli were available only for the 103 patients admitted to the second and the third studies, and of these in 60 (58%) the CSF was positive either by smear or culture . The response to therapy was similar in the 3 studies . Despite administration of rifampicin for 2 months, the mortality was high . In all, 27% of the patients died of tuberculous meningitis, 39% had neurological sequelae and 34% recovered completely . There was a strong association between the stage on admission and the mortality rate, the deaths being highest in stage III . In the first study, when isoniazid was prescribed daily in a dosage of 20 mg/kg, 39% of the patients developed jaundice; however, when the dosage was reduced to 12 mg/kg, the incidence fell to 16% . In the third study, where rifampicin was administered twice a week, the incidence of jaundice was much lower (5%).

Int J Lepr Other Mycobact Dis, 1986 Mar, 54(1), 79 - 83
An ultrastructural study of the response of traumatized rabbit tibial nerve to epineurial infection with Mycobacterium leprae; Chandi SM et al.; Crushed rabbit tibial nerves were inoculated with a suspension of living Mycobacterium leprae at and just distal to the site of nerve trauma . The resulting changes occurring over a period of time from 40 min to 72 hr post-inoculation were studied electron microscopically . Bacilli were seen in perineurial cells and in macrophages that had infiltrated the perineurium adjacent to epineurial deposits of M . leprae . It is suggested that trauma may weaken the perineurial barrier and facilitate the transperineurial passage of phagocytes, some of which may be laden with M . leprae, and may thus be a means whereby M . leprae enter the endoneurium of peripheral nerves.

Int J Lepr Other Mycobact Dis, 1986 Mar, 54(1), 16 - 20
Relapse rates in lepromatous leprosy according to treatment regularity; Almeida JG et al.; In Gudiyatham Taluk, South India, 1008 lepromatous (LL) and borderline lepromatous (BL) patients were studied . They had previously been smear positive, had attained smear negativity, and continued on DDS monotherapy . "Relapse" was defined as the reappearance of Mycobacterium leprae in skin smears . The area is endemic for leprosy . The lower relapse rates in the first three years of smear negativity alone were associated with more-regular treatment during both past smear positivity and smear negativity . From the fourth year of smear negativity onward, only the more-regular treatment during smear negativity was associated with lower relapse rates; whereas patients with more-regular treatment during past smear positivity had no lower risk of relapse than those with less-regular treatment . The finding that regularity of treatment during smear positivity seems to have no effect on relapse rates beyond the third year of smear negativity is discussed . In a leprosy-endemic area, it is argued that beyond the first three years of smear negativity in an LL or BL patient, sources of M . leprae outside the patient may be more responsible for relapse than the patient's own bacilli.

J Med Microbiol, 1986 Mar, 21(2), 145 - 50
A collaborative evaluation of a rapid, semi-automated identification system for gram-negative bacilli: the Quantum II BID; Stevens M et al.; The recently-introduced semi-automated bacterial identification system, the Quantum II BID, is designed to identify fermentative and non-fermentative gram-negative bacilli in 4-5 h . The system was evaluated independently by the two participating laboratories . Inter-laboratory reproducibility was determined by testing 181 strains in each laboratory and found to be 97.8% . A further 893 organisms, comprising 417 fresh clinical isolates and 476 stock cultures, were then tested by the system in the two laboratories . Of the fresh clinical isolates, 95.7% yielded the same result as the comparative system used (API 20E) and 93.1% of the stock strains were assigned to their expected, previously established identity . Overall agreement between the two systems for all strains examined was 94.3% . There was no significant statistical difference between the results obtained in the two laboratories.

Clin Exp Immunol, 1986 Mar, 63(3), 517 - 25
Control of the Bcg gene of early resistance in mice to infections with BCG substrains and atypical mycobacteria; Denis M et al.; The effect of the Bcg gene on the early host response to intravenous infection with a variety of BCG substrains and some atypical mycobacteria was investigated . The numbers of live bacilli of BCG Pasteur and BCG Tice recovered from the spleens of Bcgs mice (C57BL/6, B10.A and BALB/c) at 3 weeks following infection exceeded the bacterial dose injected, whereas the number of CFU recovered from the spleens of Bcgr mice (A/J, DBA/2 and C3H/HeN) did not exceed the number of CFU injected, thus following the pattern observed in Bcgr mice and Bcgs infected with BCG Montreal . BCG Russia failed to multiply in both test groups; however, the number of CFU recovered in Bcgr mice was significantly lower than in Bcgs mice . On the other hand, the presence of live bacilli in the spleens of either Bcgr or Bcgs mice injected with BCG Japan was undetectable in most cases . Involvement of the Bcg gene in the early resistance to infection with BCG Pasteur, BCG Russia, Mycobacterium kansasii and M . intracellulare was documented by the significant differences in the kinetics of infections in mice of the C.D2 (BALB/c-Bcgr) and BALB/c (Bcgs) congenic lines . In BCG Russia, M . intracellulare and M . fortuitum infections, the phenotypic expression of the Bcg gene resulted in a more rapid elimination of the bacteria in the spleens of Bcgr when compared with Bcgs mice . On the other hand, the hepatic granuloma formation correlated with bacterial load except when C.D2 mice were infected with a small dose of BCG Pasteur or M . kansasii where extensive granulomatous hepatitis developed although no bacterial multiplication occurred in the spleen . It is suggested that granuloma formation could depend of the properties of the mycobacteria as well as the genetic background of the host without implicating the bacterial burden.

Acta Cytol, 1986 Mar-Apr, 30(2), 189 - 93
Hansen's disease (leprosy) . Diagnosis by aspiration biopsy of lymph nodes; Cavett JR 3rd et al.; A 61-year-old male native of Mexico presented with generalized enlargement of lymph nodes . Fine needle aspiration (FNA) biopsy established lepromatous leprosy as the cause of the lymphadenopathy . The cytologic findings included abundant, frequently multinucleated histiocytes (globus cells), the cytoplasm of which showed multiple vacuoles; cytoplasmic membrane-bound vacuoles were seen free in the background . The vacuoles contained large numbers of acid-fast bacilli . Globus cells, while characteristic, are not specific for Mycobacterium leprae infection and are seen in certain atypical mycobacterioses in immunodeficient patients . This appears to be the first report of lymphadenopathy due to lepromatous leprosy in which the diagnosis was made by FNA biopsy . The immunologic spectrum of leprosy is correlated with clinical and pathologic findings, and the need to remember infectious processes in evaluating lymphadenopathy and the value of reserving air-dried and alcohol-fixed smears for special stains are emphasized.

Am Rev Respir Dis, 1986 Mar, 133(3), 423 - 30
Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis; Mitchison DA et al.; The response to short-course chemotherapy of patients with pulmonary tuberculosis caused by drug-resistant Mycobacterium tuberculosis was examined in 12 controlled trials carried out during the past decade in Africa, Hong Kong, and Singapore . Among those with initial resistance to isoniazid and/or streptomycin, failures during chemotherapy were encountered in 17% of 23 patients given a 6-month regimen of isoniazid and rifampin and in 12% of 264 patients given rifampin only in an initial 2-month intensive phase of their regimen . The proportion of failures fell as the number of drugs in the regimen and the duration of treatment with rifampin were increased, to reach 2% of 246 patients receiving 4 or 5 drugs including rifampin in 6-month regimens . The sterilizing activity of the regimens, whether these included rifampin or pyrazinamide, was little influenced by initial resistance, because the sputum conversion rate at 2 months was similar to that in patients with initially sensitive bacilli, and the relapse rates after chemotherapy were only a little higher . The response in the 11 patients with initial rifampin resistance was, however, much less good, failure during chemotherapy occurring in 5 and relapse afterwards in a further 3 patients . This review demonstrates the value of rifampin in preventing failure caused by the emergence of resistance during treatment and the greater sterilizing activity of rifampin and pyrazinamide compared with that of isoniazid and streptomycin.

JAMA, 1986 Feb 21, 255(7), 916 - 20
Extended use of disposable pressure transducers . A bacteriologic evaluation; Luskin RL et al.; In a prospective randomized study, contamination rates of disposable pressure transducers changed every two days (n = 81) were compared with those changed at four (n = 26) or eight days (n = 50); the mean daily incidence of contamination was 3% for each group . After four days of use, the cumulative prevalences of contamination were similar . However, after eight days, the cumulative prevalence was significantly higher in transducers used without change (6.9%) than in those changed every two days (2.9%) . Gram-negative bacilli were present in 63% of contaminated transducers; over half were from the patients' own flora . The only definite transducer-related bacteremia occurred on a day of initial contamination and should have been unaffected by the interval of change . Routine use of disposable transducers can be safely extended to four days, even in a busy intensive care unit.

Arch Intern Med, 1986 Feb, 146(2), 394 - 6
Life-threatening cat-scratch disease in an immunocompromised host; Black JR et al.; We describe a renal allograft recipient with cat-scratch disease in whom refractory hypotension, severe metabolic acidosis, pulmonary infiltrates, and encephalopathy developed . The patient first presented with a history of cat bites and scratches, fever, headache, and arthralgias . Four weeks later, the clinical presentation of septic shock suddenly developed in the patient . Cat-scratch disease was documented clinically and by finding delicate pleomorphic bacilli in Warthin-Starry silver stains of biopsy specimens taken from the primary inoculation site and regional lymph node . The administration of intravenous sulfamethoxazole and trimethoprim, erythromycin lactobionate, and tobramycin sulfate therapy correlated with recovery . Although cat-scratch disease is usually a benign, self-limited illness, this article illustrates its systemic nature, its potential for devastating complications in the immunocompromised host, and its possible response to vigorous antibiotic therapy.

J Clin Microbiol, 1986 Feb, 23(2), 251 - 7
Critical evaluation of the AutoMicrobic system gram-negative identification card for identification of glucose-nonfermenting gram-negative rods; Plorde JJ et al.; During a 6-month study we critically evaluated the accuracy of the AutoMicrobic system Gram-Negative Identification Card (Vitek Systems, Inc., Hazelwood, Mo.) in identifying glucose-nonfermenting gram-negative bacilli by testing 419 selected isolates in parallel with a conventional reference method . Of 356 isolates included in the AutoMicrobic system profile, a total of 307 (86.2%) were correctly identified, 36 (10.1%) were not identified, and 13 (3.7%) were misidentified . Fifty-eight of 63 (92%) isolates not included in the profile were correctly reported as "unidentified organisms." Overall, if the first-choice identification was always accepted, only 18 (4.3%) isolates would have been incorrectly reported . When first-choice identifications appended with the special message "questionable biopattern" were rejected, and organisms were screened for characteristic odor and antimicrobial susceptibility before final acceptance of the AutoMicrobic system report, the number of misidentifications was reduced to 5 (1.2%) . The average time to identification with the AutoMicrobic system Gram-Negative Identification Card was 15 h . This compares favorably with the 65 h required by the reference method.

Jpn J Med Sci Biol, 1986 Feb, 39(1), 21 - 4
Melittin-stimulated antimycobacterial activity of the membrane fraction isolated from phagocytes of guinea pigs; Kondo E; Virulent tubercle bacilli were incubated in Kirchner semi-solid agar medium with the membrane fraction prepared from guinea-pig peritoneal exudate cells . A marked inhibition of mycobacterial growth was observed in the presence of added melittin which is known as an activator of membrane phospholipase A . The bactericidal activity in a buffer environment was also demonstrated by the fraction alone and that stimulated by melittin.

J Clin Microbiol, 1986 Feb, 23(2), 262 - 6
Clinical comparison of a new automated infrared blood culture system with the BACTEC 460 system; Jungkind D et al.; A new blood culture instrument, the BACTEC (Johnston Laboratories, Inc., Towson, Md.) NR-660, which utilizes infrared detection of carbon dioxide from microbial metabolism, was compared with the radiometric BACTEC 460 system . There were 1,554 isolates from 18,785 paired aerobic blood cultures . Of these isolates, 1,303 were isolated from the radiometric 6B medium, and 1,259 were isolated from the NR6A medium (P = 0.06) . Analysis of the data indicated no significant differences in recovery when any individual species was considered . When organisms were considered as groups, there were no significant detection differences for gram-negative bacilli, yeasts, or anaerobes . For gram-positive cocci in aerobic medium, the BACTEC 460 detected 84.3% of the total isolates, and the BACTEC NR-660 detected 79.7% (P = 0.04) . There were 891 isolates from 13,983 paired anaerobic blood cultures . Of these isolates, 725 were recovered from the radiometric 7D BACTEC medium, and 723 were recovered from the NR7A BACTEC medium (P greater than 0.9) . In the anaerobic media there was no significant difference in detection of any organism group, including the gram-positive cocci . When the results of the aerobic and anaerobic media were combined, there was equivalence between the two systems for the detection of gram-positive cocci (P greater than 0.2) and other organism groups . When the ability to detect septic episodes was compared, there was no significant difference for any organism group (P = 0.12) . For aerobic media, the mean times for detection were 30.5 and 29.5 h for the BACTEC 460 and NR-660, respectively . For anaerobic media, the mean times for detection were 39.8 and 41.6 h for the BACTEC 460 NR-660, respectively . Compared with the BACTEC 460, the BACTEC NR-660 system had a greater ease of operation, faster test cycle, computerized data base, and equally rapid detection of positive cultures.

Laryngol Rhinol Otol (Stuttg), 1986 Feb, 65(2), 90 - 1
{Value of microscopic detection of acid fast rods in tuberculosis of the middle ear}; Wolf G; The microscopic identification of acid-proof rod-shaped bacilli via smear is of great importance for the diagnosis of tuberculous otitis media, since it is performed quickly and easily, for it enables an early diagnosis and treatment . The importance of the staining method using auramine is discussed, and it is examined if contamination by apathogenic or atypic mycobacteriae can yield a wrong positive result.

Am J Clin Pathol, 1986 Feb, 85(2), 236 - 8
Acid-fast bacilli with cytomegalovirus and herpesvirus inclusions in the skin of an AIDS patient; Kwan TH et al.; A 66-year old acquired immunodeficiency syndrome (AIDS) patient presented with cutaneous lesions suspicious for Kaposi's sarcoma . Biopsies disclosed granulomatous infiltrates with acid-fast bacilli and cytomegalovirus inclusions within macrophages and endothelial cells in one biopsy . Herpesvirus vesicle, necrotizing folliculitis, and vasculitis were observed in a second biopsy taken concurrently . These findings emphasize the polymorphous presentation of infectious disorders in AIDS and the need for multiple biopsies and for work-up with special stains in these patients.

Gynecol Oncol, 1986 Jan, 23(1), 35 - 9
Genital aerobic bacterial flora of women receiving radiotherapy for gynecologic malignancy; Gilstrap LC 3rd et al.; In the present study, genital aerobic bacterial flora was prospectively studied in 12 women receiving radiotherapy for gynecologic malignancy . Gram-positive cocci accounted for 59% and gram-negative bacilli for 27% of the 26 cervical or vaginal isolates preradiation . A similar pattern of recovery was found during external beam, 60CO whole pelvis radiotherapy . The gram-positive cocci and gram-negative bacilli accounted for 42 and 46% of the preradiotherapy rectal isolates, respectively . There was no significant change in the pattern of rectal flora during external beam radiotherapy . Thus, results from this preliminary study would indicate that external beam radiotherapy has little or no influence on the major aerobic pathogens in either the cervix, vagina, or rectum.

Am J Clin Pathol, 1986 Jan, 85(1), 67 - 72
Pathologic findings in disseminated Mycobacterium avium-intracellulare infection . A report of 11 cases; Farhi DC et al.; The pathology of disseminated Mycobacterium avium-intracellulare (MAI) was studied in 20 specimens from 11 patients . The patients ranged from 28 to 65 years and included 8 immunosuppressed and 3 immunocompetent hosts . Specimens of lymph node (five), spleen (one), liver (four), bone (three), pulmonary tissue (three), skin (three), and an aortic aneurysm were included . All cultured specimens grew MAI, but only two-thirds of these showed acid-fast bacilli (AFB) on staining . Some tissues (liver, spleen) showed granulomas similar to those seen in tuberculosis . Other tissues (skin, bone, bronchus) showed necrotizing acute and chronic inflammation with histiocytes but no definite granulomas . Lymph nodes showed a variety of nonnecrotizing and necrotizing granulomatous lesions . In skin, bone, and some lymph nodes, MAI infection appears to be histopathologically distinguishable from tuberculosis . The cases reported here are distinct from those reported in some children and patients with the acquired immunodeficiency syndrome who have massive histiocytic infiltrates with innumerable intracellular AFB . This difference may be due to a specific defect in host response involving T-cell macrophage interaction.

Scand J Infect Dis, 1986, 18(6), 533 - 8
Post-neurosurgical and spontaneous gram-negative bacillary meningitis in adults; Mancebo J et al.; In order to evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM) we reviewed the charts of 20 adult patients with the discharge diagnosis of meningitis caused by gram-negative bacilli (bacteriologically proved) seen between 1973 and 1984 . Nine patients had post-neurosurgical (post-NS) GNBM and 11 patients spontaneous (S) GNBM; the mean age of the former was 42 +/- 16 years and of the latter 56 +/- 14 years (p less than 0.05) . The overall mortality rate was 50% (33% in the post-NS group and 64% in the S group) . The glucose levels in CSF were significantly lower in the patients who died . Patients treated with combined aminoglycoside therapy presented a lower mortality rate than those treated with intravenous aminoglycoside only (25% versus 70%) . We suggest that if aminoglycoside therapy is employed, these antibiotics must be administered both intravenously and directly into CNS.

Microbiol Immunol, 1986, 30(11), 1175 - 87
Experimental pulmonary cavity formation by mycobacterial components and synthetic adjuvants; Yamamura Y et al.; An investigation was undertaken to determine the components of mycobacteria responsible for pulmonary cavity formation in tuberculosis . Rabbits received an intrapulmonary injection through the chest wall, of mycobacterial protein, II-p, mixed with either mycobacterial lipids, synthetic adjuvants or Nocardia cell wall skeleton as adjuvant . Six weeks later, they were killed and the lung lesions were examined . Cavities and necrosis were produced by the injection of II-p mixed with cord factor, Nocardia cell wall skeleton or N-acetylmuramyl dipeptide conjugated with long-chain branched fatty acids . Cavities were not produced by either the injection of II-p together with phospholipid, N-acetylmuramyl dipeptide (MDP), MDP-derivatives having no long-chain branched fatty acid, or by the injection of individual components of the mixtures . The results suggest that in tuberculosis a mycobacterial component with a long-chain branched fatty acid such as mycolic acid plays an important role in pulmonary cavity formation by enhancing the antigenicity of mycobacterial protein and helping it induce cell-mediated immunity at the site of the lesion . Passive transfer with sera from rabbits highly sensitized with tubercle bacilli failed to enhance cavity formation in the recipient animals.

Infection, 1986, 14 Suppl 2, S138 - 42
{Hemostatic parameters influenced by imipenem/cilastatin}; Ziemen M et al.; Seven patients were treated for bacterial infections with imipenem/cilastatin . Imipenem is a new broad-spectrum beta-lactam antibiotic with antimicrobial activity against gram-positive and gram-negative bacilli . Before and during treatment parameters of blood coagulation and platelet function were studied . Blood coagulation was not influenced by the antibiotic . But there was a temporary inhibition of collagen-induced platelet aggregation during the first days of treatment . No clinical signs of enhanced spontaneous bleeding tendency were observed.

Rev Mal Respir, 1986, 3(2), 99 - 103
{Diagnostic value of the intradermal tuberculin reaction in the adult, in Zaire}; Mizerero M et al.; Tuberculin tests were carried out on 400 adults with established tuberculosis and 200 apparently healthy adults . There was no significant difference in the tuberculin reactivity amongst those tuberculous patients who were clinically in a poor state and the control group . On the other hand the former reacted less than those tuberculous patients whose general physical state was normal and the difference was significant . Overall 23.75% of the tuberculous patients had negative reactions . Women were less reactive than men . The tuberculin allergy decreased with both age and the extent of tuberculous disease . There was no significant variation in the diameter of the skin test as a function of the number of Koch's bacilli . In tuberculous lymphadenopathy we noted a stronger allergy than in tuberculous disease of other parts of the body . There is a positive correlation between the tuberculin reaction and the Serum Albumin level . Associated morbidity (eg infestations, anaemia, malaria, intestinal schistosomiasis and malnutrition) reduce the tuberculin reaction . These observations reduce the diagnostic value of the intra-dermal tuberculin reaction in our environment.

Rev Mal Respir, 1986, 3(2), 73 - 85
{Results of a therapeutic trial comparing a 6-month regimen to a 12-month regimen in the treatment of pulmonary tuberculosis in the Algerian Sahara . Final report: results 3 years after the onset of treatment}; Berkani M et al.; This study has compared a daily 6-month short-course chemotherapy regimen and a daily 12-month standard duration regimen in the treatment of smear positive pulmonary tuberculosis in a rural area of Algeria where the population contains a relatively high proportion of nomads . The 6-month regimen (6M) was isoniazid and rifampicin throughout with ethambutol and pyrazinamide in addition for the first 2 months, and the 12-month regimen (12M) was isoniazid and ethambutol supplemented by streptomycin during the first month . All the 601 patients admitted had one or more sputum smears positive on examination in the local laboratory and 70% had a positive culture in the reference laboratory in Algiers . Most patients were admitted to hospital initially for one or two months where chemotherapy was fully supervised and subsequently it was self-administered . In both nomads and settled residents known to have fully sensitive strains of tubercle bacilli pretreatment the 6-month regimen was highly effective with no failures during chemotherapy and only 3% relapses after stopping chemotherapy in 126 patients compared with a combined failure rate during chemotherapy and relapse rate of 21% in the 152 patients receiving the 12-month regimen (P less than 0.001) . The results in patients with isoniazid-resistant strains pretreatment were also significantly better for the 6-month than for the 12-month regimen, one of 15 and 8 of 17 patients respectively being classified as failures or relapses (P = 0.03) . To assess the results which might be achieved by these regimens under programme conditions the outcome at 3 years was also assessed in all patients admitted to the study irrespective of whether the disease was confirmed in the reference laboratory or at independent assessment and whether or not the allocated chemotherapy was modified or further courses of chemotherapy were given . At 3 years, 82% of the 6M and 80% of the 299 12M patients had achieved a favourable status and only one 6M patient and 4 12M patients were still known to have active disease with a positive culture . A further 23 6M and 22 12M patients were known to have died, 11 in each series probably or definitely from tuberculosis . The remaining 28 6M and 34 12M patients were lost from follow-up, but 24 and 22 respectively had completed their allocated chemotherapy before defaulting . It was estimated that, overall, 272 (94%) of the 6M and 263 (91%) of the 12M patients had a favourable status at 3 years.(ABSTRACT TRUNCATED AT 400 WORDS)

Ann Fr Anesth Reanim, 1986, 5(1), 83 - 4
{Septicemia following maxillary sinusitis: a rare complication of nasotracheal intubation}; Riou B et al.; A case of septicaemia due to gram-negative bacilli secondary to maxillary sinusitis occurring is reported in a patient intubated through the nose . The search of a purulent nasal discharge and the portable X-ray film were important in establishing the diagnosis . Removing the tube and antibiotics usually give a prompt recovery.

Jpn J Antibiot, 1986 Jan, 39(1), 121 - 6
In vitro susceptibility of Pseudomonas maltophilia to antimicrobial agents; Igari J et al.; Reports on the isolation and pathogenicity of some species of Gram-negative and glucose-nonfermentative bacilli have appeared in the literature since 1962 . The infections caused by those organisms have become important problems as an opportunistic infection in immunosuppressed patients . Pseudomonas maltophilia is a glucose-nonfermentative aerobic Gram-negative rod widely dispersed in nature . The role of Pseudomonas maltophilia as an opportunistic pathogen is not thoroughly established, but a few papers on clinical infections associated with P . maltophilia have been published . P . maltophilia is considerably less susceptible to certain of the most commonly-used antibiotics . We have reviewed the susceptibilities of P . maltophilia to antimicrobial agents currently available and yearly changes of the strains in resistance to the antibiotics that have been extensively used.

Dev Biol Stand, 1986, 58 ( Pt B), 689 - 94
Potency testing of bovine tuberculins; Haagsma J; The diagnosis of bovine tuberculosis is based on the intradermal tuberculin test . Therefore in eradication campaigns HCSM or PPD tuberculins with high potency and maximal specificity per cattle dose are needed . In quality control and standardization assays the PPD tuberculins have the advantage that the protein content can serve as a basis for calculating the degree of dilution to be used for batches of the concentrated tuberculin, but this chemical estimation does not measure the biological activity of the tuberculo-proteins . Potency control of tuberculins necessitates a bio-assay method, which according to WHO report 384 should be performed under the conditions and in the animal species in which the tuberculin will be used in practice . This potency testing is performed in M . bovis sensitized cattle and guinea pigs, but the bio-assays in both species encounter several problems which must be overcome in order to obtain reliable and consistent results . At the C.V.I . numerous bio-assays have been carried out with various tuberculins and it is the aim of this report to demonstrate that so far the best correlation was obtained between tuberculous cattle and guinea pigs infected with a minimal dose of live M . bovis bacilli, whilst the results with heat killed M . bovis or BCG sensitized guinea pigs were evidently less reliable.

Infection, 1986, 14 Suppl 3, S217 - 8
{Results of treatment of bacterial inflammation of the skin with enoxacin}; Mensing H; In a microbiologically controlled, open study the 4-quinolone derivative enoxacin was tested in 51 patients suffering from infectious dermatoses . Clinical cure or improvement was observed in 91% of the patients, microbiological cure occurred in 65% . According to the results of our trial enoxacin is recommended as a therapeutic alternative, especially for the treatment of dermatitis caused by gram-negative bacilli.

Drugs Exp Clin Res, 1986, 12(8), 653 - 6
Penicillin-binding proteins of filaments of Escherichia coli induced by low concentrations of nalidixic acid, oxolinic acid, novobiocin or nitrofurantoin; Amaral L et al.; Nalidixic acid, novobiocin, oxolinic acid and nitrofurantoin, each at low concentrations, cause filamentation of Gram-negative bacilli . Filamentation induced by beta-lactam antibiotics has been correlated to the binding of these antibiotics to specific penicillin-binding proteins (PBPs) of the envelope of Gram-negative bacilli . The studies reported herein indicate that the former group of non-beta-lactam antibiotics do not bind to any of the PBPs of Escherichia coli . However, PBP 1a, PBP 4 and PBP 5/6 of the filaments induced by these agents are increased significantly.

Antimicrob Agents Chemother, 1986 Jan, 29(1), 112 - 5
Randomized evaluation of ceftazidime or ticarcillin and tobramycin for the treatment of osteomyelitis caused by gram-negative bacilli; Sheftel TG et al.; Ceftazidime, a new cephalosporin with enhanced activity against aerobic gram-negative bacilli, was compared with tobramycin and ticarcillin in a randomized clinical trial . Efficacy and safety were evaluated in 18 patients (17 males, 1 female) with gram-negative osteomyelitis . All organisms were susceptible to the treatment antibiotics(s) . There were nine patients treated with tobramycin and ticarcillin for 27 to 62 days (mean, 42 days), and nine patients were treated with 4 g of ceftazidime per day for 26 to 63 days (mean, 45 days) . All nine patients receiving tobramycin and ticarcillin had the osteomyelitis arrested after the initial treatment . Follow-up was for 2 to 38 months (mean, 22 months) . Of nine patients receiving ceftazidime three were initial treatment failures . Follow-up was for 13 to 31 months (mean, 21 months) . A patient receiving ceftazidime had a transient rise in serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase . There were three treatment failures in the ceftazidime group; no failures occurred in the group receiving the combination of ticarcillin and tobramycin . A larger series would be required to detect a significant difference between the two treatment groups.

Clin Pharm, 1986 Jan, 5(1), 34 - 50
Current concepts in clinical therapeutics: intra-abdominal infections; DiPiro JT et al.; The etiology, pathophysiology, clinical presentation, and treatment of the two major types of intra-abdominal infections--peritonitis and abscesses--are described . Peritonitis of infectious origin is the acute response of the peritoneum to microorganisms; it is classified as primary (when the source of bacteria is not apparent) or secondary (usually involving perforation of a hollow structure of the GI tract with subsequent release of microbes) . Peritonitis results in mortality because of fluid shifts and endotoxins that may cause hypovolemia and shock . Abscesses, purulent collections of fluid physically separated from the surrounding tissues, are the result of chronic inflammation following failure of the body to eradicate a pathogen completely . Secondary intra-abdominal infections are often polymicrobial because of the diversity of organisms in the GI tract . The size of bacterial inocula and the number and types of species present substantially affect patient outcome . The patient with peritonitis usually presents in acute distress, with generalized abdominal pain and faint bowel sounds . The presentation of the patient with intra-abdominal abscess is more variable and less dramatic; pain and fever may be present . The treatment of these infections requires the coordinated use of prompt surgical intervention, support of vital functions, and appropriate antimicrobial therapy . Surgical procedures are used to stop continuing bacterial contamination of the peritoneum, remove foreign material from the abdomen, and drain purulent collections; it is the foundation of treating most types of intra-abdominal infections . Aggressive fluid therapy is required to assure adequate intravascular volumes in most patients . Generally, antimicrobial coverage for both aerobes and anaerobes must be started before culture results are available . Antimicrobial therapy for specific types of infections is given in the article . Surgical procedures are the foundation of treatment of most intra-abdominal infections; antimicrobial agents active against aerobic gram-negative bacilli and anaerobes are important adjuncts.

Dev Biol Stand, 1986, 58 ( Pt B), 607 - 16
Laboratory assay methods for bovine tuberculin PPD (report of the Expert Group on Veterinary Sera and Vaccines of the European Pharmacopoeia Commission); Davidson I; It had been found that preparations of bovine tuberculin PPD that appeared to be similar in potency when assayed in guinea-pigs sensitized with killed tubercle bacilli could differ markedly in potency when assayed in cattle . In an attempt to define a laboratory assay method that would reflect accurately the performance of bovine tuberculin PPD in cattle, the European Pharmacopoeia Group of Experts on Veterinary Sera and Vaccines carried out a collaborative study of various methods of sensitization . Seven laboratories in 6 countries participated . The only method of sensitization that gave results corresponding to those obtained in cattle was that using living, virulent, bovine, tubercle bacilli . The Group concluded that it was essential to use this method in laboratory assays of bovine tuberculin PPD.

Dev Biol Stand, 1986, 58 ( Pt A), 79 - 94
Some effects of nutritional components on the morphology of BCG colonies; Osborn TW; Under appropriate conditions of growth colonies showing fine wrinkling (rugosity) of their surface and characteristic of certain BCG strains can be distinguished from colonies with a smoother non-rugose morphology that are characteristic of some other BCG strains . This study has been concerned with the influence of nutritional and other media constituents on the evolution of these colonies . In a preliminary investigation nutritional components such as enzymic digest of casein, asparagine and salts were systematically eliminated from an agar medium, separately and together, and in the presence or absence of glycerol . From this and supplementary experiments, it appeared that the nutritional element with most effect on the size and morphology of colonies is the carbohydrate . Small inocula of BCG will normally grow on simple agar media only in the presence of enrichments such as blood or albumin, or if charcoal has been added . However, in a second investigation it was found that individual colonies would develop from such inocula placed 2 cm or more away from a concentrated inoculum that had been seeded onto the medium approximately 7-14 days earlier . It appears that a diffusible agent is produced from multiplying bacilli within a colony which counteracts toxic factors in the medium and may also assist nutrition within the colony . To examine the effects of carbohydrate on the evolution of colonies, in a third investigation glycerol was added in increasing quantities to an agar medium enriched with increasing quantities of bovine albumin and/or 5% of blood, and suspensions of French (Pasteur) and British (Glaxo) BCG vaccines were seeded onto it . Individual colonies cultured from these two strains have a rugose and non-rugose morphology respectively, and to highlight the effects in question, the evolution over a prolonged period of concentrated 'drop-colonies' seeded onto the medium from each strain was studied . There was a very marked difference between the two strains in the evolution of such 'drop-colonies', and it appeared that the lateral spread of fine rugosity from those of the Pasteur strain represented an enhanced ability of small numbers of bacilli to take up the nutrient.

Clin Exp Immunol, 1986 Jan, 63(1), 105 - 10
Responsiveness to live M . tuberculosis, and common antigens, of sonicate-stimulated T cell lines from normal donors; Rook GA et al.; Live mycobacteria are more efficient vaccines against mycobacterial disease than killed ones . A possible explanation is the existence of important protective antigens released by live bacilli, which are not present in any significant quantity in dead ones . Conversely, internal mycobacterial antigens may be irrelevant to protection if not released by live bacilli . We show here, using T cell lines derived by limiting dilution from the peripheral blood of normal donors stimulated with sonicated BCG, that a variable percentage of sonicate responsive T cells is unable to respond to live M . tuberculosis . The possibility that such lines have an immunopathological, rather than protective role, is discussed.

Age Ageing, 1986 Jan, 15(1), 47 - 52
Significance of pharyngeal colonization with aerobic gram-negative bacilli in elderly institutionalized men; Nicolle LE et al.; The prevalence of pharyngeal colonization with aerobic Gram-negative rods was studied on three occasions during one year in 68 elderly males resident on two long-term care wards . For the three surveys, pharyngeal carriage was identified in 43%, 43%, and 37% of residents . Each resident tended to remain either colonized or noncolonized . Pharyngeal colonization was associated with resident incontinence, the development of infection, and increased mortality during the year of observation.

Can J Surg, 1986 Jan, 29(1), 41 - 2
Nosocomial gram-negative parotitis; Masters RG et al.; Nosocomial parotitis is an uncommon postoperative complication, usually affecting elderly, debilitated, dehydrated patients . The preponderance of gram-positive pathogens has been emphasized . The authors present two cases of gram-negative parotitis and review the literature on this condition . Because the organisms producing nosocomial infection in patients receiving intensive care are commonly gram-negative bacilli, treatment should be based on the findings of Gram's staining of the pus obtained from Stensen's duct, altered when necessary by the final culture results.

J Hosp Infect, 1986 Jan, 7(1), 82 - 5
Should potted plants be removed from hospital wards?
Siegman-Igra Y, Shalem A, Berger SA, Livio S, Michaeli D.
Seventy-nine isolates of Gram-negative bacilli were recovered from 29 potted plants on six surgical wards . The distribution of bacterial species and antibiotic susceptibility patterns revealed no correlation with 235 isolates from nearby patients during the study period . Potted plants do not appear to constitute a bacteriological hazard in the hospital.

Gastroenterology, 1985 Dec, 89(6), 1374 - 86
Cup cells: further structural characterization of the brush border and the suggestion that they may serve as an attachment site for an unidentified bacillus in guinea pig ileum; Madara JL et al.; We recognized a low incidence, spontaneously occurring colonization of guinea pig ilea by an unidentified strain of gram-negative bacteria . By thick section, bacteria were associated with 28% of cup cells but with only 0.4% of absorptive cells . Additionally, noncolonized guinea pig ileum was subsequently studied by a variety of morphologic techniques to further define the normal functional anatomy of cup cells . Cup cells have glycocalyces that are more extensive than those of absorptive cells . As judged by ruthenium red staining, cup cells are comparable to absorptive cells in the density of glycocalyceal anionic sites; thus cup cells would not be expected to bind negatively charged plasma membranes (like those of bacteria) simply on the basis of having diminished negative charge of the glycocalyx . Sequential studies of ileal loops exposed to cationized ferritin suggest cup cell microvilli are able to internalize small quantities of membrane-bound molecules but, like absorptive cells, transport these substances to lysosomelike compartments . Finally, we show that cup cells, unlike absorptive cells, readily display morphologically detectable cholesterol on their microvillus membranes, even though it is likely that cup cell microvillus membranes are highly stabilized by underlying cytoskeleton as are those of absorptive cells, which label poorly for morphologically detectable cholesterol . These studies further define cup cell structure and suggest that these cells may represent preferential sites for attachment of at least some strains of bacilli.

J Trop Med Hyg, 1985 Dec, 88(6), 367 - 72
Nocardiosis in pulmonary diseases in parts of Nigeria . I . Preliminary observations on five cases; Osoagbaka OU et al.; One hundred specimens of purulent of mucopurulent sputum form patients clinically known to be suffering from a variety of broncho-pulmonary diseases including chronic bronchitis, bronchiectasis, lobar pneumonia, bronchopneumonia and pulmonary tuberculosis, were examined macroscopically, microscopically and by cultures to establish the aetiology of the infections . In the process, five cases of nocardiosis due to Nocardia asteroides were detected . This organism was isolated from purulent sputa in which pulmonary tuberculosis an bronchitis were suspected, but from which no acid-fast bacilli (AFB) were detected by the Ziehl-Neelsen's carbol-fuchsin (Z.N.) technique . All the isolates were from the 40-70 years age group among the 24 specimens examined from the Imo State of Nigeria, giving a high incidence of 19% for the State and an overall incidence of 5% in the whole study . This implies that pulmonary nocardiosis is not an uncommon disease in Nigeria . The need for more attention to nocardiosis in the differential diagnosis of lower respiratory tract infections in Nigeria is indicated.

J Gen Microbiol, 1985 Dec, 131 ( Pt 12), 3331 - 7
Measurement of ATP generation and decay in Mycobacterium leprae in vitro; Lee YN et al.; The intracellular ATP content of Mycobacterium leprae isolated from armadillo tissue was approximately 1.5 X 10(-16) g per bacillus . During in vitro incubation of bacilli at 4 degrees C, 33 degrees C or 37 degrees C there was an exponential decrease in ATP content, the rate depending on the medium and the temperature . M . leprae incorporated phosphate into ATP and into other nucleotide materials during in vitro incubation.

Int J Lepr Other Mycobact Dis, 1985 Dec, 53(4), 595 - 9
Experimental reproduction of leprosy in seven-banded armadillos (Dasypus hybridus); Balina LM et al.; Four autochthonous seven-banded armadillos (Dasypus hybridus) from Argentina which developed disseminated leprosy are reported . The average time from inoculation to death was 14.6 months . Acid-fast bacilli (AFB) were found in the skin, nerves, spleen, lymph nodes, lungs, meninges, and striated muscle . Several tests were used to prove that the AFB found in the infected animals were Mycobacterium leprae: a) failure to grow in standard culture media for mycobacteria, b) extraction of acid-fastness with the pyridine test, c) patterns of growth in the mouse foot pad, and d) histopathologic features.

Int J Lepr Other Mycobact Dis, 1985 Dec, 53(4), 577 - 81
Electron microscopic observations of acid-fast bacilli in nasal mucosal biopsies of lepromatous leprosy patients; Hirata T; The fine structure of acid-fast bacilli in nasal mucosal lepromas of lepromatous leprosy patients was studied in ultrathin sections by the electron microscope . The cell envelope of the bacilli was the main point of these observations . The electron microscopic examination of some of the bacilli revealed the envelope to be multilaminate . Some of the cellular matter was filled with an electron-less-dense, amorphous substance, surrounded with a membrane-like structure, and was adherent to the outermost layer of the bacillary cell envelope.

Int J Lepr Other Mycobact Dis, 1985 Dec, 53(4), 600 - 9
Respiration in Mycobacterium leprae; Mori T et al.; Fairly pure leprosy bacilli were easily collected from nude mouse foot pad lepromas by the Ficoll density gradient centrifugation and alkali treatment methods . The yield of bacilli available for biochemical study was 42.6% . The density of Mycobacterium leprae was very heterogeneous . The percent of solid bacilli in the light bacilli fraction was 23%; that in the heavy bacilli fraction was 40% . The endogenous respiration activity in the heavy bacilli was greater than that in light bacilli . The average coefficient of respiration in M . leprae was 1 microliter O2/mg X hr . In the whole cells of M . leprae, a cytochrome b1 absorption peak and its Soret peak were detected at wavelengths of 560 nm and 426 nm, respectively . However, a cytochrome a2-like peak (which was observed in M . lepraemurium), and a cyt c and cyt a were not detected . Catalase activity was not found in whole cells, the cell-free extract, or particle fractions of M . leprae . Any catalase activity associated with M . leprae suspensions is a tissue contaminant . NAD-peroxidase activity was also not detected in the cell-free extract of the leprosy bacillus . These results would indicate that leprosy bacilli cannot degrade hydrogen peroxide.

Zh Mikrobiol Epidemiol Immunobiol, 1985 Dec, (12), 42 - 5
{Epidemiological analysis of the morbidity from suppurative-septic infections in a trauma center and orthopedic hospital}; Iafaev RKh et al.; Organizational measures, surgical techniques and surgical activity have proved to affect the morbidity rate of suppurative septic infections . Gram-negative bacilli have been shown to cause suppurative septic infections mostly as the result of superinfection.

Lancet, 1985 Nov 23, 2(8465), 1168 - 72
Megaloblastic anaemia in a vegetarian Hindu community; Chanarin I et al.; 138 Indian patients with megaloblastic haemopoiesis were studied . All were lifelong vegetarians . The diagnosis was nutritional cobalamin deficiency in 95 and pernicious anaemia in 20; only 4 patients had folate deficiency . A third had intestinal malabsorption, 20 had features of osteomalacia, and 87 were iron deficient . Tuberculosis was diagnosed in 17 . Cobalamin deficiency may have contributed to these complications via intestinal malabsorption and impaired bacterial killing of phagocytosed bacilli by cobalamin-deficient macrophages . The frequency of pernicious anaemia was the same in Indian subjects as in Caucasians.

Jpn J Antibiot, 1985 Nov, 38(11), 3087 - 96
{Chemotherapy in biliary tract infections (XXX) . Special reference to the concentration of micronomicin in human gallbladder tissues and bile}; Tanimura H et al.; In this study, 120 mg of micronomicin (MCR) was given to 15 cases intended for cholecystectomy intramuscularly by a single injection or 5 consecutive injections (in the evening of day -2, morning and evening of day -1, morning of day 0, and 1 hour before operation) or intravenously by 1-hour drip infusion, and levels of MCR in serum, B bile and gallbladder tissues were determined by means of HPLC and bioassay . The serum level of MCR 30 minutes after consecutive injections (8 cases) was 11.86 +/- 1.90 micrograms/ml, significantly higher than that after the single injection, 7.08 +/- 0.93 micrograms/ml . The highest bile level of MCR after consecutive injections was 10.0 micrograms/ml . The average level in 4 detectable cases, 6.33 +/- 2.06 micrograms/ml, came up to 50% of the serum level and was higher than that after the single injection, 3.53 +/- 1.39 micrograms/ml . The gallbladder tissue level of MCR after consecutive injections was 4.5 micrograms/g at the highest and 2.51 +/- 0.73 micrograms/g on the average in 5 detectable cases . This was equivalent to 20% of the serum level and higher than that after the single injection, 1.63 +/- 0.26 micrograms/g . The MIC of MCR could be determined against 8 of 10 strains detected in B bile . Against E . coli and K . pneumoniae, main causal bacteria of bile duct infections, it was as low as 0.39 to 0.78 micrograms/ml . Levels of MCR in bile and gallbladder tissues determined in this study exceeded by far the above MIC . From these results, it can be expected that clinical administration of MCR at 2 doses of 120 mg daily for 3 days or more will give rise to a sufficiently antibacterial effect against Gram-negative bacilli.

J Gen Microbiol, 1985 Nov, 131 ( Pt 11), 3131 - 4
Pseudospirochaetes in peritoneal exudates of mice injected with Bacillus aneurinolyticus; Konishi H et al.; Bodies initially thought to be spirochaetes were observed in the ascites of mice injected intraperitoneally with Bacillus aneurinolyticus (KA bacillus) . Electron microscopy revealed that these bodies were in fact 'pseudospirochaetes' originating from the flagellar bundles of the bacilli.

Ophthalmology, 1985 Nov, 92(11), 1624 - 7
Tuberculosis of the orbit; Khalil M et al.; Two cases of orbital tuberculosis in white Canadians are reported . The two patients did not suffer from pulmonary tuberculosis, the orbital disease was associated with tuberculosis sinusitis in the first case and blood-borne from constrictive tuberculous pericarditis in the second case . Acid-fast bacilli are difficult to detect in the pathological specimens and the diagnosis is usually based on the following: (1) the positive tuberculin skin test; (2) the caseating granulomatous inflammatory lesion on histopathology, which is highly suggestive of active tuberculosis; (3) the positive culture for Mycobacterium tuberculosis if the specimens are obtained early in the course of the disease; and (4) the complete resolution of the disease with the specific antituberculous medications.

Am J Surg, 1985 Nov, 150(5), 620 - 4
Tuberculosis of the breast: rare but still extant . Review of the literature and report of an additional case; Hale JA et al.; Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess . Mammography also suggests carcinoma in most instances . However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm . The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected . In the past, mastectomy was the usual treatment . Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue . The prognosis for complete cure is excellent . One case of secondary tuberculous mastitis has been reported herein . The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17 . She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus . The patient was cured of her disease after appropriate operation and a course of antituberculous drugs . This has been the only documented case of mammary tuberculosis at our institution . Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.

J Laryngol Otol, 1985 Nov, 99(11), 1119 - 25
Tuberculous laryngitis--a one year harvest; Gertler R et al.; We present nine patients with tuberculous laryngitis seen in our otolaryngology out-patient department during the year of 1983 . Four patients were previously diagnosed as having pulmonary tuberculosis and were receiving or had received treatment for the complaint prior to our consultation . Of the nine patients, eight had positive chest X-rays for pulmonary tuberculosis . Three patients were known to have positive sputum results; in three patients the result was not known, whilst in the remaining three patients the result was recorded as negative . Biopsies done on four patients were compatible with the diagnosis of tuberculous laryngitis . Two of these four were undisputedly confirmed by the presence of Acid-fast Bacilli on histological sections . Two patients demonstrated permanent structural derangement of the larynx as end-result manifestations . The incidence, site and appearance of the lesions, diagnosis and treatment are discussed.

J Bacteriol, 1985 Nov, 164(2), 911 - 3
Identity of the quinone in Bacillus alcalophilus; Meganathan R et al.; Every Bacillus species so far examined contains menaquinone as the sole quinone . In contrast, the alkalophilic Bacillus alcalophilus has been reported to be unusual in containing ubiquinone rather than menaquinone . In this communication, we demonstrate that B . alcalophilus, like all the other bacilli, contains menaquinone as the only quinone.

Infect Immun, 1985 Nov, 50(2), 555 - 9
Mycobacterium bovis BCG vaccine fails to protect protein-deficient guinea pigs against respiratory challenge with virulent Mycobacterium tuberculosis; McMurray DN et al.; Specific-pathogen-free Hartley guinea pigs were maintained on isocaloric-purified diets either adequate (30%) or moderately deficient (10%) in protein . Half of each diet group was vaccinated with viable Mycobacterium bovis BCG . Six weeks later, all animals were challenged by the respiratory route with virulent Mycobacterium tuberculosis H37Rv . At intervals of 1, 2, and 3 weeks postchallenge, guinea pigs from each diet and vaccination group were skin tested with tuberculin and sacrificed . Protein deficiency resulted in loss of tuberculin hypersensitivity . Vaccination with M . bovis BCG protected control animals, as determined by significant reductions in the number of M . tuberculosis H37Rv organisms recovered from lungs, spleen, and bronchotracheal lymph nodes 2 and 3 weeks postchallenge . Based upon the same criteria, the degree of protection afforded protein-deficient animals by M . bovis BCG vaccine ranged from partial (spleen and lymph nodes) to none at all (lungs) . Approximately the same numbers of tubercle bacilli were recovered from nonvaccinated guinea pigs in both diet groups . Protein deficiency appears to impair M . bovis BCG-induced immunity while not affecting primary pulmonary infection with virulent M . tuberculosis.

Am J Trop Med Hyg, 1985 Nov, 34(6), 1161 - 6
Transmission of leprosy in nude mice; Chehl S et al.; Nude mice in groups of 10 were exposed to M . leprae by subcutaneous injection and topically through the nose, lungs, mouth, stomach and skin, broken and unbroken . Animals injected subcutaneously and those topically exposed to M . leprae through the nose developed localized disease which in the course of time became generalized . The nose seems to be the site of entry of M . leprae in this model . To the extent that these results can be generalized to humans exposed to M . leprae, it would seem that leprosy bacilli impact topically on the nasal mucosa or are inoculated subcutaneously.

Rev Infect Dis, 1985 Nov-Dec, 7 Suppl 4, S675 - 8
Summary of worldwide clinical trials of aztreonam in patients with lower respiratory tract infections; Swabb EA et al.; Aztreonam was administered to 226 patients with lower respiratory tract infections--primarily pneumonia (181 patients)--due to gram-negative bacilli . The clinical response rate was 93%, and the microbiologic cure rate was 78% . Most patients received 1-g or 2-g intravenous doses of aztreonam three times daily for at least five days . Ninety-eight of the 226 patients were involved in a randomized comparison of aztreonam with tobramycin; the latter drug was administered to a group of 34 patients . The overall microbiologic cure rates for the two drugs were 86% and 71%, respectively . Aztreonam is effective for the treatment of lower respiratory tract infections due to susceptible gram-negative bacilli.

Rev Infect Dis, 1985 Nov-Dec, 7 Suppl 4, S559 - 71
Management of infections caused by gram-negative bacilli: the role of antimicrobial combinations; Allan JD et al.; Treatment with antimicrobial combinations is generally used to provide broad-spectrum coverage and/or to enhance antimicrobial activity (synergism) . Extensive in vitro documentation of synergism exists for many such combinations, but an obvious benefit has been difficult to demonstrate clinically . Several types of therapeutically useful combinations often result in synergism; these combinations include a cell wall-active agent with an aminoglycosidic aminocyclitol, a beta-lactamase inhibitor with a beta-lactam antibiotic, and agents that inhibit sequential steps in a metabolic pathway . Combinations of beta-lactam antibiotics may be synergistic by means of several mechanisms, but such combinations have significant potential for antagonism when used against gram-negative bacilli and, thus, must be evaluated closely before clinical use.

Rev Infect Dis, 1985 Nov-Dec, 7 Suppl 4, S552 - 8
Nosocomial infections due to gram-negative bacilli in compromised hosts: considerations for prevention and therapy; Klastersky J; Compromised patients are predisposed to the acquisition of the more resistant gram-negative bacilli from the hospital environment . In compromised hosts, infection due to gram-negative bacilli is almost always nosocomial, a result of the severity of the underlying disease and of frequent and/or prolonged hospitalization . At present, only careful handwashing by hospital personnel and diets with low microbial content for patients can minimize colonization in hospitalized compromised patients . The level of colonization by gram-negative bacilli can also be reduced by administering effective antibiotics to the oropharyngeal area by aerosol or orally.

Rev Infect Dis, 1985 Nov-Dec, 7 Suppl 4, S545 - 51
Problems and changing patterns of resistance with gram-negative bacteria; Acar JF; Throughout the antibiotic era, the emergence of drug-resistant bacteria has paralleled the development of new antimicrobial agents . As a result of selection pressures and invasive techniques that prolong the lives of seriously ill hospital patients, gram-negative bacilli have become the dominant causes of nosocomial infection . These microorganisms produce a diversity of antibiotic-inactivating enzymes . Moreover, the cell envelope of gram-negative bacteria provides a series of barriers that keep antibiotics from reaching their targets . Resistance factors can be transmitted among bacteria of different genera and species, thus conferring multidrug resistance . These problems continue to challenge scientists to better understand resistance mechanisms and to develop new compounds to circumvent them.

Thorax, 1985 Nov, 40(11), 846 - 8
Prevention of fever and gram negative infection after open heart surgery by antiendotoxin; Freeman R et al.; Naturally occurring preoperative antibody to enteric Gram negative bacilli (Escherichia coli agglutinins or antiendotoxin, or both) in 30 patients who had had open heart surgery was associated with a significantly lower incidence of early postoperative fever and postoperative Gram negative infection than occurred in 56 patients without preoperative antibodies . The protective effect was shown to be associated with antiendotoxin rather than antibody to the somatic antigen of the bacteria . Active or passive immunisation of patients having open heart surgery against endotoxin is likely to decrease significantly the morbidity after cardiopulmonary bypass.

Acta Cytol, 1985 Nov-Dec, 29(6), 974 - 8
Cytomorphology of tuberculous mastitis . A report of nine cases with fine needle aspiration cytology; Jayaram G; Nine cases of tuberculosis of the breast were diagnosed by fine needle aspiration (FNA) cytology over a six-month period . All cases presented with a breast lump, three of which clinically simulated carcinoma . FNA cytology showed a picture of suppurating granulomatous mastitis; the diagnosis of tuberculosis was established after the demonstration of acid-fast bacilli in the aspirated material.

Am Rev Respir Dis . 1985 Oct;132(4):915.
Antituberculosis activity of ofloxacin (DL 8280) on experimental tuberculosis in mice; Tsukamura M; Ofloxacin (DL 8280) is rapidly eliminated from mouse organs . It disappears quickly from the lungs and the spleen and more slowly from the liver and the kidneys . The antituberculosis activity of this agent was shown in mice when the agent was given intraperitoneally at daily doses of 1 mg per mouse (approximately 42 mg/kg) . The number of viable bacteria of Mycobacterium tuberculosis strain H37Rv contained in the liver decreased markedly in the mice treated with ofloxacin, and the inhibitory effect of the agent seemed to appear when the tubercle bacilli actively multiplied.

Am Rev Respir Dis, 1985 Oct, 132(4), 742 - 5
The effect of ethambutol on tubercle bacilli within cultured human macrophages; Crowle AJ et al.; Ethambutol (EMB) generally is believed to be clinically mycobacteriostatic . This concept was reexamined in an in vitro model of human tuberculosis that has direct relevance to in vivo effects in human subjects . Cultured human monocyte-derived macrophages infected with virulent Erdman tubercle bacilli were treated with EMB, and the resulting antimycobacterial consequences were measured by counts of acid-fast bacilli and bacterial colony-forming units . When added immediately after infection of the macrophages, EMB inhibited and killed tubercle bacilli within the cells at the same concentrations as it did in bacteriologic culture medium . When added 2 days after infection, it first appeared to increase the viable bacillary count above control culture levels, then killed intramacrophage bacilli at lower concentrations than in bacteriologic culture medium . We speculate that this occurs because macrophages enhance EMB effectiveness by killing tubercle bacilli, which have defective cell walls due to the effects of the drug . The concentrations of EMB that proved mycobactericidal in human macrophages are readily achieved clinically . The purported lesser antituberculosis effectiveness of EMB when compared to other bactericidal agents may be due to its less direct and efficient mode of killing tubercle bacilli, and the necessity therefore, for stricter maintenance of effective drug concentrations in vivo.

Infect Immun, 1985 Oct, 50(1), 1 - 8
Gamma interferon activates human macrophages to become tumoricidal and leishmanicidal but enhances replication of macrophage-associated mycobacteria; Douvas GS et al.; Recombinant human gamma interferon (rIFN-gamma) was examined for its ability to activate human peripheral blood monocyte-derived macrophages to kill tumor cells and to affect the replication of two phylogenetically distinct intracellular pathogens, Mycobacterium tuberculosis and Leishmania donovani . Macrophages preincubated overnight with doses of rIFN-gamma from 5 to 500 U/ml killed {3H}thymidine-labeled mouse L929 tumor targets, as measured by the release of {3H}thymidine into the supernatant after 48 h . Counts of macrophages initially infected with leishmania promastigotes showed that rIFN-gamma-pretreated macrophages could both inhibit the replication of and kill the resulting intramacrophage amastigotes over a 7-day period . However, rIFN-gamma pretreatment of macrophages actually enhanced mycobacterial replication over a 5- to 7-day period, as assessed by (i) counting acid-fast bacilli or (ii) lysing macrophages to release bacteria and determining the numbers of viable units . Mycobacterial growth was not affected by rIFN-gamma in the absence of macrophages . rIFN-gamma pretreatment had opposite effects on the uptake of mycobacteria and leishmania . As many as 80% fewer activated macrophages ingested mycobacteria compared with controls, whereas 50% more activated macrophages were infected with leishmania . These results suggest that rIFN-gamma may interfere with the immune destruction of intracellular tubercle bacilli and that the mechanisms of immunity against mycobacteria and leishmania may differ.

Aust N Z J Med, 1985 Oct, 15(5), 585 - 9
Microbial contamination of domiciliary nebuliser therapy equipment; Jones PD et al.; Fifty-two outpatients requiring domiciliary nebulised bronchodilator therapy were studied to determine the frequency and degree of contamination of nebuliser solutions and equipment . In 32 of the 52 patients (61%) nebuliser solutions and/or aerosols were contaminated . The degree of contamination was greater than that of ambient air in 90% of the contaminated aerosols . Diluent solutions were more frequently contaminated than salbutamol solutions (51% vs . 9%) and the organisms isolated from the solutions frequently correlated with those in aerosols . Gram-negative bacilli, particularly Pseudomonas species, were the most frequently isolated organisms.

Biosci Rep, 1985 Oct-Nov, 5(10-11), 839 - 45
Genes for the protein antigens of the tuberculosis and leprosy bacilli; Bloom BR et al.; The lambda gt 11 expression vector permitted us to survey protein antigens of Mycobacterium leprae and Mycobacterium tuberculosis expressed in Escherichia coli . Using monoclonal antibodies, recombinant clones were detected producing three major antigens of M . tuberculosis and five major protein antigens of M . leprae . These recombinant antigens produced in E . coli should prove useful for diagnosis, epidemiology and possibly the development of recombinant mycobacterial vaccines.

CMAJ, 1985 Sep 15, 133(6), 573 - 6
Isolation and geographic distribution of Mycobacterium other than M . tuberculosis in British Columbia, 1972-81; Isaac-Renton JL et al.; It has been suggested that the incidence of infection with mycobacteria other than typical tubercle (MOTT) bacilli is increasing . Laboratory and epidemiologic information relating to MOTT infection in British Columbia between 1972 and 1981 was analysed . Patient records for 1960-81 were also analysed . Of the 313 661 laboratory specimens 13 474 yielded Mycobacterium tuberculosis isolates and 3172, MOTT isolates . Over the 10 years the number of M . tuberculosis isolates declined, whereas the absolute and relative numbers of MOTT isolates increased . Members of the highly drug-resistant MAIS complex (M . avium-intracellulare, M . scrofulaceum and M . simiae) accounted for 73.3% of the 1778 potentially pathogenic MOTT isolates . MAIS isolation rates varied geographically . Analysis of patient records revealed 217 MOTT infections, of which 152 (70%) were due to MAIS organisms . Further studies are needed to determine the source of MAIS organisms in order that the infection and the disease may be more clearly understood.

No Shinkei Geka, 1985 Sep, 13(9), 1007 - 11
{A case report of intracerebral tuberculoma during antituberculous therapy}; Yamamoto N et al.; A case of multiple intracerebral tuberculoma occurred in the course of anti-tuberculous therapy is reported . A 16-year-old high school boy had been treated with isoniagid, streptomycin and paramino-salicylic acid on the tuberculous pleulitis for 3 months previously . He was admitted to our hospital because of progressive headache associated with vomiting . Neurological examination revealed bilateral full papilledema and incomplete bilateral abducens palsy . An immediate CT study with contrast enhancement demonstrated two small ring-like mass with considerable perifocal edema in the left temporal and occipital lobe, respectively . Intracerebral tuberculoma was considered to be most likely, so the patient was given antituberculous therapy with steroid and mannitol . However, despite of medical decompression, he developed intracranial hypertension aggravated, leading to removal of tumor 7 days after admission . Initially left temporal tuberculoma, which had more extensive and prominent perifocal edema, was successfully excised . The specimen was a walnut-sized granuloma with hard capsule including pus inside . Numerous tuberculous bacilli were identified with Ziel-Nielsen staining technique from the pus . Postoperative course was gratifying, and other tumor in the left occipital lobe, which was also diagnosed as tuberculoma, was treated with continuing administration of isoniagid, ethanbutol and rifampicin . However, the former two drugs were forced to be discontinued because of agranulocytosis . Only rifampicin was maintained for 2 months thereafter but no decrease of the size was observed in serial CT studies . Then left occipital tuberculoma was removed . The pathology was tuberculoma with positive bacilli staining . He discharged 1 month later without any neurological deficit but was on antituberculous therapy (rifampisin) as an outpatient for 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmology, 1985 Sep, 92(9), 1282 - 7
Cat scratch disease bacilli in the conjunctiva of patients with Parinaud's oculoglandular syndrome; Wear DJ et al.; Unilateral conjunctivitis with regional lymphadenitis has been designated Parinaud's oculoglandular syndrome (POGS) . The cause has been attributed to various infectious agents, especially leptothrix and the unidentified agent of cat scratch disease (CSD) . In 1983-84 the cause of CSD in lymph node and skin was established as small pleomorphic gram-negative bacilli . We now report identical bacteria in the conjunctival lesions of 9 of 24 patients with POGS . This confirms the belief that the CSD bacillus is a major cause of POGS.

Chest, 1985 Sep, 88(3), 426 - 8
Chyliform (cholesterol) pleural effusion; Hillerdal G; Chyliform pleural effusions are a little known occurrence only sparingly reported in the literature . At the lung department in Uppsala, Sweden, 11 cases have been seen the last few years . Typically, the exudate develops in a long-standing pleural thickening resulting from therapeutic pneumothorax many years earlier . The exudate contains a high level of cholesterol, probably breakdown products from blood cells . It is usually sterile, and only very rarely can one find tubercle bacilli growing from it . There is a tendency toward recurrence . If the patient benefits clinically from aspiration of the fluid, decortication is indicated.

Microbiol Sci, 1985 Sep, 2(9), 278 - 82
Synthesis and secretion of extracellular enzymes by bacilli; Priest FG; Bacillus spp . possess well characterized excretion mechanisms for enzymes such as alpha-amylase and serine protease . The physiological basis of this protein excretion is reviewed and the potential for secretion of foreign proteins outlined in this review.

Int J Lepr Other Mycobact Dis, 1985 Sep, 53(3), 433 - 40
Electron microscopic observations of cell wall and cytoplasmic membrane in murine and human leprosy bacilli; Hirata T; The cell wall and the cytoplasmic membrane of Mycobacterium lepraemurium in murine lepromas and M . leprae in human skin lepromas were studied in ultrathin serial sections at the electron microscopic level . The cell wall in M . lepraemurium was composed of three layers: an innermost electron-dense layer, an intermediate electron-transparent zone, and a thin outermost electron-dense layer . The fine structure of the cell wall in M . leprae was slightly different . In general, the cytoplasmic membrane of M . lepraemurium and M . leprae seemed to have a similar structure.

Int J Lepr Other Mycobact Dis, 1985 Sep, 53(3), 378 - 84
Comparison of radiometric macrophage assay and the mouse foot pad infection for the evaluation of Mycobacterium leprae sensitivity/resistance to dapsone; Sathish M et al.; Studies were undertaken in three independent centers to compare the newer, in vitro radiometric macrophage (M phi) assay with the conventional mouse foot pad infection for the diagnosis of dapsone resistance . Results obtained on 12 bacilliferous patients showed good concordance in both assays . One strain diagnosed as sensitive in the M phi assay was found to be resistant in the mouse foot pad . Three Mycobacterium leprae strains considered to be partially resistant in the mouse infection behaved as resistant strains in the M phi cultures . Attention is drawn to a rapid in vitro method for the identification of drug-resistant bacilli in leprosy patients.

Jpn J Antibiot, 1985 Aug, 38(8), 2338 - 41
{Clinical studies of cefpiramide in obstetrics and gynecology}; Ishikawa M et al.; In vivo transfer and therapeutic efficiency of a new cephalosporin derivative, cefpiramide (CPM) have studied in perinatal and gynecologic field . The following results have been obtained . The level of CPM transferred to uterus and adnexa was higher than its MIC against majority of Gram-negative bacilli, such as E . coli . This drug as demonstrated its efficiency, in treating 3 infection cases refractory to cephalothin, ampicillin and cephalexin, out of which 1 had "excellent" and 2 had "good" results . No side effect was evidenced in any of our patients . In conclusion, this drug has satisfactory tissue transfer as well as sufficient safety and excellent efficiency in treatment of perinatal infection cases.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1985 Aug, 260(1), 81 - 7
Present position of microscopy and of culture in diagnostic mycobacteriology; Urbanczik R; The relative merits of microscopy and culture are discussed; it is attempted to review the possible reasons why microscopy is considered as unreliable in TB diagnosis, including the probably false application of Bayes' theorem . In the author's opinion, microscopy still holds a firm position in the rapid and relatively reliable detection of pulmonary TB . As for culture, it is highly questionable if "better media" could accelerate the growth rate of tubercle bacilli . Therefore, it should be attempted to introduce novel techniques which will allow to decrease considerably the mycobacterial mass needed for detection . Laboratories equipped with such devices could offer their services even on an intercontinental basis, in order to have a favourable cost-benefit ratio.

J Exp Med, 1985 Aug 1, 162(2), 401 - 12
Necrotic inflammatory reaction induced by muramyl dipeptide in guinea pigs sensitized by tubercle bacilli; Nagao S et al.; In the course of studies aimed at determining whether MDP was antigenic or not, a hitherto unreported phenomenon was noticed . Injection (a provocative injection) of muramyl dipeptide (MDP) caused severe inflammation, with hemorrhage and necrosis in the footpads of guinea pigs, where tubercle bacilli in water-oil emulsion (a preparatory injection) had been injected 3-8 wk earlier . Sometimes the reaction was accompanied by generalized and fatal shock . Several related substances were tested, and only a combination of tubercle bacilli, or MDP plus proteins as the preparatory injection, and MDP as the provocative injection was found to induce this inflammatory necrotic reaction . Development of delayed hypersensitivity to protein antigens may be important for priming, but MDP and not the protein antigens provoked the reaction . This reaction was, so far, only observed in guinea pigs . Although this reaction appears to be similar to the Shwartzman reaction, the two reactions were found to differ from each other in several important points.

Am Rev Respir Dis, 1985 Aug, 132(2), 374 - 8
Clinical trial of three 6-month regimens of chemotherapy given intermittently in the continuation phase in the treatment of pulmonary tuberculosis . Singapore Tuberculosis Service/British Medical Research Council; The microflora of chronic pleural empyema . An analysis of 89 patients; Bacteriological cultures from 89 patients with chronic pleural empyema were studied . Seventy-nine patients had positive and 10 negative culture results . Forty-eight patients had a single isolate--pyogenic cocci in 32 and Gram-negative enteric bacilli in 16--and multiple organisms were grown in 31 patients . Anaerobic organisms were recovered in 6,2% . Our negative culture rate of 11,2% may reflect failure to recover anaerobes, but could represent sterilization of the empyema by prior use of antibiotics . The results of antibiotic sensitivity tests and the pathogenicity of the organisms recovered suggest that the choice of antibiotic combinations for chronic pleural empyema requires careful consideration.

Mikrobiyol Bul, 1985 Jul, 19(3), 152 - 7
{Importance of vaccination and bacteriological studies in diphtheria epidemics}; Kanra G et al.; The Ouchterlony - Elek gel diffusion test was performed in twenty-nine patients having a positive culture result for diphtheria bacilli on Loeffler and tellurite agars in January and February, 1984 and toxin production was detected in 20 of them . Except one adult patient, the cases ranged in age 2 and 12 years . In 14 patients who have received at least one immunization with diphtheria vaccine had no complication, besides three patients without immunization in whom two received antibiotics plus antitoxin therapy had carditis and soft palate paralysis . Five patients in the non-immunized group and 6 patients in the group received at least one immunization had diphtheritic membrane . In spite of three patients with cardiac and neural complications, with early diagnosis and beginning therapy with antibiotics and antitoxin before the result of in vitro toxigenicity test, O% mortality rate was obtained.

Lab Anim, 1985 Jul, 19(3), 251 - 4
Monocontamination of germ-free mice by a fastidious unidentified anaerobe; Taylor DM; Over a period of several months, 5 germ-free mouse isolators became monocontaminated with seemingly the same fastidious, anaerobic bacilli which defied identification . The organism originated in rodent diet which had been exposed to gamma-irradiation . However, it was discovered retrospectively that the irradiation doses had not been monitored, and subsequent monitoring showed the desired dose of 5 Mrad was not achieved in some parts of the load . Although inadequate sterilization was the likely cause of contamination it was not possible to explain why only this fastidious anaerobe survived the treatment, and not other more common bacterial contaminants.

Int J Pediatr Otorhinolaryngol, 1985 Jul, 9(2), 195 - 6
Facial paralysis due to primary tuberculosis of the parotid gland; Yaniv E et al.; An 11-year-old girl presented with parotid mass and facial paralysis due to primary TB of the parotis gland . The diagnosis was made only postoperatively, by histology, and microscopic examination for acid and alcohol fast bacilli.

Oral Surg Oral Med Oral Pathol, 1985 Jul, 60(1), 41 - 2
Tuberculous fistula of cheek . Report of a case; Purohit SD et al.; A case of tuberculous fistula of the cheek is reported . The fistula was caused primarily by a carious tooth and was infected with tubercle bacilli present in the sputum of the patient, who had pulmonary tuberculosis.

Am Rev Respir Dis, 1985 Jul, 132(1), 125 - 32
Infection and disease among contacts of tuberculosis cases with drug-resistant and drug-susceptible bacilli; Snider DE Jr et al.; Three hundred ninety-eight tuberculosis patients with tubercle bacilli resistant to isoniazid and/or streptomycin were matched by age, race, sex, and geographic area to an equal number of patients with tubercle bacilli susceptible to 9 drugs, including isoniazid and streptomycin, in an effort to determine whether the risk of infection and disease among contacts of patients with resistant bacilli is different from the risk among contacts to patients with susceptible bacilli . The risk of infection among contacts of previously untreated patients was not significantly different, regardless of whether the bacilli were drug-resistant or susceptible . However, the risk of infection increased if the index patient with resistant bacilli had been previously treated . We found no evidence of a lower risk of infection among contacts exposed to bacilli resistant to the highest concentration of isoniazid tested or among contacts exposed to bacilli resistant to both isoniazid and streptomycin . There was a strong association between infection risk among contacts and the age of the index case; younger patients were more infectious . Index cases tended to infect most (or all) or few (or none) of their contacts . The investigation of contacts of patients excreting drug-resistant bacilli should be given high priority.

Infect Immun, 1985 Jul, 49(1), 244 - 9
Granuloma formation by muramyl dipeptide associated with branched fatty acids, a structure probably essential for tubercle formation by Mycobacterium tuberculosis; Emori K et al.; Muramyl dipeptide, which does not induce epithelioid granuloma when injected alone dissolved in phosphate-buffered saline, could induce extensive granulomas in guinea pigs when chemically conjugated with branched, but not linear, fatty acids . Peptidoglycan fragments of Staphylococcus epidermidis could evoke epithelioid granulomas when incorporated in a water-in-oil emulsion . These findings suggest the importance of a lipid bound to muramyl dipeptide for granuloma formation . In view of the fact that mycobacteria uniquely contain large amounts of branched fatty acids, it was proposed that the complex of muramyl dipeptide and branched fatty acids, mostly mycolic acids, is a structure in tubercle bacilli responsible for tubercle formation.

Thorax, 1985 Jul, 40(7), 538 - 41
Rises in antibody to enteric gram negative bacilli after open heart surgery: a possible mechanism for postoperative pyrexia; Freeman R et al.; Paired sera, taken before operation and 10-14 days after operation from 64 patients having open heart surgery and 10 having closed heart surgery, were examined for agglutinins to seven common serotypes of Escherichia coli . The results showed that, while 20% of both groups of patients had detectable agglutinins before operation, new antibodies appeared after operation in 69% of patients having open heart surgery compared with only 10% of those having closed heart surgery, a significant difference . Thirty six pairs of sera were also examined for the preoperative presence and postoperative development of antiendotoxin . Of 22 open heart patients shown not to possess antiendotoxin before operation, 18 showed the antibody after operation, whereas none of the eight seronegative patients acquired the antibody after closed heart surgery-again a highly significant difference . These results are consistent with the hypothesis that endotoxin and other products of enteric Gram negative bacilli circulate shortly after cardiopulmonary bypass, possibly arising directly from the gut and perhaps explaining the pyrexia seen commonly at this time.

Clin Orthop, 1985 Jul-Aug, (197), 206 - 8
Nocardia asteroides sepsis of the knee; Wilkerson RD et al.; Nocardia asteroides as an infecting agent has been an increasingly identified pathogen in humans, especially in immunosuppressed hosts . The Nocardia organisms as a cause of septic arthritis have been very unusual and in all previously reported cases have occurred in immunosuppressed patients . This is a report of two additional patients, one of whom has had no history of immunosuppression either before infection or subsequent to treatment and resolution of the infection . The second is a case of a questionably immunosuppressed patient with Nocardia asteroides septic arthritis . These cases reemphasize the importance of performing not only the most common aerobic and anaerobic bacterial cultures but also fungal and acid-fast bacilli cultures for early identification of less common organisms and for the initiation of appropriate therapy.

Infection, 1985 Jul-Aug, 13(4), 193 - 6
In vitro activity of the newer quinolones compared with the classic ones and tobramycin; Boquet Jimenez E et al.; The halogenated substitution of quinolone derivatives has given rise to a new group of substances called newer quinolones, which possess extraordinary antibacterial activity in vitro . The aim of our study was to compare the effect of the newer quinolones ciprofloxacin (CIP), norfloxacin (NOR) and enoxacin (ENO) with that of the classical ones nalidixic acid (NA), oxolinic acid (OX) and pipemidic acid (PIP) and with a widely-used aminoglycoside tobramycin (TBR) . This was tested on 2,263 strains from clinical isolations . Evaluating the effect of the least active substances as a unit, we generally found the MIC90s to be of the following order: (Formula: see text) . The remaining groups among the antibiotics studied are ordered identically, the most potent being the newer quinolones in the following order: CIP is at least four times superior to NOR, which in turn is at least twice as effective as ENO for gram-positive organisms, but only 1.2 times for gram-negative bacilli.

Hinyokika Kiyo, 1985 Jun, 31(6), 1065 - 70
{Tuberculosis of the penis: report of a case and review of the literature}; Tanikawa K et al.; Tuberculosis of the penis is a rare disease . We report a case of tuberculosis of the penis . A 51-year-old man noticed a painless induration with a central ulceration on the glans penis . He had a history of tuberculosis of cervical lymph-nodes, right epididymis and leg skin . Examination of the other parts showed no evidence of tuberculosis . Tuberculin test was strongly positive . The skin lesion of the glans was excised . The pathology was epithelioid cell granuloma with Langhans' giant cell, indicative of tuberculosis . But acid-fast bacilli were not detected in the Ziehl-Neelsen preparation of the tissue . The patient was treated with isoniazid, rifampicin and cycloserine . After the treatment for approximately 5 months, recurrence was not observed and enlargement of cervical lymphadenopathy improved . We reviewed 39 cases of tuberculosis of the penis reported in Japan during the past 14 years.

Tubercle, 1985 Jun, 66(2), 141 - 4
Pleuroscopy in the diagnosis of pleural effusion using a fiberoptic bronchoscope; Sarkar SK et al.; Forty patients with undiagnosed pleural effusions were investigated by pleuroscopy, using a fiberoptic bronchoscope . Pleural biopsies diagnostic of tuberculosis were obtained in 17 cases, and in 12 of these tubercle bacilli were cultured from the pleural fluid . Pleural biopsy at thoracoscopy is superior to the percutaneous intercostal route and for this purpose the fiberoptic bronchoscope is preferable to the rigid thoracoscope.

Tubercle, 1985 Jun, 66(2), 121 - 8
Exogenous reinfection in experimental airborne tuberculosis; Ziegler JE et al.; This study of experimental airborne tuberculosis in which guinea pigs were infected with tubercle bacilli of low and high virulence, provides no support for hypotheses suggesting that a second or third exposure to tubercle bacilli leads to an adverse effect on host response to the first infecting strain or to the reinfecting strain . The principal influence of the first infection was to protect against a subsequent infection . This protection was most evident as inhibition of the spread of bacilli from the lungs to the spleen . The first infection appeared to exert less influence on events at the site of reimplantation of organisms in the lungs.

J S Afr Vet Assoc, 1985 Jun, 56(2), 107 - 8
Suspected Tyzzer's disease in two foals; Van der Lugt JJ et al.; Tyzzer's disease was diagnosed histologically in two foals, a 4-week-old Thoroughbred cross and a 6-week-old Arabian foal . Clinically both foals were in good health prior to a short illness lasting only a few hours . The liver lesions in both foals were characterized microscopically by multiple foci of necrosis . Variable numbers of elongated slender intracytoplasmic bacilli resembling Bacillus piliformis were demonstrated within hepatocytes bordering the necrotic foci.

Int J Lepr Other Mycobact Dis, 1985 Jun, 53(2), 269 - 77
Experimental leprosy in the mangabey (Cercocebus atys): necropsy findings; Baskin GB et al.; A mangabey monkey (Cercocebus atys) was inoculated intravenously and intracutaneously with acid-fast bacilli (AFB) from a mangabey with spontaneously acquired leprosy . It developed generalized lepromatous leprosy and died 46 months after inoculation . Necropsy revealed severe lepromatous infiltrates in the skin, nasal mucosa, peripheral nerves, and testicles . Internal organs were only minimally involved . The lesions seen at necropsy were very similar to those seen in untreated cases of human lepromatous leprosy . These findings further substantiate the mangabey monkey as a suitable animal model for the study of lepromatous leprosy.

Eur J Clin Microbiol, 1985 Jun, 4(3), 262 - 7
Retrospective analysis of two hundred and twelve cases of bacteremia due to anaerobic microorganisms; Bouza E et al.; Cases of bacteremia caused by anaerobic microorganisms and occurring during a four year period in a non-selected patient group in a Spanish general hospital were analysed retrospectively . Microbiological data was collected on 212 patients and clinical data on 103 patients . Cases of anaerobic bacteremia represented 8.6% of the total number of cases of bacteremia . Of the 232 anaerobic microorganisms causing bacteremia, gram-negative bacilli were responsible in 113 cases (48.7%), gram-positive bacilli in 92 cases (39.6%), gram-positive cocci in 25 cases (10.7%), and Veillonella spp . in two cases (0.8%) . The most important clinical features were fever (64%), anemia (56%), septic shock (22%) and metastatic abscesses (21%) . Patients with anaerobic bacteremia were hospitalized for an average of 51.7 days . The overall mortality was 32% and factors associated with poor prognosis were severe underlying disease, nosocomial acquisition, presence of shock, presence of metastatic foci of infection, and absence of adequate surgical drainage . The mortality rate of patients who received adequate antimicrobial therapy was 30% and that of patients who received inadequate treatment or none was 29% . It is concluded that anaerobic bacteremia has a significant rate of morbidity and mortality and that underlying disease and surgical debridement and/or drainage have greater prognostic significance than the use of antimicrobial agents.

Am Fam Physician, 1985 Jun, 31(6), 113 - 7
Current patterns of pulmonary tuberculosis; Gottlieb LS; In the past decade, the incidence of tuberculosis morbidity has been halved . Nonetheless, an estimated 15 million Americans are infected with tubercle bacilli . Care of the tuberculous patient has moved from sanatoriums to general hospitals and homes . The declining incidence makes the diagnosis less often considered, especially since the classic signs are not always present.

Arch Intern Med, 1985 Jun, 145(6), 1053 - 6
Effect of formulary restriction of cefotaxime usage; DeVito JM et al.; Cefotaxime sodium was assigned to the open formulary for 12 months and then was placed on formulary restriction to evaluate the restriction's effect on rate of use by services and appropriateness of use . Over 18 months, 187 cases (72 before and 115 after restriction) were reviewed . The majority of use (prerestriction and postrestriction) was in the medicine, pediatrics, and surgery services . The postrestriction usage rate for the three services increased significantly . Cefotaxime was used appropriately in 85% of cases during both periods and was not used prophylactically . Appropriateness of use was independent of formulary restriction . During both periods, approximately 76% of patients received cefotaxime for pneumonia, sepsis, meningitis, or immunosuppression . Of 205 infections, gram-negative bacilli accounted for over half of the pathogens isolated . Thus, formulary restriction was ineffective in reducing the rate of cefotaxime usage and had no effect on the appropriateness of usage.

Am J Clin Pathol, 1985 Jun, 83(6), 719 - 22
The role of aspiration biopsy cytology in the diagnosis of pulmonary tuberculosis; Robicheaux G et al.; The experience at one institution concerning the diagnosis of pulmonary tuberculosis by aspiration biopsy is reviewed . Twelve cases in which acid-fast bacilli were identified in pulmonary aspiration material are reported . The cytologic findings were confirmed by microbiologic culture in nine cases . The advantages of using aspiration biopsy cytology in the diagnosis of pulmonary tuberculosis are discussed . In our experience we conclude that the use of aspiration biopsy cytology in the diagnosis of pulmonary tuberculosis is not only accurate, but also offers several advantages that are important in patient care.

Hum Pathol, 1985 Jun, 16(6), 596 - 601
Secondary amyloidosis of the gastrointestinal tract: an electron microscopic study; Shousha S et al.; Biopsy specimens of the gastric antrum, duodenum, and rectum from three patients with secondary amyloidosis were examined by electron microscopy in an attempt to determine the ultrastructural distribution of amyloid filaments and to identify any secondary changes in the covering mucosal epithelial cells . The characteristic amyloid filaments were seen in the walls of submucosal arterioles and mucosal capillaries deposited within the basal lamina surrounding the endothelial cells . Filaments were also sometimes seen within the muscularis mucosa . the overlying gastric and rectal epithelial cells appeared normal, but numerous curved bacilli were seen in close contact with the microvilli of the surface epithelial gastric cells . Duodenal columnar absorptive cells were vacuolated and contained prominent lysosomes . These changes are probably degenerative and may explain, at least in part, the development of malabsorption in some patients with intestinal amyloidosis.

Pathol Biol (Paris), 1985 Jun, 33(5 Pt 2), 586 - 90
{Blood bactericidal activity and clinical course of 168 patients having septicemia}; Vieyres C et al.; The value of serum bactericidal activity (SBA) determination for assessing the effectiveness of antibiotic therapy was evaluated in a retrospective open study in 168 cases of septicemia . Outcomes in a first group (I) of 67 patients with a SBA of at least 1/4 were compared with outcomes in a second group (II) of 101 patients with a SBA below 1/4 or non-determined . Within these groups, outcomes of 37 septicemias due to Gram negative bacilli (subgroup Ia) and 22 staphylococcal septicemias (subgroup Ib) with a SBA greater than or equal to 1/4 were compared with outcomes in 26 septicemias due to Gram negative bacilli (subgroup IIa) and 22 staphylococcal septicemias (subgroup IIb) with a SBA less than 1/4 . Statistical analysis of distribution of age, sex, underlying disease, biologic parameters and antibiotics given demonstrated no significant difference between the various groups . 56 patients (86.1%) recovered in group I, against 76 (79.1%) in group II; corresponding figures are 34 (91.1%) and 21 (84%) in subgroups Ia and IIa respectively . These differences are not significant (p greater than 0.05) . Our findings suggest that an "effective" SBA fails to correlate with favorable outcome of septicemia.

Ophthalmology, 1985 Jun, 92(6), 845 - 50
Clinicopathological correlation of a solitary choroidal tuberculoma; Lyon CE et al.; In a 34-year-old black man with pulmonary tuberculosis, a rapidly enlarging choroidal tuberculoma progressed to larger size, despite appropriate systemic anti-tuberculous therapy . The eye harboring the tuberculoma became blind and painful, and was subsequently enucleated . Conventional staining of tissue sections revealed a choroidal granuloma without evidence of organisms, but tubercle bacilli were demonstrated by fluorescence microscopy.

Tubercle, 1985 Jun, 66(2), 99 - 108
Rapid methods for counting mycobacteria--comparison of methods for extraction of mycobacterial adenosine triphosphate (ATP) determined by firefly luciferase assay; Prioli RP et al.; A comparison of 5 different methods of extraction of adenosine 5'-triphosphate (ATP) from mycobacterial cells was carried out using Mycobacterium bovis, BCG as a model . ATP was measured using the luciferin-luciferase bioluminescence reaction . Boiling buffer extraction was the best method . The amount of ATP extracted correlated with the number of colony forming units over a wide range of count . Although great sensitivity in terms of number of bacilli detectable was not achieved the method was rapid and appears suitable for drug sensitivity testing of tubercle bacilli.

J Clin Microbiol, 1985 Jun, 21(6), 983 - 4
Confirmation of Legionella pneumophila cultures with a fluorescein-labeled monoclonal antibody; Tenover FC et al.; We compared a fluorescein-labeled monoclonal antibody directed against an outer membrane protein of Legionella pneumophila (Genetic Systems Corp . {GSC}, Seattle, Wash.) with a similarly labeled polyclonal reagent (L . pneumophila serogroups 1 to 6, poly; BioDx, Inc., Denville, N.J.) for the confirmation of L . pneumophila isolates grown in culture . Duplicate suspensions of 52 organisms, including 21 L . pneumophila and 8 non-L . pneumophila species of legionella, were placed on individual glass slides, fixed, and stained with both reagents, and the results were compared . Both antisera correctly identified all L . pneumophila serogroups 1 to 6, but only the GSC reagent produced definitive staining of the L . pneumophila isolates of serogroups 7, 8, and 9 . Additionally, the GSC reagent produced more uniform staining patterns around the legionella bacilli and displayed little background fluorescence when compared with the BioDx reagent.

Obstet Gynecol, 1985 Jun, 65(6), 825 - 9
Aztreonam versus gentamicin, each with clindamycin, in the treatment of endometritis; Gibbs RS et al.; A randomized comparison of aztreonam (2 g intravenously every eight hours) versus gentamicin (1.5 mg/kg intravenously every eight hours), each with clindamycin (600 mg intravenously every six hours), was performed in 119 patients with endometritis after cesarean section . Patients in both groups had similar risk factors . Genital cultures revealed an average of 3.0 isolates per specimen . Eighty-five aerobic gram-negative rods were isolated from 57 (48%) patients . All were susceptible to both aztreonam and gentamicin . Of 133 anaerobic isolates, 131 (98%) were susceptible to clindamycin . The failures in the aztreonam group were associated with a wound abscess and with an enterococcal bacteremia . Of the six failures in the gentamicin group, two were associated with persistent isolation of enteric bacilli . In the other four failures, no explanation was evident . Side effects occurred in four patients, (three diarrhea, one allergic reaction) . All were self-limited and appeared to be due to clindamycin . No patient showed nephrotoxicity . When used in combination with clindamycin, aztreonam gave clinical results similar to gentamicin.

Quad Sclavo Diagn, 1985 Jun, 21(2), 182 - 9
{Biochemical profile of mycobacteria isolated from clinical and environmental material}; Salvo S et al.; Biochemical characteristics employed to identify tuberculous and non tuberculous mycobacteria were evaluated . Tests for detection of nitrate reductase, catalase, gamma-glutamyl-transferase, niacin assay and growth on TCH media (2-thiophene carboxylic-acid hydrazide) were regarded of discriminating value . These tests have been applied to identification of 78 clinical isolates of mycobacteria . All strains were identified as Mycobacterium tuberculosis, that suggest the infrequency of human infections from Mycobacterium bovis and mycobacteria other than tubercle bacilli in our geographic area . It is also outlined that the gamma-glutamyl-transferase test constitute a rapid and simple assay for discriminating Mycobacterium tuberculosis from other closely related mycobacteria.

Gastroenterology, 1985 Jun, 88(6), 1867 - 73
Antibiotic treatment and relapse in Whipple's disease . Long-term follow-up of 88 patients; Keinath RD et al.; Reports of clinical relapse occurring after apparently successful antibiotic treatment of Whipple's disease prompted this review of long-term follow-up of treated patients . Follow-up of at least 1 yr after completion of treatment or 2 yr after diagnosis was obtained on 88 patients with documented Whipple's disease by a review of the medical literature, correspondence with the authors as needed, and questionnaires mailed to academic gastroenterology programs in the United States . Relapse was defined on the basis of morphology (preferably) or clinically, or both . Thirty-one patients relapsed, 6 of whom relapsed twice . Fifty-seven patients did not relapse . The mean time to relapse was 4.2 yr . The mean follow-up period of patients who did not relapse was 8.2 yr . The type and number of relapses were as follows: clinical, 16; central nervous system, 13; arthralgia, 5; gastrointestinal, 1; and cardiac, 2 . The clinical, arthralgia, and gastrointestinal relapses were evenly distributed between early relapses (occurring less than 2 yr after diagnosis) and late relapses (occurring greater than 2 yr after diagnosis) . All cardiac and central nervous system relapses were late . Twenty-one of 49 patients treated with tetracycline alone relapsed . Two relapses were reported in 15 patients treated with penicillin and streptomycin followed by tetracycline . Three relapses developed in 8 patients treated with penicillin alone . Five of the 16 patients treated with other regimens relapsed . Nine of the 13 patients with central nervous system relapse had been initially treated with tetracycline, 2 were treated with penicillin, and 2 were treated with combinations of antibiotics . Results of treatment of central nervous system relapse were poor in 10 of the 11 patients for whom details were available . Results of treatment of non-central-nervous-system relapse were excellent in 19 of 20 patients . It is concluded that tetracycline alone, or penicillin alone, is not adequate initial therapy for Whipple's disease and that central nervous system relapse is resistant to antibiotic therapy . The authors recommend parenteral penicillin and streptomycin followed by 1 yr of oral trimethoprim-sulfamethoxazole therapy or oral trimethoprim-sulfamethoxazole alone for 1 yr as initial therapy for Whipple's disease . Relapse should be defined by demonstration of recurrence of bacilli whenever possible.

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