Bacillus

J Neurosurg, 1983 Nov, 59(5), 735 - 44
Current concepts of bacterial infections of the central nervous system . Bacterial meningitis and bacterial brain abscess; Garvey G; Investigative work continues to provide guidance toward more rational management of bacterial meningitis and bacterial brain abscess . An increased understanding of the host's response in cases of bacterial meningitis has established that diffusibility of an antibiotic into the cerebrospinal fluid (CSF) is necessary, but is not sufficient for microbial cure . The antibiotic must also have a bactericidal effect on the pathogen . Meningitis after neurosurgery may be caused by Gram-negative aerobic bacilli . In some of these cases the newer cephalosporin antibiotics may be a useful advance . Meningitis complicating ventricular CSF shunts presents a paradigm for the problem of eradicating foreign body-related infections . Studies of the interaction of the host, the organism, and the shunt material offer some explanation for the limited efficacy of antibiotics observed in this setting . There have been advances in microbial definition of bacterial brain abscess . The identification of Bacteroides fragilis as a pathogen in certain brain abscesses has established a role for a newly available antibiotic, metronidazole . The study of the pathological distinction between cerebritis and frank abscess is clarifying two clinical characteristics of brain abscess: the limited success of antibiotic treatment and the increase in intracranial pressure . Computerized tomography has offered a valuable clinical "look" at brain abscesses; however, there are still problems in correlating the scan images with the evolving pathological process.

S Afr Med J, 1983 Oct 22, 64(18), 693 - 6
The tolerability and efficacy of a 6-month antituberculosis regimen containing rifampicin, isoniazid and pyrazinamide; Kleeberg HH et al.; The tolerability and efficacy of a 6-month daily regimen of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) were tested in 130 hospitalized patients, mostly Black, with previously untreated pulmonary tuberculosis . PZA was discontinued at the end of the 2nd month . In 6 cases treatment was discontinued because of drug intolerance . The symptoms were severe rash, mild thrombocytopenia, deteriorating haematological and renal condition and in the remaining 3 patients hyperbilirubinaemia . Of the 125 patients who could be assessed bacteriologically, 110 were infected with organisms which were fully susceptible to INH and RMP, and 95% of their cultures and 77% of their smears had converted to negative after 2 months of treatment . Similar results were obtained for all but 2 of the 15 patients with drug-resistant bacilli . Cavitation of the lungs was reduced in 78% of the patients and the extent of other tuberculous lesions diminished in 87%.

Jpn J Antibiot, 1983 Oct, 36(10), 2825 - 32
{Postoperative chemotherapy of perforating appendicitis in children; with special reference to latamoxef therapy}; Iida H et al.; We employed latamoxef (LMOX) as antibiotic therapy subsequent to the performance of appendectomies in children . Fifteen patients, consisting of 8 cases of catarrhal appendicitis and 7 cases of gangrenous appendicitis, were administered LMOX at 50 mg/kg/day, while 13 patients with peritonitis due to a perforated appendix were treated with a dosage of 90 mg/kg/day . Both of these dosages were administered in 3 equally-divided doses, as one shot intravenous injections . All of the cases of catarrhal and gangrenous appendicitis showed good, steady recovery after the surgery, and there were no instances of complications . With regard to the 13 cases of perforating appendicitis, a clinical efficacy of at least "good" was obtained in 12 patients, for an efficacy rate of 92.3% . In addition, bacteriologically, 35 out of 36 strains that were isolated initially could no longer be detected after the LMOX therapy, indicating an eradication rate of 97.2% . Complications consisted of 1 case of dehiscence of the wound, and 1 case of adhesive ileus . Comparison of the values of the laboratory tests before and after the LMOX therapy revealed no development of abnormalities . Moreover, with regard to side effects, with the exception of 1 case of transient diarrhea, there were no side effects which presented clinical problems . It was found that the causative microbes involved in these cases of appendicitis--especially in the perforative appendicitis cases--were Gram-negative bacilli such as E . coli, and an anaerobic bacterium, B . fragilis.(ABSTRACT TRUNCATED AT 250 WORDS)

Lepr India, 1983 Oct, 55(4), 739 - 42
Study of lymph node biopsies in lepromatous leprosy patients under treatment; Lele VR et al.; A study of lymph node biopsies from lepromatous leprosy patients undergoing treatment was carried out for one year in 1978-79 in the Department of Pathology, Government Medical College, Nagpur . Total 20 lymph node biopsies were studied, out of them, 12 were accompanied with skin biopsies . Typical lepromatous granulomas and presence of lepra bacilli were observed in 18 out of 20 lymph nodes, although this change was not constantly present in skin biopsies . Five out of twelve skin biopsies were bacteriologically negative . From this study, it is inferred that lymph node biopsies may be more helpful for follow up of patients after treatment.

Lepr India, 1983 Oct, 55(4), 680 - 5
Regional lymph node involvement in tuberculoid leprosy; Apte DC et al.; A study of regional lymph nodes in 44 cases of proved tuberculoid leprosy (BT & TT) is presented . Out of 26 cases of tuberculoid polar (TT) leprosy, 76.92% showed presence of paracortical lymphocytes, 61.52% showed presence of granuloma and 11.54% showed presence of acid fast bacilli in lymph nodes . In the borderline tuberculoid (BT) group, 61.1% showed granuloma, 72.22% showed presence of paracortical infiltration by lymphocytes and 11.11% showed presence of A.F.B . in lymph nodes . Lesions of tuberculoid leprosy have been conclusively demonstrated in the low resistant tuberculoid (BT) leprosy and polar tuberculoid leprosy (TT) . The presence of paracortical lymphocytes in large numbers in the lymph nodes could indicate high cell mediated immunity (CMI) and possibly a tuberculoid end of the spectrum . The skin lesions and lymph nodes had comparative histopathology.

Lepr India, 1983 Oct, 55(4), 640 - 7
"Nose-blow" smears in multibacillary leprosy patients; Padma MN et al.; 332 nose-blow specimens have been examined from 73 untreated multibacillary patients of leprosy before and periodically after they were put on a maximal, minimal or an intermediate multi-drug regimen . 80% of these specimens were found to be positive for acid fast bacilli initially . Bacillary positivity rate was more in samples containing pus or blood . Bacilli were seen in LL, LI as well as BL patients . Nearly half of the cases became negative for AFB in their nose-blow specimens within 3 months of initiation of treatment whereas none of these patients has become negative in skin smears . However, a few cases have continued to discharge bacilli in their nasal secretions even after 12 months of multi-drug regimen therapy.

Eur J Cancer Clin Oncol, 1983 Oct, 19(10), 1333 - 44
Prevention of infection among patients with cancer; Walsh TJ et al.; Recognition of the alterations of host defense allows a rational approach to preventing associated infections . One of the most effective strategies for preventing infection in the granulocytopenic patient is the combined use of oral non-absorbable antibiotics, laminar air-flow room reverse isolation with strict housekeeping techniques, low microbial diet, sterile water, and topical antiseptics and antibiotics . The prohibitive cost, however, warrants that this system be restricted to research settings . The suppression of aerobic Gram-negative bacilli and fungi and the preservation of colonization resistance with such combinations as trimethoprim-sulfamethoxazole and nystatin show promise in preventing infection in the granulocytopenic patient . Prevention of infection in neutropenic patients also requires attention to simpler but very effective measures such as immunizations, antimicrobial prophylaxis against intracellular and nonbacterial pathogens in high-risk patients, limiting invasive diagnostic and monitoring procedures, hand-washing by all personnel between visiting patients, oral hygiene, low microbial diets, axillary and perianal swabbing, and care with venipunctures and marrow aspirates . Finally, while the recommendations for prevention of infection are likely to continue to change with resulting improvement in patient care {92, 93}, a tabulation summarizing current practices can be established based on our current knowledge (Table 1).

Lepr India, 1983 Oct, 55(4), 648 - 53
Growth of Mycobacterium leprae in nude mice; Samuel NM et al.; Athymic nude mice were introduced in our laboratories in 1982 . In this paper results over one year period of nude mice inoculated with small numbers of M . leprae are described . In this study we showed that 1 X 10(4) M . leprae with low numbers of viable bacilli inoculated into hind foot pads of nude mice housed both in vinyl plastic isolators and "clean room" conditions had the ability to grow and reach remarkable levels . There was dissemination of the infection to other uninoculated foot pads by six months.

Antimicrob Agents Chemother, 1983 Oct, 24(4), 579 - 85
Radiometric macrophage culture assay for rapid evaluation of antileprosy activity of rifampin; Mittal A et al.; The antileprosy effect of rifampin was evaluated by a newly developed rapid in vitro assay wherein 31 human-derived strains and 1 armadillo-derived strain of Mycobacterium leprae were maintained for 2 and 3 weeks, respectively, in murine and human macrophages in the presence of {3H}thymidine . Of these strains, 27 showed significant incorporation of the radiolabel in cultures of live bacilli as compared with control cultures of heat-killed bacilli of the same strain . Consistent and significant inhibition of {3H}thymidine uptake was observed in M . leprae resident cultures with 3 to 200 ng of rifampin per ml as compared with similar cultures without the drug . In general, an increase in percent inhibition was seen from 3 to 20 ng/ml, with marginal increases at 40, 50, and 100 ng/ml . M . leprae strains appear to be remarkably susceptible to this drug in the in vitro assay.

J Hyg (Lond), 1983 Oct, 91(2), 277 - 86
Microbial investigation of the air in an apartment building; Simard C et al.; The microbial and viral flora in the ventilating ducts of an apartment building was evaluated . Several types of sampler (slit sampler, Andersen sampler, large volume air sampler) were used to evaluate the hourly, weekly and seasonal variation of this flora . The mean bacterial concentration was 17.2 e.f.u./m3 with a maximum level at 07.30 h (41.3 c.f.u./m3) and a minimal concentration in the early afternoon (8 c.f.u./m3) . The bacterial concentration observed correlated with the relative humidity in the air-ducts although there were no seasonal differences . The bacteria were mainly gram-positive cocci (73.5%) represented by a large number of Micrococcaceae (47.1%); gram-positive bacilli accounted for 14.2% of the isolates, gram-negative bacilli 12.0% and gram-negative cocci 0.3% . The majority of the bacteria-carrying particles were in the respirable range with 80.4% of them being less than 5 microns . The methods used did not result in the isolation of viruses during the winter sampling period.

Am Rev Respir Dis, 1983 Oct, 128(4), 673 - 9
Replication of lyophilized and cultured BCG in human macrophages; Crowle AJ et al.; If BCG must replicate well in vivo to immunize, presumably mainly in macrophages, the potency of BCG vaccines in human subjects might be measurable as the ability of the BCG to replicate in cultured human macrophages . We used this assumption to compare 6 different batches of lyophilized BCG with freshly cultured BCG and freshly cultured virulent Erdman tubercle bacilli, and to study how tubercle bacilli infect and multiply in human macrophages . The bacilli were readily phagocytized . They replicated in macrophages in proportion to how many were alive and how virulent they were, more the former than the latter among the lyophilized bacilli . The proportion of culturable bacilli in exponentially growing suspensions of BCG cultures was unexpectedly low . For suspensions of 5 of the 6 batches of lyophilized BCG, the great majority of bacilli were nonculturable . Suspensions made from the lyophilized BCG contained many large clumps of bacteria that resisted dispersion even by ultrasonic agitation . This clumpiness, presumably imparted to the bacilli during freeze-drying, caused the lyophilized BCG to infect macrophages more heavily than freshly cultured bacilli . In these experiments, native differences among macrophages from different subjects in capacity to phagocytize BCG and to inhibit its intracellular replication also were detected . These studies thus suggest that tests measuring responses of cultured human macrophages to infection with tubercle bacilli offer relatively simple, rapid, and human-being-related means for assessing several important aspects of human immunization with BCG.

J Exp Med, 1983 Oct 1, 158(4), 1145 - 59
The cutaneous infiltrates of leprosy . A transmission electron microscopy study; Kaplan G et al.; The dermal lesions of 18 patients with leprosy have been examined by transmission electron microscopy . The patients exhibited a spectrum of disease from polar lepromatous to polar tuberculoid with intermediate stages in various states of therapy and relapse . The nature and quantities of inflammatory cells and bacteria have been determined by electron microscopy to supplement previous light and fluorescence microscopy studies . Lepromatous leprosy was characterized by many parasitized foam cells containing large, multibacillary vacuoles with intact, osmiophilic Mycobacterium leprae: Bacteria were embedded in an electron-lucent matrix . No extracellular bacteria were evident . Only small numbers of scattered lymphocytes were found . As one approached the borderline state, smaller numbers of bacilli were present as singlets and doublets in small vacuoles of macrophages . The more reactive forms showed increasing bacillary fragmentation, larger numbers of lymphoid cells, and an occasional epithelioid cell . At the tuberculoid end of the spectrum, clear evidence of an exuberant lymphocyte response was evident . Large numbers of T cells with extremely long and complex filipodia were closely associated with epithelioid and multinucleated giant cells . Many of the mononuclear phagocytes appeared nonviable, and areas of necrosis were evident . Bacillary remnants were scarce and the cytoplasm of the epithelioid cells contained occasional dense bodies and many stacks of endoplasmic reticulum and mitochondria . These results suggest that Leu 3a/OKT4 helper cells may be capable of driving the effector function of mononuclear phagocytes . This would lead to a significant microbicidal effect on M . leprae, perhaps through the production of toxic oxygen intermediates.

Jpn J Antibiot, 1983 Oct, 36(10), 2893 - 900
{Therapeutic effect of cefotaxime against severe infections in patients with hematopoietic diseases}; Tsubakio T et al.; Seventy-five patients with severe infection accompanying hematologic disorder, including leukemia and malignant lymphoma, were treated with cefotaxime (CTX) . CTX was administered by intravenous drip infusion at a daily dose ranging from 4 to 16 g for terms of 3 to 21 days . The total doses were ranged from 12 to 226 g . The results obtained were as follows: Clinical effects: Excellent in 20 cases, good in 21 cases, fair in 7 cases and poor in 27 cases . The efficacy rate was 54.7% (41/75) . Clinical effectiveness on isolated organisms (27 cases): In single infection (21 cases), the efficacy rates were 80% for Gram-positive cocci, including S . aureus and 63.6% for Gram-negative bacilli other than P . aeruginosa . In mixed infection (6 cases), the rate was 50.0% . There were no significant differences in the efficacy rates for those patients who were grouped by the initial number of neutrophil (less than 100, 101--500 and over 501/mm3) . There were no significant difference in the efficacy rates for those patients who were grouped by the initial number of lymphocyte (less than 500 and over 501/mm3) . Side effects and abnormal laboratory findings: One case of skin rash and 2 cases of elevated GOT and GPT were observed . CTX was therefore considered as a clinically useful antibiotic for the severe infections even in neutropenic state in patients suffering from malignant hematological diseases.

Jpn J Antibiot, 1983 Oct, 36(10), 2715 - 20
{Clinical studies of cefotiam in the field of otorhinolaryngology}; Takeda K et al.; Cefotiam (CTM) was intravenously given to 20 patients with infections in the field of otorhinolaryngology . Daily doses of CTM were 2 to 4 g divided into 2 . Clinical responses were excellent in 11 patients, good in 8 and fair in 1, the rate of satisfactory clinical responses being 95% (19/20) . Ninety-one % (10/11) of Gram-positive cocci isolated from the patients were eradicated by the CTM treatment, while 60% (6/10) of Gram-negative bacilli were persisted . As for the side effects, eruption and elevation of GOT and GPT were observed in 1 patient.

Am J Vet Res, 1983 Oct, 44(10), 1884 - 8
Use of immunofluorescence, Gram's staining, histologic examination, and seroagglutination in the diagnosis of porcine colibacillosis; Francis DH; An indirect fluorescent antibody (IFA) test of ileal impression smears for K88, K99, and 987P pilus antigens was compared with histologic examination and seroagglutination of Escherichia coli isolates for efficacy in determining colibacillosis in pigs . Histologic examination appeared to be more effective than the IFA test in revealing colonization of the ileum by bacteria . However, histologic examination revealed little about the nature of the colonizing bacteria . Correlation between bacterial adherence, as observed in histologic sections of ileum, and the presence of bacteria with adherence pili, as determined by IFA testing, was 91% . Results of seroagglutination for pilus antigens correlated with results of histologic examination in only 84% of the cases . Pilus antigens were not identified by IFA testing or seroagglutination in 5% of the cases in which adherent bacteria were observed in histologic sections of the small intestine . Because little preparation time was required for the IFA test, results were available within 2 hours of necropsy . In contrast to histologic examination, the IFA test made possible identification of the colonizing organism as E coli and revealed the type of pilus antigen present . Adherence pili were identified more frequently by IFA testing than by seroagglutination . Examination of Gram's-stained ileal impression smears was useful in screening for colibacillosis in pigs . Bacterial adherence was found in positive correlation with the number of gram-negative bacilli observed . Bacterial adherence rarely was observed in histologic sections of ileum when smears contained less than or equal to 10 gram-negative bacilli/1,000 X microscopic field . Each diagnostic test compared offered advantages and disadvantages over the other tests . Seemingly, concurrent use of several of these tests, rather than one, should be used in the diagnosis of porcine colibacillosis.

Science, 1983 Sep 30, 221(4618), 1403 - 5
Cat scratch disease: a bacterial infection; Wear DJ et al.; Histopathologic examination of lymph nodes from 39 patients with clinical and pathological criteria for cat scratch disease revealed delicate pleomorphic Gram-negative bacilli in 34 of the 39 nodes . They were within the walls of capillaries in or near areas of follicular hyperplasia and within microabscesses . They were best seen with the Warthin-Starry silver impregnation stain . Organisms in lymph node sections exposed to convalescent serum from three patients and to immunoperoxidase stained equally well with all three samples . The organisms did not react with hyperimmune sera to Legionella pneumophila nor to several species of Rickettsia . These bacilli appear to be the causative agents of cat scratch disease.

Int J Lepr Other Mycobact Dis, 1983 Sep, 51(3), 382 - 4
Follow-up of lepromatous (LL and BL) patients on dapsone (DDS) monotherapy after attainment of smear negativity in Gudiyatham Taluk, South India; Almeida JG et al.; At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, an analysis of "relapse" rates was undertaken on all the 1293 residents of Guidyatham Taluk who were known to have lepromatous (LL) or borderline lepromatous (BL) leprosy and had attained "smear negative" status . "Relapse" was defined as the reappearance of acid-fast bacilli (AFB) in skin smears, whether by reinfection from other patients or from the patient's own persisting organisms . The "relapse" rate decreased steadily with the time elapsed after the attainment of smear negativity: 2.8% (2.8 per 100 patients per year) in the initial two years; 1.1% from the third year onwards; and 0.9% from the ninth year onwards . Of the 1293 patients, 694 (53.7%) had taken greater than or equal to 80% regular dapsone (DDS) treatment during smear negativity . In this group, the "relapse" rate from the third year onwards was only 0.7% per year . The vast majority (90.9%) of LL and BL patients on DDS monotherapy in the area had at some point attained smear negative status . It appears important to study whether a limited period of DDS monotherapy after the attainment of negative skin smears would be an effective alternative to life-long DDS treatment in LL and BL patients.

Int J Lepr Other Mycobact Dis, 1983 Sep, 51(3), 366 - 73
DDS-resistant infection among leprosy patients in the population of Gudiyatham Taluk, South India . Part 3 . Prevalence, incidence, risk factors, and interpretation of mouse foot pad test results; Almeida JG et al.; At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, a study of the population of Gudiyatham Taluk revealed that the prevalence of dapsone (DDS)-resistant infection among lepromatous (LL) and borderline lepromatous (BL) leprosy patients treated for a minimum of three years was 3.3% (33 per 1000), with an average annual incidence of 0.28% per year . DDS-resistant infection was diagnosed when review of skin smear readings showed a continuing increase in the number of Mycobacterium leprae in successive smears despite adequate DDS treatment . The attainment of smear negativity in an LL or BL patient was found to be a favorable prognostic sign, indicating a reduced risk of DDS-resistant infection . No association was found between the incidence of DDS-resistant infection on the one hand and either the regularity or the initial dosage of DDS treatment on the other . Ninety-five (88.0%) out of 108 successful mouse foot pad tests on patients with a Bacterial Index (BI) greater than or equal to 2+ detected DDS-resistant M . leprae . The mouse test detected bacilli resistant to 0.01% w/w DDS in mouse diet not only among patients deteriorating despite adequate DDS monotherapy, but also among patients improving on DDS monotherapy . Since the mouse test as presently used does not measure the proportion of M . leprae in a sample that are resistant to DDS, the detection of DDS-resistant bacilli in the mouse test may not always indicate that the patient will fail to respond to DDS monotherapy.

Int J Lepr Other Mycobact Dis, 1983 Sep, 51(3), 336 - 46
Infection of the congenitally athymic rat with Mycobacterium leprae; Dawson PJ et al.; The susceptibility of congenitally athymic rats to Mycobacterium leprae infection has been investigated . Following inoculation of small numbers of M . leprae (5 X 10(3} into the foot pad, the organisms replicated and attained a maximum of 2.6 X 10(8) per foot pad at 294 days; there was limited dissemination to the tail . In similarly inoculated neonatally thymectomized Lewis rats (NTLRs) a ceiling of 2 X 10(7) organisms was reached . When a larger inoculum (10(7} was given, the number of bacilli in athymic rat foot pads peaked at 6.7 X 10(8) and after approximately 240 days a plateau of between 2 X 10(8) and 6 X 10(8) per foot pad was reached . Dissemination to superficial tissues occurred approximately nine months after inoculation, when significant numbers of bacilli were recovered from the foot pads, ears, snout, and tail . Following intravenous inoculation of 10(7) M . leprae into athymic rats, significant numbers of bacilli were recovered from the superficial tissues by 300 days post inoculation . The numbers of organisms reached a plateau of about 10(8) by one year . Autopsy of infected animals from 1-2 years after inoculation revealed no gross abnormalities except for a purulent bronchitis and bronchopneumonia . Although normal grossly, the ears, tail, snout and foot pads showed a varying degree of infiltration by histiocytes . In some this was almost imperceptible, in others there were large accumulations of foamy macrophages reminiscent of lepromatous leprosy . The numbers of mycobacteria present in Fite stains ranged from 2+ (several organisms or clusters of organisms) to 5+ (very numerous) . The lymph nodes contained numerous non-caseating granulomata composed of activated macrophages which contained large (4+) or very large (5+) numbers of bacilli . Mycobacteria were present in the cells of the mononuclear-phagocyte series in the liver and spleen of animals killed 12-15 months post inoculation, but were absent from these cells in animals killed later . M . leprae were also numerous in the smooth muscle of the scrotum . It is concluded that congenitally athymic rats are highly susceptible to M . leprae infection . Despite their lack of thymic-dependent T cell function, it appears that they possess the defense mechanism(s) capable of limiting the infection.

J Pathol, 1983 Sep, 141(1), 41 - 54
The long-term evolution of mycobacterial BCG and preformed immune complex BCG/anti-BCG granulomas in rats; Ridley MJ et al.; In previous studies it was found that infections with BCG or complexed BCG/anti-BCG in rat skin produced granulomas that appeared to resolve at 8 months . In this follow-up study 1 year later, it appeared that while lesions due to performed complexes had resolved, those due to BCG alone had undergone a massive reactivation . Nevertheless despite the loss of CMI the infection was restricted . The bacilli, present in enormously increased numbers, were dead; the host macrophages were large and activated . Epithelioid cells and dendritic cells were common . The granuloma was confluent, with patchy necrosis and inconspicuous polymorph infiltration . Although preformed complexes with viable bacilli formed at equivalence had produced a resolving lesion, the outcome of the natural infection was complicated by an imponderable balance of immunological responses . CMI does not appear to have been a determinant during the crucial phases of the infection.

Lab Invest, 1983 Sep, 49(3), 281 - 90
Leprosy in wild armadillos (Dasypus novemcinctus) on the Texas Gulf Coast . Ultrastructure of the liver and spleen; Meier JL et al.; Recent studies have established that the "naturally-occurring leprosy-like disease of wild armadillos" is, indeed, caused by Mycobacterium leprae indistinguishable from M . leprae from human lepromatous leprosy . The present study reports the ultrastructure of the mycobacteria and host response in deep viscera, liver and spleen, in Texas armadillos with sylvatic leprosy . Evidence for acid-fast bacillary proliferation in these organs and penetration of hepatocytes is given . Acid-fast bacilli concentrated in activated macrophages in Billroth cords and sheaths of Schweigger-Seidel of the spleen and in Kupffer cells of the liver . Both mycobacteria and host response seen in lepromata of sylvatic leprosy, lepromatous lesions produced by injection of inocula from human lepromata and human lepromata, are compared.

Am J Med, 1983 Aug 29, 75(2A), 68 - 71
Rationale for use of antimicrobial combinations in treatment of gram-negative infections . A review of recent reviews; Rahal JJ Jr; All investigators apparently agree that the most common and compelling reason for using more than one antibiotic to treat a single organism is to achieve a bactericidal effect . Most studies, both retrospective and prospective, have demonstrated that two effective antibiotics yield better results than one in neutropenic patients and/or those with rapidly fatal underlying disease, despite the absence of consistent in vitro synergy . Bacteremias caused by Pseudomona aeruginosa or Klebsiella pneumoniae may be benefited most by synergistic combinations . This may not be true for patients with non-neoplastic disease and normal granulocyte counts, or for patients infected with other species of gram-negative bacilli . Synergistic bactericidal activity is necessary for the successful therapy of endocarditis due to P . aeruginosa, but it may not assure success . The systemic immunodeficiency of neutropenic patients may parallel a localized immunodeficiency in endocarditis, since leukocytes are not effectively mobilized to the site of infection in endocarditis . Antagonistic antibiotic combinations are likely to be particularly harmful in neutropenic patients.

Experientia, 1983 Aug 15, 39(8), 899 - 902
Fibrin and collagen deposition and fibroblasts proliferation in granuloma of murine leprosy . Comparison of two mouse strains with different immune reactions; Satoh M et al.; Comparative immunofluorescence study with murine lepromas induced in C57BL/6NJcl (immunologically high responder) and CBA/N (low responder) mouse strains revealed that fibrin formation was associated with cell-mediated immune resistance against invasive bacilli . Histochemistry on paraffin sections further elucidated fibroblast proliferation and formation of collagen fibers following fibrin deposition only in murine lepromas with positive host reactions.

South Med J, 1983 Aug, 76(8), 1046 - 8
Mixed bacterial infection of the pericardium; Parsons R et al.; Polymicrobic bacterial infection of the pericardium was detected in a 59-year-old patient ultimately proven to have esophageal carcinoma . Such infections are becoming more frequent, often combine gram-negative bacilli and anerobes, and may be deceptively mild clinically . Origin from an occult head and neck or gastrointestinal focus rather than from pulmonary (pneumococcal) or distant (staphylococcal) sources distinguishes these infections . Newer diagnostic techniques (computerized tomography and echocardiography) coupled with surgical drainage and appropriate antibiotic therapy may improve the current 67% mortality.

Antimicrob Agents Chemother, 1983 Aug, 24(2), 282 - 6
Activities of aztreonam and new cephalosporins against infrequently isolated gram-negative bacilli; Strandberg DA et al.; The susceptibilities of 159 clinical isolates of glucose nonfermentative gram-negative bacilli were determined for eight new monobactam or beta-lactam antibiotics . Imipemide (N-formimidoyl thienamycin) was effective against the largest number of species, although not against Pseudomonas maltophilia . Cefoperazone and ceftazidime, but not cefsulodin, were active against infrequently isolated Pseudomonas species . Aztreonam, moxalactam, cefotaxime, and ceftizoxime demonstrated selective activity against several species, including certain amino-glycoside-resistant isolates.

Antimicrob Agents Chemother, 1983 Aug, 24(2), 156 - 62
Statistical comparison of the antibacterial activities of broad-spectrum penicillins against gram-negative bacilli; Fass RJ; Minimal inhibitory concentrations (MICs) or two alpha-carboxypenicillins (carbenicillin and ticarcillin) and three acylaminopenicillins (azlocillin, mezlocillin, and piperacillin) for 300 aerobic and facultative gram-negative bacilli were determined by a microdilution method and compared by parametric statistical tests . Within each group of penicillins, MICs were highly interrelated; MICs of one antibiotic were readily predictable based on knowledge of MICs of another antibiotic . Ticarcillin was consistently more active than carbenicillin by approximately one dilution step, but the relative activities of the acylaminopenicillins varied by bacterial species . The acylaminopenicillins were generally more active than the alpha-carboxypenicillins, particularly against alpha-carboxypenicillin-resistant organisms . There were exceptions, however, and antibiotic MICs in one group were not readily predictable on the basis of the knowledge of antibiotic MICs in the other group . The enhanced antibacterial potencies and spectra of the acylaminopenicillins against gram-negative bacilli make these antibiotics potentially useful therapeutic agents . It is not necessary for clinical laboratories to routinely perform susceptibility tests with all five antibiotics.

Postgrad Med J, 1983 Aug, 59(694), 516 - 7
Guillain-Barré syndrome associated with tuberculosis; Vyravanathan S et al.; Two cases of Guillain-Barre syndrome occurring in association with chronic pulmonary tuberculosis are reported . A cell-mediated, delayed hypersensitivity reaction to, or invasion of the nerve roots by tubercle bacilli would seem to be the likely explanation of the neuropathy.

Invest Ophthalmol Vis Sci, 1983 Aug, 24(8), 1147 - 9
Ocular penetration of N-formimidoyl thienamycin (MK-787) and potentiation by dipeptidase inhibitor (MK-791); Finlay KR et al.; N-formimidoyl thienamycin (MK-787) is a new beta-lactam with potent activity against both aerobic and anaerobic gram-positive and gram-negative bacteria . Its spectrum and activity suggest it may be useful in treatment of complicated intraocular infections . Its ocular penetration was studied in New Zealand white rabbits immediately before and after the third dose of 40 mg/kg administered intravenously at q6h intervals . Plasma, aqueous humor, and vitreous humor were obtained by direct aspiration, and antibiotic levels were assayed using an agar well diffusion method . MK-787 penetrated uninflamed intraocular fluids, including vitreous humor, although vitreous concentrations achieved (0.1-0.2 micrograms/ml) were significantly lower than the mean peak plasma (15 micrograms/ml) and aqueous concentrations (7 micrograms/ml) . Nevertheless, the intraocular levels attained approached or exceeded the MIC90 for most sensitive organisms including some gram-negative bacilli important in bacterial endophthalmitis . When administered in combination with the renal enzyme inhibitor MK-791, plasma and aqueous concentrations of MK-787 were markedly potentiated, although vitreous concentrations were minimally affected . The potential usefulness of MK-787 in conjunction with MK-791 in the infected eye should be examined further in an animal model of bacterial endophthalmitis.

Aust Vet J, 1983 Aug, 60(8), 243 - 5
An outbreak of Mycobacterium bovis infection in cats in an animal house; Isaac J et al.; An outbreak of tuberculosis due to Mycobacterium bovis in cats in an animal house was investigated . It was concluded that the index case was infected by ingestion of contaminated meat obtained from a knackery and that some of the other cases were infected by inhalation of tubercle bacilli shed from a discharging sinus in the index case . A possum was also infected and a research worker apparently received a significant challenge.

Clin Exp Immunol, 1983 Aug, 53(2), 319 - 27
Induction of delayed type hypersensitivity against ultrasonicated Mycobacterium lepraemurium bacilli without simultaneous local reactivity against live bacilli or protective immunity; Lovik M et al.; Delayed type hypersensitivity (DTH) was induced in C3H mice by subcutaneous immunization with Mycobacterium lepraemurium (MLM) antigens in Freund's complete (FCA) or Freund's incomplete (FIA) adjuvant . The total ultrasonicate (MLMSon-P) of MLM bacilli as well as the water soluble fraction (MLMSon-S) of this ultrasonicate was found effective . MLMSon-S was used as the test antigen . Specific DTH also developed after immunization with heat-killed MLM bacilli in FIA, but not with heat-killed bacilli in saline . Some mice were pre-treated with cyclophosphamide (CY) or splenectomized to augment the effect of immunization . In no instance was DTH to MLMSon-S accompanied by detectable local reactivity to live MLM bacilli measured as swelling of the infected footpad or by reduced multiplication or dissemination of the bacilli during the first 11 weeks after inoculation . As determined by testing in the infected footpad 8 weeks after inoculation, MLM infection did not induce DTH to MLMSon-S in non-immunized mice, and MLM infection was found to neither augment nor suppress established DTH to MLMSon-S . The experiments thus demonstrated a clear dissociation between DTH to MLMSon-S and local reactivity to live MLM bacilli, as well as between DTH to MLMSon-S and protective immunity to MLM infection.

Eur J Respir Dis, 1983 Jul, 64(5), 347 - 54
Serum calcium during chemotherapy for active pulmonary tuberculosis; Kitrou MP et al.; Serum calcium was prospectively studied in 50 consecutive patients with active pulmonary tuberculosis . Twenty-four of them (48%) developed hypercalcaemia during an observation period of at least 8 weeks . Maximal increase in serum calcium (corrected for serum albumin) occurred three weeks after initiation of treatment, by which time 28% of the patients were hypercalcaemic . The increase in serum calcium was followed by a spontaneous remission . Only two patients developed symptoms related to hypercalcaemia, which promptly responded to steroid administration . No patient received vitamin D supplements before or during the study . No correlation could be found between hypercalcaemia and either the presence of acid-fast bacilli in the sputum or the season of the year . There was a trend for higher serum calcium values in the patients with the more severe radiographic changes on admission . Hypercalcaemia in patients with pulmonary tuberculosis seems to be triggered by chemotherapy . However, the mechanism(s) by which anti-tuberculosis treatment affects calcium metabolism remains uncertain.

Jpn J Antibiot, 1983 Jul, 36(7), 1593 - 8
{Clinical evaluation of micronomicin for the treatment of postoperative infections in cancer patients}; Ohmori K et al.; Micronomicin (MCR, Sagamicin), a new derivative of aminoglycoside, was used in 9 patients with postoperative infection mainly caused by Gram-negative bacilli . A dose of 60-120 mg was intramuscularly administered continuously twice a day for 3-21 days . The therapeutic results were excellent in 2, good in 3, fair in 1 and poor in 2 cases . The assessment was impossible in 1 patient . The effective rate was 62.5% . No side effects were encountered in any cases.

Vestn Khir Im I I Grek, 1983 Jul, 131(7), 11 - 5
{Bacteriological characteristics of a surgical hospital}; Petrov VP et al.; 42426 bacteriological inoculations from different objects were performed in a many-profile surgical hospital . Carriage of bacilli among the medical staff was 27%, among the patients admitted to the hospital it was 99-100% . The amount of bacilli-carriers among the patients was found to decrease by the time of discharge from the hospital.

Arch Microbiol, 1983 Jul, 134(4), 303 - 8
Selection methods in bacilli for recombinants and transformants of intra- and interspecific fused protoplasts; Akamatsu T et al.; The intraspecific fusion frequencies obtained with the direct selection method on a semi-synthetic regeneration medium between strains of B . subtilis and B . licheniformis were distributed from 9.9 X 10(-2) to 4.5 X 10(-3), which was one or two orders higher than those of interspecific recombinations between B . subtilis and B . licheniformis . The regeneration media were also useful for selecting interspecific transformants from plasmid carrier to noncarrier . This selection could be used as a primary selection method for inter- and intraspecific recombinants obtained by protoplast fusion.

Lepr India, 1983 Jul, 55(3), 570 - 5
Bacillaemia in lepra reaction: its correlation with liver pathology; Zawar PB et al.; Thirty patients of lepromatous leprosy in a state of reaction (ENL) were studied for bacillaemia and a correlation was made with liver pathology . Buffy coat smears were examined in all, eliminating as far as possible the chances of contamination of blood by the skin bacilli . Thirteen out of thirty patients showed presence of acid fast bacilli (AFB) in the buffy coat smear . Hepatic involvement in the form of leprous granuloma was observed in all, of which 93.3% showed presence of AFB . It is concluded that during reaction the possibility of heightened bacillaemia is less likely and that the systemic spread of infection is not accentuated during the bouts of reaction.

Lepr India, 1983 Jul, 55(3), 450 - 4
Observations on the culture of M . leprae in Medium V . A preliminary report; Prabhakar R et al.; This paper reports the preliminary findings of an investigation using Medium V for culture of M . leprae . The medium was prepared adhering to the procedures adopted by Veeraraghavan . Tissues from 7 cases of lepromatous leprosy (Bacteriological Index of 3 or more) were inoculated into Medium V and incubated at 8-10 degrees C for 72 hours . Quantitative estimation of leprosy bacilli were made employing the enumeration technique of Veeraraghavan . There was no evidence of multiplication in any of the cultures . The findings are in conformity with those of Kato (1983) and of Katoch and Desikan (1983).

Rev Infect Dis, 1983 Jul-Aug, 5 Suppl 3, S606 - 13
Rifampin in the treatment of leprosy; Bullock WE; The minimal inhibitory concentration of rifampin for Mycobacterium leprae is less than 1 microgram/ml . Therapy with rifampin has proved efficacious both in mice experimentally infected with M . leprae and in humans with leprosy . Rifampin kills M . leprae more rapidly than do other antileprosy drugs currently available . Consequently, M . leprae bacilli from patients with lepromatous disease are rendered noninfectious within three weeks after the institution of rifampin therapy, as determined in the mouse footpad test system . Administration of this antibiotic substantially reduces the quantities of M . leprae discharged in the nasal secretions of lepromatous patients within three weeks, thus rapidly decreasing the potential infectivity of these individuals . Intermittent rifampin therapy for leprosy has been successful, with a low incidence of adverse reactions to the drug . Worldwide, the prevalence of primary and secondary resistance of M . leprae to dapsone has increased markedly . Therefore, the World Health Organization recommends a multidrug regimen that includes intermittent administration of rifampin for the treatment of leprosy.

Rev Infect Dis, 1983 Jul-Aug, 5(4), 657 - 79
Spectrum of disease due to rapidly growing mycobacteria; Wallace RJ Jr et al.; One hundred twenty-five cases of disease due to rapidly growing mycobacteria were observed over a four-year period . Cutaneous infections accounted for 74 cases (59%) . Of these, 40 followed surgical procedures (especially augmentation mammaplasty or median sternotomy), and 34 were due to accidental penetrating trauma . Among the 24 patients with pulmonary disease, the mean age was approximately 60 years, the majority of patients (63%) were women, and most had unilateral noncavitary disease . Other infections included disseminated disease with multiple nodular skin lesions and positive blood cultures, cervical lymphadenitis, keratitis, and endocarditis associated with a prosthetic valve . Infected tissues showed mixed acute and granulomatous inflammation; acid-fast bacilli, when present, occurred in extracellular clumps within microabscesses . Mycobacterium fortuitum and Mycobacterium chelonei were encountered with approximately equal frequency; 80% of isolates of M . chelonei were subspecies abscessus, and 83% of isolates of M . fortuitum were biovariant fortuitum . The outcome in these infections was generally good, although 9% of the patients, including all those with endocarditis, died . Infections due to M . fortuitum and M . chelonei are probably markedly under-diagnosed, and these organisms are capable of causing a wide spectrum of clinical disease.

J Antimicrob Chemother, 1983 Jul, 12 Suppl A, 171 - 5
Ceftazidime, as a single antibiotic, in the treatment of multi-resistant Gram-negative infections in intensive care; Gasparetto A et al.; In this study we have evaluated the efficacy and tolerance of ceftazidime used as the only antibiotic in the treatment of 19 critically ill patients, with serious infections caused by multiply resistant Gram-negative bacilli in an intensive care unit . The bacteria isolated showed a high susceptibility to ceftazidime and a moderate resistance to seven other antibiotics . Clinical improvement occurred in 42.1% of the patients treated . Tolerance, both local and general, to the drug was considered good . Ceftazidime appeared to be capable of replacing beta-lactam and aminoglycoside combinations in the treatment of serious infections caused by Gram-negative species in ICUs, but further experience is necessary.

Infect Immun, 1983 Jul, 41(1), 121 - 7
Alterations in the membrane of macrophages from leprosy patients; Birdi TJ et al.; Macrophage cultures pulsed with viable Mycobacterium leprae were assessed for erythrocyte rosetting in three groups of individuals, i.e., normal subjects, and tuberculoid and lepromatous patients . Of these, only the lepromatous group showed a reduction in rosetting ability after infection with M . leprae . The specificity of such a reduction pattern was confirmed by using various mycobacteria to infect the macrophages . A threshold effect was noted in all three groups . Although a reduction was obtained in the amount of rosetting of macrophages from lepromatous patients with 10(4) acid-fast bacilli per culture, tuberculoid and normal macrophages resisted such an effect with as large a dose as 20 X 10(6) to 30 X 10(6) and 30 X 10(6) bacilli per culture, respectively . The M . leprae-caused alterations in macrophages from lepromatous patients were reversible by treatment with trypsin and colchicine . Cytochalasin B and Tween 80 were unable to alter the pattern . Treatment of cells with neuraminidase was inconclusive since it enhanced rosetting values of both control and infected cultures . These manipulations were significant in elucidating the target point of the host (macrophage) and parasite (M . leprae) interaction and in delineation of the external and internal effects upon the macrophages . Both M . leprae and macrophages were participants in Fc reduction, as treatment of the former with rifampicin and of the latter with cyclocheximide significantly augmented the rosetting ability . In conclusion, it appears that M . leprae, upon entering a lepromatous macrophage, initiates the production of a protein which acts via the microtubules to alter membrane topography . It is possible that the altered membrane prevents effective macrophage-lymphocyte interaction . This could be one of the mechanisms by which cell-mediated immunity is suppressed in lepromatous leprosy.

Jpn J Antibiot, 1983 Jul, 36(7), 1604 - 14
{Clinical effect of cefmenoxime on cholecystitis; its clinical efficacy and tissue concentration}; Bekki E et al.; A new antibiotic drug of cephalosporin, with marked resistance to beta-lactamase, cefmenoxime (CMX) for parenteral use was used in 14 patients with acute or subacute cholecystitis and cholangitis . CMX was given by intramuscular or intravenous drip infusion at a daily dose of 500 mg to 2 g . Clinical response was excellent in 3 cases, good in 10 cases, fair in 1 case and poor in none . Any clinical adverse effect was not recognized . CMX in a dose of 500 mg was given by intramuscular administration before the operation to 8 patients, and in 7 cases CMX in a dose of 1 g was given by intravenous administration before or during the operation . Tissue specimens of different sites were taken from the removed organs . The materials of A-bile and B-bile were subsequently taken at intervals . CMX concentrations in the A-bile increased after intramuscular injection and reached to peak 2 hours, then declined very slowly . CMX concentrations in the A-bile after intravenous administration reached to peak at 1 hour, then declined very slowly, too . CMX concentration in the B-bile reached to high level of the concentration comparative quickly after intramuscular and intravenous administration, and it was thought to be excreted through the gallbladder wall . CMX concentration in the gallbladder wall was directly proportional to the degree of pathological changes of the inflammation . On the CMX concentration in patients with cholecystitis and cholangitis, the concentration in A-bile, B-bile and gallbladder wall were observed higher than the MIC of CMX for pathogenic Gram-negative bacilli . CMX therefore will be a very useful drug when used for chemotherapy of the infectious diseases of the biliary tract.

Lepr India, 1983 Jul, 55(3), 426 - 49
Growth of Mycobacterium leprae in a redox system; Chatterjee BR; Mycobacteria recovered from human lepromatous nodules and presumably M . leprae, have been grown in a medium that ensured a minimal oxygen tension at initiation of growth, and an increasing availability of oxygen as bacillary growth increased requiring marginal increments in oxygen tension . This physicochemical environment was achieved by the addition of strong biological reductants in the medium, and a combination of partial vacuum and alkaline pyrogallol in the culture vessel . In addition, n-tetradecane, a straight chain hydrocarbon, and lipids like Cholesterol and Lecithin, all three substances mixed in the aqueous medium as liposomes, were added and found to be useful . Menadione, or Vitamin K3, added to the medium considerably improved growth efficiency . Growth occurred initially as non-acid fast coccoids and bacilli that gradually changed to acid-fast bacilli and globi, and cell-wall deficient, spherical L-form elements . Appearance of growth in any form was perceptible within 1 to 2 weeks and optimal growth as acid fast bacilli took upto 3 months . Both the acid fast and non-acid fast bacilli could not be grown in conventional media, but the non-acid fast coccoids could be readily isolated from these cultures in a specially enriched liquid medium . The problem of harvesting of the growth free of lipid-hydrocarbon substances has still not been solved, as also an optimum oxidation-reduction potential . The growth is transferable.

J Biol Chem, 1983 Jun 25, 258(12), 7556 - 62
Further specific extracellular phenolic glycolipid antigens and a related diacylphthiocerol from Mycobacterium leprae; Hunter SW et al.; Mycobacterium leprae in infected armadillo tissue produces extracellular phthiocerol-containing lipids in amounts well in excess of the bacterial mass . The principal component (1.38 mg in 1 g of liver, wet weight, containing 3.7 X 10(10) M . leprae bacilli) consists of a mixture of two phthiocerol homologs, 3-methoxyl-4-methyl-9, 11-dihydroxyoctacosane and 3-methoxyl-4-methyl-9, 11-dihydroxytriacontane, (formula: see text); in which the hydroxyl functions are acylated by a mixture of three 'mycocerosic acids': 2,4,6,8-tetramethylhexacosanoate, 2,4,6,8-tetramethyloctacosanoate, and 2,4,6,8-tetramethyltriacontanoate . The structures were established by saponification of the native lipid, direct probe electron impact- or chemical ionization-mass spectrometry of the phthiocerol or its permethylated derivative, and gas-liquid chromatography-electron impact-mass spectrometry of the methyl esters of the fatty acids . In addition to the previously reported M . leprae-specific triglycosylphenolicdiacyl phthiocerol (Hunter, S . W., Fujiwara, T., and Brennan, P . J . (1982) J . Biol . Chem . 257, 15072-15078), the extracellular products contain small amounts (about 60 micrograms/g of infected liver, wet weight) of two other phenolic glycolipids, one of which (Phenolic Glycolipid III) has been structurally elucidated, (formula: see text); assuming certain enantiomeric configurations for the sugar substituents; the R-acyl functions are identical with those in the diacylphthiocerol . Phenolic Glycolipid-III reacts in enzyme-linked immunosorbent assays with sera from patients with leprosy and with rabbit antisera raised against whole M . leprae . The phthiocerol-containing lipids may be synonymous with the electron transparent capsules of M . leprae, and their unreactive state may confer on them the role of passive protectors of the bacillus.

Nucleic Acids Res, 1983 Jun 25, 11(12), 3973 - 87
In vitro transcription of the cloned chromosomal crystal gene from Bacillus thuringiensis; Klier A et al.; We have determined the conditions required for in vitro transcription of the cloned chromosomal crystal gene from Bacillus thuringiensis using either the homologous vegetative RNA polymerase or a sporulation specific form of this enzyme . The gene is actively transcribed by the latter enzyme (form II) but not by the vegetative one . Evidence for a specific recognition between the form II enzyme and the promotor site of the crystal gene was obtained by binding experiments . They showed that the binding is increased by the presence of some additional factors, which change the specificity of the vegetative core-enzyme . The sequence of the promoter has been determined and the start-point of the transcription deduced . Two hexanucleotide sequences, TACAAT and CCTACG, centered at - 10 and - 35 bp are present, but are somewhat different from the consensus sequences previously described in other bacilli.

N Z Med J, 1983 Jun 8, 96(733), 418 - 20
Plasmids and hospital acquired infections; Bridgewater P et al.; One hundred multiply resistant gram-negative bacilli isolated in a routine clinical microbiology laboratory over a six month period have been examined for their ability to transfer their resistance pattern, or part of it, to a sensitive recipient Escherichia coli and for plasmid carriage . Sixty-six of these transferred resistance and plasmids were isolated from 40 . The importance of investigating the occurrence and spread of plasmids in providing epidemiological data for the control of hospital infection is emphasised.

J Laryngol Otol, 1983 Jun, 97(6), 523 - 5
Hoarseness in tuberculosis; Vyravanathan S; A study has been made of hoarseness in 26 tuberculous patients in Kandy (Sri Lanka) . Tuberculous inflammation of the vocal cord or ventricular fold was its cause in 18 of them, in 17 of whom the laryngeal infection was due to direct implantation of tubercle bacilli from lung cavities through cough; in one it was probably haematogenous . Hoarseness in the other eight patients was due to recurrent laryngeal nerve palsy, the nerve being involved in tuberculous lesions, in six instances in the mediastinum and in three instances in the right apical pleura . However caused, hoarseness associated with active inflammatory disease cleared with anti-tuberculous chemotherapy, whereas that associated with fibrosis persisted.

Hansenol Int, 1983 Jun, 8(1), 22 - 45
{Histopathological study of the cubital epineurium in patients with undifferentiated forms of Hansen's disease}; Katz DR et al.; Twelve hanseniasis patients, undifferentiated group, with negative bacilloscopy and having undergone no prior treatment, were submitted to a biopsy of the cubial epineurium for histopathological study . All subjects were clinically observed after one month, and six of them were examined 4 to 5 years afterwards . Histopathology of the epineurium presented acid-fast bacilli in one patient and tuberculoid granuloma formation tendency in another . Epineural thickening was observed in nine patients and perivascular lymphomonocuclear inflammatory infiltration in six . The clinical examination after 1 month in the 12 patients as well as after 4 to 5 years in 6 of them, demonstrated innocuousness of the performed biopsy . Four to five years after the initial observation, the clinical examination showed that two patients who remained Mitsuda negative did not present histopathologically thickened epineurium at the beginning, while in four patients who then presented positive Mitsuda, the initial histopathological examination showed epineural thickening . Among the nine patients having a histopathologically thickened epineurium, six did not present initial lesions in the upper limbs . Therefore, the study of the cubital epineurium early thickening deserves special mention, and should be performed in a larger number of patients, as well as in control groups, since the follow-up of four among six patients showed epineural thickening and reversal of the Mitsuda reactions to positivity.

Nippon Yakurigaku Zasshi, 1983 Jun, 81(6), 529 - 38
{Effect of cianidanol (KB-53) on delayed skin reactions in mice compromised by carbon tetrachloride and 1-naphthylisothiocyanate}; Tajima S et al.; A study was carried out to investigate the influence of 3 kinds of hepatotoxic agents on the peripheral blood leucocyte population, the splenocyte population and the delayed type hypersensitivity (DTH) in mice . These parameters were not affected by the intraperitoneal injection of D-galactosamine (Gal) . The intensity of picryl chloride induced DTH (PC-DTH) in mice was significantly lowered with the administration of carbon tetrachloride (CCl4) and 1-naphtylisothiocyanate (ANIT) in a dose-dependent manner after the mice were sensitized to picryl chloride (PC) from one to three days after the subcutaneous injection of CCl4 and ANIT . However the peripheral blood leucocyte population and splenocyte population were not affected by these chemicals . The lowering effect of CCl4 and ANIT on PC-DTH was somewhat weakened when PC sensitization was performed seven days after the injection of CCl4 and ANIT . No lowering effect was observed when PC sensitization was performed fourteen days after the injection of CCl4 and ANIT . The intensity of PPD induced DTH (PPD-DTH) was also lowered by the administration of CCl4 and ANIT when the sensitization to tubercle bacilli was performed three days after the injection of CCl4 and ANIT . Cianidanol (KB-53) prevented the decrease of PC-DTH and PPD-DTH in the mice injected with CCl4 and ANIT in a dose-dependent manner, but did not affect DTH in normal mice . So it seems that KB-53 has an immunostimulating effect on decreased cellular immunity.

Am J Med, 1983 Jun, 74(6), 934 - 40
Double-blind randomized study of prophylactic trimethoprim/sulfamethoxazole in granulocytopenic patients with hematologic malignancies; Gualtieri RJ et al.; In a double blind study, oral prophylactic trimethoprim/sulfamethoxazole was evaluated for its utility in preventing serious infections in patients with hematologic malignancy . Of 58 evaluated granulocytopenic episodes in 47 patients, acute leukemia was the underlying malignancy in 46 episodes . Trimethoprim/sulfamethoxazole prophylaxis resulted in fewer microbiologically documented infections (seven versus 15; p = 0.029) . This was primarily the result of a reduction in episodes of bacteremia in the trimethoprim/sulfamethoxazole-treated group as compared with the placebo-treated group (three versus nine episodes; p = 0.05) . The combined frequency of disseminated candidiasis, candidemia, and esophagitis of presumed fungal etiology was greater in the trimethoprim/sulfamethoxazole-treated group (six) than in the placebo-treated group (two) but not significantly so (p = 0.13) . Similarly, there were no significant differences between groups in the overall incidence of infectious complications, number of febrile days, use of parenteral antibiotics, or number of days following randomization to first infectious episode . Throat and rectal surveillance cultures more frequently revealed trimethoprim/sulfamethoxazole-resistant gram-negative bacilli and yeasts in the trimethoprim/sulfamethoxazole-treated group . More frequent emergence of yeast isolates from previously culture-negative patients was documented (p = 0.033) . Thus, in this study, trimethoprim/sulfamethoxazole prophylaxis during granulocytopenia reduced the incidence of microbiologically documented infections . However, the emergence of resistant bacteria and of fungi may limit the potential usefulness of this approach.

J Clin Pathol, 1983 Jun, 36(6), 662 - 6
Examination of operation specimens from patients with spinal tuberculosis for tubercle bacilli; Allen BW et al.; Operation specimens from 52 Hong Kong patients considered to have tuberculosis of the spine were sent at -78 degrees C to London where they were cultured on two Lowenstein-Jensen medium slopes, a slope of 7H11 medium made selective with antibiotics and in two bottles of selective liquid Kirchner medium . Cultures of M tuberculosis, usually with only scanty colonies, were obtained from 37 of the patients . Pus and caseous matter yielded more positive cultures and more numerous colonies than other specimens, but eight of the 37 patients yielded positive cultures only from tissues lining abscess walls or from bone or intervertebral disc specimens . Cultures in Kirchner medium were never contaminated and twice as many were positive as cultures on the slopes; nine patients had cultures positive only on Kirchner medium . It is recommended that (i) a variety of operation specimens, always including pus or caseous material in volumes of at least 1 ml, should be sent for bacteriology; (ii) specimens should be cultured in selective Kirchner medium, with or without Lowenstein-Jensen slopes; (iii) cultures should be incubated for a minimum of 8-9 wk.

Int J Lepr Other Mycobact Dis, 1983 Jun, 51(2), 205 - 10
The distribution of Mycobacterium leprae in the hair follicle of the eyebrow; Gummer CL et al.; Longitudinal sections of hair follicles from the eyebrows of patients with active, untreated, lepromatous leprosy were studied . Mycobacterium leprae were found in the dermal papilla and outer root sheath of both anagen and telogen hair follicles . Bacilli were rarely found in those cell lines continuous with the environment, i.e., the hair shaft and the inner root sheath . The biochemical fate of these cell lines is such that they would not provide a suitable medium for the survival and transport of bacilli into the environment . We conclude that it is unlikely that the hair follicle plays a significant role in the dissemination of M . leprae but it may be important in providing a suitable site for the incubation of the bacillus within the dermis.

Infect Immun, 1983 Jun, 40(3), 1096 - 103
Comparison of the immunogenicity of vaccines prepared from viable Mycobacterium bovis BCG, heat-killed Mycobacterium leprae, and a mixture of the two for normal and M . leprae-tolerant mice; Shepard CC et al.; Intradermal vaccines consisting of viable Mycobacterium bovis BCG, heat-killed Mycobacterium leprae, or mixtures of the two were titrated in mice in doses of 10(5.2), 10(5.8), 10(6.4), 10(7.0), and 10(7.6) acid-fast bacilli . The immune response was measured by sensitization (48 to 72 h foot pad enlargement on challenge with 10(7.0) heat-killed M . leprae) and by protection against infection with a viable M . leprae challenge . There was increasing response with increasing dose of vaccine, and overall the responses to the three vaccines were similar . At the lowest dose, however, the combination of BCG and M . leprae gave superior protection . The local reaction to the vaccines in the lower dose range was less severe with the M . leprae vaccine . In another experiment, the three vaccines were compared in normal mice and in mice that had been rendered tolerant by intravenous injection of M . leprae . The tolerant mice developed no measurable sensitization on vaccination with M . leprae, but they developed partial but distinct sensitization on vaccination with BCG, alone or in combination with M . leprae . The tolerant mice developed little or no protection with any of the vaccines, however.

Int J Lepr Other Mycobact Dis, 1983 Jun, 51(2), 211 - 8
The degradation of Mycobacterium leprae by a comparison of its staining properties; Ridley MJ; The disintegration of Mycobacterium leprae is revealed by a study of its acid-fast component, its non-acid-fast cell walls using methenamine silver, and its BCG-positive cytoplasmic component . Solid bacilli stain by the three stain techniques used to identify these products, but the BCG component is demonstrated only with difficulty and appears granular . Degradation of M . leprae is fairly rapid in BT, BB, and BL, and clearance of bacillary products occurs almost simultaneously because of the destruction of the cell walls . However, clearance is slower in nerves and BCG-positive material persists . The breakdown of cell walls is slow in LL and their clearance is delayed, but BCG-positive material is cleared as fast as it leaks out . ENL appears to coincide with a more rapid breakdown and release of disintegration products from degenerate macrophages . The Mitsuda reaction appears as an epithelioid cell granuloma after complete degradation of M . leprae with residual BCG positive material at 30 days.

S Afr Med J, 1983 May 28, 63(22), 850 - 4
Criteria for the diagnosis of pulmonary tuberculosis; Escreet BC et al.; Diagnostic criteria for pulmonary tuberculosis are presented in the form of a weighted diagnostic protocol . These criteria were evolved to standardize the diagnosis of pulmonary tuberculosis for a prospective study of the disease and its treatment, and were first tested in the evaluation of 469 referred patients, of whom 300 were found to have tuberculosis . The criteria have subsequently been validated clinically and statistically through their application to 1679 patients with radiological abnormalities suggestive of tuberculous disease, of whom 1154 were proved to have pulmonary tuberculosis . Application of these criteria whenever pulmonary tuberculosis is suspected has removed the dilemma often faced by clinicians when presented with a suggestive chest radiograph, a single sputum smear positive for acid-fast bacilli resembling Mycobacterium tuberculosis, or a strongly positive tuberculin test . We believe that these criteria put each of these separate findings into perspective . They allow the diagnosis of pulmonary tuberculosis to be made with confidence and prevent the erroneous diagnosis of non-tuberculous disease . Their use should alleviate the tendency towards an overdiagnosis of active pulmonary tuberculous disease, and thereby the waste of therapeutic and social resources.

J Hand Surg {Am}, 1983 May, 8(3), 333 - 5
Aeromonas hydrophila wound infection of the hand initially presenting as clostridial myonecrosis; Geller HS et al.; A traumatic hand laceration in a previously health 17-year-old boy resulted in a rapidly progressive palmar space infection, with gas formation, in the soft tissues caused by Aeromonas hydrophila . Typically associated with aquatic injuries, A . hydrophila was not initially suspected since the injury did not occur near water . Physicians treated trauma-related soft tissue infections, particularly when the initial Gram stain shows many polymorphonuclear leukocytes and gram-negative bacilli, must consider the possibility of an Aeromonas infection even if the injury occurred in a nonaquatic environment . Appropriate therapy, including vigorous wound debridement and an aminoglycoside antibiotic, will be curative in an immunologically normal host.

Tissue Antigens, 1983 May, 21(5), 380 - 4
HLA-A, -B, -C and -DR antigen profile in pulmonary tuberculosis in North India; Singh SP et al.; Investigations for the HLA-A, -B, -C and -DR antigens were conducted on 124 random North Indian patients with confirmed diagnosis of pulmonary tuberculosis by the demonstration of acid fast bacilli in the sputum . 109 appropriately matched controls from the same ethnic background were also tissue typed . No significant deviation was observed in the HLA-A, -B, and -C locus antigens . With the HLA-DR typing, there was a marginal increase in DR2 and a concurrent significant decrease in DRw6 in the patient group . These deviations were, however, insignificant when correction for the P value was made . ABO blood group typing results indicate that blood group 'O' may afford protection against TB . The involvement of both DR2 and DRw6 is interesting as it is also implicated in leprosy, another mycobacterial disease . The results suggest the possibility of a common gene in the MHC for both tuberculosis and leprosy.

Am J Clin Pathol, 1983 May, 79(5), 591 - 7
Demonstration of bacteroides capsules by light microscopy and ultrastructural cytochemistry; Strohm H et al.; Forty-six anaerobic gram-negative bacilli, including 26 members of the Bacteroides fragilis group (BFG), were examined for capsules by the India ink technic . Thirty-five were encapsulated, including all the BFG strains . As a follow-up, seven of these isolates and two previously studied reference strains (B . fragilis ATCC 23745 and Bacteroides vulgatus ATCC 8482) were examined for capsules by ultrastructural cytochemistry . Using the periodic acid thiocarbohydrazide silver proteinate (PATCSP) method of Thiery, all the BFG examined were encapsulated . In addition to the reference strains, this included one strain of B . fragilis and four of Bacteroides thetaiotaomicron . One non-BFG strain showed no capsular material . Differences between these results and those reported previously with the ruthenium red technic may reflect species differences in the chemical composition of Bacteroides capsules.

Jpn J Antibiot, 1983 May, 36(5), 956 - 62
{Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology}; Nakamura H et al.; Fundamental and clinical studies were made on T-1982 (cefbuperazone) and the results were obtained as follows . Serum and uterine tissue concentrations of T-1982 were determined at 26 minutes before and at 20 to 80 minutes after the completion of intravenous drip infusion of 1 g . The levels of T-1982 in the fallopian tube, ovarium, endometrium, myometrium and uterine cervix were 23.7, 19.5, 50.5, 10.9 micrograms/g and 17.5 micrograms/g at 20 minutes after the completion of infusion . The levels were sufficiently effective against major pathogens (Gram negative bacteria and anaerobic bacilli) isolated in the field of obstetrics and gynecology . T-1982 was administered to 11 patients, including 7 of acute adnexitis, each one of pelveoperitonitis, pyometra, puerperal fever, and 1 of puerperal fever with sepsis, at a dose of 1-2 g twice a day for a period of 5 to 9 days by intravenous injection or intravenous drip infusion . Clinical responses were excellent in 5, good in 3 and poor in 3 . No adverse reactions nor marked changes in laboratory findings were observed in any of the cases treated with T-1982.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1983 May, 16(2), 71 - 83
{Evaluation of the GNF computer-coding system for the identification of non-fermentative Gram-negative bacilli}; Tarng CM et al.; In order to evaluate the effectiveness of the GNF computer-coding system for the identification of glucose non-fermenting gram-negative bacilli, we employed 406 strains of bacteria including 367 clinical isolates and 39 standard strains for testing . These strains were inoculated into the following eleven conventional biochemical test media: Triple Sugar Iron Agar, Simmon's Citrate Agar, Christensen's Urea Agar, Sulfide-Indole-Motility Medium, Semisolid Voges-Proskauer Test Medium, Moeller's Ornithine Decarboxylase Test Medium, Pyocyanin Test Medium, Oxidation/Fermentation (O/F) Glucose, O/F Fructose, Nitrate Broth, Moeller's Arginine Dihydrolase Test Medium . The results of these tests plus those from the hanging drop motility test and the oxidase test were converted into bacterial code number and then checked with the GNF computer-coding system . It was found that the first preference of agreement was 75.6%, second 15.3%, third 5.9%, and fourth or more 3.2% . In regard to the speed of bacterial identification by using the GNF system and information from hemolysis pattern and flagella stain, it was indicated that 84.7% would be correctly identified within 36-48 hours after isolation . If more confirmational tests were employed, the accurate identification rate would reach to 98.7% after 4 days of isolation . In addition, the use of the GNF computer-coding system can standardize identification procedures, shorten the identification period, and save cost in terms of materials supply, inoculation time, media preparation and media-storing space . Therefore, we conclude that the GNF computer-coding system is an effective tool in the identification of the glucose non-fermenting gram-negative bacilli.

Infection, 1983 May-Jun, 11(3), 167 - 9
Colistin and trimethoprim-sulfamethoxazole for the prevention of infection in patients with acute non-lymphocytic leukaemia . Decrease in the emergence of resistant bacteria; Rozenberg-Arska M et al.; In a previous study we demonstrated that trimethoprim-sulfamethoxazole decreases the prevalence of infection in patients with severe granulocytopenia . However, treatment was accompanied by a relatively high incidence of multiresistant microorganisms . We therefore conducted this study to determine whether the addition of colistin to the trimethoprim-sulfamethoxazole regimen prevents the emergence of these resistant bacteria . Thirty consecutive adult patients with acute non-lymphocytic leukaemia received trimethoprim-sulfamethoxazole plus colistin p.o . prophylactically . The results of this study were compared with the results of our previously published controlled study . Trimethoprim-sulfamethoxazole plus colistin was as effective as trimethoprim-sulfamethoxazole in preventing infection . However, the addition of colistin significantly reduced the acquisition of and infection by gram-negative bacilli which were resistant to trimethoprim-sulfamethoxazole . Only two patients were colonized with resistant strains, and no infections with these strains were observed . We have concluded that patients with acute non-lymphocytic leukaemia should receive a combination of trimethoprim-sulfamethoxazole plus colistin prophylactically during remission induction treatment.

J Antimicrob Chemother, 1983 May, 11 Suppl C, 71 - 8
Phagocytosis of filaments of Escherichia coli produced with mezlocillin; Lorian V et al.; The phagocytosis of filaments of Escherichia coli produced with mezlocillin differs from the phagocytosis of normal bacilli in that pseudopods are employed for bacilli, but the entire body of the polymorphonuclear cell (PMN) participates in the engulfment of a filament . A single PMN was observed phagocytizing one or more filaments 20-50 micron long . The mass of a filament is about ten times larger than the mass of a bacillus . When equal bacterial mass, one filament or 10 bacilli, is exposed to PMNs comparable bacterial killing results after 2-3 h of incubation.

Acta Cytol, 1983 May-Jun, 27(3), 355 - 61
Inflammatory responses in experimental tuberculosis pleurisy; Antony VB et al.; A model of tuberculous pleurisy in New Zealand white rabbits was developed to describe the sequential cellular and biochemical changes in pleural fluid . Bacille Calmette-Guerin (BCG) in 4 X 10(7) colony-forming units was introduced into the right pleural space of rabbits previously sensitized by intradermal BCG . Pleural fluid was obtained via serial thoracenteses . A normal-pH, normal-glucose, exudative effusion was seen through 144 hours . Polymorphonuclear leukocytes were the first cells to respond to the introduction of tubercle bacilli in the pleural space; they remained the predominant cell for the first 24 hours and were followed by macrophages, which peaked at 96 hours, and then by lymphocytes . Numerous granulomata were observed on both the visceral and parietal pleura ten days following intrapleural instillation of BCG . We propose that the polymorphonuclear leukocyte influx is not a nonspecific response to pleural injury and that such a leukocyte response, either itself or through its interaction with the macrophage, plays a role in host defense mechanisms against the tubercle bacilli.

Zh Mikrobiol Epidemiol Immunobiol, 1983 May, (5), 47 - 50
{Importance of immunoelectrophoresis in agar and disc electrophoresis in polyacrylamide gel for characterizing different strains of Bordetella pertussis}; Samsonova VS et al.; The antigenic composition of typical and atypical B . pertussis strains obtained in the foci of pertussis infection, as well as experimentally obtained antibiotic-resistant B . pertussis strains, has been studied by the methods of immunoelectrophoresis in agar and electrophoresis in polyacrylamide gel (PAAG) . Immunoelectrophoresis in agar has been found capable of differentiating B . pertussis culture from a group of unidentified morphologically similar Gram-negative bacilli by their antigenic composition and thus suitable for use as an additional criterion in the identification of atypical B . pertussis strains . PAAG electrophoresis has permitted finding differences in the set of protein antigens in the control strain and in its clones obtained by multiple subculturing in media with antibiotics added.

Genetika, 1983 May, 19(5), 693 - 707
{Factors limiting the gene expression of Escherichia coli in the cells of bacilli}; Lideman LF; The barrier to the Escherichia coli gene expression in bacillar cells is caused both by differences in DNA regulatory elements involved in the interaction with RNA polymerase and ribosomes, and by the structure and function features of the very enzymes which carry out this interaction.

Aktuelle Gerontol, 1983 May, 13(3), 87 - 9
{Therapeutic principles of bronchopulmonary infections in the aged}; Kummer F; Airways and lungs are equipped with a highly effective defense mechanism . These can bei found damaged in the aged: Cough is weaker, mucociliary clearance and mucous production are irregular . This damage can bei caused and increased by smoking, recurrent infection, and some sorts of air pollution (SO2) . We call it a primary infection, when the organ has been intact as well as the general condition (immune defense etc), and where the causative agent is a virus or virus-like organism . A secondary infection is conditioned by previous disease, and when the causative agents are bacilli . Finally, a tertiary infection is dependent on a defense failure of the body and on opportunistic organisms . For elderly patients, secondary infections outweight the others (recurrent purulent bronchitits) . However, tertiary infections must also bei considered in bedridden or post-operative patients or in those with metabolic disease . Finally, pneumonia in the aged must be differentiated in terms of underlying carcinoma, infarction, aspiration and tuberculosis . Therapy of primary (viral)infection consists mainly in prophylaxis of bacterial secondary infection . The choice of drug, dosage and duration of treatment depends on the degree of previous damage to the organ, of complications and status of the whole body and it's defense mechanisms.

Br J Dis Chest, 1983 Apr, 77(2), 185 - 8
NK cell activity in pulmonary tuberculosis; Yoneda T et al.; Natural killer (NK) cell activity, which may provide defence mechanism in the immune surveillance system, was studied in 38 patients with active pulmonary tuberculosis and 54 sex-, and age-matched healthy controls . The mean NK cell activity in patients with active pulmonary tuberculosis (58.7 +/- 26.4%) was significantly higher (P less than 0.001) than that in healthy controls (17.4 +/- 12.2%) . Classifying the patients into three groups according to the state of excretion of tubercle bacilli, the mean NK cell activity in newly diagnosed patients was 43.2 +/- 20.7%, in advanced disease 59.4 +/- 30.3%, and in successfully treated patients 71.9 +/- 25.9%.

Thorax, 1983 Apr, 38(4), 267 - 70
Role of fibreoptic bronchoscopy in the diagnosis of mycobacterial diseases; Funahashi A et al.; From January 1976 to December 1981 mycobacteria were recovered for the first time from the respiratory tract of 179 patients . Twenty-three patients had undergone fibreoptic bronchoscopy during initial investigation after three or more expectorated sputum specimens were negative for acid-fast bacilli . Three of these patients had nodular lesions on the chest radiograph and the diagnosis of mycobacterial disease was made only after thoracotomy . In the remaining 20 patients bronchial brushings yielded a positive culture in 19, while bronchial brushing was negative in one patient in whom culture of sputum before bronchoscopy had been positive . In eight of these 19 patients (group A) bronchial brushing was the only source that gave a positive result from culture, while in 11 patients (group B) both bronchial brushing and prebronchoscopy sputum yielded positive cultures . When these two groups were compared no difference was seen in their clinical presentation or radiographic findings but there was a notable difference in the quality of the presentation or radiographic findings but there was a notable difference in the quality of the prebronchoscopy sputum . Six of eight patients in group A had poor prebronchoscopy sputum, while 10 of 11 in group B had good prebronchoscopy sputum . It is concluded that, if a patient is unable to produce sputum or is able to produce only a poor specimen, fibreoptic bronchoscopy may be a useful means of obtaining additional material for culture.

J Infect Dis, 1983 Apr, 147(4), 624 - 34
Selective antimicrobial modulation as prophylaxis against infection during granulocytopenia: trimethoprim-sulfamethoxazole vs . nalidixic acid; Wade JC et al.; Sixty-two profoundly granulocytopenic patients with acute leukemia undergoing induction chemotherapy were prospectively randomized to receive either trimethoprim-sulfamethoxazole plus nystatin or nalidixic acid plus nystatin for prevention of infection . Patients given trimethoprim-sulfamethoxazole plus nystatin during initial remission induction experienced an increased duration (22.6 vs . 13.6 days) of profound granulocytopenia (less than 100 granulocytes/mm3; P = 0.007) . Acquisition of gram-negative bacilli was more frequent among patients treated with nalidixic acid plus nystatin while filamentous fungi were acquired more frequently by patients receiving trimethoprim-sulfamethoxazole plus nystatin (P = 0.05) . The median duration of on-study time prior to documentation of first infection was longer for patients receiving trimethoprim-sulfamethoxazole plus nystatin (17 days) than for those receiving nalidixic acid plus nystatin (eight days) (P = 0.0002) . Three infection-related deaths occurred among patients receiving nalidixic acid; seven occurred among patients receiving trimethoprim-sulfamethoxazole, five of which were secondary to pneumonia due to Aspergillus flavus . Both of these methods of selective antimicrobial modulation have apparent advantages, but each has disadvantages serious enough to limit their routine use.

Mayo Clin Proc, 1983 Apr, 58(4), 233 - 40
Antituberculous agents . Isoniazid, rifampin, streptomycin, ethambutol, and pyrazinamide; Van Scoy RE et al.; Effective antituberculous drugs have radically improved the prognosis of the patient with active tuberculosis . Surgical therapy is rarely needed, and sanitoriums have largely vanished . Triple-drug therapy may be indicated initially for cavitary pulmonary disease, meningitis, miliary disease, and moderate to severe renal disease . Short-course therapy twice or three times weekly with isoniazid and rifampin may be used in cavitary pulmonary disease and probably in these other serious infections as well . Isoniazid alone is adequate for prophylaxis . The major cause of therapeutic failure is noncompliance of the patient in taking the medication regularly . The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobial agents used . When treatment failure is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated . A single drug should never be added to a failing regimen.

Am J Infect Control, 1983 Apr, 11(2), 57 - 62
The hospital tuberculosis registry: an aid to infection control; Bryan CS; Maintenance of a "central tuberculosis registry" has been proposed to facilitate communication between hospital personnel and other persons such as members of health departments and practicing physicians involved in the care of patients . A 5-year experience revealed additional benefits: (1) recognition, and partial correction, of deficiencies in tuberculin testing; (2) recognition and termination of a pseudoepidemic of false positive acid-fast bacilli smears; (3) increased frequency with which patients were placed in respiratory isolation at the time of admission to the hospital; and (4) decrease in the indicence of tuberculin conversions among hospital employees . It is suggested that such a registry should be included in all hospital infection control programs.

Ann Intern Med, 1983 Apr, 98(4), 530 - 5
Clinical use of the new beta-lactam antimicrobial drugs . Practical considerations for physicians, microbiology laboratories, pharmacists, and formulary committees; Brooks GF et al.; New beta-lactam antimicrobial agents with extended antibacterial activity for gram-negative bacilli are being developed and marketed . These drugs provide major advances, especially for treatment of serious infections caused by multiresistant organisms . Several of the drugs have been marketed and many more will be available . Some of these drugs are considerably more costly than the older beta-lactams . The large number of new antimicrobial drugs coupled with their high costs pose complex problems for physicians, microbiology laboratories, and pharmacists . Community hospitals, large general hospitals, and tertiary care hospitals have different needs for patient care and will need different formats for unbiased education, susceptibility testing, pharmacy stocking, and controlling or monitoring for inappropriate use.

Acta Leprol, 1983 Apr-Jun, 1(2), 93 - 100
{Effect of beta-1,3 glucan and other immunomodulators of microbial origin on experimental leprosy in mice}; Rayyan W et al.; The effect of beta-1,3 glucan and cell walls of S . cerevisiae on one hand and of peptidoglycans from strain LDC 15 and C . renale and cell walls of C . Hofmannii on the other hand has been investigated in the experimental leprosy infection in mice . beta-1,3 glucan, by enhancing the function of the reticulo-endothelial system, is the most active inhibitor of the multiplication of Hansen's bacilli . Peptidoglycan of strain LDC 15 is less active and seems non specific.

Lepr India, 1983 Apr, 55(2), 247 - 51
Mouse foot pad growth of M . leprae in relation to bacteriological index; Bhatia VN et al.; A retrospective analysis was made of the mouse foot-pad growth of M . leprae from 35 cases of lepromatous leprosy with B.I . ranging from 1.33 to 4.0 (Dharmendra scale) . Of these 35 cases, 6 were found to be harbouring dapsone resistant bacilli and 18 cases sensitive bacilli . In 11 of them there was no growth in the control group of animals . The analysis showed that there was no difference in the mean B.I . between those showing no growth and those showing growth in the 1st, 2nd or 3rd harvest . A minimum B.I . around 1.5 is considered adequate for positive foot-pad takes . Another interesting observation made in the study was that the growth rate in the control group foot-pads was consistently higher in mice receiving dapsone resistant bacilli as compared to those inoculated with bacilli, sensitive to the drug.

Ann Trop Med Parasitol, 1983 Apr, 77(2), 187 - 93
Lepromatous leprosy in man; depth of the cellular infiltrate and bacillary mass in relation to the possibility of transmission of leprosy by biting arthropods; McDougall AC et al.; In order to further define the possible role of arthropods in the transmission of leprosy, the depth of the cellular infiltrate and bacillary mass in the skin of patients with untreated lepromatous leprosy was measured, and this was related to the depth of penetration of the mouthparts of some species of arthropods of medical importance . The results confirmed that large numbers of bacilli are readily available to the biting apparatus of several species of arthropods, but not to that of the scabies mite, which has only a superficial attachment and depth of penetration . The data do not indicate that leprosy transmission in man (or animals) occurs through biting arthropods, but they do lend support to this possibility, if only in a mechanical sense.

Jpn J Antibiot, 1983 Apr, 36(4), 881 - 7
{Clinical studies of T-1982 (cefbuperazone) in the field of pediatrics}; Watanabe N et al.; T-1982 (cefbuperazone), a new cephamycin antibiotic, was clinically and bacteriologically studied in 25 children with bacterial infections . The following results were obtained . 1 . The antibacterial activity of T-1982 was determined against clinically isolated bacteria . T-1982 demonstrated excellent activity against Gram-negative bacilli, the MICs being less than 0.39 microgram/ml against E . coli and K . oxytoca, less than 1.56 microgram/ml against H . influenzae . 2 . Clinical response was excellent or good in all 24 cases evaluated . The efficacy rate was 100% . 3 . As for side effects associated with T-1982, slight and transient elevation of GOT, GPT and eosinophil, slight decrease of platelet and eruption were observed . From these results, T-1982 is considered to be a useful antibiotic for treating bacterial infections in children.

Arch Intern Med, 1983 Apr, 143(4), 683 - 8
Osteomyelitis beneath pressure sores; Sugarman B et al.; Twenty-eight pressure sores were evaluated prospectively . Osteomyelitis was reported histologically in nine of 28 bones and pressure-related changes were reported in 14 bones . Roentgenograms suggested the presence of osteomyelitis in four instances of histologically proved osteomyelitis . Technetium Tc 99m medronate bone scans were highly sensitive, showing increased uptake in all cases of osteomyelitis; however, increased uptake also occurred commonly in uninfected bones due to pressure-related changes or other noninfectious causes . Cultures of bone biopsy samples usually disclosed anaerobic bacteria, gram-negative bacilli, or both . The diagnosis of osteomyelitis must be considered if a pressure sore does not respond to local therapy . If the technetium Tc 99m medronate uptake is increased in the involved area, or roentgenographic findings are abnormal, the diagnosis can only be made with certainty by histologic examination of bone . Antibacterial treatment should be selected based on the results of bone culture.

Lepr India, 1983 Apr, 55(2), 200 - 8
Evaluation of drug regimen in lepromatous leprosy--II; Ramu G et al.; A 2 year follow-up study of 4 drug regimen in 45 cases is reported; whereas the combination of Rifampicin and Dapsone had been found to effect clearance of bacteraemia within a week and effect negativity of nasal smears in a shorter period of time, at 2 years the clinical and bacteriological results in the DDS, DDS + Rifampicin, DDS + Thiacetazone + INH, and DDS + Clofazimine regimen were similar . However, on inoculating bacilli obtained from the dartos muscle into the foot-pads of mice, multiplication was found in 1 out of 11 cases on Rifampicin and DDS, whereas 2 out of 9 cases on DDS + Thiacetazone + INH; 2 out of 10 cases on DDS + Clofazimine and 4 out of 8 cases on DDS alone showed multiplication . Therefore at the end of 2 years there was no significant difference in the results of treatment with any of the drug combinations used in the trial . However, the drug combinations have been found to be better than monotherapy with dapsone alone.

J Infect Dis, 1983 Mar, 147(3), 427 - 33
Infection due to organisms of the Mycobacterium fortuitum complex after augmentation mammaplasty: clinical and epidemiologic features; Clegg HW et al.; Periprosthetic infections due to Mycobacterium fortuitum and Mycobacterium chelonei occurred in 17 women over a 3.5-year period after implantation of prostheses for breast augmentation . The median incubation period for 16 of the women was 28 days (range, one week to over two years) after surgery; etiologic diagnosis was usually delayed for weeks to months . Odorless and serosanguineous or purulent material was found when the implants were removed, and acid-fast bacilli were often present when smears were examined . Wound infections were chronic and refractory to therapy with various antimicrobial agents . Persistent or recurrent mycobacterial infections complicated attempts to implant new prostheses . Whereas M . fortuitum isolates were susceptible to amikacin, multiple strains of M . fortuitum were distinguished by conventional antituberculous and broth microdilution susceptibility tests . Several clusters of infections were temporally and geographically related; however, sporadic cases were also reported, and no evidence of a contaminated common product or other single source of infection was found.

Int J Lepr Other Mycobact Dis, 1983 Mar, 51(1), 7 - 17
A clinical and immunological study of four babies of mothers with lepromatous leprosy, two of whom developed leprosy in infancy; Duncan ME et al.; One hundred thirteen women and 27 healthy controls were studied throughout pregnancy, at delivery, and followed up with their babies during lactation . Thirty-eight of the mothers with lepromatous leprosy were found to have solid-staining bacilli in skin smears or biopsies, and hence were considered potentially highly infectious to their unborn children by hematogenous spread via the placenta . Two babies of mothers within this group were diagnosed as having leprosy on clinical and histological grounds . A third baby could well have had leprosy, but the case was not proven . The fourth baby did not have leprosy and, although it did have ringworm, was thus deemed to be a reasonable control . The leprosy skin lesions were first observed at a special followup clinic when the children were between the aged of 9 and 17 months . The demonstration of IgA and IgM anti-M . leprae antibodies in cord sera was taken as an indication of intrauterine immunologic stimulation, and hence transplacental transmission of M . leprae . The two babies with proven leprosy showed an early and significant increase in serum IgA and in particular serum IgM anti-M . leprae antibody activity . A third baby, suspected of having leprosy but in whom the diagnosis was not proven, showed a similar but less marked increase in serum IgA and IgM activity . The fourth baby showed no such rise in anti-M . leprae activity . A decrease in serum IgG anti-M . leprae antibody activity could be demonstrated in one of the babies with leprosy after healing of the leprosy lesions, but not in the second baby.

Int J Lepr Other Mycobact Dis, 1983 Mar, 51(1), 29 - 32
Leprous synovitis . A study of fifty cases; Holla VV et al.; A study of 50 synovial biopsies of proved lepromatous patients with arthritis was carried out . Out of these 50 cases, 14 cases were suffering from lepra reaction and the histopathological study of the synovium in these 14 cases revealed the presence of only vasculitis and lymphocytic infiltration . In the remaining 36 cases, not associated with lepra reaction, the synovial lining showed hyperplasia and villous hypertrophy, and the synovial tissue showed congestion, pannus formation, the presence of macrophage granulomas and, in some cases, even intact acid-fast bacilli . Since there was no other cause for arthritis, it is perhaps likely that the primary synovial involvement in these 36 cases may be the cause of the arthritis . In the ten cases of lepromatous leprosy without arthritis studied as controls, no histopathological abnormality in the synovium could be detected.

Int J Lepr Other Mycobact Dis, 1983 Mar, 51(1), 1 - 6
Involvement of subcutaneous veins in lepromatous leprosy; Mukherjee A et al.; Venous involvement in 31 patients with lepromatous leprosy has been studied in biopsies from clinically involved and clinically normal subcutaneous veins from the forearm . Twenty-nine of these showed histological evidence of leprous phlebitis . The earliest lesion was intimal cell hyperplasia with the presence of acid-fast bacilli in small groups in the intimal cells . This gradually progressed to total occlusion of the vein by lepromatous exudate . The results indicate much greater involvement of veins and possibly other components of the vascular system in patients with lepromatous leprosy than is generally accepted . The importance of such involvement in the pathogenesis of leprosy is also discussed.

Mayo Clin Proc, 1983 Mar, 58(3), 154 - 7
Metronidazole; Rosenblatt JE et al.; Metronidazole, a nitroimidazole derivative, is a unique antimicrobial agent that is active against both bacterial and parasitic organisms, although only the anaerobic members of these groups are susceptible . It has been used for the treatment of trichomoniasis for about 20 years and is also effective against amebiasis and giardiasis . More recently, metronidazole has emerged as a principal agent for the treatment of anaerobic bacterial infections . It is highly effective against all species of anaerobes except certain non-spore-forming gram-positive bacilli and cocci and is the only agent rapidly bactericidal against the Bacteroides fragilis group . Clinical studies have proved its efficacy in prophylaxis for elective colorectal surgical procedures and in the treatment of deep abdominal sepsis (usually in combination with another agent, such as an aminoglycoside) . Metronidazole is the treatment of choice for nonspecific vaginitis that seems to be a mixed infection due to anaerobes and Gardnerella vaginalis . Adequate concentrations in the blood are produced after both oral and intravenous administration, and the side effects are infrequent and minimal.

Antimicrob Agents Chemother, 1983 Mar, 23(3), 374 - 8
Interactions of beta-lactam antibiotics and antineoplastic agents; Ueda Y et al.; The in vitro interactions of four beta-lactam antibiotics and five antineoplastic agents were examined with 100 clinically isolated strains of four species of gram-negative bacilli . Generally, by the checkerboard dilution method, beta-lactam antibiotics, when tested in combination with mitomycin C, bleomycin, or 5-fluorouracil, showed synergistic action, whereas when tested in combination with carboquone, they showed antagonistic action . Almost no combinations of adriamycin showed the interactions . Among beta-lactam antibiotics, piperacillin was more frequently synergistic than cefoperazone, cefazolin, or carbenicillin when tested in combination with each antineoplastic agent against various species.

Tubercle, 1983 Mar, 64(1), 15 - 21
Bacteriophage typing of strains of Mycobacterium tuberculosis from Nepal; Goode D; One hundred strains of Mycobacterium tuberculosis isolated from cases of pulmonary tuberculosis in Nepalese villagers were typed with the World Health Organization set of bacteriophages . The number of strains in the 3 major phage types A, I, and B were 19, 53, and 28 respectively . This distribution is significantly different from those described in other geographical regions . In particular there was a relatively low incidence of type A strains and, in common with South India, there was a high proportion of type I strains . All the strains in this study were resistant to 5-Furan-2 carbonic acid hydrazine and 34 were highly resistant to isoniazid . Representative strains of the 3 phage types, including 4 isoniazid-resistant type I strains, did not differ in their virulence in the guinea pig; thus the type I strains found in Nepal may not be of the same origin as those of this phage type from India which are usually attenuated in the guinea pig . This study provides further evidence for the existence of geographical differences in the types of tubercle bacilli.

Aust Vet J, 1983 Mar, 60(3), 80 - 3
Antibiotic resistant coliform bacilli, isolated from freshly slaughtered poultry and from chilled poultry at retail outlets; Bensink JC et al.; Antibiotic resistance in coliforms isolated from poultry was investigated . Poultry carcases were examined immediately after slaughter or at retail outlets; the carcases were from the same processing plant and 100 were examined from each source . Approximately 85% of the total of 13,858 isolates examined were found to be resistant to at least one antibiotic . Highly significant differences were found in the levels of antibiotic resistance from the 2 sources; ampicillin, chloramphenicol, and sulphonamide resistance was found more frequently in isolates from poultry at retail, while resistance against streptomycin and neomycin occurred more frequently in isolates from poultry examined at slaughter . The data were insufficient to explain these changes . Transfer of resistance occurred less frequently in isolates from poultry at retail; in particular the transfer of resistance from coliforms other than Escherichia coli was found to be greatly reduced.

Int J Lepr Other Mycobact Dis, 1983 Mar, 51(1), 72 - 6
Use of cycloheximide for cultivating Mycobacterium lepraemurium in cell culture; Matsuo Y; A serial increase in the number of Mycobacterium lepraemurium with successful subcultures has been obtained in cell culture with cycloheximide treatment . The infected cells seldom floated off the culture vessel . They could be maintained and would support the bacillary multiplication in good condition for ten weeks or more without changing the medium frequently . An overall generation time of the intracellular bacilli up to the tertiary culture for the total period of 35 weeks was 22.1 days.

Pathol Biol (Paris), 1983 Mar, 31(3), 195 - 7
{Antibiogram of mycobacteria for erythromycin, tetracycline and cotrimoxazole}; Demoulin L et al.; Disc method checks the bacterial susceptibility to erythromycin, tetracycline and cotrimoxazole, while the percentage method determines the MIC and the proportion of resistant bacilli at a critical concentration . The mycobacteria include 113 strains representing 12 species . Both methods show that cotrimoxazole is more active on germs than the other substances . Nevertheless, the sensitivity varies with the species, according to the technique . As the proportion method is a more reliable test to establish the susceptibility of mycobacteria, we have only used this technique to determine the activity spectrum of the various drugs . Specifically, M . marinum, M . scrofulaceum and M . szulgai are inhibited by the three substances, while M . kansasii, M . ulcerans and M . xenopi are especially sensitive to cotrimoxazole and erythromycin . M . fortuitum and M . haemophilum are particularly sensitive to cotrimoxazole, while they are resistant to erythromycin and tetracycline . It is the contrary with M . chelonei . M . avium and M . tuberculosis are sensitive to erythromycin and cotrimoxazole, but to a lower degree, while M . bovis does not respond to any drugs.

Clin Exp Immunol, 1983 Mar, 51(3), 421 - 9
T cell subsets in leprosy lesions: in situ characterization using monoclonal antibodies; Narayanan RB et al.; Cryostat sections of dermal lesions from 30 untreated leprosy patients were studied by indirect immunofluorescence using monoclonal antibodies defining T cell subsets and Ia like antigens . Most lymphocytes in leprosy lesions were positive for OKT3 and Ia like antigens indicating thereby the presence of activated T cells . Maximal numbers of these cells were seen in localized paucibacillary tuberculoid leprosy lesions in close association with epithelioid cells . A decline in their numbers was observed over the leprosy spectrum with a marked reduction in disseminated, multi-bacillary, lepromatous leprosy where only scattered OKT3+ cells were visualized . OKT4 and OKT8 positive cells defining T cell subsets, were frequently found within the OKT3+ lymphocytes throughout the leprosy spectrum . The ratio of OKT4+/OKT8+ cells ranged from 1.2 to 5.0 in tuberculoid and from 0.2 to 1.0 in lepromatous lesions . Macrophages in the granulomas stained intensely with anti-Ia antisera . Ia like antigens were expressed to the same degree on macrophages with or without intracellular acid fast bacilli.

J Pathol, 1983 Mar, 139(3), 275 - 90
The histopathology of tissues in "resistant" and "susceptible" strains of mice infected with a moderate dose of Mycobacterium lepraemurium; Adu HO et al.; A systematic study by light and electron microscopy of tissues from BALB/c and C57BL/6 mice infected subcutaneously with 10(7) Mycobacterium lepraemurium organisms was carried out at various times throughout the infection . The relatively resistant C57BL/6 mice had an earlier inflammatory response at the site of the infection than did the susceptible BALB/c mice . The infiltration in the former strain contained fibroblast-like cells and epithelioid cells early on in the infection . Few lymphocytes were observed in both strains throughout the infection . The spread of acid-fast bacilli was slower in the resistant strain (C57BL/6) . The findings indicated that the rate of cellular infiltration at the infection site and the nature of the cells in the infiltration may determine the outcome of this infection.

Int J Lepr Other Mycobact Dis, 1983 Mar, 51(1), 84 - 8
Electron microscopic observations of intracytoplasmic inclusions in human and murine leprosy bacilli; Hirata T; The intracytoplasmic inclusions of Mycobacterium leprae in human lepromata and M . lepraemurium in murine lepromata were studied in ultrathin serial sections at the electron microscopic level . The inclusions were mostly homogeneous and spherical, and did not exist uniformly throughout the bacillary cells . They did not appear to be delimited by membranous structures and apparently had no internal structure . There seemed to be fundamentally little difference between M . leprae and M . lepraemurium in the fine structure of these inclusions . However, the large diffuse inclusions observed in the cells of M . lepraemurium may be a special feature of murine bacilli.

J Infect, 1983 Mar, 6(2), 123 - 7
Legionella pneumophila seen in Gram stains of respiratory secretions and recovered from conventional blood cultures; Farrington M et al.; We report a fatal case of Legionnaires' disease in which Legionella pneumophila was easily visible in large numbers in Gram stains of clinical material and was recovered from conventional blood cultures after seven days incubation . The presence of many readily seen Gram-negative, pleomorphic bacilli in direct Gram stains of respiratory secretions should support a possible diagnosis of Legionnaires' disease.

South Med J, 1983 Mar, 76(3), 284 - 9
Whipple's disease: pathogenetic considerations; Ho KJ et al.; A typical case of Whipple's disease was manifested by malabsorption and nondeforming peripheral arthritis for five years . A definite diagnosis was made by duodenal mucosal biopsy which revealed the characteristic histologic features by light microscopy, intracellular and extracellular Whipple's bacilli by electron microscopy, and a typical immune cross-reactivity pattern by immunofluorescence technique . Whipple's bacilli apparently elicit no effective humoral and cellular immune response; macrophages thus play the key role in its pathogenesis . Antibiotic treatment resulted in a dramatic relief of symptoms and rapid restoration of body weight . We stress that in patients with nondeforming peripheral arthritis associated with malabsorption syndrome, Whipple's disease, despite its rarity, should be included in the differential diagnosis.

Transplantation, 1983 Feb, 35(2), 144 - 9
Immunosuppressive effect of bredinin on cell-mediated and humoral immune reactions in experimental animals; Kamata K et al.; Bredinin (BR), an imidazole nucleoside isolated from Eupenicillium brefeldianum was previously reported to prolong kidney allograft survival in dogs . The immunosuppressive effect of BR was studied in experimental animals . In beagles, in vitro responses of lymphocytes stimulated by mitogens or allogeneic cells were suppressed by in vitro BR treatment . BR, given in vivo, also showed an inhibitory action against development of delayed hypersensitivity reaction to tubercle bacilli in guinea pigs or against hemagglutinin production following booster SRBC injection in rabbits . Of note may be the fact that BR was found to have an immunosuppressive potency comparable to that of azathioprine and, in addition, to show a decreased hepatotoxicity compared with the latter.

Jpn J Antibiot, 1983 Feb, 36(2), 398 - 407
{Tissue distribution of cefotetan in the field of obstetrics and gynecology}; Nishino H et al.; The concentrations of cefotetan (CTT) in serum, uterus, ovary and oviduct tissues were determined in 30 patients after single intravenous drip infusion of 1 g over 1 hour . 1 . Peripheral blood level of CTT was determined from 3 to 24 hours after injection . The maximum level was observed at 3 hours after injection and the concentration went down gradually with time . 2 . The tissue concentrations of CTT in intrapelvic organs also tended to decrease with time and hardly detected 24 hours after injection . 3 . From 3 to 12 hours after injection, mean penetration rate of CTT into intrapelvic organs was 40% and more . 4 . Among intrapelvic organs, penetration rate into portio was highest, and others were ovary, uterine cervix, oviduct, endometrium, myometrium and uterine myoma in order of lowering penetration rate . 5 . The penetration rate into uterine myoma was approximately half that into normal tissue . Considering above results, CTT is expected to show sufficient effects against Gram-negative bacilli and Bacteroides sp . when reasonably dosed.

Oral Surg Oral Med Oral Pathol, 1983 Feb, 55(2), 113 - 20
Chemotherapy-associated oral infections in adults with solid tumors; Dreizen S et al.; The frequency of chemotherapy-associated oral infections in adult inpatients with solid tumors was determined in 825 subjects with carcinoma, 60 with sarcoma, and 115 with lymphoma . The total number of documented oral infections in the 1,000 patients was 97 (9.7 percent), with frequency rates of 8.4 percent, 11.7 percent, and 18.3 percent for the patients with carcinoma, sarcoma, and lymphoma, respectively . All but six of the infections were caused by a single organism . Microbiologically, 68.9 percent of the infections were ascribable to fungi, 10.7 percent to gram-negative bacilli, 10.7 percent to herpes simplex, and 9.7 percent to gram-positive cocci . The patients with solid tumors were less than one third as prone to oral infections as adults with acute leukemia treated in the same hospital . Among the solid tumor group, those with lymphoma were almost twice as likely to develop infections of the mouth during chemotherapy as those with carcinoma or sarcoma . The oral infection experience in the previously reported patients with acute leukemia and in the present series of patients with solid tumors strongly suggests that the more aggressive the malignancy and the more potent the chemotherapy, the greater the tendency to stomatologic infections.

Infect Immun, 1983 Feb, 39(2), 865 - 72
Mycobacterium leprae infection in nude mice: bacteriological and histological responses to primary infection and large inocula; Lancaster RD et al.; Previous studies have demonstrated that congenitally athymic, nude mice are highly susceptible to infection with Mycobacterium leprae . In this study, we showed that footpad inoculation of nude mice with different inoculum sizes of M . leprae resulted in exponential growth of bacilli until bacillary numbers reached approximately 10(10) bacilli per footpad . There was dissemination of the infection from approximately 10 months after inoculation . When nude mice were compared with thymectomized and irradiated mice and normal intact mice for the ability to detect growth from large inocula of low viability, nude mice were the most sensitive, permitting the detection of 10(2) viable M . leprae among 10(7) irradiation-killed organisms . There was widespread dissemination of the infection throughout the reticuloendothelial system and the tissues of the cooler body sites from approximately 10 months after inoculation . Histologically, the lesions resembled those seen in lepromatous leprosy, although the bacillary load appeared larger and was similar to that seen in heavily infected tissues of the nine-banded armadillo . An unusual feature was the presence of numerous foci of neutrophil polymorphs in the footpads and liver of infected nude mice.

Arch Dis Child, 1983 Feb, 58(2), 143 - 5
Infection in neonatal hypothermia; El-Radhi AS et al.; Infection, particularly of the respiratory tract, was present in 80 of 138 children with neonatal hypothermia . The most common lesion was right upper lobe atelectasis and was probably due to aspiration pneumonia . In children older than 3 days infection elsewhere, mainly owing to Escherichia coli bacilli, was common.

J Invest Dermatol, 1983 Feb, 80(2), 81 - 5
Comparative study with two polar types of murine leprosy: an involvement of plasminogen activator and its possible regulating factor in the granulomatous tissue reaction; Izaki S et al.; Enzymatic activities in a saline-extractable fraction from two polar types of murine lepromas were investigated using pyroglutamyl-glycyl-arginine-p-nitroanilide and plasminogen-rich, as well as plasminogen-free, fibrin plates . An inhibitor activity for urokinase was also measured . C57BL/6NJcl (immunologically high responder strain) mice inoculated with 2 X 10(8) Mycobacterium lepraemurium developed a localized lepromatous lesion after 4 weeks . The tissue extracts obtained after 4-6 weeks exhibited inhibition for urokinase (8.8 IU/mg protein), but no enzymatic activity . After 8-11 weeks, when the lepromas showed an ulcerative change, prominent peptide hydrolytic activity (84.8 nmol/mg/protein/ min) was demonstrated . The fibrin plate assay confirmed that plasminogen activator is predominantly involved (26.4 IU/mg protein) . The proteolytic activation was apparently correlated with discharge of purulent materials containing the bacilli and subsequent limitation of leproma development . However, similar modulation of the fibrinolytic enzyme-inhibitor system was not shown in CBA/N mice (immunologically low responders) . The tissue extracts showed a low level of urokinase inhibitor activity (1.9 IU/mg protein), but no peptidolytic or plasminogen activator activity . Consequently, lepromas were developed progressively until 25 weeks after infection and dissemination from the lepromatous lesion took place thereafter . In comparison with histologic findings, which revealed accumulation of lymphocytes and mononuclear cells in the peripheral zone of lepromatous lesions in the C57BL/ 6NJcl, but not in the CBA/N mice, a controlling mechanism of plasminogen activator in tissue is assumed to be involved in the development of the granulomatous tissue reaction.

Schweiz Med Wochenschr, 1983 Jan 22, 113(3), 100 - 1
{Atypical mycobacteria (MOTT): incidence and significance}; Salfinger M; Statistics on the number, species and diagnosis of mycobacteria isolated from human specimens in 1981 at the Institute of medical microbiology of the University of Zurich are presented . 83% of the strains obtained from patients were classifiable as typical mycobacteria whereas 17% proved to be MOTT (mycobacteria other than tubercle bacilli) . The clinical significance of the isolated species was assessed according to the criteria of Yamamoto et al . (Amer . Rev . resp . Dis . 96, 773-778 {1967}) and Wolinsky (Amer . Rev . resp . Dis . 119, 107-159 {1979}) . Only in one out of 40 patients from whom MOTT (M . avium) was isolated could a causal connection be assumed between the isolate and the patient's disease . All microscopic determinations of specimens containing MOTT yielded negative results except that described above (in which 3 smears out of 6 were positive) . Several Swiss laboratories have recently reported a significant increase in MOTT isolates.

Schweiz Med Wochenschr, 1983 Jan 22, 113(3), 88 - 90
{Field experiences with the 6-month Singapore therapy in the treatment of open lung tuberculosis in Cambodian refugees}; Rieder H et al.; The particular situation of a refugee camp with transit character, as represented by "holding Centre Khao-I-Dang" (KID) for Cambodian refugees in Thailand, had to be taken into consideration when determining the therapy plan for the disease that is epidemiologically most important, smear-positive pulmonary tuberculosis . Under Singapore conditions daily administration of isoniazid (H) and rifampicin (R) for 6 months combined with a 2-month intensive phase of streptomycin (S) and pyrazinamide (Z) daily proved highly effective . The large-scale transfers in KID in February and March 1981 led to consistent administration of this therapy plan, which is recommended by the WHO . By the end of September 1981 61 patients aged 15 years and over had entered the "Thai/Swiss Red Cross TB Programme" . Criterion for entrance was the presence in sputum of acid-fast bacilli in the Ziehl-Neelsen stain . The routine examinations consisted of three microscopic sputum examinations per month, a sputum culture and a chest x-ray before commencement of therapy, followed by a chest x-ray at the end of the intensive phase and at the end of therapy . Efficacy and side effects of the 6-month therapy in our collective were similar to those of the Singapore study.

J Am Vet Med Assoc, 1983 Jan 15, 182(2), 168 - 9
Eastern white-tailed deer as a reservoir of ruminant paratuberculosis; Chiodini RJ et al.; Ten white-tailed deer were shot and killed at a Connecticut farm that had a 6-year history of bovine paratuberculosis, and organs from these animals were examined for evidence of paratuberculosis . Mycobacterium paratuberculosis was isolated from the cecal lymph node, terminal ileum, and ileocecal valve of 1 deer and from the cecal lymph node of another . Characteristic lesions and acid-fast bacilli were not observed . It was concluded that infected deer could serve as sources of infection for domestic stock.

Jpn J Ophthalmol, 1983, 27(1), 27 - 34
Case of sarcoidosis with uncommon tumorous mass formation in bulbar conjunctiva; Matsuo M et al.; A case of sarcoidosis with ocular involvement, including uncommon tumorous mass formation on the bulbar conjunctiva, was reported . The patient was a 62-year-old woman who had been suffering from chronic bronchiolitis for several years . The conjuctival masses, yellowish brown in color with localized injection and follicles, were found in both eyes . In addition to the conjunctival masses, the common manifestations of sarcoidosis were observed in the eyes, showing nodules on the iris and trabeculum, discrete fluffy "snowball" opacities in the vitreous, and perivascular nodules on the retinal vessels . Microscopically, the biopsy specimen obtained from he conjunctival masses was composed of epithelioid tubercles with Langhans type and foreign body type giant cells . Ziehl-Neelsen stain revealed no tuberculous bacilli . Transbronchial lung biopsy also revealed epithelioid tubercles . Both ocular and pulmonary lesions were observed to respond well to treatment with corticosteroid hormone . We emphasized that patients with interstitial pneumonitis or pulmonary fibrosis should be examined ophthalmologically, and recommended conjunctival biopsy in patients with suspected sarcoidosis.

Mikrobiologiia, 1983 Jan-Feb, 52(1), 109 - 13
{Change in the ultrastructure of Bacillus polymyxa cells in the process of sporogenesis}; Ermakova GN et al.; The fine structure of consecutive modifications was studied in sporulating cells of Bacillus polymyxa 153 growing in a liquid aerated medium . The stages of sporogenesis were found to be similar, in principle, with those in other species of the Bacillus genus, but also had certain peculiarities . In contrast to other bacilli, the nucleoid axial thread was not formed in B . polymyxa cells at the first stage of sporulation . The structure of the of the prospore nucleoid forming the local central zone differed from that of the vegetative cell nucleoid at the second stage . The ultrastructural changes observed when the spore septa was formed indicated that its structure was identical with that of the septa of vegetative division, in contrast to which the cell wall material did not undergo lysis but was preserved at the following stages of sporogenesis . The formation of the spore envelope material could easily be discerned in the cytoplasm of the mother cell . The fine structure of mature spores is described in this paper for B . polymyxa . The outer rigid part of its spore envelope was shown, for the first time, to consist of three layers, the surface one having an ordered fibrillar structure.

J Urol (Paris), 1983, 89(1), 21 - 5
{Tomodensitometry in the diagnosis of perinephritic phlegmon}; Merimsky E et al.; Twenty-nine patients with perinephric abscess were treated during the last 15 years . Twenty-seven abscesses were cured by drainage performed as soon as the diagnosis has been made . One patient died from septicemia in spite of the treatment . One patient died because the correct diagnosis was not revealed until the autopsy . Ten patients had a nephrectomy performed on them later on . Staphylococcus and gram negative bacilli were equally isolated . Stones were present in twenty patients . Eleven patients were diabetic . The clinical picture is not always clear, and diagnosis might be difficult . The different radiological signs help to reach a correct and prompt diagnosis . To these classical signs we can add during these last years Gallium-67 radionuclide studies, ultrasound and computerized tomography, each of these having its indication and usefulness.

Br J Surg, 1983 Jan, 70(1), 44 - 7
Acute necrotizing colitis and obstruction; Teasdale C et al.; Acute necrotizing colitis is a rare complication of colonic obstruction . Six cases occurring during a 20-month period are described . The presenting features were those of colonic obstruction with shock but without perforation . At laparotomy changes ranged from mucosal necrosis to frank gangrene in the colon proximal to the obstructing lesion . Gram stains of resected colon showed Gram-positive bacilli, resembling clostridia, invading the mucosa and submucosa . Two patients treated by defunctioning colostomy alone died but the remaining 4 survived after total colectomy . The cause is not known but raised intraluminal pressure may result in terminal mucosal ischaemia allowing anaerobic organisms to invade the bowel wall.

Infect Immun, 1983 Jan, 39(1), 38 - 42
Hyperthermic enhancement of serum antimicrobial activity: mechanism by which fever might exert a beneficial effect on the outcome of gram-negative sepsis; Mackowiak PA et al.; We have previously demonstrated heightened antibiotic activity at temperatures at the upper end of the physiological range . In the present studies we examined the effect of physiological variations in temperature on the antibacterial activity of antibiotic-free pooled human serum by comparing serum minimal inhibitory and bactericidal titers for gram-positive and gram-negative bacterial strains at 33, 37, and 41 degrees C . We observed a progressive rise in both minimal inhibitory and minimal bactericidal titers with temperature for all classes of gram-negative bacilli studied . However, gram-positive cocci were generally resistant to serum, even at the highest experimental temperature . Bacterial strains adapted to growth at temperatures normally encountered on body surfaces were more susceptible to the enhancing effect of hyperthermia on serum inhibition than were strains adapted to 37 degrees C . In addition, in vitro adaptation of one bacterial strain to different temperatures within the physiological range resulted in readily apparent variations in colonial morphology . These in vitro observations indicate that serum antibacterial activity and bacterial morphology may vary in response to minor changes in either the temperature to which bacteria are adapted before examination or the temperature of the assay system . If similar principles operate in vivo, hyperthermically augmented serum antimicrobial activity might represent one mechanism by which fever exerts a beneficial effect on the outcome of gram-negative sepsis.

Int J Clin Pharmacol Res, 1983, 3(3), 195 - 201
Compared sensitivities of 532 bacterial strains to six cephalosporins; Courtieu AL et al.; In this study measurements were made of the minimal inhibitory concentrations of 6 cephalosporins (cefamandole, cefuroxime, cefadroxil, cefoxatin and cefotaxime in comparison with cefalothin) against 532 bacterial strains isolated at the Regional Hospital Centre, Nantes, France, between 15.12.1977 and 15.3.1978 . There were 163 Gram-positive bacteria of 2 species and 369 Gram-negative bacilli of 11 species and different genera . The results have been produced in the form of cumulative curves, in percentage for the most numerous genera or species . Cefalothin remained the most active on S . aureus and Listeria . Cefamandole came second . The action of the four other cephalosporins was very closely related to that in relation to S . aureus . For all the Gram-negative bacilli, Cefotaxime was the most active . Its MIC's can be up to more than 100 times lower than those of the other cephalosporins . Of the others, cefamandole appeared the best . It was difficult to classify the last four, as the MIC's may vary from one bacterial species to another . The bacterial activity (MBC) in a liquid medium was found for 178 of the strains (10 genera or species) of which one was Gram-positive (S . aureus) . The ratio MBC/MIC (the measurements were taken in a liquid medium in all cases) confirmed the fact that all the cephalosporins are clearly bactericidal (the ratio was most often equal to 1 and sometimes to 2) for all the Gram-negative bacilli . Cefalothin and cefotaxime appeared the most bactericidal and cefamandole the least.

Pol Arch Weter, 1983, 23(4), 99 - 111
{Cultural, biochemical and serological characteristics of Mycobacteria, avium and atypical, isolated from pigs slaughtered in the Białystok abattoirs}; Holub M; Two hundred and thirty-eight strains of acid-fast bacilli isolated from lymph nodes of pigs were examined . Among these strains 198 were classified as Myc . avium and 40 - as atypical bacilli belonging to group II, III and IV of Runyon's classification . Only 118 strains of Myc . avium showed cultural and biochemical properties typical for these species . Some of the remaining strains were positive in the arylsulphatase test, in the reduction nitrate test or in the hydrolysis of Tween 80 test, but were negative in all amidase tests . The serological study of the bacilli belonging to Myc . avium - intracellulare group was performed according to Schaefer's method . It was found that among Myc . avium strains serotype 2 dominated (187 strains) . Myc . avium serotypes 1 and 3 appeared sporadically . The majority of atypical bacilli were classified as Myc . fortuitum, and only some strains were identified as Myc . intracellulare and Myc . vaccae . Some strains remained unclassified . The results showed that identification of Myc . avium and some atypical strains isolated from pigs by means of cultural and biochemical tests is not sufficient . The agglutination test with the use of sera specific for individual serotypes of Myc . avium - intracellulare group is very useful for identification of bacilli belonging to these groups . If we have a full set of specific sera we can identify Myc . avium and Myc . intracellulare more quickly and better than with use of cultural and biochemical tests.

Scand J Infect Dis Suppl, 1983, 40, 101 - 2
Treatment of the Gardnerella vaginalis syndrome with a single 2 gram oral dosage of metronidazole; Balsdon MJ; The Gardnerella vaginalis syndrome (GVS) is characterized by a smelly vaginal discharge of pH greater than 5.2 . The microscopic appearance of the discharge is diagnostic . The Gram stain shows masses of small Gram variable bacilli which have a 'pepper and salt' pattern, and the wet film 'clue cells' and 'rafts' (floating clumps of small bacilli) . The amine test is an additional diagnostic aid . 30 patients with this syndrome were treated with 2 g of metronidazole in a single oral dosage . 29 patients were cured at one week and 2 patients had a recurrence four weeks later.

J Hyg Epidemiol Microbiol Immunol, 1983, 27(2), 185 - 8
What means a sporadic positive sputum culture with scanty colonies of mycobacterium tuberculosis? (From the IUAT trial on preventive chemotherapy of fibrotic lesions); Krebs A; Sporadic positive cultures, with only a few colonies, in persons with fibrotic lesions, even with stable x-ray lesions may indicate "an isolated relapse of doubtful clinical significance" (7); but in agreement with (7), our findings show that the frequency of consecutive break-down, earlier or later, is so high that either careful follow-up or sufficient preventive therapy, with consideration to drug sensitivity of the bacilli, is mandatory.

Neurosurg Rev, 1983, 6(3), 139 - 52
Pathology and pathogenesis of predilective sites of nerve damage in leprous neuritis . Nerves in the arm and the face; Dastur DK; A very brief review of the literature on the clinicopathological aspects of leprosy is given; mainly through references . The salient features of the two main types of leprosy--tuberculoid and lepromatous--are presented in a Table . The surgical and pathological findings are briefly described and the pathogenesis of involvement of the facial nerve (a motor nerve) is discussed . On the basis of (i) the severe histopathologic changes (degeneration) of the most distal part of the zygomatic branch of the facial nerve (innervating the orbicularis oculi), with sparing of the roots of all branches and the trunk of the nerve; (ii) the concurrent loss of cutaneous sensations in the territory of the maxillary division of the trigeminal nerve (the region of the zygoma and the lower eyelid); and (iii) the close approximation or even anastomoses occurring between the ultimate branches of these two nerves, it is postulated that paralysis of orbicularis oculi occurs secondarily to the sensory nerve damage, i.e . due to spread of infection from the sensory branches of the trigeminal to the motor branches of the facial nerve . The surgical and pathological findings of the nerves in the arm, especially the ulnar and the median and their branches are described, in tuberculoid and lepromatous leprosy . The forms of nerve degeneration, the occasional axon regeneration, and the role of the Schwann cell in harbouring the bacilli, are illustrated . The lysosomal enzyme activity in the Schwann cells of nerve fibres, particularly of unmyelinated fibres which preferentially phagocytose the M . leprae, and their role, albeit not very successful, in degrading the bacilli and controlling the infection, are also stressed, through light and electronmicrographs . The constellation of secondary factors of the terrain operating to produce further damage to primarily diseased nerves, is discussed . These factors include indirect compression from unyielding fibroosseous tissues, minor traumata, stretching of the nerves, and their exposure to lower temperatures in subcutaneous tissues.

Med Cutan Ibero Lat Am, 1983, 11(6), 423 - 30
{The Rubino reaction . Criterion for inactivation in lepromatous patients}; Arruda MS et al.; Approximately 55% of active lepromatous patients respond positively to the Rubino reaction . With arrested cases this rate of positivity lowers considerably to about 15% . In an effort to associate this reaction with the presence of bacilli, a study of 796 cases was undertaken . The patients were divided into: a control group, active tuberculoid cases, arrested tuberculoid cases, active borderline cases, arrested borderline cases, active lepromatous cases, and arrested lepromatous cases . The patients were submitted to the following tests: Rubino reaction, presence of cryoglobulins, and VDRL and PCR positivity . By the results obtained we may conclude that: a) A positive Rubino reaction may be present in all the forms of leprosy studied, this reaction having an inverse relationship with the organism's resistance to "M . leprae" . b) The Rubino reaction has specificity to leprosy . c) This reaction does not depend on the number of bacilli present in the host . d) A positive Rubino reaction is not related to the presence of cryoglobulins in the serum, nor to VDRL or PCR positivity, nor to the length of time the patient's disease has been arrested . The authors present these findings and suggest that this reaction be used as one of the criteria for determining cure.

Trans R Soc Trop Med Hyg, 1983, 77(5), 660 - 4
A quick method of demonstrating bacillaemia in patients with lepromatous leprosy and ultrastructural studies of the circulating acid-fast bacilli; Saha K et al.; While studying circulating immune complexes (CIC) in the sera of lepromatous patients by the polyethylene glycol (PEG) precipitation technique, we found (by light microscopy) abundant acid-fast bacilli (AFB), morphologically similar to those seen in slit skin smear preparations from these patients, precipitated with the PEG precipitated materials . Both solid and non-solid AFB could be readily identified . Ultrastructures of these AFB in the PEG aggregates showed some similarity with those detected in the PEG precipitates prepared from armadillo-derived lepromin under identical conditions . The most striking difference between the AFB in the test sera and that in the armadillo-derived lepromin was the absence of any transverse band in the former . This suggested that the AFB in the patients' circulation were not in division stage . Furthermore, electron-dense material were deposited on the AFB co-precipitated from the patients' sera, which were not found on the AFB co-precipitated from the armadillo-derived lepromin.

Scand J Infect Dis Suppl, 1983, 39, 92 - 6
Antimicrobial prophylaxis of infections in head and neck cancer surgery; Piccart M et al.; 429 patients undergoing surgery for head and neck tumors were involved in 4 consecutive, randomized clinical trials of antimicrobial prophylaxis: placebo versus ampicillin plus cloxacillin (2 g of each daily for 6 days), ticarcillin (5 g X 12, 8-hourly) versus carbenicillin (10 g X 12, 8-hourly) short carbenicillin prophylaxis (1 day) versus prolonged carbenicillin prophylaxis (4 days) and clindamycin (900 mg, 4 daily doses) versus clindamycin plus netilmicin (90 mg, 4 daily doses) . Aerobic gram-negative strains were the microorganisms most frequently isolated either from colonized or infected wounds . The first controlled study showed a significant decrease in the rate of postoperative bacterial infections in the treated group as compared to the placebo-treated group (p less than 0.05) . In all the subsequent treatment groups, postoperative infection rates ranged from 6 to 16% . Short prophylaxis was as effective as prolonged prophylaxis . A regimen directed mainly against anaerobes (clindamycin) did not seem of less value than broad spectrum regimens covering most aerobic gram-negative bacilli.

Z Erkr Atmungsorgane, 1983, 161(1), 46 - 50
{The doctrine of immunity in the light of Robert Koch's concepts}; Schneeweiss U; Robert Koch's epochal discovery of the tubercle bacilli provided the first complete evidence for the specific nature of the causative agents of the most important human infectious disease . It was on this basis that Koch developed his ideas about the doctrine of immunity . The high specificity of "Koch's basic experiment" became the cornerstone of the specific early recognition and prophylaxis of tuberculosis and provided a pattern of specific immune diagnostics in general . Basing on the antitoxin experiments of Behring and Ehrlich against diphtheria and tetanus, Koch presumed humoral immune mechanisms to exist also for tuberculosis . These investigations were abandoned after long-lasting efforts . The concept of Robert Koch and his school about the specific humoral immunity of infectious diseases was dominating immunological research for half a century until the elucidation of the cellular nature of the tuberculin reaction became a general asset of modern immunology . Only thereafter this discipline gave full swing from the immunochemical to the immunobiological approach . Robert Koch's merits as a physician and as an investigator reside in his strictly causal-analytical way of thinking and working which was adopted also in the search for the causes of cancer . In studying the immunological virus-host relationship one arrives from the "whence" of the disease at the "why" of its pathological form . This may be conceived of as a conceptual model for problems concerning the biological evolution and differentiation in modern pathology.

Microbiol Immunol, 1983, 27(5), 395 - 407
Effect of phorbol myristate acetate, a tumor-promoting agent, on the growth of Mycobacterium lepraemurium in the mouse footpad; Tomioka H et al.; Phorbol myristate acetate (PMA), a potent inflammatory agent with tumor-promoting activity, was examined for its effect on the growth of Mycobacterium lepraemurium (MLM) in the left hind footpad of mice . When the animals were infected with 10(4) MLM and received multiple injections of 3 micrograms of PMA in the infection site weekly during the first 2 months and biweekly thereafter, the growth of the bacilli was markedly enhanced . PMA injection in the infection site resulted in severe footpad swelling accompanied by inflammatory signs such as redness, edema, induration, and sometimes ulcer . Acetic acid, as potent an inflammatory and hyperplastic agent as PMA but without any appreciable tumor-promoting action, did not stimulate MLM growth when it was injected biweekly in the site of infection with MLM at a dose of 30 mumol per injection . When mice were infected with 10(8) MLM, proper elimination of bacilli from the infection site was observed during the first 3 months . In this case, multiple injections of PMA in the infection site resulted in the enhancement of the elimination of MLM by host defense mechanisms, although PMA caused as severe inflammation as that observed when MLM infection was produced with a small inoculum (10(4) MLM) . In both cases, dexamethasone was synergistic with, but indomethacin and L-l-tosylamide-2-phenyl-ethylchloromethyl ketone were antagonistic to, the effect of PMA.

Lepr India, 1983 Jan, 55(1), 39 - 44
Taxonomic studies on Mycobacterium leprae; Dhople AM; M . leprae harvested from livers and spleens of infected armadillos showed close similarity in biochemical characteristics with M . vaccae than with any other cultivable mycobacteria . Further more . M . lepraemurium was least similar to M . leprae . Thus, M . leprae can be linked with fast-growing groups of acid-fast bacilli, and perhaps most closely with the M . vaccae complex.

Can J Microbiol, 1983 Jan, 29(1), 60 - 8
An improved method for the preparation of mycobacterial spheroplasts and the mechanism involved in the reversion to bacillary form: electron microscopic and physiological study; Udou T et al.; An efficient method is described for preparing spheroplasts and protoplasts by treating bacillary cells of Mycobacterium smegmatis with precise concentrations of L-glycine (followed by lysozyme) . This improved procedure was widely applicable to many rapidly growing mycobacteria by selecting the concentrations of glycine suitable for the individual strains used . The process of reversion of spheroplasts to original bacillary form on solid and in liquid media, as revealed by electron microscopy, appeared to involve the formation of an internal elementary or initial body with subsequent budding from the spheroplast . The internal membrane systems appeared to function in the induction of initial bodies and in the maturation of elementary bodies to become dividing forms . Possible mechanisms involved in the development of bacilli from spheroplasts are discussed.

Oral Surg Oral Med Oral Pathol, 1983 Jan, 55(1), 52 - 7
Oral lesions in borderline and reactional tuberculoid leprosy; Alfieri N et al.; Thirty patients, fifteen with borderline and fifteen with reactional tuberculoid leprosy, were submitted to clinical and histopathologic studies of the buccal mucosa for detection of specific lesions . Five reactional tuberculoid and eight borderline patients presented specific conditions characterized by chronic granulomatous lesions with bacilli, chronic granulomatous lesions without bacilli, and nonspecific chronic inflammatory lesions with bacilli . The infiltrate had small extension, low bacterial levels and the mucosa, with the exception of one case, did not show ulceration . These results suggest that in the reactional tuberculoid and borderline patients the buccal mucosa is not an important source of bacilli elimination.

Ecol Dis, 1983, 2(2), 145 - 8
Tuberculosis in Inuit; Grzybowski S et al.; Tuberculous infection was first introduced to the majority of the Inuit (Eskimos) in the first half of this century . In the 1950s tuberculosis became a grave problem with the mortality rate approaching 1% per annum and the incident rate almost 3% . The annual risk of infection has been estimated at 25% per annum . These are probably the highest rates recorded anywhere in the world in the 20th century . Some 20-30 years ago, an intensive case-finding programme as well as a treatment programme began in all three jurisdictions where the Inuit live (northern Canada, Alaska and Greenland) . The preventive measures differed; Alaska relying mainly on chemoprophylaxis and Greenland on BCG vaccination, while Canada adopted both measures . Over the last 20 years, the rates fell rapidly with the mortality rate approaching zero, and the morbidity (incidence) rate falling (Canadian Inuit) by the record 14% per annum . The high rates in the Inuit were, in part, an expression of the lack of 'natural' resistance acquired by other races through the exposure to tubercle bacilli for many generations . Over-crowding in igloos and frequent starvation among those Inuit who relied on cariboo meat, undoubtedly contributed a great deal to the gravity of the problem . The rapid decline of the rates is without doubt primarily caused by the intensive tuberculosis programme and the compliance of the Inuit with the demands of this programme; better housing and in some cases, improved nutrition doubtlessly also played a part.

Clin Ther, 1983, 5(3), 243 - 50
Treatment of lower respiratory tract infections with cefoperazone; Kaplowitz LG et al.; Fifteen patients with documented bacterial lower respiratory tract infections were treated with cefoperazone (2 gm every 12 hours, administered parenterally) as the single antibiotic therapy . Pulmonary infections included pneumonia (10), anaerobic lung abscess (2), bronchitis (2), and exacerbation of bronchiectasis (1); most of the patients had concomitant illnesses that compromised their host-immune status . Bacteria recovered from respiratory tract cultures included aerobic gram-negative bacilli (17), anaerobes (6), and aerobic gram-positive cocci (3) . After therapy, lasting 5 to 28 days, nine patients had complete resolution of their infection, and the remaining six patients had significant clinical improvement . Diarrhea was the adverse reaction most commonly noted; others included an unusual reaction resembling serum sickness, and, in one patient treated for 24 days, hypotension and a subsequent decrease in renal function . Drug-related abnormalities in blood and serum values were few and mild . Cefoperazone was found to be effective in the treatment of lower respiratory tract infections.

Acta Derm Venereol, 1983, 63(2), 158 - 60
Bacteria and fungi in severe foot infection; Noble WC et al.; In a study of severe foot infection in 21 miners, an attempt was made to match nine clinical parameters with both bacteriological and mycological findings . Erythema was significantly more pronounced in the presence of dermatophytes but less pronounced in the presence of Gram-negative bacilli . No other clinical parameter differed in relation to the presence of particular microorganisms.

N Engl J Med, 1982 Dec 23, 307(26), 1593 - 7
The cutaneous infiltrates of leprosy: cellular characteristics and the predominant T-cell phenotypes; Van Voorhis WC et al.; We report on the characteristics of cells in the cutaneous lesions and blood of 21 patients with lepromatous, tuberculoid, and intermediate forms of leprosy . A large proportion of the infiltrates in lepromatous lesions consist of macrophages heavily parasitized with Mycobacterium leprae . The T cells in the lesions are devoid of OKT4/Leu 3a-positive ("helper") cells and consist almost exclusively of OKT8/Leu 2a-positive ("suppressor") populations . In contrast, the tuberculoid infiltrates contain well-organized epithelioid and giant-cell granulomas and only remnants of bacilli, and the predominant T cell is from the OKT4/Leu 3a-positive subset . In both tuberculoid and lepromatous infiltrates, T cells and macrophages expressed HLA-DR antigen . No marked alteration in the distribution of blood T-cell phenotypes was noted . We conclude that there is a marked difference between T-cell subsets in lepromatous and tuberculoid infiltrates, which may influence the microbicidal activity of macrophages in the lesions.

Arch Dis Child, 1982 Dec, 57(12), 952 - 4
Caseating regional lymphadenitis complicating BCG vaccination: a report of 6 cases; Tam PK et al.; Six infants had caseating regional lymphadenitis complicating BCG vaccination . There was a delayed onset and a lack of immediate vaccination complications . Three infants had frank abscesses . Additional affected nodes undetected clinically were found at operation in all cases . All lymph nodes contained tubercles, 3 showing acid-fast bacilli, 2 of which grew Mycobacterium bovis . Complete excision followed by antiuberculous chemotherapy produced satisfactory results.

J Radiol, 1982 Dec, 63(12), 723 - 8
{Broncholithiasis}; Pinet F et al.; Eight cases of broncholithiasis requiring surgical treatment are reported, and diagnostic and therapeutic difficulties of this affection discussed . Clinical symptomatology is not very specific and associates slight or moderate hemoptyses with signs of a febrile pulmonary disorder . Expectoration of a broncholith was not observed in these cases . Radiological images were suggestive by demonstrating hilar and/or peripheral calcifications, often with a parenchymatous opacity in the same region . Fibroscopy is not always conclusive and may even suggest the presence of a tumor . A tuberculous etiology is admitted in France in spite of the absence of bacilli in the sputum . Differential diagnosis from cancer is a real problem, this explaining why two pneumonectomies were performed, in addition to the six lobectomies.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Dec, (12), 84 - 7
{Frequency of detection and the species composition of anaerobic gram-negative nonsporulating bacteria in suppurative pathology in emergency surgery}; Ianisker GIa et al.; The improved technique of cultivation allowed to detect obligatorily anaerobic microorganisms in 58 out of 94 samples from patients with purulent inflammatory processes . The results of the studies showed that anaerobic microorganisms were most frequently isolated from the exudate of the abdominal cavity and the purulent discharge of wounds in peritonitis patients . Gram-negative nonsporulating bacilli made up 25.3% of all the isolated cultures . The identification of these microorganisms allowed to determine that in the exudate of the abdominal cavity, the discharge of surgical and posttraumatic wounds, and of the pleural cavity the representatives of the family Bacteroidaceae mainly occurred . Most frequently B . thetaiotaomicron and B . fragilis were isolated.

Surg Gynecol Obstet, 1982 Dec, 155(6), 839 - 45
Empyema thoracis; de la Rocha AG; Seventy-five adult and 25 pediatric patients with empyema thoracis are reported upon herein . A high incidence of postpneumonectomy and postlobectomy empyema were found in the adult population, 15.5 and 3.7 per cent, respectively . The causal factors of such a high incidence are unknown . Faulty surgical techniques and poor clinical judgment in the management of patients undergoing thoracic operations will invariably lead to a significant mortality and morbidity . Morbidity was indirectly evaluated by the length of hospitalization, the mean being 56.8 days for the adult population and 22.6 days for the pediatric group . These figures barely expose the degree of frustration and suffering that patients with empyema thoracis go through . To decrease the incidence of iatrogenic empyema with its associated mortality and morbidity, good clinical judgment and impeccable surgical techniques must be used in the management of patients having thoracic operations . An aggressive approach to drain the empyemic space to allow pulmonary expansion of sterilization of the postpneumonectomy space must be taken once faced with this complication . Children require no more than repeat thoracentesis or placement of an intercostal chest tube to obtain sufficient drainage and recovery . Antibiotic therapy must be selected according to the bacteria encountered and the results of the sensitivity test . Close supervision is mandatory to detect overgrowth, frequently encountered with the use of broad spectrum antibiotics . Anaerobic bacteria as well as fungus and acid-fast bacilli must be searched for during the routine bacteriologic workout.

J Clin Microbiol, 1982 Dec, 16(6), 1106 - 9
Improved method for testing susceptibility of Mycobacterium tuberculosis to pyrazinamide; Butler WR et al.; The acid medium required to test susceptibility of Mycobacterium tuberculosis to pyrazinamide (PZA) is a major problem in obtaining reliable test results . Satisfactory growth is usually obtained on Middlebrook and Cohn 7H10 medium at pH 5.5 if albumin-dextrose-catalase (ADC) supplement rather than oleic acid-albumin-dextrose-catalase is used; however, some lots of ADC supplement still fail to support growth at this low pH . A rapid turbidimetric test was developed to determine the growth-supporting potential of ADC enrichment for M . tuberculosis at pH 5.5 . An atmosphere supplemented with 5 to 10% carbon dioxide, used to stimulate growth of tubercle bacilli on 7H10 medium, counteracted the growth-inhibiting effects of PZA . By using optimum conditions of medium and pH, the susceptibility of 90% of M . tuberculosis strains to PZA was determined.

Infect Immun, 1982 Dec, 38(3), 932 - 7
Suppression of tuberculoimmunity in mice by Evans blue dye; Crowle AJ et al.; Evans blue dye, which acts as an adjuvant in mice to promote induction of cell-mediated immunity, was found earlier to apparently act contrarily and decrease tuberculoimmunity . This phenomenon was investigated here in a long-term experiment examining the persistence of the suppressed immunity . Systemic suppression after injection of only 1 mg of dye was confirmed and was found to last for more than 2 weeks but less than 11 weeks . Localized evidence for dye-caused depression of tuberculoimmunity also was seen by the development in dye-injected mice immunized with emulsified whole bacilli of caseating tubercles at sites of pulmonary infection, a very rare type of pathology for tuberculosis in mice . The experiment, in addition, detected an aging-related decline in mice of resistance to tuberculosis evident by shortened survival, enlarged pulmonary tubercles, and increased susceptibility to systemic tuberculin reaction.

Tubercle, 1982 Dec, 63(4), 255 - 68
The development of clinical tuberculosis following infection with tubercle bacilli . 1 . A theoretical model for the development of clinical tuberculosis following infection, linking from data on the risk of tuberculous infection and the incidence of clinical tuberculosis in the Netherlands; Sutherland I et al.; Information on the risk of tuberculous infection in the Netherlands has been linked with information on the incidence of tuberculosis, in an attempt to estimate the risks of developing the disease following infection or reinfection . It was postulated that: (a) those with a recent primary infection had a characteristic risk of developing progressive primary tuberculosis; (b) those with a distant (i.e . not recent) primary infection and a recent reinfection had a characteristic risk of developing exogenous tuberculosis; and (c) those with a distant primary infection but no recent reinfection had a characteristic risk of developing endogenous tuberculosis . The information on the risk of tuberculous infection was used to estimate the size of the population in each of these infection classes for different age-groups and calendar years in the Netherlands . Using multiple regression to link these population figures with the information on tuberculosis incidence in the same age group and calendar year, it was possible to estimate the above risks of developing tuberculosis . For Netherlands males aged 15-69 years during the period 1951-70 the three risks of developing pulmonary tuberculosis were estimated to be: (a) 5.06 per cent annually (for 5 years) following primary infection; (b) 1.91 per cent annually (for 5 years) following reinfection; (c) 0.0253 per cent annually, after the first 5 years following primary infection, in the absence of reinfection . The corresponding (and significantly different) estimated annual risks of development of pulmonary tuberculosis for females were 5.85, 1.10 and 0.0020 per cent respectively . From these risks, it may be estimated that the degree of protection conferred by a distant primary infection, against pulmonary tuberculosis arising from a recent reinfection, was 63 per cent for males and 81 per cent for females . The estimated relative proportions of cases of progressive primary, exogenous and endogenous tuberculosis varied considerably with age and calendar year . Progressive primary tuberculosis was dominant at the younger ages, exogenous and endogenous tuberculosis at older ages . At these older ages, the great majority of cases in the Netherlands in the early 1950s appeared to be exogenous in origin, but by 1970, with the decrease in the risk of infection, the exogenous contribution had dwindled substantially, especially among males.

Int J Lepr Other Mycobact Dis, 1982 Dec, 50(4), 477 - 9
The morphology of bacilli at different levels of the dermal infiltrate in lepromatous leprosy; Girdhar BK et al.; The Morphological Index (MI) of bacilli at three levels of the granuloma in 20 skin biopsies from untreated lepromatous patients has been recorded . The more superficial part of the granuloma and the subepidermal free zone showed a significantly higher MI, compared to the mid and lower zones . Possible reasons for this non-uniform distribution of morphologically intact bacilli are discussed.

J Clin Microbiol, 1982 Dec, 16(6), 1025 - 9
Quantitative microbiological monitoring of hemodialysis fluids: evaluation of methods and demonstration of lack of test relevance in single-pass hemodialysis machines with automatic dialysate proportioning with reverse osmosis-treated tap water; Doern GV et al.; Two methods for estimating the quantity of microorganisms present in hemodialysis fluid, a blood agar surface-spread plate method and a total-count water tester device impregnated with modified standard plate count agar (Millipore Corp., Bedford, Mass.), were evaluated . Both methods exhibited comparable precision; however, colony counts obtained with the total-count water tester were consistently and unacceptably low . The need for routine quantitative microbiological monitoring of hemodialysis fluids such as that recommended by the American Public Health Association was not supported by the results of this study . Such testing was not of value in predicting untoward reactions for patients undergoing hemodialysis, nor did quantitative testing of hemodialysis fluids identify the buildup of potentially hazardous levels of contamination within hemodialysis systems . Finally, the kinds of organisms found in hemodialysis systems, i.e., gram-negative water-borne bacilli, were elucidated.

J Am Vet Med Assoc, 1982 Dec 1, 181(11), 1355 - 7
Mycobacterium bovis isolated from a dusky langur with granulomas in the intestine; Himes EM et al.; Tubercles were seen in the spleen of a male dusky langur (Presbytis obscurus) on laparotomy . Subsequently, tuberculous lesions in the intestine, lungs, and a hilar lymph node were observed on necropsy of the monkey . Histologic examinations of these tissues revealed granulomas, and acid-fast bacilli were observed within granulomas in replicate sections that were stained with auramine-O . An acid-fast organism was isolated and identified as Mycobacterium bovis . Guinea pigs and rabbits inoculated intraperitoneally with the organism developed granulomas in the lungs, liver, and spleen . Lesions did not develop in chickens inoculated with the culture.

Hansenol Int, 1982 Dec, 7(2), 88 - 94
{Modification of the basic stain of the Ziehl-Neelsen technic in the identification of Mycobacterium leprae}; Siqueira LF et al.; Authors analyse the counterstain with methylene blue solution in the usual Ziehl-Neelsen method . Considerations are made on the characteristics of the dye substance . A technique alteration is proposed: a "concomitant alkalization" of the classic aqueous methylene blue solution, by adding some drops of sodium hydroxide solution, 1:500, on the slide at the moment of the staining . By this technique it was observed: a) a larger validity period of the solution; b) an absence of precipitate in the slides; c) an easier visualization of the substrate; d) a larger contrast among the substrate and the bacilli.

Leber Magen Darm, 1982 Nov, 12(6), 245 - 8
{Tuberculous stenosis of the duodenum}; Rohner HG et al.; A 51-year-old man came to hospital admission one year after the first occurrence of upper abdominal pain, nausea, fever, melaena and discrete symptoms of inflammatory disease, X-ray examination of the chest, colon and ileum were normal . Sonography and computertomographic examination showed a mass in the pancreatic head region . Diagnosis was established by endoscopy and examination of bioptic material, showing ulcerating and stenosing tuberculosis of the duodenum with caseating, tuberculoid granuloma and acid stabile bacilli . Tubercle bacilli of the human type could be demonstrated in bacterial culture . Granuloma of epitheloid cells could also be found in the liver . Drug therapy with tuberculostatic drugs brought about complete healing of the macroscopical lesions within 4 weeks . In patients with stenosing processes of the duodenum tuberculosis should also be taken into account as a rare cause of this condition.

Arch Androl, 1982 Nov, 9(3), 244 - 50
Atrophy of seminiferous tubules of mouse testes after intratesticular injection of BCG and their regeneration; Das RP et al.; Bacillus Calmette-Guerin (BCG) suspended in saline and given in a single intratesticular injection with uniform distribution at a dose of 10 units (1 unit containing 10(6) bacilli) was effective in inducing aspermatogenesis in mouse testes without affecting the Leydig cells . All tubules were free of spermatozoa 14 days after the treatment and remained so until 35 days . About 50% of the tubules did not have any germinal elements . Other tubules had mostly one or two layers of germ cells in the basal compartment . Full recovery of spermatogenesis was observed after 120 days . Proliferation of the residual germinal elements in the partially atrophied tubules was probably responsible for recovery, as the total number of tubules in BCG injected testes was 115 at 120 days (time of recovery) as compared to 258 in controls . The reduction in the number of tubules was compensated by a significant increase in the diameter of the tubules (118.4 +/- 3.23 micron in controls vs . 209 +/- 4.54 micron on recovery at 120 days), so that the overall size of the testes remained essentially unaltered.

J Clin Pathol, 1982 Nov, 35(11), 1177 - 80
Sensitivity tests with cephalosporins; Waterworth PM; The sensitivity of 127 strains of miscellaneous Gram-negative bacilli to various cephalosporins was determined by three methods . Disc tests with cephaloridine (CLOR), cephalothin (CTIN) and cephalexin (CLEX) made most strains of beta-lactamase-producing Escherichia coli appear sensitive . Eight cephalosporins were tested by the agar break-point method using concentrations of 16 and 4 mg/l for all except cefotaxime (CTAX), when 8 and 1 mg/l were used . In repeated tests there was considerable variation in the response of many strains to the lower concentration of CLOR, CTIN, CLEX and to a lesser extent, cefoxitin (CFOX) and cefuroxime (CROX), and beta-lactamase-producing E coli appeared as sensitive or moderately sensitive to all . Cephalosporins CLOR, CLEX, and CROX were then tested by inoculating 2 ml volumes of broth containing a 30 microgram disc; all the beta-lactamase-producing E coli grew in CLOR and CLEX but were inhibited by CROX.

Ann Microbiol (Paris), 1982 Nov-Dec, 133(3), 389 - 400
Use of a unit gravity sedimentation chamber for the purification of Mycobacterium leprae; Das PK et al.; The present paper summarizes results concerning a mild isolation method of Mycobacterium lepraemurium and M . bovis-BCG from host tissues, and describes the application of such a method in purifying M . leprae (M1) from either infected armadillo tissues or human skin biopsies . This isolation method consists of homogenization, two-phase partition in dextranpolyethylene glycol and finally sedimentation in sucrose gradient using a unit gravity chamber . Such a purified M1 preparation appears to be devoid of host-tissue contaminants as examined by light and electron microscopy as well as by a radioimmuno spot test . The results indicate that the present method is mild enough to allow the purification of M1 from infected host tissues with in vivo conservation of antigenicity and viability of the bacilli.

Rev Can Biol Exp, 1982 Nov, 41(3), 197 - 200
{Pathogenicity in the rat of Mycobacterium lepraemurium cultivated in vitro}; Ishaque M; The pathogenicity in Sprague-Dawley rats of Mycobacterium lepraemurium cultivated on egg-yolk medium was investigated . The results show that in vitro grown cultures provoked hugh subcutaneous lepromata in rats similar to those produced by the in vivo grown M . lepraemurium . The acid-fast bacilli isolated from lepromata of rats infected with the in vitro or in vivo grown cultures were microscopically and histopathologically identical to each other.

Am J Clin Pathol, 1982 Nov, 78(5), 755 - 8
An evaluation of the practicality of the spot-indole test for the identification of Escherichia coli in the clinical microbiology laboratory; Peterson WC et al.; Colony morphology and the spot-indole test were evaluated to assess the practicality of the rapid identification of Escherichia coli isolates directly from primary isolation plates . One hundred ninety-one lactose-fermenting, gram-negative bacilli were identified by standard testing procedures (either API-20E, Micro-ID, or a 5-test biochemical battery) . These isolates also were tested with the spot-indole test, using either a 1% or 5% p-dimethylaminobenzaldehyde or 1% p-dimethylaminocinnamaldehyde reagent . Of the total 191 E . coli isolated, 128 (67.0%) were single-colony types on the primary plates, and 112 (58.6%) met the morphologic criteria and were positive and spot-indole testing . Of these 112, 111 (99.1%) were identified accurately as E . coli by the morphologic criteria/spot-indole approach . This method can be recommended as a practical diagnostic aid in the clinical microbiology laboratory as it allows significant cost and time savings for the majority of the most frequently isolated gram-negative bacilli.

Rev Infect Dis, 1982 Nov-Dec, 4 Suppl, S623 - 8
Clinical evaluation of moxalactam in the treatment of respiratory tract infections, hepatobiliary infections, and septicemia; Saito A; A total of 489 patients with a variety of infections was treated with moxalactam in Japan . The drug usually was administered by drip infusion in doses of 2-4 g per day for seven to 14 days . The clinical response was satisfactory in 277 (77.4%) of 358 patients with respiratory tract infections, 95 (84.8%) of 112 with hepatobiliary infections, and 15 (78.9%) of 19 with septicemia (including 2 with meningitis) . Overall, moxalactam was effective in 387 (79.1%) of all patients treated . Of the pathogenic organisms isolated, 87.9% of the gram-positive cocci and 82.1% of the gram-negative bacilli were eradicated . Ninety-two of 156 patients who failed to respond to previous antibiotic therapy showed a satisfactory response to moxalactam . Adverse effects--mainly rash and fever--occurred in only 3.3%, and abnormal results of laboratory tests--mainly elevation of hepatic enzyme levels and eosinophilia--occurred in 5.7% of all patients treated.

Lepr India, 1982 Oct, 54(4), 671 - 6
Concomitant occurrence of leprosy and tuberculosis--a clinical, bacteriological and radiological evaluation; Kumar B et al.; One hundred and seventeen consecutive patients of leprosy were bacteriologically and radiologically investigated for evidence of concomitant tuberculosis anywhere in the body . Out of the total, only 9 patients (7.7%) showed evidence of active tuberculosis bacteriologically and/or radiologically . Three patients had sputum positive for AFB, 2 out of these were radiologically negative while one had evidence of pulmonary tuberculosis . From 7 patients with radiological evidence of tuberculosis, tubercle bacilli could be grown in only one . Tuberculosis was found to occur throughout leprosy spectrum . It is important to recognise the presence of tuberculosis in leprosy patients so that proper therapeutic measures may be taken to avoid monotherapy of tuberculosis.

Infect Immun, 1982 Oct, 38(1), 157 - 61
Neutralization of bacteria- and endotoxin-induced hypotension by lipoprotein-free human serum; Abdelnoor AM et al.; Normal human serum and a fraction rich in lipoprotein, Cohn fraction IV1, have been shown in previous studies to detoxify native endotoxin by decreasing lethality for mice, fever in rabbits, and by the alteration of the characteristic endotoxin-anti-endotoxin precipitin pattern in gels . These studies are extended herein and document the ability of normal human serum and fraction IV1 to neutralize the induction of hypotension in rabbits by viable gram-negative bacilli . Further fractionation of serum, using an ultracentrifugal flotation method for producing lipoprotein-free human serum and purified high-density lipoproteins, revealed the lipoprotein-free fraction to be capable of inhibiting endotoxin hypotensive activity and to alter diffusion of endotoxin in gels . On the other hand, the purified high-density lipoproteins failed to negate either activity.

Ann Intern Med, 1982 Oct, 97(4), 503 - 8
Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia; Wade JC et al.; Staphylococcus epidermidis, a major component of the skin flora, is usually considered a contaminant when recovered from diagnostic cultures . Since 1974 infections caused by gram-negative bacilli and S . aureus occurring among patients with granulocytopenic cancer have remained constant; infections due to S . epidermidis occurring before 1977 at a rate of 2.0 per 1000 days of hospitalization of patients with acute leukemia, increased to 14.6 per 1000 days in 1979 . All S . epidermidis infections before 1977 originated from skin sites; since 1977 the respiratory tract and alimentary canal have become the predominant sites of origin . Predisposing factors for infection were profound granulocytopenia (less than 100/microL), a diagnosis of acute leukemia, and an oral nonabsorbable antibiotic regimen lacking vancomycin . The increased incidence of infection was not related to a nosocomial source or the more frequent use of long-term indwelling catheters . Methicillin resistance among isolates was common (40%) . Intravenous vancomycin therapy provided the best therapeutic results . Diagnostic cultures positive for S . epidermidis in the setting of infection and profound granulocytopenia warrant appropriate antibiotic therapy.

Ann Acad Med Singapore, 1982 Oct, 11(4), 587 - 92
Tuberculous lymphadenitis in Singapore; Chee YC; An analysis of patients diagnosed as having tuberculous lymphadenitis (the second commonest form of tuberculosis after respiratory tuberculosis) in 1980, was carried out to ascertain the pattern of disease and methods of diagnosis . Of 114 cases so notified, 97 were available for this purpose . Diagnosis was on lymph node biopsy with histological examination and/or bacteriological culture confirmation . Patients with tuberculous lymphadenitis tended to be young (more than 60% below 31 years old), and to have cervical involvement (88.6% of cases) . A female preponderance (as in other studies) and a disproportionate number of Indians and Malays (thrice and twice that expected on the basis of their ethnic proportion of the Singapore population) were noted . Only 25 out of 97 biopsied glands were sent for mycobacterial culture by the surgeons and 16 grew niacin positive Mycobacteria tuberculosis . This 64% culture-positive rate is more sensitive and specific than the histological demonstration of acid-fast bacilli (13.4%) in the diagnosis . It must be stressed that the pathologist can only report a picture consistent with or supportive of a diagnosis of tuberculosis and be more confident if acid-fast bacilli are seen microscopically . The diagnosis cannot be absolute except on a positive culture which also identifies typical or atypical mycobacteria and allows drug sensitivity testing . Surgeons removing lymph nodes in patients suspected to have tuberculous lymphadenitis must send these to both the bacteriologist and pathologist, the tissue to the former not being suspended in formalin but saline.

Eur J Clin Microbiol, 1982 Oct, 1(5), 288 - 93
Gardnerella vaginalis and its clinical syndrome; Balsdon MJ; The Gardnerella vaginalis syndrome is a well defined but benign condition characterized by a smelly vaginal discharge of pH greater than 5.0 . It is not associated with inflammation . It often occurs in association with cervical infections . The microscopic appearance of the discharge is typical and diagnostic . The wet mount shows "clue cells" and "rafts" (floating clumps of small bacilli) and the Gram stain has the "pepper on salt" pattern of masses of small gram-variable bacilli . The amine test is an additional diagnostic aid . Cultures are useful but not necessary for diagnosis . The treatment of choice is oral metronidazole 400 mg twice daily for five days.

Lepr India, 1982 Oct, 54(4), 623 - 33
A study of continuous bacillaemia in borderline and lepromatous type of leprosy; Raval SN et al.; The present work has established beyond doubt that bacillaemia occurs practically in all cases of borderline and lepromatous leprosy . The number of bacilli in the blood is significantly high, to the tune of 4,000 bacilli per ml . Even so, it does not produce any adverse symptoms of septicaemia . Special emphasis was laid in the present study for determining the continuity or otherwise of bacillaemia . Some of the patients had continuous bacillaemia according to the criteria fixed in the present study . It was also found that the number of bacilli discharged into the blood bears no relationship with the bacillary load in the body as assessed by skin and nasal smears.

Surg Neurol, 1982 Oct, 18(4), 271 - 3
Postoperative neurosurgical infections due to bacillus species; Young RF et al.; The cases of 2 patients with postoperative ventriculitis due to Bacillus species bacteria are presented . Bacillus licheniformis was isolated from one patient following removal of an intraventricular meningioma, and Bacillus cereus from another patient following placement of a ventriculoperitoneal shunt . Both isolates were resistant to a variety of antibiotics, but both were sensitive to gentamicin and chloramphenicol . These cases emphasize several points; (a) Bacillus species, usually thought to be nonpathogenic, may produce intracranial infections; (2) species identification is important for epidemiological purposes and for the selection of appropriate chemotherapeutic agents; and (3) in cases of suspected ventriculitis, chloramphenicol or gentamicin should be considered for Gram's staining revealing gram-positive bacilli . In addition, we recommend that when planning antibiotic prophylactic regimens, consideration should be given to including one of these agents to assure coverage of Bacillus species.

Lepr India, 1982 Oct, 54(4), 605 - 12
Composite skin contact smears in multibacillary leprosy patients; Hameedullah A et al.; "Composite skin contact smears" technique was used in 20 multibacillary leprosy patients to find out the presence of AFB on their intact skin . One hundred and twenty one AFB were found in 930 sq.cm . area of skin surface examined . Seventy-five AFB were solidly staining and 46 were granular . The bacilli were found in all the sites examined . Immunofluorescent staining showed M . leprae in one out of four patients . The number of bacilli discharged from the intact skin seems adequate for the transmission of leprosy considering the large surface area of the skin and evidence in mouse experiments that multiplication of M . leprae can be obtained after inoculation of very small number of bacilli.

JAMA, 1982 Sep 10, 248(10), 1199 - 202
Long-term amikacin use . Effects on aminoglycoside susceptibility patterns of gram-negative bacilli; Moody MM et al.; Amikacin sulfate was first used sparingly at our cancer center in 1976; since 1979, it has been the only aminoglycoside used for systemic cancer therapy for patients with granulocytopenia . As the development of resistance has been correlated with antibiotic use over time, we wished to determine if prolonged use of amikacin in our patients had led to increased amikacin resistance . A total of 1,129 strains were recovered from 315 patients during a 13-month period . Each species isolated per patient was considered once . Seven percent of the patients had amikacin-resistant strains (2.7% of isolates), and 10% of patients had gentamicin-resistant strains (4% of isolates) . Amikacin resistance was significantly less than in an earlier study . Unrestricted use of amikacin has not led to a concomitant increase in amikacin resistance in gram-negative bacilli.

Inflammation, 1982 Sep, 6(3), 235 - 44
Increased hyaluronic acid is associated with dermal delayed-type hypersensitivity; Campbell RD et al.; Rabbits sensitized subcutaneously with heat-killed bacilli Calmette-Guerin (BCG) and challenged intradermally with heat-killed BCG or purified protein derivative (PPD) demonstrated classical dermal delayed-type hypersensitivity which peaked two days postchallenge . Animals challenged with BCG developed dermal granulomas as measured by induration and gross observation . Challenge with either PPD or BCG resulted in increased levels of dermal hyaluronic acid (HA) by two days postchallenge . Dermal HA returned to normal levels by seven days postchallenge regardless of the challenge antigen . These results indicated that increased HA is associated with dermal delayed-type sensitivity, but increased HA is not associated with dermal granulomatous hypersensitivity . These results are in contrast to previously reported work which indicates that increased HA is associated with both pulmonary delayed hypersensitivity and pulmonary granulomatous hypersensitivity.

Hum Pathol, 1982 Sep, 13(9), 866 - 70
Mycobacterium xenopi: infection in an immunocompromised host; Damsker B et al.; Mycobacterium xenopi was isolated from bronchoscopic and resected lung specimens from a patient who had diabetes mellitus and chronic myelogenous leukemia . While in remission, the patient developed spreading pulmonary infiltrates and died . At postmortem examination, acid fast bacilli were found in enormous numbers in histologic preparations of pulmonary hilar and mesenteric lymph nodes . Concomitant pulmonary infection with Aspergillus, Pneumocystis carinii, and cytomegalovirus was also evident . The probable dissemination of M . xenopi to pulmonary hilar and mesenteric lymph nodes attests to its invasive potential in the immunocompromised host and reinforces its role as an agent of nontuberculous mycobacterial disease.

Am J Clin Pathol, 1982 Sep, 78(3), 390 - 4
Malakoplakia of palatine tonsil; Kalfayan B et al.; This paper's purpose is to document a case of unilateral tonsillar malakoplakia . Escherichia coli was repeatedly cultured from the lesion, and the isolate was studied by expert microbiologists who found no abnormalities in its biologic properties . The course of the lesion was followed by repeated punch biopsies before, and after the institution of antibiotic therapy . Following treatment, healing was characterized histologically by the disappearance of edema, granulocytes and bacilli, a striking initial increase in the number of Michaelis-Gutmann (MG) bodies and other calcified particles, and an increase in the number of foamy plasma cells, before the eventual resolution of the lesion.

Acta Cytol, 1982 Sep-Oct, 26(5), 691 - 4
Malacoplakia of the uterine cervix: report of two cases; Wahl RW; Two cases of malacoplakia involving the uterine cervix are reported . Lesions of the genital tract caused by this uncommon granulomatous reaction may suggest malignancy clinically and may present with vaginal bleeding . Cytologic findings in cervical smears from both patients included inflammation and abundant histiocytes . The characteristic finding is the Michaelis-Gutmann body, which can be identified in cervical smears, especially with the use of PAS or von Kossa stain . Gram-negative bacilli may be cultured from the tissue or identified on Gram's stain . Antibiotics are probably effective in eradication, as is surgical excision.

Acta Cytol, 1982 Sep-Oct, 26(5), 678 - 80
Characteristics of cerebrospinal fluid in tuberculous meningitis; Jeren T et al.; A retrospective study of 84 cases of tuberculous meningitis from a ten-year period is presented . Lumbar punctures had been performed, and the dynamics of cytologic changes in the cerebrospinal fluid (CSF) had been followed weekly during the course of the disease . The typical clinical picture, the course of the disease and cytologic characteristics of the CSF are noted . Of particular interest were some cases presenting atypical cytologic, as well as clinical, pictures of tuberculous meningitis . These patients had pleocytosis lasting as long as two years . In the first ten days, neutrophils predominated (60% to 80%); then mononuclear cells, such as lymphocytes, lymphoid cells, monocytoid cells and macrophages, became predominant . From the third week of the disease, plasmocytes (20%) were found in 30% of these cases . The presence of reticulomonocytes and reticulohistiocytic cells that could hardly be classified was also noted . By detailed analysis of the cytologic changes in the CSF, the suggestion of a diagnosis of tuberculous meningitis can be made before Koch's bacilli are found, even when the clinical picture and course of the disease are atypical.

Int J Lepr Other Mycobact Dis, 1982 Sep, 50(3), 306 - 15
Phagocytosis in leprosy . 5 . The effect of the infection with Mycobacterium lepraemurium on the level of diverse hydrolytic lysosomal enzymes of murine peritoneal macrophages; Rojas-Espinosa O et al.; The effect of the infection with M . lepraemurium on the activity of several lysosomal enzymes of mouse peritoneal cells was studied . The enzymes studies were acid- and alkaline-phosphatases, acid (cathepsin D-type) proteinase, beta-glucuronidase, deoxyribonuclease, a nonspecific lipase, and lysozyme . Enzyme determinations were carried out four months and six months after the infection with 15.5 X 10(7) bacilli per mouse . Clear differences between M . lepraemurium-infected and normal animals were observed at four months of infection, with all of the mentioned enzyme activities well above the normal values . At six months of infection, a tendency to decrease to normal values of the enzyme activities was observed . It is suggested that this biochemical activation of mouse peritoneal cells reflects the effect of the cell-mediated immune response triggered by the infection with the murine leprosy bacillus . M . lepraemurium-infected mice possess macrophages in a high state of biochemical activation; yet, they are unable to get rid of the infecting microorganism.

Tubercle, 1982 Sep, 63(3), 201 - 8
Activity of amikacin against Mycobacteria in vitro and in murine tuberculosis; Sanders WE Jr et al.; Amikacin was found to be a potent inhibitor of clinical isolates of Mycobacterium tuberculosis in vitro . The drug was also active against some, but not all, strains of M . intracellulare, M . kansasii and rapidly growing mycobacteria in concentrations that may be attained clinically . Activity was independent of susceptibility or resistance of the isolates to commonly used antituberculosis agents . Groups of mice were infected intravenously with M . tuberculosis H37Rv and then treated daily with amikacin, streptomycin, isoniazid or kanamycin . One third of the mice in each group were killed 30, 60 and 90 days after infection . Extent of pulmonary disease was recorded and tubercle bacilli were enumerated in lungs . Isoniazid eradicated tubercle bacilli from the lungs within 90 days . The remaining drugs were suppressive . Amikacin was more efficacious than streptomycin or kanamycin given in equivalent or greater dosages . Because of its potent activity in vitro, efficacy in experimental tuberculosis and activity against drug resistant mycobacteria, amikacin merits further study as a potential therapeutic agent for tuberculosis and other mycobacterial infections.

Infect Immun, 1982 Sep, 37(3), 1042 - 9
Glyoxylate metabolism and adaptation of Mycobacterium tuberculosis to survival under anaerobic conditions; Wayne LG et al.; Tuberculosis is characterized by periods in which the disease may be quiescent or even clinically inapparent, but in which tubercle bacilli persist and retain the potential to reactivate the disease . The present study was carried out in pursuit of an in vitro model which might contribute to the understanding of the physiology of nonreplicating persisters, with oxygen limitation used as the means of inducing this state . When actively growing aerated cultures of Mycobacterium tuberculosis were suddenly placed under anaerobic conditions the bacilli died rapidly, with a half-life of 10 h . When the bacilli were grown in liquid medium without agitation, they adapted to the microaerophilic conditions encountered in the sediment; the adapted bacilli in the sediment did not replicate there but were tolerant of anaerobiosis, exhibiting a half-life of 116 h . Among the early events associated with the adaptation were the synthesis of an antigen designated URB, the function of which is not known, and a fourfold increase in isocitrate lyase activity . The bacilli later exhibited a 10-fold increase in synthesis of a glycine dehydrogenase that catalyzes the reductive amination of glyoxylate, concomitantly oxidizing NADH to NAD . Specific activities of other enzymes studied were either not affected or moderately diminished in the sedimented bacilli . It is proposed that the glyoxylate synthesis in this model serves mainly to provide a substrate for the regeneration of NAD that may be required for the orderly completion of the final cycle of bacillary replication before oxygen limitation stops growth completely . This orderly shutdown is essential to continued survival of M . tuberculosis in a quiescent form.

Clin Exp Immunol, 1982 Sep, 49(3), 532 - 42
IgA, IgM and IgG anti-M . leprae antibodies in babies of leprosy mothers during the first 2 years of life; Melsom R et al.; IgA, IgM and IgG anti-M . leprae antibody activity was estimated by solid phase radioimmunoassay in repeated serum samples from cord sera to sera taken 2 years after birth from 29 babies of mothers with lepromatous leprosy (Group 1) and 16 babies of mothers with tuberculoid leprosy and non-leprosy control mothers (Group 2) . IgA anti-M . leprae antibody activity could be detected in 30% and IgM anti-M . leprae antibody activity in 50% of cord sera from Group 1, but not in any of the cord sera from Group 2 . After birth, there was a significantly higher increase of IgA and IgM anti-M . leprae antibody activity in sera taken 3-6 months after birth from babies of Group 1 compared to Group 2, but the IgA and IgM activity in sera taken after 6 months of age showed the same increase in the two groups . IgG anti-M . leprae antibody activity showed a marked decrease in sera from both Groups 1 and 2 taken 3-6 and 6-9 months after birth compared to the activity in the cord sera . No increase of the IgG activity could be demonstrated even in sera taken 15-24 months after birth in any of the two groups . These findings are discussed in relation to possible transfer of M . leprae bacilli across the placenta, the influence of M . leprae and other mycobacteria exposure on the antibody activity, the poor IgG anti-M . leprae antibody response and subclinical leprosy infection in babies exposed to leprosy below 2 years of age.

Clin Exp Immunol, 1982 Sep, 49(3), 517 - 22
Radiolabelled M . leprae resident in human macrophage cultures as an in vitro indicator of effective immunity in human leprosy; Prasad HK et al.; Twelve strains of human derived, freshly extracted M . leprae maintained within human macrophages showed a 2.1-13.2-fold increase in the incorporation of 3H-thymidine compared to parallel cultures containing heat-killed bacilli of the same strain . The addition of antigen stimulated lymphokines from five paucibacillary, tuberculoid leprosy patients resulted in the inhibition of the uptake of the radiolabel by 49-87% . Minimal, or no, inhibition was noted in the presence of similar culture supernatants from five bacilliferous lepromatous leprosy individuals . The results indicate that in contrast to lepromatous leprosy, tuberculoid patients possess antigen reactive lymphocytes which modulate macrophage function through soluble products . Attention is drawn to a rapid and sensitive in vitro method with potential for studying the immunological mechanisms leading to bacterial killing in human leprosy.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Sep, (9), 34 - 42
{Serological varieties of Klebsiella pneumoniae in pneumonia}; Kiseleva BS et al.; 118 K . pneumoniae cultures isolated from the pulmonary tissue samples, taken during autopsy from 33 patients who had died of pneumonia, and from the sputum of 19 living patients with chronic pneumonia, as well as 2 strains, K1 and K2, from the International Reference Klebsiella collection, formerly known as Friedlander's bacilli A and B, were studied . Besides K . pneumoniae K1 and K2, 10 other serovars of these bacteria, viz . K9, K11, K13, K16, K18, K19, K20, K62, K64, K82, were isolated, both as pure cultures and in association with other organisms, from the foci of inflammation in the pulmonary tissue in acute pneumonia . The K . pneumoniae serovars isolated from the sputum samples were essentially the same as those isolated from the autopsy material . The disease was found to have similar clinical and pathological manifestations irrespective of a K . pneumoniae serovar isolated in each particular case, which was indicative of the similar pattern of pulmonary tissue lesions characteristic of Friedlander's pneumonia . A new name for the nosological form of this disease is proposed: Klebsiella pneumonia instead of Friedlander's pneumonia . K . pneumoniae should be considered as pathogenic microorganisms, which was formerly known in respect of Friedlander's bacilli.

Jpn J Antibiot, 1982 Sep, 35(9), 2252 - 76
{Fundamental and clinical studies of ceftizoxime in obstetrical and gynecological field}; Hayasaki M et al.; This paper, is concerned with fundamental and clinical studies of ceftizoxime, a newly developed cephalosporin derivative, in the field of obstetrics and gynecology . 1 . Concentrations of ceftizoxime after administration 1 g of ceftizoxime by 1 hour drip infusion were determined in genital organs in 17 patients and the exudate of pelvic dead space in 6 patients . Simulated maximal concentrations with the ratios to the simulated peak serum levels were as follows: 27.9 micrograms/g for fundal myometrium with the ratio of 48%, 36.0 micrograms/g for portio vaginalis with 62%, 17.1 micrograms/g for ovary with 29%, 15.0 micrograms/g for oviduct with 26% and 16.2 micrograms/ml for the exudate of pelvic dead space with 30% . 2 . Minimal inhibitory concentrations of ceftizoxime were determined against clinically isolated organisms from female genital infectious diseases . Ceftizoxime was found to have a potent in vitro activity against Gram negative bacilli; for example, 0.1 microgram/mg or low against E . coli and K . pneumoniae . Against P . aeruginosa, P . cepacia and b . fragilis, ceftizoxime had an activity which expected to be effective in the clinical use . 3 . We gave ceftizoxime to 6 patients comprising 4 patients with puerperal fever, 1 with septic abortion and 1 with tubo-ovarian abscess in daily doses of 2 to 3 g by b.i.d or t.i.d intravenous drip infusion for 4--12 days . The results of the treatment were 'excellent' in 3 patients, 'good' in 2, and 'unevaluatable' in 1 . 4 . Adverse reactions occurred in 2 patients who showed eruption during the medication with ceftizoxime . These patients had allergic histories due to penicillin derivatives . From the above results it is concluded that ceftizoxime is a useful drug for infections in obstetrical and gynecological field.

Jpn J Antibiot, 1982 Sep, 35(9), 2219 - 33
{Fundamental and clinical studies of cefotiam in the field of oral surgery}; Yamamoto T et al.; Cefotiam (CTM) is a new synthetic cephem antibiotic developed in Japan . The results of the fundamental and clinical studies are as follows . 1 . CTM showed antibacterial activity, in terms of MIC, as strong as those of cephalothin (CET) and cefazolin (CEZ) for Gram-positive cocci, and several times superior to for Gram-negative bacilli . 2 . CTM serum levels approximately reached the peaks on completion of 60 minutes intravenous drip infusion of 1 g of this preparation dissolved in 5% glucose solution of 250 ml; the mean value was 65.00 micrograms/ml . Then the levels dropped rather quickly up to 180 minutes after the start of drip infusion . After that, the levels dropped gradually up to 360 minutes . 3 . As for the passage of CTM in the oral tissues, satisfactory passage was observed in both maxillomandibular marrow and gingiva, which adequately exceeded MICs of the clinically isolated strains of oral infections . 4 . This preparation was administered 1 g of 2 g daily by intravenous drip infusion in 18 cases of moderate or more serious infections in the field of oral surgery; the clinical efficacy rate obtained was 94.4% . 5 . No manifestations of side effect were observed clinically . As for laboratory findings, 1 case of large increases in GOT and GTP (a hepatitis B antigen positive patient) and 2 cases of slight increase in GTP were observed . On the basis of these results of the fundamental and clinical studies, it was concluded that CTM is an excellent antibiotic for the treatment of oral infections.

Jpn J Antibiot, 1982 Sep, 35(9), 2195 - 9
{Fundamental and clinical studies on piperacillin in the field of obstetrics and gynecology}; Nakamura H et al.; Fundamental and clinical studies were made on piperacillin (PIPC) and the results were obtained as follows . Serum and uterine tissue concentrations of PIPC were obtained from 36 to 215 minutes after intravenous single shot of 2 g of PIPC . The cervix uteri, endometrium and corpus uteri showed the highest antibiotic levels of 38.0, 43.0 and 33.0 mcg/g, respectively, at 65 minutes after injection, and oviduct and ovary showed the highest level of 31.5 and 28.5 mcg/g at 36 minutes . Its concentrations were sufficiently effective against the major pathogens (Gram-negative bacilli and anaerobes) demonstrated in the field of obstetrics and gynecology . PIPC was administered 6 patients, including 3 of pelvic peritonitis (isolated organism was E . coli 1), 2 of acute endometritis (Klebsiella sp . 1, Peptococcus sp . + Bacteroides sp . 1) and 1 of acute adnexitis, in a dosage of 1 or 2 g twice or 3 times a day for a period of 5 to 8 days by intravenous administration or intravenous drip infusion . Clinical response was obtained excellent in 1 and good in 5 . No adverse reaction as observed in any of the cases treated with PIPC, nor was there any marked changes in the laboratory findings.

Endoscopy, 1982 Sep, 14(5), 178 - 9
Laparoscopic diagnosis of tuberculous ascites; Rodriguez de Lope C et al.; We report 14 patients with tuberculous peritonitis presenting as persistent and exudative ascites . We found a primary site of tuberculous infection in only 10% of the patients . PPD test was positive in 9 patients . Ascitic fluid showed a protein content in excess of 3.5 g/dl . and more than 300 cells/mm3, mainly lymphocytes, in all patients, Ziehl stain and the culture for Tb . bacilli were negative in all cases . The confirmatory diagnosis was made by laparoscopy and peritoneal biopsy . Good views were obtained on all occasions, and there was no morbidity . Appearances were similar in all cases . Multiple white tubercles were scattered over the parietal and visceral peritoneum . filmy adhesions were present . Four patients had cirrhotic liver disease confirmed by laparoscopy . The biopsy specimen showed caseating granulomata, and the auramine stain was positive in four cases . We conclude that laparoscopy and biopsy is a safe and effective method of obtaining an early diagnosis in patients with tuberculous ascites, especially if they also have cirrhosis.

Arch Intern Med, 1982 Sep, 142(9), 1663 - 7
Piperacillin plus amikacin therapy v carbenicillin plus amikacin therapy in febrile, granulocytopenic patients; Winston DJ et al.; In a prospective randomized trial, febrile, granulocytopenic patients received either piperacillin sodium plus amikacin sulfate or carbenicillin disodium plus amikacin as initial empiric antimicrobial therapy . Although significantly more gram-negative aerobic bacilli isolated from initial cultures were susceptible to piperacillin than to carbenicillin (54 of 58 v 30 of 58), the overall response rates for the two regimens were similar (113 of 143 or 79% for piperacillin plus amikacin and 116 of 154 or 75% for carbenicillin plus amikacin) . Piperacillin plus amikacin was associated with less hypokalemia (26 of 143 v 56 of 154) . Nephrotoxicity, which was minimal with both regimens, developed less frequently in patients receiving carbenicillin plus amikacin (12 of 143 v two of 154) . These results suggest that the overall efficacy of piperacillin plus amikacin is similar to carbenicillin plus amikacin and that piperacillin plus amikacin may be associated with less hypokalemia but more nephrotoxicity.

Clin Exp Immunol, 1982 Sep, 49(3), 523 - 31
SDS-PAGE analysis of M . leprae protein antigens reacting with antibodies from sera from lepromatous patients and infected armadillos; Chakrabarty AK et al.; Studies have been conducted to characterize M . leprae bacilli derived from infected armadillos . First, the proteins of the mycobacterial extracts were fractionated by SDS-PAGE . Subsequently, the proteins in the gel were electrophoretically transferred on a strip of nitrocellulose paper by the technique of 'electrophoretic blotting' . The separated bacterial protein bands, thus immobilized on the nitrocellulose paper were made to react immunologically with sera from the lepromatous patients, infected armadillo sera and other experimental mycobacterial antisera . It was observed that a majority of M . leprae proteins contained antigenic determinants also present on proteins of BCG . In addition, only two specific antigen bands of 33KD and 12KD were conspicuously detected by the patients' sera and the infected armadillo sera . These substances were further identified as polysaccharides or glycoproteins since they could only be stained by Schiff's reagent or alcian blue . Only 12KD glycoprotein band reacted with concanavalin A, whereas wheat germ agglutinin (WGA) did not show any reaction with them . These 33KD and 12KD glycoprotein antigens were found to lose their antigenicity after pepsin treatment and can be considered as glycoproteins . Further, radiolabelling experiments showed that 12KD antigen underwent radioiodination under usual conditions, but 33KD glycoprotein failed to be similarly radiolabelled . It is suggested that these protein antigens have M . leprae specific determinants on a cross-reacting component.

Infect Immun, 1982 Aug, 37(2), 786 - 93
Lymphokine-induced mycobacteriostatic activity in mouse pleural macrophages; Zlotnik A et al.; We have developed an in vitro assay to study the intramacrophage replication of Mycobacterium tuberculosis or Mycobacterium bovis BCG . In this assay, extracellular mycobacterial replication was avoided by using a small infecting inoculum and a new method for efficiently removing nonphagocytocytized bacilli . The ability of different mycobacterial strains to replicate in mouse pleural macrophages correlated with their virulence . The effect of lymphokines prepared by incubating spleen cells from BCG-immunized mice with mycobacterial antigens was tested with this assay . In the presence of lymphokines, mouse pleural macrophages were able to inhibit the intramacrophage replication of both BCG and M . tuberculosis . This assay is a useful in vitro model for studying antibacterial cellular immunity expressed by macrophages.

Am J Clin Nutr, 1982 Aug, 36(2), 284 - 9
Colonization of the oropharynx with Gram-negative bacilli in children with severe protein-calorie malnutrition; Gilman RH et al.; Oral pharyngeal isolation of Gram-negative bacteria was compared in four groups of Bengali children; acutely ill, severely malnourished outpatients swabbed on hospital admission; ill but less severely malnourished outpatients from the same area as the malnourished children; orphans also less severely malnourished but not acutely ill; and well controls drawn from a priviledged socioeconomic group . The expected weight for height percentage (National Center Health Statistics/Center for Disease Control median) of the four groups was respectively 67, 91, 97, and 97% . Isolation of Gram-negative bacteria from 74 of 87 (85%) severely malnourished children was significantly greater (p less than 0.01) compared to 43 of 113 (38%) outpatients, to 20 of 93 (22%) orphans, and to five of 51 (10%) controls . A total of 71 malnourished children under 5 yr of age (90%) had higher rates of Gram-negative throat colonization than did 16 older children (63%) (p less than 0.01) . Thus there was an increased rate of Gram-negative colonization in severely malnourished children especially among the younger age group . In the subset of ill children, Gram-negative pharyngeal colonization was significantly associated inversely with nutritional indices and age . The high rate of such carriage may be partly responsible for the increased susceptibility of Gram-negative infection demonstrated in these children.

Can Med Assoc J, 1982 Jul 15, 127(2), 119 - 23
Double-blind trial of perioperative intravenous metronidazole prophylaxis for abdominal hysterectomy; Vincelette J et al.; A double-blind trial of perioperative intravenous metronidazole treatment to prevent infections at the operative site and unexplained fever after abdominal hysterectomy was conducted in 106 patients . Metronidazole prophylaxis reduced the rate of recovery of anaerobes from vaginal swabs for several days and prolonged the high rate of vaginal carriage of enterococci and aerobic gram-negative bacilli following hysterectomy . Although the fever index, calculated from the duration of a temperature above 37.3 degrees C, was significantly lower in the metronidazole-treated group than in the placebo-treated group, the frequency of postoperative infections, the proportion of patients requiring antibiotic treatment and the average duration of hospital stay were similar in the two groups . These results do not support the reported value of perioperative metronidazole prophylaxis in patients undergoing abdominal hysterectomy.

Am Rev Respir Dis, 1982 Jul, 126(1), 142 - 51
Experimental diffuse alveolar damage in baboons; Johanson WG Jr et al.; Lung repair after diffuse alveolar damage (DAD) may be modified by supportive therapy or the occurrence of complications . To provide a clinically relevant model of DAD, we studied the feasibility of long-term respiratory support of 5 normal baboons and 20 baboons with oleic-acid-induced lung injury . Oleic acid caused DAD, which evolved through exudative and reparative phases similar to those seen in human disease . Fibrotic residuals were present at 1 month but resolved by 6 months . Pulmonary function abnormalities, including reduction in total lung capacity and diffusing capacity, and hypoxemia occurred with DAD but resolved within 1 month . Bronchopulmonary infection with gram-negative bacilli was a common and frequently fatal complication . Revisions in management of the upper airway and the use of topical polymyxin B prevented this complication . Other complications included hemorrhagic gastritis, postextubation, upper airway obstruction, and pulmonary embolism . This model simulates many features of DAD in humans and should provide a valuable resource for future study.

Ann Microbiol (Paris), 1982 Jul-Aug, 133(1), 93 - 7
Adsorption of mycobacteriophages on Mycobacterium leprae: taxonomic significance; David HL et al.; The following bacteriophages were shown to adsorb on Mycobacterium leprae: BK1, Clark, Sedge, Baits, Watson and D29 . Bacteriophages that did not adsorb on the leprosy bacilli were Bg1, Legendre, Marshall, Panetti, Leo and Wiseman . The taxonomic significance of these findings and some prospective consequences of these investigations are discussed.

Ann Microbiol (Paris), 1982 Jul-Aug, 133(1), 53 - 8
Mycobacterial lipids in infected tissue samples; Young DB; Mycobacteria synthesize characteristic lipids which can readily be distinguished from those synthesized by the host cells which they infect during pathogenesis . This fact can be exploited to provide information about mycobacteria growing in infected tissue samples: (a) qualitative analysis of lipid extracts from lepromatous leprosy skin biopsies reveals the presence of several mycobacterial lipids including an M . leprae-specific glycolipid, phthiocerol dimycocerosate and mycolic acids; (b) quantitative analysis shows that the amount of mycobacterial lipids present in lepromatous lesions is much greater than that expected on the basis of the number of acid-fast bacilli present; (c) incorporation of 14C-acetate into cell wall mycolic acids can be used to monitor the growth of intracellular mycobacteria.

Ann Microbiol (Paris), 1982 Jul-Aug, 133(1), 129 - 39
Reduction of potassium tellurite and ATP content in Mycobacterium leprae; David HL et al.; The purpose of this investigation was to examine those properties of Mycobacterium leprae which might be useful in estimating the heterogeneity of the bacterial populations harvested from the tissues of experimentally infected armadillos . The following technical procedures were applied: fluorescent microscopy on smears stained by an Auramine O-Ethidium bromide dual procedure, fine structure observation of ultrathin sections, reduction of potassium tellurite as observed under the electron microscope, and ATP content of the bacteria . The quantitative data from these procedures was compared to the morphological index, and it was shown that the results did not correlate . However, the study of tellurite reduction was interesting because this technique may prove useful in evaluating the contamination of M . leprae preparations by host tissues . More significant was the fact that M . leprae reduced tellurite . Even though the reduction was at a very low efficiency under the conditions described, it would be possible to use this technique to investigate the effects of several substrates on the respiratory activity of the leprosy bacilli.

J Clin Pathol, 1982 Jul, 35(7), 698 - 705
Problems in the disinfection of class 1 microbiology safety cabinets; Everall PH et al.; Microbiology safety cabinet disinfection procedures using formaldehyde have been tested . Tubercle bacilli were killed by concentrations of formaldehyde obtained by heating commercial formalin irrespective of whether the bacilli were in the cabinet free space or above the prefilters . However, Bacillus stearothermophilus spore papers for for the testing of low temperature steam/formaldehyde sterilisers were almost never sterilised and a strain of Staphylococcus epidermidis (NCTC 7944) showed a resistance intermediate between the B stearothermophilus spores and the tubercle bacilli . Tests using a vaccine strain of poliovirus type 3 indicated a considerable degree of resistance of the virus to the action of formaldehyde . No such resistance was demonstrated by vaccinia virus or echovirus 14 . Chemical and biological evidence is presented which indicates that filter paper discs are an unsuitable carrier material for a challenge organism in testing the efficiency of any formaldehyde sterilising process . Recommendations are made towards developing a satisfactory test procedure.

Appl Environ Microbiol, 1982 Jul, 44(1), 59 - 66
Large intestine bacterial flora of nonhibernating and hibernating leopard frogs (Rana pipiens); Gossling J et al.; The bacteria in the large intestines of 10 northern leopard frogs (Rana pipiens) were enumerated and partially characterized . Four nonhibernating frogs were collected in the summer, four hibernating frogs were collected in the winter, and two frogs just emerged from hibernation were collected in the spring . All frogs had about 10(10) bacteria per g (wet weight) of intestinal contents and about 10(9) bacteria per g (wet weight) of mucosal scraping, although the counts from the winter frogs were slightly less than those from the other two groups of frogs . Another group of 14 summer frogs, after treatment to induce hibernation, showed a drop in bacterial counts accompanied by a change in the composition of the flora . In most frogs, Bacteroides was the dominant organism . Other bacteria repeatedly isolated at high dilutions were strict anaerobes, including butyrigenic and acetogenic helically coiled bacteria; fusobacteria; and acetogenic, small, gram-positive bacilli . These data indicate that the intestinal flora of frogs is similar to that of mammals and birds and that this flora can be maintained at temperatures close to freezing.

Thorax, 1982 Jul, 37(7), 526 - 7
Low incidence of rifampicin-resistant tubercle bacilli; Collins CH et al.; In a six-year survey 10(0.15%) of 6849 patients with European names and 31 (1.0%) of 3079 patients with non-European names yielded cultures of Mycobacterium tuberculosis that were resistant to rifampicin . Only two of each group had organisms resistant to rifampicin alone . Resistance to one or more other antituberculous drugs was found in eight of the European and 29 of the non-European group . Two patients in each group were known to have received treatment for the first time in the United Kingdom; 17 of the non-Europeans were known to have been treated abroad; precise information was not available for the other 12 . The overall six-year incidence of patients with rifampicin-resistant M tuberculosis was only 0.41% . The very low incidence among Europeans is probably the result of stricter regimens than are possible in some other areas.

Lepr India, 1982 Jul, 54(3), 461 - 70
Effect of freezing Mycobacterium leprae in tissues; Dhople AM; The effects of freezing tissues from M . leprae-infected armadillos as well as biopsy specimens from leprosy patients have been studied . No loss of viability of M . leprae was observed using mouse foot pad technique . Similarly, using bioluminescent determinations of bacterial ATP, it was shown that these bacilli retain all their metabolic activity during such freezing and thawing process . The practical implications of these findings have been discussed.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Jul-Sep, 31(3), 187 - 94
{Effectiveness of the examination of the different categories of contacts of pulmonary tuberculosis patients as a part of epidemiological investigations}; Dobre V et al.; In view of evaluating the global efficiency of the epidemiologic investigation in relation to its area an analysis was carried out of 127 investigations involving 1 252 tb contacts . The contacts were classified in three groups: intrafamilial and intradomiciliary, intrafamilial but outside the home, and extrafamilial and outside the home; the results of the examinations were compared between them on the one hand and with the proportion of allergic children (51.6%) and the instantaneous prevalence of bacilli eliminating cases (0.31%) on the other hand . These were obtained in an area with a high endemic ratio of tuberculosis, following integral biological and radiophotographic case-finding . Children who were tb contacts, belonging to the first group also included the highest proportion of allergies (48.3%) while in the other two groups the number of allergic children was similar to that of allergic children in the locality with a high endemic ratio of tuberculosis . The radiophotographic examination of adults who were contacts of tuberculous patients showed that the lowest proportion of tuberculous patients with active tuberculosis (0.4%), which was found in the third group, was still above the instantaneous prevalence of bacilliferic patients from the area with high ratio of endemic tuberculosis . In conclusion, the present technical structure of epidemiological investigations corresponds to the actual level of the endemy and no group of contacts can be excluded from the investigation.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Jul-Sep, 31(3), 179 - 86
{Evolution of chronic pulmonary tuberculosis and the possibility of preventing chronicization (in the Iaşi judicial district)}; Ionescu C et al.; The instantaneous prevalence of patients with pulmonary tuberculosis has been evaluated; the patients were included in the dispensarization group I between 1974 and 1980 . Initially there was a decrease of the prevalence of the patients in Group I B but over the last years this was stable at 11.7-13.5 0/0000 inhabitants . The decrease which had been obtained at first was due to the immediate effect of repeated treatments with new tuberculostatic drugs resulting in sterilization and inclusion in the Group II of dispensarization of many of the preexisting patients while the ceiling which occurred later was determined by the quantitative balance of therapeutic failures and relapses entering the Group I B and cases which left the Group as a result of medical solutions, death or change of address . It was also noted that most of the patients in whom presence of the bacilli had been determined by microscopic techniques and by cultures constituted a relatively stable group over the entire period of the study, and oscillated between 11 and 17.5%, and 56.5 and 65.9% respectively . The quantitative balance established over the last years between the "entrances" and the "exits" from Group I B may be altered firstly by lowering the number of failures and relapses after the first treatment . The nature of unfavourable factors which influence the prognosis may be classified as follows: bio-psycho-social implications (males--81.5%, age--between 30 and 50 years, 51.4%, lack of occupation, 31.5%, low educational level, 80.1% chronic ethyl intoxication 51.4%, psychoses, 12.7%, other associated diseases, 34.3%, and primary drug resistance, 7.1%); consequences of a late detection; deficiencies in the rhythm and the duration of the first treatment with tuberculostatic drugs (non-cooperation--64.2%, irregularities--38.5%, interruptions--42.8%, secondary drug resistance--14.2%).

Lepr India, 1982 Jul, 54(3), 420 - 7
Lack of correlation between morphological index and viability as assessed by the uptake of 3H-thymidine by macrophage resident M . leprae; Sathish M et al.; Thirty strains of M . leprae derived from skin biopsies of lepromatous leprosy patients were scored for Morphological Index (MI) and concurrently maintained for 2 weeks in macrophage cultures containing 3H thymidine . Selective and significant incorporation of the radioactive label was observed in cultures containing freshly extracted M . leprae as compared to control cultures with autoclaved bacilli from the same biopsy . The percentage incorporation of 3H thymidine ranged from 103 to 1140% . Morphological Index of the bacilli from these individuals varied from zero to 8 . Six cultures containing bacilli with MI of less than or equal to 1 and 3 containing bacilli with MI of zero showed significant incropration of 3H thymidine . There was no correlation between the percent of solid or beaded bacilli in the inoculum and the ability of M . leprae to incorporate 3H thymidine in the macrophage cultures.

J Submicrosc Cytol, 1982 Jul, 14(3), 515 - 20
Mast cells in Whipple's disease; Tavarela Veloso F et al.; Abundant degranulating mast cells were observed during an ultrastructural study of jejunal biopsy from an untreated patient with Whipple's disease . Some of these cells were observed in intimate contact with macrophages containing bacteria in various stages of disintegration . Thereafter bacilli were often seen within the cytoplasm of mast cells, enclosed within vacuoles . These findings are suggestive of a cooperation between mast cell and macrophage in the defence of the organism against Whipple's bacillus.

Eur J Clin Microbiol, 1982 Jun, 1(3), 144 - 8
Synergism of trimethoprim combined with aminoglycosides in vitro and in serum of volunteers; Zinner SH et al.; In vitro synergism of trimethoprim plus amikacin and trimethoprim plus sisomicin against 66 gram-negative bacilli was studied by microtiter checkerboard dilution . Synergism was defined as an FIC or FBC index equal to or less than 0.5 . Fifty-two percent of strains were inhibited and 65% killed synergistically by the former combination, and 27% and 36% respectively by the latter combination (p less than 0.01) . Serum bactericidal activity against 16 strains resistant to ampicillin and/or cephalothin was studied using serum from five volunteers one and six hours after intravenous administration of trimethoprim (160 mg), amikacin (250 mg) or the combination, and from six volunteers after administration of trimethoprim, tobramycin (1 mg/kg) or the combination . With trimethoprim and amikacin serum bactericidal titers greater than or equal to 1:8 were found more frequently with the combination (77 of 80 samples) than with either drug alone (trimethoprim 19 of 80 samples, amikacin 60 of 80 samples, p less than 0.01) . Trimethoprim plus amikacin may be useful in the treatment of infections with gram-negative rods resistant to cephalothin and ampicillin.

Jpn J Antibiot, 1982 Jun, 35(6), 1615 - 22
{Clinical studies of cefoxitin in the field of abdominal surgery}; Takahashi Y et al.; Cefoxitin (CFX) was administered to total 25 patients who were admitted to the surgical ward of the hospital . The results of these studies are as follows . 1) Dis susceptibility tests of the 20 strains (many Gram-negative bacilli and 2 strains of anaerobic Bacteroides) isolated from the patients to antibiotic were performed and 17 strains were good susceptibility to CFX . 2) In 9 patients of postoperative infections, 8 patients (including 2 patients with infections due to mixed E . coli and Bacteroides) were good with the clinical efficacy rate of 88.9% . 3) In 16 patients used for prevention of postoperative infections, 15 patients were good with the clinical efficacy rate of 93.8% . 4) No side effects were noted due to CFX . The results of these studies demonstrated that CFX is safe and effective in treatment of infections and for prevention of postoperative infections in the field of gastrosurgery.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Jun, (6), 50 - 3
{Latent bacterial carrier state and resistance to colonization after antibiotic therapy}; Shustrova NM et al.; The enteral administration of antibiotics has been shown to induce the occult carriership (persistence) of sporulating Gram-positive bacilli inhabiting the intestine before the use of antibiotics and V . eltor introduced orally after the administration of antibiotics is stopped . After the prolonged use of some antibiotics the intestinal tract has been found to become an inadequate environment for the life of nonpathogenic E . coli easily colonizing the intestine of intact germ-free animals . Such form of resistance of colonization is an unfavorable consequence of antibiotic therapy.

J Clin Microbiol, 1982 Jun, 15(6), 1111 - 9
Accuracy and precision of the autobac system for rapid identification of Gram-negative bacilli: a collaborative evaluation; Barry AL et al.; Gram-negative bacilli were identified within 3 to 6 h by determining susceptibility to 18 different antibacterial agents in the Autobac I system and by applying a two-stage quadratic discriminant analysis to the susceptibility patterns . The Autobac system was compared with standard reference methods for identifying glucose nonfermenters and glucose fermenters . Intralaboratory and interlaboratory precision of the Autobac system was comparable to that of the reference methods . Sensitivity (accuracy) and specificity of the two systems were also comparable, although there were some differences with certain species . Autobac responses were considered to be equivocal (needing additional tests) if the relative probability of an accurate identification was less than 0.70 . Only 5% of 2,889 strains produced such equivocal results; a similar number of strains gave low probability levels with the reference methods . When the two systems disagreed, an independent reference laboratory arbitrated, confirming 49% of the Autobac responses and 36% of the reference identifications . With equivocal responses excluded, the overall accuracy of the Autobac system was 95.3% compared with 95.9% for the reference method . The respective accuracy estimates would be 93.8% and 93.1% if all first-choice identifications were evaluated.

Klin Monatsbl Augenheilkd, 1982 Jun, 180(6), 556 - 8
{Endophthalmitis caused by mycobacterium tuberculosis}; Manthey KF et al.; A 60-year-old woman developed an anterior uveitis of unknown etiology in her right eye . Topical treatment was corticosteroids led to a regression of the inflammation, but three months later a severe relapse occurred, followed by endophthalmitis and blindness . At this time a previously unknown pulmonary tuberculosis was diagnosed . In histologic sections of the enucleated eye numerous acid-fast bacilli were demonstrated . Diagnostic and therapeutic considerations are discussed.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1982 Jun, 252(2), 268 - 73
{Additional studies of the pathogenicity of aerobic spore-forming organisms (genus Bacillus) for mice}; Bodnar S et al.; An investigation of the parenteral pathogenic potential of aerobic spore-forming bacteria (genus Bacillus) in mice revealed that in the case of i.p . inoculation (0.5 ml suspension, 10(6)-10(7) viable cells per ml) only B . cereus was pathogenic, killing appr . one half of the inoculated animals (293 out of 577) . Other bacilli (B . subtilis, B . megaterium, B . pumilus etc.) administered intraperitoneally did not produce any lethal effect . If inoculated intracerebrally, B . cereus killed appr . 90% of the mice (138 out of 155), while for other bacilli the rate was appr . 50% only (260 out of 529) . It is suggested that most of the aerobic spore-forming organisms cultured from cases of hospital infections are B . cereus which, however, does not completely exclude the presence of other species.

Hansenol Int, 1982 Jun, 7(1), 25 - 35
{Acid-fast bacilli in the water of the Lake of Aleixo}; Salem JI et al.; The presence of acid-fast bacilli in the waters of the lake of Aleixo is recorded . This site is a hanseniasis colony . The physical-chemical environment of this lake is described by an annual cycle and it is intended to relate the quality of the water to the highest or to the lowest frequency of detected mycobacteria . It is suggested that the work in this lake system should be continued towards a more specific characterization of these microorganisms and the determination of their viability.

Hansenol Int, 1982 Jun, 7(1), 1 - 7
Mast cell and Mycobacterium leprae in experimental leprosy; Kumar R et al.; The association of mast cells and lepra bacilli was studied in the foot pad skin of immunosuppressed mice inoculated with 10(5) lepra bacilli . The mice were killed at intervals varying from 2 1/2-14 months postinoculation . M . leprae are found in large numbers in nerves, blood vessels, muscle fibres, hair follicles, sweat and sebaceous glands . Mastocytosis and extensive degranulation are seen at similar sites . Since these are the structures most affected in leprosy where the lepra bacilli and degranulating mast cells accumulate, there appears a close relationship between the two . This could be due to the composite role of mast cells in host tissue response and mastocytosis and degranulation may be related to this.

Tubercle, 1982 Jun, 63(2), 89 - 98
Controlled trial of 4 three-times-weekly regimens and a daily regimen all given for 6 months for pulmonary tuberculosis . Second report: the results up to 24 months . Hong Kong Chest Service/British Medical Research Council.
{Clinical laboratory approach for determination of effective dose of cefotiam . Observation from disc susceptibility test and MICs}
Uete T, Tsuzaki Y, Furukawa S, Matsuo K.

Reliability of cefotiam disc diffusion susceptibility test was investigated for determining whether the disc results correlate with minimal inhibitory concentration (MIC) or not . The results of Showa disc and Oxoid disc were well correlated . The inhibitory zone size of Showa disc and MIC were also well correlated, indicating reliability of the cefotiam disc test . The disc result, was observed over 84% of clinically isolated S . aureus, S . epidermidis, S . pneumoniae, S . pyogenes, E . coli, K . pneumoniae, P . mirabilis and H . influenzae . Their mean MICs were less than about 1.5 microgram/ml . Such a result should be useful for the determination of drug dose in various clinical conditions in order to obtain the proper drug levels in blood and tissues . The results of antibiotic disc diffusion susceptibility test with various bacteria isolated from clinical materials were compared . Cefotiam revealed a potent antimicrobial activity against Gram-positive cocci, showing a similar potency to that of cephalothin and cefazolin . However, it showed a stronger activity against Gram-negative bacilli than that of cephalothin, cefazolin, cephalexin and cefoxitin, revealing less resistant strains . Cephalosporins developed recently such as cefotaxime, cefoperazone, ceftizoxime, latamoxef etc . show very potent antimicrobial activity against Gram-negative bacilli, but their activity against S . aureus and S . epidermidis is weaker than that of cefotiam, cephalothin, cefazolin etc . Therefore, cefotiam can be considered as one of the drugs of first choice for surgical perioperative prophylaxis and blind therapy.

Immunology, 1982 Jun, 46(2), 387 - 94
The immunoregulatory role of bone marrow . III . Further characterization of the suppressor cell and its mode of action; McGarry RC et al.; In vitro primary antibody responses of spleen cells can be suppressed in a dose-dependent manner by the addition of bond marrow cells (BMC) . This suppression was not abrogated by treatment of BMC with anti-Thy 1, anti-Lyt nor with anti-I-J antisera and complement . Furthermore, preculture of BMC with the synthetic thymic pentapeptide (TP5) or Soluble Thymic Factor (STF) before anti-Thy-1 treatment was similarly ineffective in removing the suppressor cell activity . Similarly, treatment of BMC with polyvalent anti-immunoglobulin serum or anti-Ia antiserum and complement failed to remove the suppressor activity . However, preparations of anti-H-2 and anti-stem-cell antisera were capable of significantly decreasing the suppressive ability of BMC . BMC were also shown to be capable of suppressing antibody responses induced by the polyclonal activators dextran sulphate (DxS), lipopolysaccharide (LPS) and purified protein derivative from tubercle bacilli (PPD) . The non-specificity of this suppressor coupled with the absence of well-defined antigen on its surface may suggest that this cell represents a basic level of immune regulation.

Ophthalmology, 1982 May, 89(5), 499 - 501
Preseptal cellulitis caused by Mycobacterium intracellulare; Warman ST et al.; A case of preseptal cellulitis caused by Mycobacterium intracellulare is presented . A 56-year-old white woman developed erythema, induration, and tenderness of the lids of her right eye after chalazion removal, which did not respond to three weeks of broad spectrum antibiotics . Incision and drainage with biopsy revealed granuloma, and acid-fast bacilli were seem . Mycobacterium intracellulare was isolated on culture, resistant to all the antimicrobials that the patient was given . Antimicrobial therapy was discontinued, and the infection resolved over 15 months.

Am Rev Respir Dis, 1982 May, 125(5), 559 - 62
Nosocomial tuberculosis; Catanzaro A; Hospital employees are at risk of contracting tuberculosis from patients . The undiagnosed case with sputum-smear positive for acid-fast bacilli is the usual source case . However, even the smear-negative patient may pose a risk . This was documented by a high rate of skin test conversion in hospital staff exposed to a smear-negative, culture-positive patient in a respiratory intensive care unit . The patient required bronchoscopy, intubation, and assisted ventilation . Of susceptible hospital staff members who were exposed to the index case, 14 of 45 (31%) converted their PPD skin test . Ten of 13 (77%) susceptible hospital staff members present at the time of bronchoscopy converted, compared with 4 of 32 (12.5%) who were not present at bronchoscopy (Fischer's exact test p = 0.0006) . Rough calculations suggest that during the bronchoscopy and intubation the index case generated at least 249 infectious units per hour . At the ventilation levels in this area, this resulted in 1 infectious unit of tuberculosis in each 68.9 cubic feet of air . Improved ventilation, high efficiency filters, and ultraviolet irradiation are effective recommended ways to clean the air of infectious particles.

Infect Immun, 1982 May, 36(2), 768 - 74
Repeated delayed-type hypersensitivity reactions against Mycobacterium lepraemurium antigens at the infection site do not affect bacillary multiplication in C3H mice; Lovik M et al.; Delayed-type hypersensitivity was induced in cyclophosphamide-pretreated C3H/TifBom mice by subcutaneous immunization in the thorax with ultrasonicated Mycobacterium lepraemurium bacilli in Freund incomplete adjuvant . Seven weeks after immunization, 2.5 X 10(7) acid-fast M . lepraemurium bacilli suspended in diluted sonicate were injected into one hind footpad, and during the next 6 weeks three additional infections of sonicate were given at intervals into the infected footpad . After each injection a strong local reaction developed, which after the first three injections peaked at 24 h . The kinetics of the reaction was accelerated after the repeat injections . Each time the reaction subsided within 1 week . From 2 days to 11 weeks after the inoculation of bacilli there was a 10-fold increase in bacillary numbers in the footpad and a 3,000-fold increase in the draining popliteal lymph node . The degree of bacillary multiplication was the same in animals which had experienced repeated local reactions and in control animals . Thus, repeated strong delayed-type hypersensitivity reactions to M . lepraemurium antigens apparently were without any measurable effect on the bacillary multiplication . This observation provides further evidence for a dissociation in C3H/TifBom mice between delayed-type hypersensitivity to soluble mycobacterial antigens and protective immunity against mycobacteria . Possible explanations for our findings are discussed.

J Clin Pathol, 1982 May, 35(5), 550 - 4
Comparison of culture and microscopy in the diagnosis of Gardnerella vaginalis infection; Ison CA et al.; A comparison was made between human blood agar containing amphotericin B, nalidixic acid and either gentamicin or colistin for the isolation of Gardnerella vaginalis from cases of non-specific vaginitis seen in a clinic for sexually transmitted diseases . The medium containing gentamicin was more inhibitory for non-Gardnerella species, but not sufficiently inhibitory to allow direct plating in the clinic without spreading for single colonies . The diffuse beta haemolysis produced by G vaginalis on human, but not on horse blood agar, proved very useful in differentiating it from other vaginal organisms and was not affected by the antibiotics used . This characteristic, together with Gram stain morphology, oxidase and catalase, provides a simple, reliable methods of identifying G vaginalis . Sixty women with symptoms of vaginitis, in whom no other pathogen was isolated, were examined by culture and microscopy . Gardnerella vaginalis was grown from 45 whereas only 31 had positive microscopy (clue cells or Gram-variable bacilli) . There was no significant difference between the rate of isolation of G vaginalis in the group with positive microscopy (25/31) and that with negative microscopy (20/31).

Jpn J Antibiot, 1982 May, 35(5), 1308 - 21
{Experimental and clinical studies of cefmetazole in the field of oral surgery}; Minami Y et al.; Experimental and clinical studies were carried out on cefmetazole (CMZ), a synthetic antibiotic of cephamycin group, and the following results were obtained . 1) The minimal inhibitory concentrations (MICs) of CMZ against Gram positive cocci (30 strains) isolated from the patients with oral infections showed slightly inferior to those of ABPC, CEZ, while MICs against Gram negative bacilli (166 strains) of CMZ exhibited stronger activity than ABPC, CEZ . 2) The mean serum concentration of CMZ at 60 minutes after drip infusion showed 65.6 micrograms/ml . The concentration of CMZ in oral tissues varied in 4--60% of serum level at 60 minutes after drip infusion . The concentration in pus showed 15.2 micrograms/g at 60 minutes after drip infusion . 3) CMZ was administered by the drip infusion to 22 patients with various infections in the oral surgical field . The efficacy rate was 90.9% . 4) No side effect was observed.

J Infect Dis, 1982 May, 145(5), 733 - 41
Infection with Mycobacterium avium-intracellulare and the protective effects of Bacille Calmette-Guérin; Edwards ML et al.; The protective efficacies of bacille Calmette-Guerin (BCG) and Mycobacterium avium-intracellulare (MAI) were examined in guinea pigs that were infected by the respiratory route with one of three strains of Mycobacterium tuberculosis: two strains obtained as recent sputum isolates from an ongoing BCG trial in south India and laboratory strain H37Rv . Groups of animals were given all combinations of two treatments with BCG, MAI, or placebo and than challenged . The numbers of tubercle bacilli recovered from the primary lung lesions, primary lesion-free lung lobes, and spleens were used to estimate the relative protective effects of the various treatments . In general, BCG and MAI protected equally well against the low-virulence strain of M . tuberculosis . For the two more virulent strains the results were less clear; however, a substantial protective effect of MAI compared with BCG was noted . Infection with MAI did not significantly alter the capacity of BCG to protect against tuberculous infection.

Am J Med, 1982 Apr, 72(4), 650 - 8
Active tuberculosis undiagnosed until autopsy; Bobrowitz ID; In this report 21 patients in whom tuberculosis was the primary cause of death, but which was not diagnosed until necropsy, are reviewed . Of the 21 deaths, 11 were due to pulmonary tuberculosis and 10 to miliary tuberculosis . Proper evaluation of the following factors might have led to the correct diagnosis in many of the patients: A family history of tuberculosis, prior pleurisy, a gastrectomy, diabetes mellitus or end-stage renal failure; all can be associated with an increased incidence of tuberculosis . A negative tuberculin skin reaction does not exclude the presence of active tuberculosis . In the search for Mycobacterium tuberculosis, the examination of just one or two sputum specimens is not an adequate bacteriologic investigation . A positive gastric smear can have diagnostic importance . Ascitic fluid findings can be characteristic of tuberculous peritonitis . A negative bone marrow aspirate for acid-fast bacilli does not exclude miliary tuberculosis . Significant anemia, high fever and leukopenia increases the possibility of tuberculosis . The persistence and/or progression of lung infiltration, irrespective of supposedly specific antibiotic therapy, strongly suggests tuberculosis . Miliary tuberculosis can present as an adult respiratory distress syndrome . All but one patient in this series had fever . the failure to diminish the pyrexia believed due to specific lung infections with presumably effective antibiotics, and the inability of therapy to control other conditions thought to cause the fever indicate the presence of tuberculosis . Tuberculosis, especially miliary disease, should be considered as a possible etiology of fever of unknown origin . If the diagnosis of tuberculosis is highly suggestive, even without bacteriologic confirmation, a therapeutic trial of antituberculosis drugs should be given.

J Clin Immunol, 1982 Apr, 2(2), 69 - 74
Thymus-dependent lymphocytes in leprosy . II . Effect of chemotherapy on T-lymphocyte subpopulations; Mshana RN et al.; The basis of the immunological unresponsiveness seen in leprosy patients is unknown . Untreated lepromatous leprosy patients display an unspecific cellular anergy which disappears with treatment, leaving an anergy specific for Mycobacterium leprae . These patients suffer from a complication, erythema nodosum leprosum, characterized by a recurrent eruption of tender skin nodules disappearing in 2 to 3 days . These nodules show a histological picture reminiscent of an Arthus reaction . Erythema nodosum leprosum can occur in untreated patients but it is more frequent in those receiving effective chemotherapy, and this has been thought to be due to massive release of antigen from the bacilli . By using monoclonal antibodies detecting different subpopulations of human peripheral blood T lymphocytes, we have shown that both borderline lepromatous leprosy patients had increased circulating suppressor cells (P less than 0.001) while the total number of T cells was within the normal range . The suppressor-cell population decreased with the duration of treatment, the change being evident at as early as 21 days . Five patients developed erythema nodosum leprosum during the study period . In all these patients the number of suppressor cells was decreased prior to the complication, increasing to original values with clinical recovery from this syndrome . There was no significant effect on T-lymphocyte subpopulations during chemotherapy of borderline tuberculoid leprosy patients . It seems that antileprosy chemotherapy precipitates erythema nodosum leprosum by interfering with immunoregulatory T cells.

Genetika, 1982 Apr, 18(4), 588 - 95
{Bacillus licheniformis as an object for the propagaton of heterologous genetic material from bacilli}; Panina LI et al.; Bacillus licheniformis was transformed with plasmids pUB110 and pJJ10 (pUB110 - pBR322) isolated from Bac . subtilis and Escherichia coli, respectively . It was revealed that the structure and genetic properties of the plasmids did not change during the transformation process . pJJ101 (pJJ10-rib) DNA isolated from E . coli and containing helper pJJ10 plasmid was used, as a recipient . It was shown that pJJ101 rib markers were "rescued" by the resident plasmid during transformation of Bac . licheniformis (pJJ10) . Plasmid pLP1 containing ribB, ribD, Kmr genes and the pUB110 replicator, was isolated from the transformants . pLP1 plasmid might be considered as a detected derivative of the parental pJJ101 plasmid . The deletion is presented by 3,9 MD segment that contains the pBR322 replicator . pLP1 DNA is capable of transforming plasmidless strains of Bac . licheniformis and Bac . subtilis.

Lepr India, 1982 Apr, 54(2), 228 - 33
Viability of M . leprae under normal and adverse atmospheric conditions; Kaur S et al.; Harvested bacilli from fresh lepromas were subjected to drying at room temperature for varying periods, were exposed to direct sun-rays, UVR, and were then injected into the foot pads of thymectomised irradiated mice for checking the viability . The organisms could survive UVR for 30 minutes, direct sunlight for 2 hours and room temperature for 7 days . Details are presented.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Apr-Jun, 31(2), 97 - 106
{Dynamics of the risk of tuberculosis infection and invalidity in Romania}; Anastasatu C et al.; Analysis of epidemiological indicators is of particular importance, and relevant for assessing the efficiency of the prevention and fighting programs against tuberculosis . The most relevant epidemiometric indicators are the incidence of the infection and that of the disease itself . The annual risk of infection with tuberculous bacilli is considered as the most valuable indicator of extension or limiting tendencies of endemia, and of the efficiency of anti-tuberculosis programs . The annual incidence of the infection at the age of 14 years established by various methods, and improper conditions determined by mass allergizing of the infantile population by mandatory B.C.G . vaccination has decreased from 3,5% in 1960 to 0.8-1.0% in 1980 . The level is still high, as compared with other european countries, but the rate of decrease has accelerated over the last years, a fact which demonstrates the efficiency of fighting measures applied . The incidence of contracting tuberculosis should be dealt with separately with regard to children and adults, since in children it is mainly related to primary infection, while in adults it is related to the presence of minimal lesions with phtysiogenic potential which can be traced to the post-primary stage, as well as to immuno-depressing influence of some environmental factors . In this connection the incidence of tuberculosis in children has been reduced in our country in the last 25 years from 297.2% to 10.3% . The risk of developing the disease has fallen from 1/230 in 1950 to 1/9 700 in 1980 . The risk of developing the disease has decreased more rapidly in older children (between 5 and 9 years) than in the younger ones (0 to 4 years) . The incidence of tuberculosis in the population aged above 15 years has fallen from 352.6% in 1955 to 70.5% in 1980 . The risk of developing the disease in adults was of 1/284 in 1956 and 1/1 418 in 1980 . The authors also make an analysis of the dynamics of some demographic risk factors, such as sex, age and environment.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Apr-Jun, 31(2), 177 - 84
{Considerations on the results of initial chemotherapy in pulmonary tuberculosis}; Strautiu R et al.; The results of initial chemotherapy applied in 501 patients with secondary pulmonary tuberculosis hospitalized and treated between 1973 and 1978 are analized . At the end of the treatment the following results have been noted: 94.8% bacteriological negativation, and 5.2% of cases which had not been influenced by chemotherapy and had constantly presented Koch bacilli in their sputum . From the clinical and radiological viewpoints a persistence of cavitary lesions was noted in 12.1% of all patients, or in 22.4% of those who presented initially with cavities . In the surveillance period 7.5% of the patients again became positive, and another course of therapy solved the new positivity in 84.2% of those involved . A percentage of 95.2% global favourable results have been noted in the final stage of the therapy, and 4.8% failures . Relapses, and bacteriological failures were noted with a higher frequency in males, and are in direct proportion with the extension of the lesions and the severity of the clinical forms . Eighteen of the patients (3.6%) had a course which led to chronicization of the disease . The favourable results and the reduction to a minimum of the therapeutic failures could be obtained by a correct application of chemotherapy and dispensarization of the patients under control.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Apr-Jun, 31(2), 107 - 15
{The value of bacteriological controls in the epidemiological studies of tuberculosis}; Ionescu C et al.; The authors make an analysis of bacteriological data concerning patients with tuberculosis from a certain area (the Jassy County) which have been recorded between 1971 and 1980 . An analysis is presented of the instantaneous and of the maximal prevalence of tuberculous bacilli carriers in the urban and the rural environments, and the incidence of tuberculosis in children and adults, also in the urban and the rural media . Some other aspects are studied of primary drug resistance, as well as of secondary resistance . The data presented in the paper stress the major role of the bacteriological investigation in the epidemiological follow-up of tuberculosis, as well as the fact that bacteriological indicators are capable to evidence essential aspects of the evolution of tuberculosis endemia in a certain area.

Clin Orthop, 1982 Apr, (164), 141 - 8
Anaerobic septic arthritis; Fitzgerald RH Jr et al.; During a 3 1/2 year period anaerobic septic arthritis was diagnosed in 43 patients (46 joints) . The hip and knee accounted for 83% of the infected joints . Anaerobic infections complicated elective musculoskeletal surgery in 23 patients, including 21 with total joint arthroplasties . An additional 12 patients developed septic arthritis following surgical treatment of traumatic injuries of an extremity . Gram-positive cocci were the anaerobes most commonly found in these two groups of surgical patients, accounting for 64% of the isolates; Peptococcus magnus was the most common organism . In contrast, gram-negative bacilli (especially Bacteroides fragilis) comprised 63% of the anaerobes isolated from eight patients with chronic debilitating diseases who had not had prior surgery . Only anaerobes were recovered from approximately half of all the patients with septic arthritis while mixed aerobic-anaerobic cultures accounted for the remainder . Adequate treatment required aggressive surgery and prolonged (minimum of three weeks) antimicrobial therapy . Infected total joint arthroplasties had to be removed . Loss of joint function occurred in six patients with posttraumatic infections when surgery was delayed or antimicrobials were inadequate . Outcome was poorest in the patients with chronic debilitating diseases, four of whom died.

N Z Med J, 1982 Mar 24, 95(704), 173 - 6
Polymicrobial nature of vaginitis in young women: a microbiological and therapeutic study; Kippax RA et al.; Thirty-six young females attending the Student Health Service with vaginitis were investigated by serial semiquantitative aerobic, anaerobic, fungal, mycoplasma and viral cultures over a 10 day period and results were correlated with signs and symptoms . Antifungal therapy (econazole pessaries and cream) resulted in clearance of candida from 13 out of 16 patients where there was no increase in the anaerobic flora . In the four subjects where candida was isolated along with Gardnerella vaginalis plus abnormal anaerobic flora, only one cleared with econazole, the remaining three clearing during therapy with metronidazole . In the nine subjects with Gardnerella vaginalis and abnormal anaerobic flora, metronidazole relieved symptoms despite failure to eradicate G . vaginalis in seven indicating the pathogenic role of the anaerobic flora rather then G . vaginalis . Mycoplasma hominis, Ureaplasma urealyticum and gram negative enteric bacilli were not implicated as primary agents in causing vaginitis.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1982 Mar, 251(3), 341 - 4
{Occurence of M . africanum in the Federal Republic of Germany (author's transl)}; Schroder KH; In the last years mycobacteria have been isolated in the Federal Republic of Germany identical or similar to "M . africanum" . The identification of the species remains uncertain, but nevertheless these mycobacteria belongs to the group of tubercle bacilli and they are different from M . Tuberculosis and from M . bovis . It seems that these mycobacteria have not been isolated yet from white patients in other European countries.

Can Med Assoc J, 1982 Mar 1, 126(5), 493 - 5
Tuberculous pleurisy; Enarson DA et al.; A review of the records for all cases of tuberculous pleurisy notified in Canada from 1970 through 1974 and in British Columbia from 1967 through 1976 showed that in the periods studied the annual incidence of this condition was low, just under nine cases per million population, and was declining . The disease commonly occurred a few months after a primary infection with tubercle bacilli . Bacteriologic confirmation of the diagnosis was possible in only 40% of the cases since biopsy specimens were not consistently cultured.

Rev Infect Dis, 1982 Mar-Apr, 4(2), 270 - 5
Genetic aspects and epidemiologic implications of resistance to trimethoprim; Acar JF et al.; Trimethoprim-resistant gram-negative bacilli have been isolated since shortly after the combination of a sulfonamide with trimethoprim available for clinical use 10 years ago . Factors not yet fully understood are responsible for the high or low percentage of resistant strains isolated in different countries at different times . Despite the widespread use of this combination, the percentage of trimethoprim-resistant bacteria has not exceeded 25% in a general hospital in Paris . Resistance to trimethoprim can be mediated by mutations within the bacterial chromosome or can be plasmid-mediated.

J Clin Microbiol, 1982 Mar, 15(3), 384 - 90
Comparison of the Oxi/Ferm and N/F systems for identification of infrequently encountered nonfermentative and oxidase-positive fermentative bacilli; Koestenblatt EK et al.; The N/F system (Flow Laboratories, Inc . Rockville, Md) and the Oxi/Ferm Tube, (Roche Diagnostics, Div . Hoffman-La Roche, Inc . Nutley, N.J.) were evaluated in parallel for identification of infrequently encountered nonfermentative gram-negative bacilli and oxidase-positive, fermentative gram-negative bacilli selected from fresh clinical isolates and stock cultures . When compared with conventional media, the Flow N/F system correctly identified 97.7% (86 or 88) of all strains tested . No organisms were misidentified, but this system failed to identify two strains . Six supplemental tests were needed for the complete identification of 16 strains (18%); however, correct results were obtained within 48 h for 85% of the isolates . The Oxi/Ferm method correctly identified 87.5% of the isolates; 7% were incorrectly identified, and the method failed to identify five strains . Seventeen supplemental tests were required to identify 64 strains (73%) . Complete identification within 48 h was obtained for 60% of the organisms tested.

Int J Lepr Other Mycobact Dis, 1982 Mar, 50(1), 68 - 75
Ultrastructural features of the multiplication of human and murine leprosy bacilli in macrophages of nude mice; Fukunishi Y et al.; Ultrastructural features of the growth of M . leprae and M . lepraemurium in nude mouse macrophages were studied by ultrathin sectioning and freeze-etching . In nude mouse macrophages, M . leprae produced spherical droplets (foamy structures) similar to those in human lepra cells . On the other hand, M . lepraemurium produced typical crystalline material in nude mouse macrophages, which is quite the same as that observed in the C3H strain mouse, Spherical droplets in the form of foamy structures seem to be made up of a specific substance produced by the multiplication of M . leprae in suitable host cells (human, nude mouse, and armadillo macrophages).

Rev Infect Dis, 1982 Mar-Apr, 4(2), 562 - 5
Intravenous pharmacokinetics and in vitro bactericidal activity of trimethoprim-sulfamethoxazole; Spicehandler J et al.; Trimethoprim-sulfamethoxazole (240 mg of trimethoprim plus 1,200 mg of sulfamethoxazole) was administered intravenously in a volume of 200 ml to 7 volunteers every 12 hr for 4 days . The mean peak levels of TMP and SMZ in plasma were 3.22 and 100 micrograms/ml, respectively, on day 1 and 5.91 and 178 micrograms/ml, respectively, on day 4, when a steady state was achieved . Tests of in vitro susceptibility indicated that these concentrations are bactericidal for a large proportion of enteric gram-negative bacilli.

Rev Infect Dis, 1982 Mar-Apr, 4(2), 484 - 90
Treatment of cystitis in women with a single dose of trimethoprim-sulfamethoxazole; Counts GW et al.; The efficacy of a single dose (four tablets) and of 10-day courses of trimethoprim-sulfamethoxazole (TMP-SMZ) was studied in 77 women with symptomatic cystitis and negative tests for antibody-coated bacteria . Cure rates after six weeks were 76% for single-dose therapy and 87% for 10 days of treatment . For Escherichia coli infections, cure rates after six weeks were 80% and 86%, respectively . However, 10-day treatment eliminated enteric bacilli from urethral and vaginal sites more often than did single-dose therapy . Two weeks after completion of treatment, perineal colonization was observed more often in the women who developed recurrent infections than in those who did not (P = 0.01) . During these two weeks, recurrent infections were found somewhat more often in the women who had received single-dose therapy than in those who had undergone 10-day treatment (5 of 38 vs . 2 of 39; P = 0.07) . With conventional courses of antibiotics, retreatment of all recurrent infections was less successful in women previously given single-dose therapy . Recurrent infections were also more frequent in women infected with bacteria other than E . coli . Both drug regimens were well tolerated . However, serious adverse reactions were fewer in patients treated with a single dose (8.5%) than in patients treated for 10 days (15%) . Single-dose therapy with TMP-SMZ appears as effective as 10-day therapy in acute uncomplicated cystitis caused by E . coli.

Arch Pathol Lab Med, 1982 Mar, 106(3), 112 - 4
Disseminated Mycobacterium avium-intracellulare infection appearing as a panniculitis; Sanderson TL et al.; A 34-year-old woman had wide-spread panniculitis due to a disseminated infection with Mycobacteria avium-intracellulare . The patient had previously received treatment with high dosages of corticosteroids . Suppurative lesions teeming with acid-fast bacilli and without formation of granulomas were found in many organs, including the skin, mediastinum, spleen, liver, and gastrointestinal tract . Both the appearance of disseminated M avium-intracellular infection resembling panniculitis and the involvement of mediastinum have not previously been reported, to our knowledge.

Hokkaido Igaku Zasshi, 1982 Mar, 57(2), 211 - 6
{Studies on tubercle bacilli and their contaminant bacteria in the sputum of pulmonary tuberculosis after chemotherapy }; Sakai I; Growth activity and morphological changes of tubercle bacilli under prolonged chemotherapy were examined in the sputa of patients with pulmonary tuberculosis . Special attention was paid to the growth activity and pathogenicity of smear-positive and culture-negative bacilli . In addition, the incidence of tubercle bacilli and contaminant bacteria in the sputa was also followed during the prolonged chemotherapy . 1) One case out of about 70 patients with pulmonary tuberculosis showed persistent smear-positive and culture-negative bacilli in the sputa over a period of 15 month . The bacilli were successfully cultured on the Kirchner medium fortified with calf sera . The harvested bacilli were injected into guinea pig for their pathogenicity . However, no macroscopic changes were observed with the tuberculin test remaining negative . 2) Tubercle bacilli disappeared from the sputa of most patients who had received chemotherapy over a period ranging from several weeks to month . Contaminant bacteria were usually recovered from sputa containing less tubercle bacilli . In sputa rich in tubercle bacilli contaminant bacteria were sparse, but as the tubercle bacilli decreased by chemotherapy, so increased reciprocally the bacteria which were shown to be resistant to anti-tuberculosis drugs used.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1982 Mar, 251(3), 297 - 307
Koch's Tubercle Bacillus - a centenary reappraisal; Grange JM; The tubercle bacillus discovered by Robert Koch in 1882 was termed Mycobacterium tuberculosis in 1886 . This organism was later found to be only one of many acid fast bacilli, some of which caused diseases resembling tuberculosis in various animals and some lived freely as saprophytes . The strains associated with disease were also referred to as tubercle bacilli and in later years those which differed in their properties from Koch's original isolates were given separate species names . Modern taxonomic methods have enable the species within the genus Mycobacterium to be carefully defined . The use of such methods has shown that the strains called M . tuberculosis, M . bovis, M . microti and M . africanum belong to a single evolutionary unit or species . It is therefore recommended that the latter three species names should be discarded and that the variants should be regarded as types of M . tuberculosis . The term "tubercle bacilli" had been applied to the variants of M . tuberculosis and also to quite distinct species of acid fast bacilli such as M . avium . It is therefore necessary to define the term "Tubercle bacillus" whenever it is used . The "classical" subdivisions of M . tuberculosis are based on simple cultural properties and pathogenicity in mammalian hosts . More recent methods enable other important subdivisions to be made . These include three major phage types of the human strains and two variants of the bacillus is therefore one of a heterogeneous group of acid fast bacilli which can, nevertheless, be seen to belong to the evolutionary distinct species Mycobacterium tuberculosis.

Am Rev Respir Dis, 1982 Mar, 125(3 Pt 2), 31 - 41
Microbiology of tubercle bacilli; Wayne LG; Based on conventional taxonomic analyses, as well as molecular level studies on DNA and catalases, the tuberculosis complex (M . tuberculosis, M . microti, M . bovis, and M . africanum) appears to consist of a single species . This species does not occur normally free in nature, but depends on host-to-host transmission for its continued existence . Members of the complex are sufficiently distinct genetically from known free-living mycobacteria so that it is unlikely that they would evolve from the free-living species at a significant frequency in nature, although that is presumably how they arose in the first place . Therefore, eradication of tuberculosis seems to be a realistic hope . The technical means now exist for control of the disease; some improvements in diagnostic technology can be expected to accelerate the control efforts . At a basic science level, more information is needed about the ability of M . tuberculosis to survive in a latent state in a host, only to revive years later, if the control of tuberculosis is to progress to eradication.

JAMA, 1982 Feb 5, 247(5), 639 - 41
Nosocomial sinusitis; Caplan ES et al.; During a 24-month period, 34 cases of nosocomial sinusitis associated with nasopharyngeal instrumentation were identified in 32 severely traumatized patients, accounting for 5% of all nosocomial infections . Diagnosis was based on roentgenographic findings consistent with acute sinusitis and either purulent material aspirated from the involved sinus or purulent nasal discharge . All patients had fever and most had leukocytosis . Forty-one pathogens, mostly Gram-negative bacilli, were recovered from 25 patients by aspiration of their sinuses; 14 infections were polymicrobic . Possible predisposing factors were nasotracheal tubes, nasogastric tubes, nasal packing, high-dose corticosteroids, prior antibiotic therapy, and facial and cranial fractures . With treatment and removal of the nasal tube, 20 patients had clinical resolution of their disease . Seven, although asymptomatic, had persistent radiological abnormalities consistent with chronic sinusitis . Five patients died of intercurrent disease before resolution of their sinusitis . Sinusitis should be ruled out as a cause of infection in febrile intensive care patients with an indwelling nasal tube.

Antimicrob Agents Chemother, 1982 Feb, 21(2), 294 - 8
Comparative in vitro study of SQ26,776; Fainstein V et al.; A new monocyclic beta-lactam antibiotic, SQ26,776, was evaluated in vitro against clinical isolates, and its activity was compared with that of other cephalosporins, penicillins, and aminoglycosides . This compound was very active against the majority of the aerobic gram-negative bacilli tested, including 47 multiresistant strains . It had no activity against the gram-positive cocci . It also showed activity comparable to that of moxalactam, ceftazidime, ceftriaxone, thienamycin, and tobramycin . It was superior to mezlocillin . The in vitro activity suggests that SQ26,776 should prove useful in settings in which the most likely pathogens are gram-negative bacilli.

Lancet, 1982 Jan 30, 1(8266), 242 - 5
Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway; du Moulin GC et al.; The gastric and upper-airway flora of 60 consecutive patients treated with antacids or cimetidine in a respiratory/surgical intensive-therapy unit were studied . In 52 (87.0%) patients one or more organisms were cultured simultaneously from both upper airway and stomach . A sequence of transmission was clear in 17 of these patients . Pneumonia due to gram-negative bacilli developed in 31 patients; in most cases the causative organisms were of gastric origin . No pneumonia developed in the 8 patients whose gastric and upper-airway flora were different . The number of gram-negative bacilli in gastric aspirates correlated with the pH of the gastric aspirate . Treatment of seriously ill patients with antacids or cimetidine may encourage airway colonisation and predispose the patients to pneumonia caused by gram-negative bacilli.

Natl Inst Anim Health Q (Tokyo), 1982 Winter, 22(4), 170 - 9
Pathological changes in goats experimentally inoculated with Pseudomonas pseudomallei; Narita M et al.; Sixteen goats were inoculated subcutaneously or intraperitoneally with cultured Pseudomonas pseudomallei isolated from a goat . They showed either acute or chronic phase of disease . When inoculated intraperitoneally, animals suffered from a septicemic illness of short duration accompanied with micro-abscesses scattered widely throughout the body . In animals subcutaneously inoculated no clinical signs were exhibited, but the disease was of rather long duration, and lesions were large and localized in the spleen and lungs . Coincident with lesions, a large number of Pseudomonas pseudomallei organisms were isolated from abscesses in the spleen and lungs . Ultrastructurally, numerous bacilli could be detected in the cytoplasm of macrophages in the abscesses . They had an electron-dense cell wall . Most of them were surrounded by electron-dense substance.

Z Erkr Atmungsorgane, 1982, 159(3), 295 - 302
{Cytologic picture of florid pulmonary tuberculosis in bronchial aspirates}; Jager J; In 24 patients suffering from florid pulmonary tuberculosis we found a fairly characteristic cytologic pattern in smears from aspiration material yielded by bronchoscopy . Besides elements of specific granulation tissue, histiocytes, alveolar macrophages and squamous cells of metaplastic origin a high proportion of specimens exhibited a slightly detritic background rich in leucocytes, containing clusters of respiratory epithelial cells with reactive appearance . The significance of this pattern for suspicion of tuberculosis is emphasized . The diagnosis may be proved by evidence of acid fast bacilli in cytologic smears.

Z Erkr Atmungsorgane, 1982, 159(3), 289 - 94
{Localised aspergillosis of the lung caused by Aspergillus niger}; Gemeinhardt H et al.; A 51-year old man with a history of pulmonary tuberculosis suffered an exacerbation without demonstration of tubercle bacilli . The mycological examination of sputum specimens discovered an infection with Aspergillus niger . Diagnosis was confirmed by the pure culture of this fungus in bronchial mucus and the cultural and histological identification in surgical material . As a histological feature strong double-refractile crystalline material was found in fungi and surrounding lung tissue (wall of cavern), probably oxalate crystals, developed from oxalic acid, produced by Aspergillus niger.

Ann Otolaryngol Chir Cervicofac, 1982, 99(9), 391 - 6
{Cervicofacial infections due to atypical mycobacteria and tuberculous lymph nodes}; Desnos J et al.; Cold abscesses in the cervical region, without associated general and functional signs, may be tuberculous lymph nodes or infected foci due to atypical mycobacteria . In the former, long-term antibiotic therapy, possibly followed by surgery conducted under conditions applicable to curettage for these lesions, is formally indicated . Treatment is of only moderate value in the second case, and spontaneous healing without other than esthetic sequelae usually occurs . These two lesions are quite different, therefore, but this was not recognized, and confusion still exists in many cases, for two reasons . Firstly, acid-alcohol-resistant bacilli are found in the pus in both cases, and a distinction cannot be made between them without culture . Secondly, pathological examination of specimens removed demonstrates identical appearances . The only way to distinguish between the two lesions, and to avoid excessively long or aggressive treatment, is by means of bacterial culture.

Acta Obstet Gynecol Scand, 1982, 61(6), 491 - 4
Tuberculous peritonitis simulating peritoneal carcinosis; Kiilholma P et al.; Two cases are reported exemplifying the difficulties faced in the clinical diagnosis of peritoneal tuberculosis . Two fertile-aged nulliparous females were admitted with symptoms and signs of an acute abdomen . Both showed a relative intestinal obstruction, abdominal mass and ascitic fluid . A malignant disease was suspected and laparotomy was performed . Tuberculous peritonitis was demonstrated histologically in biopsy and later confirmed by positive culture for tubercle bacilli . In the first case the correct diagnosis was disclosed during operation by frozen section, although the histological picture also indicated possible carcinosis because of a heavy mesothelial hyperplasia . A 9-month chemotherapy with isoniazide and rifampicin, supplemented during the first 2 months by streptomycin or ethambutol, was successful in both cases.

Prog Pediatr Surg, 1982, 15, 161 - 7
Tuberculous peritonitis in children; Chavalittamrong B et al.; Twelve patients with tuberculous peritonitis were studied . The provisional diagnosis was based on clinical, laboratory and radiological investigations . Later on peritoneoscopy with biopsy established the diagnosis . The presenting symptoms varied and not one symptom or sign was of definite diagnostic significance . Ten of the twelve patients gave a history of exposure to tuberculosis . Ascites was present in three patients, while liver enlargement was observed in seven patients . At the original clinical examination none was diagnosed as tuberculous peritonitis . The results of 5 TU tuberculin test were 10 mm or more in six patients . The chest roentgenogram was abnormal in seven patients, while multiple calcified mesenteric lymph nodes were demonstrated in three patients on the abdominal roentgenogram . Proven sites of tuberculosis besides the tuberculous peritonitis were discovered in seven patients, including pulmonary tuberculosis and tuberculous cervical adenitis . The ascitic fluid studies did not allow a conclusive diagnosis; only one of three ascitic fluid yielded acid-fast bacilli . Peritoneoscopy performed at the same time with peritoneal biopsy seems to be the best approach to establish a definite diagnosis . This disease may easily be overlooked and misdiagnosed, and without specific treatment may give rise to serious complications.

Z Erkr Atmungsorgane, 1982, 158(3), 331 - 7
{A case of generalized tuberculosis}; Motomiya M et al.; A 52 years old female with suspected malignancy was hospitalized because of fever and lymph node swelling . In spite of lymph node biopsy, bone marrow aspiration, blood culture and other diagnostic procedures, no clue to definite diagnosis was obtained . During the course of hospitalization, abscesses with fistulae appeared and tubercle bacilli were demonstrated in the pus from a subcutaneous abscess . Thus, the diagnosis of tuberculosis was established . Finally the patient died of massive bleeding as a result of perforation into thoracic aorta of the zone of necrosis of esophageal wall . It is to be emphasized that tuberculosis should be kept in the list of differential diagnosis of continuous fever.

Pharmacology, 1982, 25(2), 73 - 81
Effect of in vivo increase of free fatty acids on human plasma protein binding of furosemide; Colombo R et al.; The in vivo effects of increased free fatty acid (FFA) plasma levels on the protein binding of furosemide were investigated in 30 adult-onset diabetics and 22 patients suffering from bacterial infections (gram- negative bacilli and gram-positive cocci) . In diabetics, FFA were 2.43 +/- 1.63 mEq/l, and in subjects with bacterial infections 1.82 +/- 0.92 mEq/l . Furthermore, the percent of oleic acid and, to a very lesser extent, palmitoleic acid increased linearly with the increase of the FFA plasma level . The free furosemide fraction was about 1% or less in subjects with a molar ratio of FFA to albumin below 4, but a displacement of the drug from the plasma proteins occurred consistently when this ratio was above 4 . At a molar ratio of FFA to albumin as high as 9.34, the free furosemide was 6.7% of the total concentration (8.9 microgram/ml) . These results do not quantitatively agree with previous in vitro studies employing single fatty acids and human serum albumin, suggesting that in vivo plasma composition is not adequately reproduced during in vitro experiments on protein-binding displacement of drugs by FFA.

Z Erkr Atmungsorgane, 1982, 158(1-2), 224 - 32
{Investigations on the equivalent of different tuberculin preparations}; Mydlak G et al.; Report on the comparison of the effectiveness of seven tuberculin preparations from 6 countries to RT 23 . In 2 field trials performed among tuberculous patients with confirmed excretion of tubercle bacilli significant differences have been found among the preparations when their effectiveness and specificity was determined expressed in terms of the rate of negative (0-5 mm) reactions and the size of reaction and its range of variation . Only three of the seven preparations were equivalent to RT 23, one of them was even superior to it; another of the equivalent preparations originated from the stock substance of RT 23 . However, one among the deviating preparations originated from RT 23, too, having a threefold higher rate of negative tuberculin reactions . Investigations in the USA with tuberculin preparations from this country done in time parallel to those reported here, had a similar result and the same conclusions . There are set limits to the comparison of testing results with tuberculins of different production . Thus, the comparison of incidence and prevalence of tuberculous infection obtained with different tuberculins must be met only with caution.

Pharmazie, 1982 Jan, 37(1), 47 - 50
{2-Chloro-6-methyl-4-benzylphenol (CMB), a potential antimicrobial agent Part 1: Microbiostatic Efficiency (author's transl)}; Weuffen W et al.; The antimicrobial agent 2-chloro-6-methyl-4-benzylphenol (CMB) can be made from a by-product of herbicide synthesis . CMB is of good to very good effectiveness against dermatophytes and yeast-like moulds and also against Gram-positive cocci . Its activity against Gram-negative rod-shaped bacilli is poor, but the contemplated concentration of 1% will be sufficient for practical purpose . A comparison with commercially available antimicrobial agents gives the impression that its closer examination will be promising . Possibilities of application studies aiming at discovering convenient fields of application are indicated.

Infection, 1982 Jan, 10(1), 50 - 2
A comparative in vitro study of thienamycin; Fainstein V et al.; The in vitro activity of thienamycin was compared to that of other antibiotics against a large panel of bacteria obtained in blood cultures from cancer patients . This compound was the most active against gram-positive cocci and also proved to be extremely active against the gram-negative bacteria . It was also very active against multi-resistant gram-negative bacilli . Because of its broad spectrum of activity including Pseudomonas spp., thienamycin deserves clinical testing in the future.

J Pathol, 1982 Jan, 136(1), 59 - 72
Experimental granulomas induced by mycobacterial immune complexes in rats; Ridley MJ et al.; After BCG were complexed with homologous anti-BCG serum IgM was found to be firmly bound to the organisms . Preparations were made at antigen/antibody equivalence and at two-fold and four-fold antibody excess . They were injected subcutaneously into rats . At equivalence the mixtures provoked rapidly developing necrotic destructive lesions containing many bacilli . Injection of mixtures at antibody excess caused the rapid formation of epithelioid cell granulomas without necrosis and containing few bacilli . Compared with the injection of BCG alone, injection of comparable numbers of IgM-complexed bacilli at equivalence led to more rapid necrosis but also more rapid resolution of the granulomas which followed, Delayed-type skin reactions to PPD took longer to develop after injection of complexed BCG, usually as long as 4 weeks . The delay varied directly with the degree of antibody excess . This failure to detect cell mediated immunity was reflected in the histology of the draining lymph nodes which differed strikingly from that seen after injection of BCG alone . In animals injected with bacilli in excess antibody, epithelioid cell granulomas formed and viable bacilli were apparently eliminated before skin reactions to PPD developed . It is concluded that circulating immunoglobulin, perhaps IgM in particular, is likely to play a significant role in the pathogenesis of tuberculosis and similar diseases and that the relative ratio of antigen to antibody within the lesions may be crucial in influencing the balance between tissue destruction and healing.

J Pathol, 1982 Jan, 136(1), 41 - 57
The role of antibody in primary and reinfection BCG granulomas of rat skin; Spector WG et al.; Primary subcutaneous infection of rats with BCG leads to a three stage local reaction . There is first a short-lived simple granuloma corresponding with high levels of cell mediated immunity (CMI) . This is followed by an explosive phase of necrosis and local Mycobacterial multiplication corresponding with low levels of CMI and high levels of circulating anti-BCG antibody . Finally the lesion resolves via an epithelioid cell granuloma as bacteria fall in number and CMI returns . Reinfection with BCG produces quite different lesions when initiated at different stages of the primary infection . Reinfection during the short first stage causes a self-healing epithelioid granuloma . Reinfection during the long second stage produces a florid necrotic, bacilli-laden lesion . Reinfection during the third stage produces only a vestigial, transient granuloma . It is suggested that the evolution of tuberculous lesions depends on the interplay of CMI, bacillary load and circulating antibody . A large antigenic load in the presence of high antibody titres causes necrosis and bacillary multiplication, whereas reduced bacterial numbers plus antibody and high CMI lead to compact granulomas and healing . The first situation may be analogous to immune complex disease in antigen excess and the second to complexes in antibody excess . An analogy is drawn between the reinfection experiments and natural infection after BCG vaccination in humans . It is postulated that BCG vaccination in man may be followed by a phase in which antibody is high relative to CMI . If because of high prevalence rates, natural infection with large doses of bacilli was more likely to occur at this time, the results might help to explain the failure of BCG prophylaxis in India and comparable countries, as opposed to its success in the UK.

Chest, 1982 Jan, 81(1), 31 - 5
The transiency of oropharyngeal colonization with gram-negative bacilli in residents of a skilled nursing facility; Irwin RS et al.; To determine the duration and persistence of gram-negative bacillary (GNB) oropharyngeal colonization over a specified period and the risk of subsequent GNB pneumonia developing in nursing home patients, we prospectively cultured for 31 weeks the oropharynges of patients in a skilled nursing facility . Over a 31-week period, an average of 13.8 percent of the patients showed colonization (weekly prevalence rates ranged from 0 to 29 percent) . No patient had pneumonia during the study period . We concluded that the presence of GNB in the oropharynx of our patients is transient, continually changing over an extended period, and that GNB colonization as a transient occurrence is not directly associated with an increased risk of GNB pneumonia . Our data also emphasize the limitations of previously described single-culture survey studies in predicting the importance of GNB oropharyngeal colonization.

Trans R Soc Trop Med Hyg, 1982, 76(2), 183 - 6
Experimental leprosy with Mycobacterium lepraemurium in hairless mice (Mus musculus); Packchanian A et al.; Forty-three homozygous albino hairless mice (Mus musculus) were inoculated intradermally on the head, back, sides and base of the tail with suspensions of lepromatous tissue containing numerous Mycobacterium lepraemurium (Hawaiian strain) . Visible nodules were noted in all mice . These lepromatous nodules enlarged slowly and often merged with each other, covering up to two thirds of the dorsum . Several mice became blind during the course of the infection . All of the mice died or were killed 68 to 287 days following inoculation . Post-mortem examinations on representative mice showed, in addition to observed cutaneous lesions, generalized systemic murine leprosy . Smears and histological sections from nodules, skin, lymph nodes, spleen, liver, kidney, heart and lung were positive for acid-fast bacilli . The cysts in the skin (which are degenerated hair follicles filled with keratin-like material and which are one of the characteristics of hairless mice) contained scattered acid-fast bacilli, but no acid-fast globi . Ten mice with hair (M . musculus) which were used as controls did not reveal noticeable cutaneous nodules; however, all developed generalized visceral leprosy similar to that of the hairless M . musculus . Thus, hairless mice (with thymus) can be looked upon as a model for studying experimental cutaneous leprosy.

Antimicrob Agents Chemother, 1982 Jan, 21(1), 26 - 32
Rapid, radiolabeled macrophage culture method for detection of dapsone-resistant Mycobacterium leprae; Nath I et al.; Mycobacterium leprae cells extracted from the skin biopsies of 14 bacilliferous lepromatous patients were maintained in human-murine macrophage cultures for 3 weeks in the presence of {3H}thymidine and DDS (4,4'-diaminodiphenyl sulfone) . All cultures except one containing freshly extracted viable bacilli showed significant incorporation of {3H}thymidine as compared to control cultures containing heat-killed bacilli of the corresponding strain . Six susceptible strains of M . leprae obtained from untreated, freshly diagnosed patients showed significant inhibition of the uptake of the radiolabel in the presence of 3 and 10 ng of DDS per ml per culture . Eight strains of M . leprae obtained from patients clinically suspected of DDS resistance were tested in a similar manner . These strains were also concurrently inoculated in the footpads of mice given orally 10(-2), 10(-3), and 10(-4) g of DDS per 100 g of body weight for 9 months . Concordant results were obtained by both methods: five strains were found to be resistant, one was susceptible, and one was partially resistant . Strain VIII did not incorporate {3H}thymidine in the macrophage cultures and proved to be resistant in the mouse footpad . The macrophage culture system provides a sensitive, rapid screening method for the early diagnosis of DDS resistance.

Z Erkr Atmungsorgane, 1982, 158(1-2), 117 - 24
{Pathogenic mycobacteria}; Kappler W; It is well established that mycobacteria other than tubercle bacilli and M . leprae are important human pathogens . At least 15 species comprise all the presently known mycobacterial pathogens of man . Eleven species are potential pathogens because disease production often dependent on special factors of the human host . The comments include some characterization of the mycobacteria, especially of the potential pathogenic species . A summary of important nontuberculous mycobacterial diseases of man is presented.

Z Erkr Atmungsorgane, 1982, 158(1-2), 110 - 6
{Development of control and eradication of tuberculosis among cattle in GDR}; Schwedler H; Report on the development of tuberculosis control among cattle being a process not free from contradictions and disappointments for a long time . In 1956 the prevalence rate of tuberculosis infection among cattle amounted to 48%; half of all cows infected excreting tubercle bacilli with milk . Tuberculosis was rather common among other domestic animals, too . In 1955 in dose connexion with the socialist reorganisation of agriculture a complex programme of eradicating tuberculosis among cattle was resolved and initiated in GDR . Since 1978 tuberculosis among cattle is eliminated bringing also a higher productivity in milk and meat.

Acta Leprol, 1982 Jan-Jun, (86-87), 97 - 109
{Correlation between early (Fernandez) and late (Mitsuda) reactions in non-contact children and adolescents without manifestations of leprosy, tested with human lepromin and different concentrations of armadillo antigen in 3 double-blind trials}; Bechelli LM et al.; The authors carried out 3 double blind trials to determine the correlation between the early and the late lepromin reactions and to verify the practical and control values of the 48 hours or Fernandez reaction . Children and adolescents non-contacts were tested with human lepromin (40 x 10(6) bacilli/ml) and different concentrations of armadillo lepromin (160, 40, 20, 10, 5, 2,5, and 1 x 10(6) bacilli/ml) . The conclusions are as follows: 1 . The coefficients of correlation (r values) point out that the correlation between the two reactions is poor or almost null . 2 . The negative or doubtful reactions, the most often observed, have no practical value because they are almost always followed by a positive Mitsuda reaction . 3 . The positive Fernandez reaction was always followed by a positive Mitsuda reaction . Thus it has practical importance . However as the frequency of early positivity is low with human and armadillo lepromin of lower concentrations, recommended in routine testing, the 48 hours reading is unnecessary and without control value . It would represent a loss of time and money.

Z Erkr Atmungsorgane, 1982, 158(1-2), 155 - 62
{The effect of Robert Koch's discovery and investigations on the development of the therapy of tuberculosis}; Eule H; The discovery of the tuberculous bacillus and the methods of cultivation have been fundamental prerequisite for the development of the therapy of tuberculosis . Substances with antimycobacterial activity in vitro even in low concentrations have been found out already by Robert Koch, however not any effective ones in vivo . The cultural demonstration of tubercle bacilli is not only important for diagnosis but the essential criterion of efficacy of the drugs and for the success of treatment . Experiments with cultures of tuberculous mycobacteria represented the basis for detection of new antituberculous drugs, for the elucidation of the mechanism of their effect, for the inquiry of the type of antituberculous activity and the basic mechanism of the development of resistance . Out of these the principles for avoiding of that has been built up . Cultures are also used for the principal and individual determination of the concentration of antituberculous drugs in blood and organs . By the excellent efficacy of the causal antituberculous therapy it is possible to cure all kind of tuberculosis without any surgical interventions which are now needless . The results of in vitro-experiments on cultures represented also the starting point for the further development of antituberculous treatment . One-phasic or two-phasic intermittent treatment and short-course therapy have simplified treatment and marked it easier, which is supervised under ambulatory conditions, too . They lowered the costs for drugs and staff considerably . The causes of relapses, which have become now the main problem instead of resistance, could been investigated by means of tuberculous cultures . The possibilities of the realisation in practice of the obtained knowledge in the scale of a country are demonstrated on the example of the GDR and referred to the social and economical conditions, of which Robert Koch already had drawn the attention.

Am J Trop Med Hyg, 1982 Jan, 31(1), 36 - 41
Human intestinal sarcosporidiosis: report of six cases; Bunyaratvej S et al.; Specimens of resected small intestine from six patients aged 3 to 70 years with acute enteritis contained sexual forms of sarcosporidia . Histopathologically, the diagnoses were either segmental eosinophilic enteritis or segmental necrotizing enteritis . The presence of sarcosporidia in market beef (Bos indicus), and the patients' habit of eating the beef uncooked in the form of chili-hot dishes, suggest that the species is an ox-man parasite similar to Sarcocystis hominis (Railliet and Lucet, 1891) Dubey, 1976 . Presence of numerous Gram-positive bacilli in segmental necrotizing enteritis suggests an interplay between two etiological agents in producing the hosts' inflammatory responses . Five patients recovered after resection, but one died due to extensive necrosis of the intestinal wall and leakage at the site of anastomosis . Only conventional antibiotics were given after the operations . None of the five surviving patients has had recurrent enteritis for at least 1 year.

Am Fam Physician, 1982 Jan, 25(1), 119 - 20
Diagnosing tuberculosis by fine-needle aspiration biopsy; Rothenberg J et al.; This case report exemplifies the effectiveness of percutaneous fine-needle aspiration biopsy in confirming active pulmonary tuberculosis when conventional methods fail to document the disease . Aspiration biopsy of the suspicious lesion allowed direct examination, which demonstrated acid-fast bacilli . Culture of the aspirate grew Mycobacterium tuberculosis.

Scand J Infect Dis Suppl, 1982, 35, 17 - 22
Current approaches to the classification, characterisation and typing of pathogenic anaerobic bacteria; Collee JG et al.; Characterisation systems based on the demonstration of soluble antigens and toxins are of much practical value but have clear taxonomic limitations . This is illustrated by reference to our work with some of the pathogenic clostridia . The definition and classification of the anaerobic cocci is a difficult and continuing challenge . Systems for the classification and characterisation of the gram-negative non-sporing anaerobic bacilli are evolving well, though there are still some very difficult areas . A selection of the most helpful tests is indicated . Biotyping systems are compared with serotyping systems; the results of serological approaches to characterisation are encouraging . The further exploration of bacteriocin typing seems to be merited . The challenge of characterisation and classification of anaerobic spirochaetes commonly involved in human infections must now be taken up.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Jan-Mar, 31(1), 31 - 41
{Aspects of dysmicrobism in the isolation of Koch bacilli and its pathological implications}; Jemna I et al.; The results are presented, of a follow-up over several years concerning the changes which occurred in the products sampled from tuberculous patients, with regard to the ecologic balance between Mycobacterium tuberculosis, and other mycobacteria and fungi under the influences of chemical drugs and antibiotics . Thus atypical mycobacteria have been recorded, in a proportion of 1.07% (and in some periods as high as 2.52%) . Other species were also identified, classified according to morphological and chemical characteristics . These species are included in a synoptic scheme used in laboratories which are concerned with the isolation of mycobacteria . At present different species of mycobacteria can be isolated on the same culture medium, as appears also from the results of the authors of this study . Beside manifestations of dysmicrobism another fact was also demonstrated, namely the frequent isolation of fungi in patients undergoing anti-tuberculous therapy, or secondary to the anti-tuberculous treatment . This has permitted, on the basis of the authors' cases to confirm some pulmonary mycoses according to generally accepted rigorous laboratory techniques . The present study stresses the new pathologic phenomena interrelated with tuberculosis . These data expand the knowledge of laboratory techniques and methods, and improve cooperation between laboratories and clinical units involved in the diagnosis and treatment of pulmonary affections.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1982 Jan-Mar, 31(1), 19 - 24
{Quantitative relations in bacteriological research in tuberculosis}; Ticau S et al.; The authors have carried out a comparative analysis of the sensitivity of the microscopic examination as compared with that of the bacteriologic cultures in the evidencing of the Koch bacilli in biologic products obtained from new cases of tuberculosis, before the start of any kind of treatment with tuberculostatics . The authors attempted to establish the proportion of positive results with the two tests in the conditions of an increased number of slides to be examined by microscopic methods from 1 to 4 . At the same time other reciprocal quantitative relationships have been determined between these two tests, and differences were evidenced at the same time between the positive results obtained in symptomatic and asymptomatic patients . It was concluded that for achieving an optimal output with bacteriological investigations of tuberculosis the ideal solution is to examine 3 slides prepared from a specimen, and to seed 3 culture tubes, or 4 tubes for asymptomatic patients.

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