Z Erkr Atmungsorgane, 1982, 158(1-2), 24 - 35 {Social aspects in fighting against tuberculosis}; Ganguin HG; In 1884 Robert Koch postulated in his essay on "The Etiology of Tuberculosis" favouring moments for the settling of tubercle bacilli to explain the predisposition and diversified course of tuberculosis in grown-up persons . Under the conception "disposition" he also subsumised exogen factors beside the internal conditions and proclaimed that all steps undertaken against tuberculosis should take into account the social conditions . Only to effect the treatment in a sanatorium for such patients, it is also necessary to care for their families and for the patients themselves after they left the sanatorium . Complex fighting programmes developed according to the thorough analysis of the social surroundings, including the influences of occupation, income, expenses for food, housing and clothing, the legislation with regard to the health law and education to health duty as well as the level of medical science . Briefly, there was stated that the tuberculosis mortality depends on the standard of life . From the war-epidemiology of tuberculosis at least 3 parallel curves resulted, decisively influencing the mortality, the curves of infection and charging with work as well as the curve of nourishment . So the tuberculosis was characterised as a social disease . No wonder that social appearances--and war is one of them--stamp the special picture . As a model of applied knowledge, the strategy of fighting tuberculosis in the GDR and its outstanding results are discussed . After the antituberculosis chemotherapy was introduced, which shortens the duration of the disease and removes its chronic relapsing course, the significance of the social factors, however, decreased, but concerning the situation in the Third World, their knowledge is of great importance and not only of historical interest. Med Cutan Ibero Lat Am, 1982, 10(1), 41 - 6 {Lucio's leprosy}; Gibert E et al.; A case of diffuse lepromatous leprosy with lepra reaction type II-Lucio's phenomenon-in a 24 years old male patient is reported . The histological examination of the necrotic lesions and of the apparently normal skin showed the presence of dense perivascular and perianexial lymphohystiocitic infiltrates with great quantities of bacilli . The first biopsy did not show a picture a leuccocytoclastic vasculitis but only areas of necrosis . The immunofluorescence studies revealed on direct examination complement deposits on vessel walls . The complement levels in blood were lowered and circulating inmunecomplexes were also detected . These data confirm the opinion that Lucio's phenomenon is caused by circulating inmunecomplexes fixed on dermal vessel walls causing skin necrotic lesions. Chemotherapy, 1982, 28(2), 135 - 42 Modulating effect of subinhibitory concentrations of compound LY 127935 on the virulence of Escherichia coli in the mouse; Pusztai-Markos Z et al.; The filamentous forms of a serum resistant Escherichia coli strain developed under in vitro exposure to subminimal inhibitory concentration of the compound LY 127935 showed a higher resistance against host defence than the nontreated control bacteria . Significantly diminished LD50 values and a longer lasting persistence in the peritoneal cavity of the mouse were found after intraperitoneal infection . In order to exclude the suggestion that the enhanced virulence was only due to the separation of filaments into normal virulent bacilli, the course of experimental infection with normal virulent germs was investigated under treatment with subtherapeutic doses of the antibiotic . When animals treated with repeated doses of 10-15 microgram/kg of LY 127935 were intraperitoneally infected a significantly smaller elimination rate of bacteria was observed in the peritoneal cavity than in animals injected with saline. Scand J Infect Dis, 1982, 14(4), 283 - 8 Serum sensitivity of strains isolated and antibodies against O antigen in gram-negative bacteraemia; Clumeck N et al.; The sensitivity of blood culture isolates to the bactericidal activity of normal human serum (NHS) has been studied in 101 patients with gram-negative sepsis . These results were compared with clinical status and outcome, and to the presence of specific IgG or IgM antibodies to O antigens of bacteraemic strains in autologous serum . 23% of the strains were markedly resistant, 27% markedly sensitive and 50% intermediately sensitive to the bactericidal activity of NHS . Shock or death occurred more frequently in immunocompromised patients and those infected with serum-resistant strains . IgG antibody titres to O antigens were significantly lower in patients with serum-resistant organisms regardless of their immune status . Resistance to natural bactericidal antibodies and low immunogenicity of the infecting organism, plus immunodeficiency in the host, may account for apparent increased virulence of some gram-negative bacilli. Folia Haematol Int Mag Klin Morphol Blutforsch, 1982, 109(3), 377 - 89 Infection prophylaxis in acute leukaemia patients: comparison of selective and total antimicrobial decontamination of the gastrointestinal tract; Bhaduri S et al.; In a retrospective study, total antimicrobial decontamination with strict reverse isolation (ITD) and selective decontamination without isolation (SD) were compared as means of preventing infection in patients with acute leukaemia . Thirty patients were treated with ITD and 34 patients with SD . The surveillance cultures indicated that aerobic gram-negative bacilli and yeast could be equally eliminated effectively in both the groups . The anaerobic flora was only minimally influenced by SD . The incidence of acquired infections was 1.17 per patient in group ITD as compared to 0.85 in group SD . In group ITD, acquired bacterial infections were mostly caused by gram-negative bacilli (63%) whereas in the group SD these microorganisms accounted only for 25% of the infections . In group SD the total number of fever days was significantly lower and the mean duration of pyrexial episodes was substantially shorter . The results indicate that SD is an effective and inexpensive method for preventing gram-negative infections and might be at least as effective as ITD. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1981 Dec, 251(1), 79 - 82 {Cases of severe enteric disease caused by spore-forming aerobic bacteria in Hungary (author's transl)}; Bodnar S et al.; For a long time there has been doubt the facultative enteropathogenicity of saprophytic bacteria of the genus Bacillus; even today, it is not generally recognized . The simultaneous presence of numerous factors is known to be required for the genesis of enteric diseases (food poisoning) . Among bacilli, B . cereus is the most pathogenic one, however, other species may also be involved . In Central Europe, food poisoning caused by bacteria become manifest after a latent period of 6-10 h . Gastric and intestinal convulsions which last for 8-12 h hand diarrhea with watery stools are observed . Nausea, vomiting, headache, and fever are rare symptoms . Cases of food poisoning observed in America and England were mainly characterized by nausea and vomiting lasting 4-6 h after a latent period of 1-2 h . both types have shown a mild course . In the present communication, 5 comparatively severe cases are described, of which 2 occurred in children . In 3 cases . foods of animal origin were incriminated as vehicles of infection, which had not been stated for earlier cases . The potential of spore-forming organisms, in particular of B . cereus, for causing severe disease should not be overlooked. J Clin Invest, 1981 Dec, 68(6), 1435 - 40 Role of salivary protease activity in adherence of gram-negative bacilli to mammalian buccal epithelial cells in vivo; Woods DE et al.; Serious illness is accompanied by markedly increased susceptibility to colonization of the respiratory tract by gram-negative bacilli and an increase in the number of such organisms which adhere to regional epithelial cells during incubation in vitro . Trypsinization of cells from normal subjects causes a similar increase in bacillary adherence . We studied bacillary adherence to buccal cells in vitro, protease activity of upper respiratory secretions with a fibrin plate technique, and the amount of fibronectin on the surface of buccal cells with a direct radioimmunobinding assay . Among 10 patients seriously ill with acute respiratory failure bacillary adherence to buccal cells and protease activity in secretions were increased compared with controls and cell-surface fibronectin was decreased; all patients were colonized in vivo with gram-negative bacilli . These changes were persistent and 80% of the patients died . Serial determinations were made in eight patients undergoing coronary artery bypass surgery . Following surgery, protease activity and bacillary adherence increased and cell-surface fibronectin decreased; 38% of coronary artery bypass patients became colonized . In these uncomplicated patients the changes observed were transient, largely returning to normal by the third postoperative day . Increased protease activity of secretions and alterations in epithelial cell surfaces as reflected by loss of buccal cell-surface fibronectin occur swiftly after major illness and appear to underlie enhanced cell adherence of bacilli and colonization of the upper respiratory tract . These findings suggest new approaches to the prevention of nosocomial pneumonia. J Immunol, 1981 Dec, 127(6), 2417 - 21 Genetic control of natural resistance to Mycobacterium bovis (BCG) in mice; Gros P et al.; Mice of 12 inbred strains infected i.v . with Mycobacterium bovis (BCG) exhibited 2 distinct patterns of response as determined by the degree of BCG burden in the spleens of animals at 3 wk after infection with 10(4) viable bacilli: susceptible (C57BL/6J and related sublines, BALB/c and DBA/1J) and resistant (A/J, C3H/HeCr, DBA/2J, CBA/J, C57Br, AKR) . Mendelian analysis of this trait on segregating backcross and F2 populations derived from the mating of resistant and susceptible progenitors was compatible with the hypothesis that resistance to BCG is controlled by a single, dominant, autosomal gene, which is being given the designation Bcg . The product of the Bcg gene was found to influence the early phase of host response resulting in the genetic advantage of the resistant host being demonstrable as early as 24 hr after infection. Am J Med, 1981 Dec, 71(6), 983 - 90 Piperacillin or ticarcillin plus amikacin . A double-blind prospective comparison of empiric antibiotic therapy for febrile granulocytopenic cancer patients; Wade JC et al.; Piperacillin plus amikacin was compared in a prospective randomized double-blind trial with our standard regimen of ticarcillin plus amikacin as empiric therapy of fever in patients with granulocytopenia . Profound persistent granulocytopenia (fewer than 100/microliter polymorphonuclear leukocytes without any rise during therapy) was present in 60 percent of the patient trials in both treatment groups . Of 38 microbiologically and clinically documented infections treated with piperacillin plus amikacin, 22 (58 percent) showed improvement . Of 34 microbiologically and clinically documented infections treated with ticarcillin plus amikacin, 19 (56 percent) showed improvement . There was no difference in response between groups according to the site of infection or infecting pathogen . Toxicity was minimal, with an equivalent incidence of immediate reactions, nephrotoxicity and superinfection . Patients receiving ticarcillin plus amikacin became colonized with more resistant gram-negative bacilli (17) than did those receiving piperacillin plus amikacin (3) . Despite the monosodium structure of piperacillin, hypokalemia was not reduced for patients who received piperacillin plus amikacin . Although piperacillin has a wider in vitro antibacterial spectrum than ticarcillin, the clinical efficacy and toxicity of the combination of piperacillin plus amikacin were similar to those of ticarcillin plus amikacin as empiric therapy. Nouv Presse Med, 1981 Nov 28, 10(43), 3545 - 8 {Relationship between bacterial sensitivity to antimicrobial agents and their consumption (author's transl)}; Jarlier V et al.; Computerized data on the sensitivity of 20,006 strains of Gram-negative bacilli to ampicillin, cephalothin, gentamicin, tobramycin, nalidixic acid and co-trimoxazole were collected and evaluated in relation to drug consumption and hospital activity . Despite species-related differences, global sensitivity increased from 1975 to 1978 by 44.8% for cephalotin, 14.4% for ampicillin, 7.1% for gentamicin and 4.8% for tobramycin . There was no change in sensitivity to nalidixic acid and co-trimoxazole . During the same period the consumption of cephalosporins and aminoglycosides decreased by 28% and 21% respectively . Following a decrease between 1975 and 1977, the consumption of ampicillin and of nalidixic acid (and related compounds) went up again to reach in 1978 the same level as in 1975 . Co-trimoxazole consumption remained unchanged . Since hospital activity remained the same throughout the period under study, it seems justified to correlate the increase in bacterial sensitivity observed to the decrease in consumption of antimicrobial agents. C R Seances Acad Sci III, 1981 Nov 23, 293(11), 631 - 3 {Antigen L, a new antigen from tubercle bacilli active in delayed hypersensitivity in animals sensitized with living bacilli (B.C.G.)}; Romain F et al.; This report described the occurrence of an antigen in the tubercle bacilli . The antigen, designated antigen L, was mainly active in delayed hypersensitivity reaction in Guinea Pigs sensitized with living bacilli such as the B.C.G . strain . It was found in cultures filtrates of bovine strains as well as the human strains of tubercle bacilli. Ann Microbiol (Paris), 1981 Nov-Dec, 132 B(3), 405 - 17 {Isolation and characterization of the three first strains of "Legionella pneumophila" found in France (author's transl)}; Bornstein N et al.; The technical methods of culture and identification of the three first strains isolated in France of Legionella pneumophila serogroup 1, are described . In two patients, bacilli were seen by the direct fluorescent antibody (DFA) method, either during the course of the disease (case 1) or at postmortem examination (case 3) . The causal strain was cultivated after guinea-pig inoculation or directly from either bronchial aspirate or postmortem lung . Identification of L . pneumophila required the determination of metabolic characteristics, DFA characterization and cellular-fatty acids analysis (by gas-liquid chromatography) . In the three cases, a significant seroconversion was detected by indirect fluorescent antibody test . The relative value of the differnt methods of diagnostic methos is discussed and the importance of strain isolation is emphasized. Appl Environ Microbiol, 1981 Nov, 42(5), 850 - 5 Limulus amoebocyte lysate and direct sampling methods for surveillance of operating nebulizers; Reinhardt DJ et al.; The Limulus amoebocyte lysate test for detection of endotoxin (Pyrogent; Mallinckrodt Chemical Co.) and the Easicult method (Orion Diagnostica) for detection of bacteria were compared with direct dilution sampling, a standardized technique for respiratory therapy surveillance previously developed in our laboratory . Tests of 206 reservoirs of nebulizers were done in three hospitals in Georgia . Forty-five percent of all reservoirs sampled were contaminated . Gram-negative, nonfermentative bacilli were the predominant contaminants . The results of the Limulus test and the Easicult system were in agreement with those of the direct dilution sampling tests approximately 84 and 90% of the time, respectively . Direct dilution of water samples onto blood agar plates was the most sensitive, reliable, and informative method for detecting viable bacteria . The Easicult and Limulus systems were sensitive enough to detect greater than or equal to 10(3) colony-forming units per ml . Positive Limulus tests and negative culture tests, reflecting detection of endotoxin but not of viable gram-negative bacteria, occurred in 20 of 206 (9.7%) instances . Positive cultures and negative Limulus tests were noted in 13 of 206 (6.8%) samplings . The Limulus test is a valuable procedure, for it can detect moderate-to-heavy microbial contamination within 1 h of testing and affords the opportunity to remove contaminated equipment from patients within minutes of a positive test result . These results demonstrate the potential value of the Easicult and Limulus tests for selective surveillance of operating nebulizers. Arch Ophthalmol, 1981 Nov, 99(11), 2014 - 27 Bitot's spots responsive and nonresponsive to vitamin A . Clinicopathologic correlations; Sommer A et al.; Conjunctival biopsy specimens from patients with Bitot's spot responsive and nonresponsive to vitamin A were studied by light and electron microscopy . In both types, the lesions demonstrated keratinization with granular cells, irregular maturation, inflammatory infiltration of the conjunctival substantia propria, and loss of goblet cells . Only in the responsive cases were these changes generalized . Prominent Bitot's spots represented massive accumulations of Gram-positive bacilli and keratin debris . Responsive cases improved histologically within seven days of treatment, and goblet cells began to return within two weeks . These results support our previous suggestions that there is little basis for attempting to differentiate, clinically, between the two types of lesions and that at least some nonresponsive lesions represent a persistent metaplastic change induced during a prior episode of vitamin A deficiency. Antimicrob Agents Chemother, 1981 Nov, 20(5), 642 - 7 In vitro activity, efficacy, and pharmacology of moxalactam, a new beta-lactam antibiotic; Snepar R et al.; Moxalactam, a potent new beta-lactam antibiotic with a relatively wide spectrum of activity against facultative and anaerobic gram-negative bacilli, was evaluated in vitro and in 28 patients with a variety of severe infections with moxalactam-susceptible organisms (minimum inhibitory concentration less than or equal to 31 microgram/ml) . Although therapy was successful in most of these patients, caution is suggested because of the development of resistance on therapy in one patient, persistence of Bacteroides fragilis endocarditis in another, and for certain organisms, a significant inoculum effect on the minimum inhibitory concentration and minimum bactericidal concentration of moxalactam. Z Hautkr, 1981 Oct 15, 56(20), 1364 - 70 {Leprosy in Bulgaria . Epidemiology, Clinical forms and treatment (author's transl)}; Mikhailov P et al.; Leprosy is a rare disease in Bulgaria . There have been 58 cases registered during the last one hundred years . The number of leprous patients in 1980 was 13, most of them came from the northern part of the country . The epidemiological studies indicate, that in some of the cases the infection has been acquired in other countries (South America, Romania, Jugoslavia, The Caucasian region), in most patients, however, the disease has been acquired in Bulgaria by an unknown source of infection . The most frequent clinical form is Lepra lepromatosa and the rarest Lepra indeterminata . All patients have been treated with 4,4-diaminodiphenyl sulphone (DDS), combined with Thiambutosine . The length of treatment depends upon the clinical type of leprosy . The results of the treatment are promising . Only two patient still reveal acid fast bacilli. Eur J Respir Dis, 1981 Oct, 62(5), 344 - 51 Diagnostic thoracoscopy; Enk B et al.; During a 5-year period, diagnostic thoracoscopy was attempted in 566 patients and successfully performed in 556 . No deaths due to thoracoscopy occurred and complications were few . In patients with malignant disease of the pleura, positive biopsies were obtained in 95 of 137 patients (69%) . A positive culture for tubercle bacilli was obtained from pleural biopsy in 27 of 36 patients (75%) with bacteriologically confirmed pleural tuberculosis . Thoracoscopy improved the diagnostic accuracy in these conditions . In patients with benign tumours as well as anatomical abnormalities thoracoscopy was diagnostic . In other conditions thoracoscopy was rarely able to give a positive diagnosis, but it proved very helpful in ruling out malignant disease and tuberculosis . The number of false positive was small, about 3% in this series. Lepr India, 1981 Oct, 53(4), 525 - 30 Intraspecies differences of resistance against leprosy in nine-banded armadillos; Kirchheimer WF et al.; Infection of nine-banded armadillos with decreasing doses of armadillo-passaged leprosy bacilli show that most individuals of this species are susceptible and only about 20 percent are resistant regardless of the size of the infecting bacterial dose . It is pointed out that the intraspecies distribution of resistance to leprosy in human beings and in nine-banded armadillos differs because most individuals of the former species are resistant . Attention is drawn to the possibility that the results of anti-leprosy vaccination in armadillos might not apply to vaccination of human beings because the differences in distribution of resistant individuals might also reflect different mechanisms of susceptibility in the two species. Am J Gastroenterol, 1981 Oct, 76(4), 369 - 73 Segmental tuberculosis of the colon diagnosed by colonoscopy; Breiter JR et al.; Segmental tuberculosis of the colon is a rare clinical entity . In the absence of pulmonary or ileocecal involvement, colonic tuberculosis may be difficult to differentiate from neoplasm or Crohn's disease by symptomatic and radiological means . Colonoscopy and biopsy can, however, establish the diagnosis and prevent operative intervention, as indicated in the present report . A patient with a radiologically demonstrated strictured lesion of the sigmoid colon was found at colonoscopy to have several hemorrhagic transverse ulcers ranging in diameter between 1-4.5 cm . Multiple target colonoscopic biopsies, specifically from the ulcer beds, revealed necrotizing granulomas and acid-fast bacilli . Antituberculous chemotherapy produced remarkable symptomatic, radiographic and endoscopic improvements and averted exploratory laparotomy for the establishment of the diagnosis . This case report points out the importance of colonoscopic biopsy as a useful diagnostic modality in this disease. Br J Dis Chest, 1981 Oct, 75(4), 358 - 66 Recent trends in empyema thoracis; Benfield GF; One hundred and twenty-three patients with empyema thoracis presenting between 1968 and 1978 were studied . The predominant cause was pneumonia, with thoracic and gastrooesophageal surgery as the other important predisposing factors . 99 patients had received antibiotics before hospital admission and organisms were isolated from the empyema of 62 of these (63%) . Of the 62 patients with organisms 39 (63%) had previously received an antibiotic appropriate to the sensitivity of the pathogen . Staph . aureus, Str . pneumoniae and anaerobes were the organisms most frequently found in empyemata following pneumonia, whilst Gram-negative enteric bacilli, the most frequently isolated organisms, were the predominant pathogens in postoperative cases . Following treatment with antibiotics alone or with closed chest drainage 29% of empyemata resolved but another 64% required subsequent surgery . The former group had a mean duration of symptoms of 2.8 (SE +/- 0.8) weeks before hospital treatment whereas the surgically treated group had symptoms for a mean period of 8.3 (SE +/- 1.5) weeks . 83% of patients who required thoracotomy had a history of more than four weeks at the time of admission . Thirty-six deaths were recorded, 11 of which were attributable to the empyema, giving an empyema mortality-rate of 9% . We conclude that with widespread use of antibiotics the nature of empyemata has changed and that those now seen are more often refractory to closed chest drainage, particularly if the history prior to hospital admission is longer than four weeks. Klin Wochenschr, 1981 Oct 1, 59(19), 1093 - 9 {Comparative study on the value of selective decontamination of the digestive tract in acute leukemia patients (author's transl)}; Jehn U et al.; A comparative study of infectious morbidity and mortality in neutropenic patients with acute leukemia receiving chemotherapy was undertaken to test the effects of a suppression of endogenous and ambient microorganisms . Patients were allocated to receive {1} oral antibiotics (neomycin, colistin, and nystatin) in conventional ward isolation; {2} no antimicrobial suppression but conventional ward isolation; {3} strict isolation, filtered air, sterilized food and oral antibiotics . Significantly fewer infections with Gram-negative bacilli were seen in patients with strict isolation plus endogenous microbial suppression versus patients receiving selective gut decontamination versus patients without nonabsorbable antibiotics in simple reverse isolation . The death rate from infection was significantly reduced in patients who received antibiotics for gut flora suppression in conventional ward isolation compared with the corresponding control group . In addition, a significant improvement of leukemic remission rate was seen in this group . The protocol for decontamination was well tolerated. J Laryngol Otol, 1981 Oct, 95(10), 1049 - 57 The epithelium and chronic inflammatory cells in scleroma . (An electron microscopic study); Toppozada H et al.; The ultrastructure of 15 cases or rhinoscleroma have been studied . The epithelium showed intercellular edema, a reaction to the polysaccharide coat of intact bacilli, passing through defects in the basal lamina and subsequently inviting polymorph migration . The transitional stages between normal and 'reactive' plasma cells to the formation of the Russell body and the Unna cell were demonstrated, thus supporting the theory of an intracellular formation of the Russell bodies. Am J Med, 1981 Oct, 71(4), 693 - 703 Past and current roles for cephalosporin antibiotics in treatment of meningitis . Emphasis on use in gram-negative bacillary meningitis; Landesman SH et al.; The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid . Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered . The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis . Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases . In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures. Rev Infect Dis, 1981 Sep-Oct, 3(5), 973 - 8 Experimental infections with Mycobacterium intracellulare; Gangadharam PR et al.; Information on the pathogenesis of Mycobacterium intracellulare disease is necessary to facilitate the finding of effective drugs . As a first step, development of a suitable small-animal model is needed . Examination of several strains of mice and M . intracellulare led us to conclude that the Swiss Webster strain of mice and the 8330 and 571-8 strains of M . intracellular were most useful . Since the use of normal mice resulted only in a chronic type of disease lasting many months, immune suppression by means of trypan blue, silica, or a combination of cyclophosphamide and cortisol was attempted in order to generate an acute infection . Higher numbers of bacilli were recovered from organs in the immune-suppressed animals as compared with the controls, more so in the lungs than in the spleen, although no acute type of disease process resulted. Rev Infect Dis, 1981 Sep-Oct, 3(5), 960 - 72 Mycobacterial infections in animals; Thoen CO et al.; Mycobacteria other than mammalian tubercle bacilli are capable of producing disease in a wide range of animal hosts . Serotypes of Mycobacterium avium complex cause the most important mycobacterial diseases in domestic animals . Although disease is most common in lymph nodes, a wide variety of tissues may be involved, including tissue from spleen, liver, lungs, kidney, central nervous system, gall bladder, intestinal mucosa, skeletal system, ovaries, and the skin. Rev Infect Dis, 1981 Sep-Oct, 3(5), 862 - 6 Lipid analysis for the identification of mycobacteria: an appraisal; Jenkins PA; A review is presented of the use of lipid analysis by thin-layer chromatography for the identification and classification of mycobacteria . Specific lipid patterns are known for 15 species (in some cases a species may exhibit more than one pattern), and these patterns normally correlate well with serotypes . In six species the lipid pattern is not very distinctive but can still be useful . No specific lipid patterns have been detected in 15 species, three of which can be classed as tubercle bacilli, and only two of the remainder are pathogenic for humans. Rev Infect Dis, 1981 Sep-Oct, 3(5), 1008 - 12 Epidemiology of mycobacteria other than tubercle bacilli in South Africa; Kleeberg HH; The findings of the last two decades in the area of the epidemiology of mycobacteria other than tubercle bacilli are reviewed . The veterinary problem of cross-reactivity in cattle to the tuberculin test was overcome by comparative use of avian purified protein derivative (PPD) . Outbreaks of mycobacterial lymphadenitis in swine occur sporadically and are due to Mycobacterium intracellulare . The reservoir for nontuberculous mycobacteria appears to be in the environment, especially on growing fodder plants; water cannot be incriminated . In humans very few cases of mycobacteriosis have been found . However, countrywide surveys of random sputum cultures have shown that exposure of rural people to Mycobacterium avium-intracellulare is either continuous or frequent . Ten percent of African children react specifically to avian PPD tuberculin . No direct influence of this exposure on the incidence of tuberculosis can be seen . No protective effect by mycobacteria other than tubercle bacilli is postulated. Ann Clin Lab Sci, 1981 Sep-Oct, 11(5), 386 - 91 Gold nephropathy; Antonovych TT; The early use of gold in medicine and dentistry dates back to the ancient Chinese and Egyptians . The discovery in 1890 that gold salts were toxic in vitro to tubercle bacilli led to the extensive treatment of tuberculosis with gold salts in the first three decades of this century . Eventually, gold therapy was extended to arthritis and lupus erythematosus, because of the belief that these diseases were forms of tuberculosis . Because of its beneficial effect particularly on active rheumatoid arthritis, chrysotherapy has remained one of the most widely used treatments of rheumatoid arthritis for the past half century . Toxicity of gold salts includes hypersensitivity reaction of skin and mucous membranes, bone marrow depression, and nephrotoxicity . The nephrotoxic clinical manifestations are renal insufficiency, proteinuria and hematuria, and the nephrotic syndrome . The pathologic changes are tubular degeneration, acute tubular necrosis or immune complex glomerulonephritis . The justification that any of these possible changes are the result of gold therapy rests clinically upon the time relationship of gold therapy and the renal symptoms, and pathologically upon the presence of gold inclusions (aurosomes) in proximal tubular epithelial cells . Aurosomes can at times be visualized by light microscopy, are usually seen by electron microscopy, and can be identified by microprobe analysis . Their pathology will be illustrated and pathogenic mechanisms discussed. Tubercle, 1981 Sep, 62(3), 155 - 67 A study of the characteristics and course of sputum smear-negative pulmonary tuberculosis; Mouse macrophage functions under the influence of factors released by spleen cells preincubated with the methanol extraction residue (MER) tubercle bacillus fraction; Exposure of mouse peritoneal macrophages in vitro to the nonspecific immunomodulator MER (methanol extraction residue fraction of phenol killed, acetone washed tubercle bacilli) failed to heighten their phagocytic and bacteriostatic activities toward Staphylococcus albus, even when amounts of the agent below the threshold of gross toxicity were employed . In contrast, exposure of such macrophages to supernatants of whole splenocyte suspensions that had been obtained from normal donors and were incubated with MER resulted in consistent potentiation of both phagocytosis and bacteriostasis . The findings suggest that the MER effect on macrophages function is mediated, in this system, by soluble lymphocyte product(s). Infect Immun, 1981 Sep, 33(3), 854 - 61 Promotion of the translocation of enteric bacteria from the gastrointestinal tracts of mice by oral treatment with penicillin, clindamycin, or metronidazole; Berg RD; Specific pathogen-free mice were treated orally with antibiotics to determine whether the resulting disruption of the normal flora ecology would allow certain gram-negative enteric bacteria to overpopulate the ceca, thereby promoting the translocation of these bacteria from the gastrointestinal tract . The mice were treated orally with penicillin, clindamycin, or metronidazole for 4 days, and then the antibiotic was discontinued . The mice were tested at various intervals for viable enteric bacilli translocating from the gastrointestinal tract to the mesenteric lymph nodes . Penicillin treatment decreased the total anaerobe population levels in the ceca an average of 1,000-fold, whereas clindamycin treatment decreased these anaerobe levels only 10-fold, and metronidazole treatment slightly increased the anaerobe levels . Penicillin or metronidazole treatment slightly increased the anaerobe levels . Penicillin or metronidazole treatment increased the enteric bacilli populations in the ceca an average of 1,000-fold, whereas clindamycin treatment increased the enteric bacilli populations 100,000-fold . The peak incidence of translocation of the enteric bacilli to the mesenteric lymph nodes averaged 100% after penicillin treatment, 97% after clindamycin treatment, and 62% after metronidazole treatment . Thus, oral treatment of mice with penicillin, clindamycin, or metronidazole for only 4 days disrupts the normal flora ecology, allowing an overgrowth in the ceca of the gram-negative enteric bacilli and promoting their translocation to the mesenteric lymph nodes. J Biochem Biophys Methods, 1981 Sep, 5(3), 177 - 86 Affinity chromatography of proteolytic enzymes on silica-based biospecific sorbents; Stepanov VM et al.; New biospecific sorbents for affinity chromatography of proteolytic enzymes were prepared by the attachment of the cyclopeptide antibiotics bacitracin, bacilliquin or gramicidin S to aminosilochrom via a reaction with p-benzoquinone . The content of the cyclopeptide ligands within the sorbents varied from 2 to 46 mumol/g . The sorbents prepared by this reaction were successfully applied in the purification of the carboxylic proteinases produced by fungi, Russula decolorans (a basidiomycete) and Trichoderma lignorum, as well as crude pepsin . Serine proteinases from Thermoactinomyces vulgaris, Trichoderma koningii, Trichoderma lignorum and bacilli (subtilisins) were also submitted to chromatography on these materials . The yields of purified enzymes approached quantitative levels, sometimes being higher as a result of elimination of inhibitors . An important advantage of these sorbents is their stability against the enzymes degrading the carbohydrate matrixes of affinity sorbents synthesized on the basis of agarose, dextran or cellulose derivatives. Can J Microbiol, 1981 Aug, 27(8), 788 - 94 In vitro cultivation of Mycobacterium lepraemurium and its identification by animal inoculation; Ishaque M; The primary in vitro cultures from lepromata of mice or rats previously infected with the Hawaiian strain of Mycobacterium lepraemurium were obtained on Ogawa egg-yolk medium at 34 degrees C in approximately 90 days of incubation . Optimal growth of subcultures was achieved in 40 to 60 days of incubation and such cultures were used to test their pathogenicity in animals . The in vitro grown subcultures provoked in mice subcutaneous lepromata identical to those produced by the in vitro grown M . lepraemurium . Also, mice infected subcutaneously and intravenously with the in vitro grown subcultures developed lesions in livers, spleens, and kidneys similar to those of mice infected with the mouse passage murine leprosy bacilli . Microscopically and histopathologically, the acid-fast bacilli derived from organs infected with the in vitro or in vivo grown cultures were indistinguishable from each other. Biokhimiia, 1981 Aug, 46(8), 1347 - 63 {Intercellular serine proteinases from spore-forming bacilli}; Strongin AIa et al.; Some physico-chemical properties, immunological reactions, structural, functional and evolutionary features of intracellular serine proteinases from spore-forming bacilli were studied . These enzymes belong to an individual subfamily of serine proteinases and in terms of their structure and evolution are most closely related to secretory subtilisins . Intracellular serine proteinases are found in a wide variety of microorganisms--from the spore-forming bacilli to Escherichia coli and are characterized by a higher (as compared to secretory subtilisins) rate of evolution due to a more rigid selective control of the structure and function of intracellular enzymes . Active intracellular proteinases have a unique dimeric structure, which allows to exclude random proteolysis of native proteins in vivo . Secretory subtilisins and intracellular bacillary serine proteinases are coded by separate closely related structural genes, whose presence in the bacillary genome can be explained by duplication of the precursor gene . The existence of duplicated genes of serine proteinases provides sufficient evidence for the marked structural divergence and a high rate of evolution of secretory subtilisins. Am J Med, 1981 Aug, 71(2), 210 - 6 Septicemic complications of the cutaneous T-cell lymphomas; Posner LE et al.; The records of 60 consecutive patients with cutaneous T-cell lymphomas were reviewed to determine the incidence, etiology, predisposing factors, therapy, complications and outcome of septicemia . Fourteen (23 percent) patients had 26 septicemias: due to gram-positive cocci in 21 and to gram-negative bacilli in five . The presence of stage IV lymphomatous disease (p 0.032), generalized erythroderma (p less than 0.001), palpable lymph nodes (p 0.014), and histologic involvement of lymph nodes (p 0.023) and peripheral blood (p less than 0.001) identified a subset of patients at high risk for sepsis . Sepsis was correlated with locally infected sites in 77 percent of the episodes . Single antimicrobial therapy was successful in all septicemias due to gram-positive cocci but was accompanied by five secondary gram-negative bacillary superinfections (80 percent fatal) . The subsequent mortality in all patients who survived infection (50 percent) indicated their poor over-all prognosis. Am Rev Respir Dis, 1981 Aug, 124(2), 138 - 42 A controlled trial of a 2-month, 3-month, and 12-month regimens of chemotherapy for sputum smear-negative pulmonary tuberculosis: the results at 30 months . Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council; Scanning electron-microscopy of plague in Papillon-Lef:evre syndrome; Supra and subgingival plaque associated with periodontal lesions in patients with Papillon-Lefevre syndrome were studied by examining extracted teeth and associated soft tissue by scanning electron and light microscopy . Four zones of plaque were described according to their location along the tooth surface . Supragingivally, cocci, filamentous bacilli and "corncob" formations were seen . Fusiform bacilli colonized the surface of supragingival plaque on the root surface . Subgingival sites, particularly apical areas, had numerous spirochetes adherent to the plaque surface as well as directly to the cementum surface . Microcolonies of bacteria, probably Mycoplasma, could be seen in the subgingival plaque . The findings of a potentially pathogenic plaque, attached subgingival spirochetes and microcolony formation may have important therapeutic and research implications. Jpn J Antibiot, 1981 Aug, 34(8), 1148 - 57 {Clinical evaluation of cefotiam in internal medicine, with special reference to infectious disease associated with hematological disorders (author's transl)}; Uchida T et al.; Clinical evaluation of cefotiam (panspolin), a new cephem antibiotics, was performed in the infectious disease associated with hematological disorders and in the respiratory system . In hematological dis orders, 40% of good and 25% of fair results were obtained in clinical effects . In respiratory infections, however, 92% of good results were obtained . Opportunistic infection due to Gram-negative bacilli are often experienced in patients with leukemia . Since cefotiam has sufficient bacteriocidal effects in broad spectrum, it would be a good therapeutic agent against infectious diseases associated with hematological disorders. Lepr India, 1981 Jul, 53(3), 425 - 31 Myco . leprae infection in normal, thymectomised irradiated and thymus transplanted mice; Kaur S et al.; Normal mice and thymectomised, X-irradiated and thymic transplanted groups of mice were challenged with 10(3) Myco . leprae in the foot pad . Course of infection was studied for a period of seven months by sacrificing animals every month and counting the bacilli from the pooled tissues . In the thymectomised irradiated group the counts showed a plateau from 5th month onwards, whereas in control and thymus implant group the counts rose in 6th and 7th months. Lepr India, 1981 Jul, 53(3), 390 - 4 Discharge of M . leprae in milk of leprosy patients; Girdhar A et al.; A quantitative estimation of discharge of M . leprae in the milk of 39 leprosy female patients has been made . Twelve of the 39 patients (10 LL/BL and 1 each of T/BT and BB) showed bacilli in their milk . Only one of these patients was on treatment . AFB count in 10 ml of milk was found to range from 4.3 X 10(4) to 4.3 X 10(5) . Significance of discharge of such a large number of bacilli in breast milk is discussed. J Clin Pathol, 1981 Jul, 34(7), 719 - 22 Survival of tubercle bacilli in heat-fixed sputum smears; Allen BW; Tubercle bacilli, which survived heat fixation, were detected with a slide culture technique which allowed the entire smear to be examined . Both conventional flame fixation and the use of a controlled hot-plate failed to render tuberculous sputum smears safe for further handling . Smears which were stained with the phenol-auramine method failed to yield growth on culture . If delay between preparation and staining is unavoidable, it is recommended that smears are given additional treatment to prevent the survival of tubercle bacilli. Am Rev Respir Dis, 1981 Jul, 124(1), 21 - 5 Hemagglutination tests for tuberculosis with mycobacterial glycolipid antigens . Results in patients with active pulmonary tuberculosis before and during chemotherapy and in healthy tuberculosis contacts; Reggiardo Z et al.; Hemagglutination tests using three serologically active mycobacterial glycolipids as antigens were carried out on serum specimens from patients with pulmonary tuberculosis and from healthy family contacts of patients with tuberculosis in Singapore . A positive response to any of the three antigens was found in 82.5% of 211 patients with newly diagnosed disease and in 21% of 100 contacts . The much higher proportion of positive results in the contacts than in other groups of healthy subjects previously reported might have been due to subclinical infection with tubercle bacilli or with other environmental mycobacteria . The use of rules derived from discriminant analysis improved discrimination between patients and contacts, so that a positive result was obtained in 72% of patients and 5% of contacts . Serial positive titers during 1 yr of chemotherapy showed an initial slight increase during the first month and then a slow decrease, although conversion from a serologically positive result to a negative result was uncommon . The occurrence of widely variable patterns of response to the three antigens in different patients emphasizes the importance of using a battery of tests, each with a separate antigen. Can J Microbiol, 1981 Jul, 27(7), 735 - 7 {Modification of the koch bacillus by a material extracted from tuberculosis lesions}; Lafont J et al.; Lymph node lesions of tuberculous cattle and swine gave, after disruption, centrifugation through 2.2 M sucrose, and ultrafiltration, a material that brings about, in vitro, modification of the tubercle bacilli or chromogenic mycobacteria into bacterial elements that are not acid fast, rapidly growing on nutritive agar supplemented with glycerol . The phenomenon is similar to that which the authors have previously described, using an inducing agent extracted from cultures of mycobacteria, called "endometallaxic conversion." Hansenol Int, 1981 Jun, 6(1), 51 - 4 {An unusual case of erythema nodosum leprosum}; Petri V; An unusual manifestation of erythema nodosum leprosum (ENL) in a female, 24 years old, whose clinical history and picture was suggestive of acute systemic erythematous lupus rather than hanseniasis is described and commented . The diagnosis of ENL was attained only after it was demonstrated the presence of AAR bacilli in the ulcerated lesions. Acta Pathol Microbiol Scand {B}, 1981 Jun, 89(3), 149 - 52 The importance of blood volume cultured on detection of bacteraemia; Sandven P et al.; The effect of culturing 2 and 5 ml of blood in 18 ml of supplemented peptone broth I (SPB I) and 45 ml of supplemented broth II (SPB II) respectively, was compared . A total of 204 isolates were recovered from 78 patients . There were 136 isolates recovered from both the 45 and the 18 ml tubes . 20 isolates from the 18 ml tube only and 48 isolates from the 45 ml tube only . Both Gram-negative bacilli and Gram-positive cocci were recovered more frequently from the 45 ml tube than from the 18 ml tube (p less than 0.05) . From patients with two or more positive blood cultures the diagnosis of bacteraemia would not have been made in 5 out of 53 patients (9.4%) if only the small culture tube had been used. Trop Geogr Med, 1981 Jun, 33(2), 117 - 21 Pulmonary infections by atypical mycobacteria in a rural coastal region of Karnataka, India; Kotian M et al.; The sputum specimens from 6,829 cases were obtained from patients diagnosed as "relapsed cases" of pulmonary tuberculosis and chronic non-specific respiratory diseases (CNSRD) . Of these 1,191 (17.4%) were culture positive for acid fast bacilli with 292 (4.23%) human and 899 (13.7%) being atypical mycobacteria . These data imply that, if not all, most of the reported cases of relapsed pulmonary tuberculosis could be due to atypical mycobacteria in South West Coast of India and that this agent in some patients could be responsible for chronic infections of the lung as well . Practically all of these patients are from rural areas living in close contact with nature and animals . This poses the question whether atypical mycobacterial infection could be considered a zoonosis. J S Afr Vet Assoc, 1981 Jun, 52(2), 143 - 5 A mycobacteriosis in a sheep resembling paratuberculosis (Johne's disease); Newsholme SJ et al.; In a sheep which was euthanased because of severe emaciation and weakness, slight thickening of the ileum was seen grossly . Microscopically there was a granulomatous ileitis with obliterative lymphangitis and lymphangiectasis . Granulomatous lesions were also present in the liver and some mesenteric lymph nodes . Large numbers of acid-fast bacilli were present within epithelioid macrophages in the lamina propria of the ileum . Although the identity of the Mycobacterium spp . involved was not established, the possibility of paratuberculosis is discussed . The apparent rarity of this disease in sheep in South Africa is considered . Particular attention is drawn to the absence of diarrhoea in this case, to the slightness of the gross changes and to the importance of submitting material for mycobacterial culture. J Hyg (Lond), 1981 Jun, 86(3), 275 - 83 The importance of soap selection for routine hand hygiene in hospital; Ojajarvi J; Five different types of liquid soap were studied in hospital wards, each during two months' use . Altogether 1306 finger print samples were taken from the hands of the staff by sampling twice a week and the acceptability of the soaps was measured by a questionnaire . During the use of different soaps only slight differences were found in the numbers of total bacteria or in the occurrence of Staph . aureus and gram-negative bacilli on the hands . During the use of the emulsion-type product studied, several persons who had dermatological problems had lower mean bacterial counts of the fingers than during the use of the other soaps . This soap was also favourably accepted by the staff . After over one year's use of pine oil soap and alcohol, the staff of the hospital was satisfied with the method . However, several persons with skin problems admitted to not using soap or alcohol . The considerable differences found in the acceptability of soaps imply that for use in hospital the choice of a soap acceptable to the nursing staff is important in promoting proper hand hygiene. Int J Lepr Other Mycobact Dis, 1981 Jun, 49(2), 198 - 204 Detection of mycobacterial lipids in skin biopsies from leprosy patients; Young DB; Thin-layer chromatography was used to compare lipid extracts from lepromatous skin biopsies with those from normal skin and from Mycobacterium leprae purified from armadillo spleen . Several lipids were found in infected skin which were absent from normal skin but corresponded to lipids present in the purified M . leprae . These included mycolic acids, a 6-deoxyhexose-containing lipid (glycolipid I) and a wax ester (possibly related to the Mycobacterium tuberculosis wax, phthiocerol dimycocerosate) . Unlike Mycobacterium lepraemurium, M . leprae contained no C-type mycosides . In terms of lipid profile, M . leprae from armadillo spleen showed the same characteristics as bacilli from human skin samples . Quantitative analysis of mycobacterial lipids in lepromatous skin biopsies indicated that their concentrations were much higher than would be predicted from the number of acid-fast bacilli present . Accumulation of lipid debris from dead M . leprae could provide a protective environment in infected cells for remaining viable bacilli. Int J Lepr Other Mycobact Dis, 1981 Jun, 49(2), 177 - 9 Leprosy and female reproductive organs; Sharma SC et al.; Thirty-five adult female patients with bacillary positive leprosy were studied to determine its effect on menarche, menstrual cycle, fertility, and menopause . Endometrial biopsies studied in 26 patients showed no evidence of leprosy bacilli granuloma or tubercle bacilli on culture . Menstrual blood examined in six patients with bacillemia did not reveal leprosy bacilli . Products of conception examined from two patients were negative for granulomata or leprosy bacilli . Leprosy was found to have no direct effect on menarche, menstruation, fertility, and menopause. Tubercle, 1981 Jun, 62(2), 95 - 102 Clinical trial of six-month and four-month regimens of chemotherapy in the treatment of pulmonary tuberculosis: the results up to 30 months; Identification of mycobacteria by smear examination of the culture; Mycobacteria can be tentatively identified by the arrangement of the bacilli on smears made from the growth and stained by the Ziehl-Neelsen method . The basis of this method is the presence or absence of cords with or without loose bacilli around . Agreement of a high degree (92.7% to 97.0%) was obtained between the identification of mycobacteria by this smear technique and by the niacin test . It is recommended that this simple procedure may be used for preliminary identification, especially in developing countries. Int J Lepr Other Mycobact Dis, 1981 Jun, 49(2), 187 - 93 The uptake of 3H-thymidine in Mycobacterium leprae inoculated mouse macrophage cultures as a rapid indicator of bacillary viability . Factors influencing the specificity of the in vitro assay; Sathish M et al.; Mouse peritoneal macrophages derived from BALB/c were used as host cells for 17 human-derived M . leprae strains . Simultaneous pulsing with 3H-thymidine (3H-Tdr) showed uptake of the radiolabel in 58.8% of the bacilli over a 14 day period . Preliminary data of three M . leprae strains indicate that the 3H-Tdr is preferentially incorporated into the mycobacterial DNA and not into the mammalian host cell DNA . This in vitro assay provides a rapid assessment of M . leprae viability . The factors influencing the uptake of 3H-thymidine are described. Jpn J Antibiot, 1981 Jun, 34(6), 907 - 14 {A study of safety of cefmetazole (CS-1170) in pregnant women during the perinatal stage (author's transl)}; Acid-fast microscopy on polycarbonate membrane filter sputum sediments; Polycarbonate membrane filters were used to concentrate 916 sputum specimens for detecting acid-fast bacilli by microscopic examination . These results were compared with those of smears prepared from centrifugates and direct smears of the same specimens . Culture isolation, the control procedure, demonstrated the presence of acid-fast bacilli in 76 specimens . The number of positive specimens detected by microscopy was 82 on polycarbonate membrane filter concentrates, with an 80.2% sensitivity; 53 on centrifugate smears, with a 62.2% sensitivity; and 44 on direct smears, with a 55.8% sensitivity . Acid-fast microscopy results demonstrated that the sensitivity of the polycarbonate membrane filter sputum concentration method was superior to that of the recommended centrifuge concentration method and that the former method may be considered a rapid alternative when culture for acid-fast bacilli is impractical. J Clin Microbiol, 1981 Jun, 13(6), 1105 - 8 Use of agarose gel electrophoresis of plasmid deoxyribonucleic acid to fingerprint gram-negative bacilli; Schaberg DR et al.; Agarose gel electrophoresis of the plasmid deoxyribonucleic acids from 60 gram-negative bacilli recovered during investigations of nosocomial epidemics was used to fingerprint the strains . This method was as specific at differentiating bacterial strains as more conventional phenotyping methods . In all cases, plasmid band fingerprints of epidermic strains isolates were identical whereas coisolate plasmid deoxyribonucleic acid patterns were different . Agarose gel electrophoresis of plasmid deoxyribonucleic acid is proposed as a method which can be used in conventional microbiology laboratories as an adjunct to or, possibly, replacement for other methods of identifying bacterial strains. Br J Exp Pathol, 1981 Jun, 62(3), 259 - 69 Experimental production of pulmonary granulomas . I . Immune granulomas induced by chemically modified cell walls and their constituents; Hamamoto Y et al.; The intrabronchial instillation of stimulants in an oily vehicle induces a solitary inflammatory focus in the rabbit lung . When heat-killed tubercle bacilli were administered to tuberculo-immune animals, a necrotizing focus with cavities was induced . Delipidation of the bacterial cells stimulated the production of a necrotizing focus . In contrast, acetylation of the mycobacterial cell walls resulted in the replacement of cavity formation with epithelioid-cell granuloma production similar to that seen after the administration of Wax D, a peptidoglycolipid fraction of the cell walls . These lesions were induced much faster than in controls, indicating that some immune mechanisms are involved . In the present study of the specific granuloma induction mechanism, the biological activities of the chemical constituents of Wax D were examined . It was concluded that specific granuloma induction is due to the long delayed hypersensitivity antigenicity of Wax D which is brought about by the conjugation of biologically inactive mycolic acid with Arthus-antigenic peptidoglycan . Wax D glycolipids with delayed-type antigenicity also take part in the induction . The intrinsic adjuvant activity of these compounds may stimulate granuloma production . The haemagglutination antigenicity and Arthus-type antigenicity of the polysaccharide or peptidoglycan moiety are not involved. Gastroenterology, 1981 Jun, 80(6), 1468 - 75 Bacillary characteristics in Whipple's disease: an electron microscopic study; Dobbins WO 3rd et al.; Extensive electron microscopic observations of 19 intestinal biopsies obtained from 13 patients with untreated Whipple's disease are reported . The outstanding feature is the profuse presence of bacilli free within the lamina propria of the intestinal mucosa and the presence of numerous macrophages containing ingested bacilli . Intestinal epithelial cell invasion by bacilli is identified in 11 patients, and evidence of bacillary invasion is identified within the lymphatic endothelium of 4 patients, within capillary endothelium of 3 patients, within polymorphonuclear leukocytes of 5 patients, and within plasma cells of 2 patients . Reported for the first time is the presence of bacilli within intrinsic smooth muscle of the lamina propria of 2 patients, within intraepithelial lymphocytes of 1 patient, and in mast cells of 1 patient . These observations suggest that the Whipple bacillus is an intracellular pathogen . Intracellular pathogens, unlike pyogenic bacteria, may survive within macrophages . The morphologic appearance of the Whipple bacillus is reviewed . Emphasis is placed upon the unique nature of an outer "membrane" external to the cell wall of Whipple bacilli, a feature that is one of the identifying characteristics of the Whipple bacillus and that may explain the inability to culture the bacillus in vitro. Med J Aust, 1981 May 30, 1(11), 588 - 9 Tubercle bacilli retain pathogenicity after seven weeks chemotherapy; Cassidy JT; Guinea pig inoculation of sputum from patients on anti-tuberculous therapy shows that, in some cases, the tubercle bacilli retain their pathogenicity for seven weeks or more . It is and has been accepted in general for many years now that patients with active pulmonary tuberculosis receiving anti-tuberculous drugs become noninfectious in a relatively rapid time . Several factors have been said to contribute to this . Among these are: (i) patients on chemotherapy have a reduced cough and consequently expel fewer tubercle bacilli into the atmosphere; (ii) it has been suggested that patients receiving antituberculous drugs excrete these in the sputum droplets along with the tubercle bacilli and evaporation of the droplets causes concentrations of the anti-tuberculous drugs to increase, thereby reducing or destroying the viability of the organism; and (iii) chemotherapy rapidly reduces the number of bacilli excreted in sputum and this in itself may reduce the possibility of infection. J Clin Lab Immunol, 1981 May, 5(3), 149 - 52 Lymphocyte transformation to Legionella pneumophila; Plouffe JF et al.; Lymphocytes from seventeen subjects with previously diagnosed Legionnaires' disease and 63 subjects without a history of Legionellosis were studied in a transformation assay with a crude extract of Legionella pneumophila . In the lymphocyte transformation assay the mean stimulation index was 48+/-14 in the Legionnaires' disease group and 18+/-13 (p less than 0.001) in the control group . Endotoxin from Escherichia coli did not stimulate the cultures . Extracts from multiple other gram negative bacilli had minimal stimulation which was similar in lymphocytes from both groups . Lymphocytes from 2/3 of the subjects without a history of Legionellosis had increased incorporation of radionucleotide over background when incubated with the crude extract of L . pneumophila indicating that these subjects may have been exposed to L . pneumophila in the past and may be immune to Legionnaires' disease . This may help explain the very low attack rate (1.6-3.4%) in epidemics. Can Med Assoc J, 1981 May 1, 124(9), 1165 - 7 Resistance to aminoglycoside antibiotics of gram-negative bacilli isolated in Canadian hospitals; Duncan IB et al.; A survey was made of the frequency of resistance to amikacin, gentamicin and tobramycin among aerobic gram-negative bacilli isolated over a 4-week period in 1979 at six large, geographically separated Canadian hospitals . In the entire series of 4407 isolates the frequency of resistance was 2.5% to amikacin, 8.1% to gentamicin, 5.9% to tobramycin and 1.7% to all three . Most (81%) of the resistant bacteria were acquired by the patients after admission to hospital . The frequency of resistance to the three aminoglycoside antibiotics in each hospital largely reflected the local rate of cross-infection by endemic strains of resistant bacteria. Biokhimiia, 1981 May, 46(5), 920 - 9 {Extracellular serine proteinase of Bacillus thuringiensis}; Epremian AS et al.; Pure extracellular serine proteinase has been isolated from a broth filtrate of Bacillus thuringiensis, strain 69-6R by fractionation with ammonium sulfate and affinity chromatography on Sepharose 4B derivatives containing p-(omega-aminomethyl)-phenylboronic acid and cyclopeptide bacillichin as ligands . The enzyme is completely inactivated by phenylmethylsolfonyl fluoride, a specific reagent for serine proteinases, has the molecular weight of 29 000 and pI of 8.4, reveals maximal activity and stability at pH 8.5 and is inactivated at pH values below 4 and above 10 and at temperatures above 60 degrees . The enzyme hydrolyzed azokasein, bovine serum albumin and synthetic chromogenic peptide substrates, e.g . benzyloxycarbonyl-L-alanyl-L-alanyl-L-leucyl p-nitroanilide and possesses the esterolytic activity . In terms of its physico-chemical characteristics, interaction with specific inhibitors and substrates, extracellular serine proteinase from Bacillus thuringiensis can be related to subtilisins . However, its amino acid composition-Lys16, His4, Arg8, Asx28, Thr16, Ser18, Glx29, Pro12, Gly32, Ala31, Val19, Met5, Ile12, Leu18, Tyr11, Phe10, Trp4 appears to be an intermediate between that of subtilisins and intracellular serine proteinases of Bacilli. Rev Infect Dis, 1981 May-Jun, 3(3), 599 - 626 Gram-negative anaerobic bacilli: Their role in infection and patterns of susceptibility to antimicrobial agents . II . Little-known Fusobacterium species and miscellaneous genera; George WL et al.; Twenty infrequently reported species of gram-negative anaerobic bacilli other than Fusobacterium nucleatum, Fusobacterium necrophorum, and members of the genus Bacteroides were studied with regard to their role in infection and their susceptibility to antimicrobial agents . In addition, the literature regarding the recovery of these organisms from both the normal flora and infections of humans was reviewed . During a six-year period at the Wadsworth Clinical Anaerobic Bacteriology Research Laboratory (Veterans Administration Wadsworth Medical Center, Los Angeles, Calif.), 39 (6%) of 679 specimens obtained from anaerobic infections yielded "other gram-negative anaerobic bacilli" (OGNAB) . Fusobacterium naviforme, Fusobacterium gonidiaformans, Fusobacterium varium, Fusobacterium mortiferum, and Fusobacterium russii were the most commonly isolated OGNAB . Most of the OGNAB tested were resistant to erythromycin, and most strains, except for F . varium, were susceptible to beta-lactam antibiotics and clindamycin . Chloramphenicol and metronidazole were active against all strains of OGNAB tested . Certain Fusobacterium species are undoubtedly previously unrecognized members of the normal flora of the oropharynx, upper respiratory tract, or urogenital tract and may be present in infections derived from these floras. J Infect Dis, 1981 May, 143(5), 739 - 41 Influence of vaccination-challenge interval on the protective efficacy of bacille Calmette-Guérin against low-virulence Mycobacterium tuberculosis; Edwards ML et al.; The influence of vaccination-infection interval on protection induced by bacille Calmette-Guerin (BCG) was studied in an animal model of experimental airborne tuberculosis . Guinea pigs were simultaneously skin-tested with mammalian tuberculin and intracellularin and vaccinated with BCG-Copenhagen (strain no . 1331) . At weekly intervals thereafter, groups of animals were infected by the respiratory route with about five viable units of a recently isolated strain of Mycobacterium tuberculosis of low virulence . The animals were necropsied six weeks after challenge, and tubercle bacilli recovered from primary lung lesions, primary lesion-free lung lobes, and spleens were counted . Protection was defined as a significant reduction in the number of bacilli recovered from the tissues of vaccinated as compared with unvaccinated animals . The data obtained for two of the three tissues indicated that BCG-Copenhagen induced a significant level of protection against this low-virulence of M . tuberculosis. J Infect Dis, 1981 May, 143(5), 734 - 8 Influence of the virulence of Mycobacterium tuberculosis on protection induced by bacille Calmette-Guérin in guinea pigs; Hank JA et al.; The protective efficacy of two bacille Calmette-Guerin (BCG) vaccines was examined in guinea pigs infected by the respiratory route with strains of Mycobacterium tuberculosis differing in virulence . Virulence was defined as the degree of tissue damage (weight) of primary lesions excised from lungs of unvaccinated guinea pigs killed 28-42 days after infection . Groups of animals vaccinated with BCG-Copenhagen (strain no . 1331), a vaccine of high potency, or those vaccinated with BCG-Prague (strain no . 725), an experimental vaccine of low potency, and groups given placebo were challenged six weeks later with one of three challenge strains differing in virulence . Protection was assessed from the difference in the number of tubercle bacilli recovered from excised primary lung lesions or from primary lesion-free lung lobes of vaccinated vs . unvaccinated animals . The virulence of the challenge strain influenced the efficacy of BCG vaccination; however, the results of other studies with a laboratory strain were in general replicated. Am Rev Respir Dis, 1981 May, 123(5), 529 - 32 Distribution of ethambutol in primate tissues and cells; Liss RH et al.; Ethambutol (EMB) concentrations that kill Mycobacterium tuberculosis in vitro accumulated in squirrel monkey tissues and cells known to be sites of tubercular infections . After oral administration of a clinically relevant 25 mg/kg dose, the whole-body distribution and intracellular localization of EMB were studied by radioautography . Tissue concentrations of drug were assayed by radiochemical and microbiological methods . The EMB was distributed rapidly and widely to most body tissues including lung and localized within pulmonary alveolar and axillary lymph node macrophages . The EMB in lung at 2 and 5 h after drug administration was markedly higher than the corresponding plasma concentrations and exceeded concentrations that are bactericidal in vitro for tubercle bacilli . These observations may help explain the early bactericidal activity of EMB in humans . Similarities in plasma and tissue concentrations of the drug in both species suggest the usefulness of the squirrel monkey as a model for the use of EMB in humans. Schweiz Med Wochenschr, 1981 Apr 18, 111(16), 555 - 61 {Clinical suspicion of tuberculosis and non-tuberculous mycobacteria}; Kuonen G et al.; During the year 1979, 28 out of 95 patients with positive culture for acid-fast bacilli exhibited non-tuberculous mycobacteria (29.5%) . In 15 cases the radiological and clinical findings were consistent with the diagnosis of tuberculosis, but only in one case (cutaneous lesion) was the pathology due to the mycobacteria isolated whereas in all others the bacteria was a saprophyte . This study suggests that non-tuberculous mycobacteria may be more frequent than expected in our region, and demonstrates the importance of their precise identification in order to stop their treatment . Nevertheless, in case of doubt and until identification results are obtained, such patients must be treated as probable tuberculosis cases. Lab Anim Sci, 1981 Apr, 31(2), 196 - 9 Infection of white carneaux pigeons (Columbia livia) with Mycobacterium avium; Pond CL et al.; Avian tuberculosis, caused by Mycobacterium avium, occurred in three White Carneaux pigeons . Clinical signs varied and included anorexia, lameness, torticollis, and the development of cutaneous nodules . Lesions at necropsy consisted of caseating hepatic, pulmonary, and cutaneous granulomas . In one animal, the marrow in several bones was replaced with caseous material . Histopathologically, the granulomas contained necrotic material and acid fast bacilli surrounded by epitheloid cells, giant cells, and lymphocytes . Treatment of affected animals was not attempted . False positive and false negative reactions occurred when intradermal tuberculin skin testing was done. Isr J Med Sci, 1981 Apr, 17(4), 236 - 44 Response in the hindfoot pad and popliteal lymph node of C57BL mice to infection with Mycobacterium marinum; Mor N et al.; C57BL mice inoculated in the hindfoot pads with 5 X 10(3) viable Mycobacterium marinum developed a localized disease process, characterized by swelling of the foot and increases in the number of acid-fast bacilli and colony forming units recovered . These changes became maximal 10 to 14 days after inoculation and then decreased in intensity . An acute inflammatory response appeared in the hindfoot pad during the first 24 h and increased in intensity during the next few days . By seven days after inoculation, the polymorphonuclear leukocytes had been largely replaced by lymphocytes and macrophages which led, during the next two weeks, to the extensive formation of granulomas . Epithelioid granulomas developed after at least 90% of the organisms had been killed . Simultaneously the popliteal lymph node increased greatly in size due to hyperplasia of the paracortical area, which contained a large number of pyroninophilic cells, and packing of sinusoids with small lymphocytes . Well-formed epithelioid granulomas containing acid-fast bacilli developed in the popliteal node . A small number of viable bacilli were found in both the hindfoot pad and the popliteal node 18 months after inoculation; this was accompanied by solid resistance to secondary challenge. J Laryngol Otol, 1981 Apr, 95(4), 393 - 8 The changing pattern of laryngeal tuberculosis; Hunter AM et al.; Laryngeal tuberculosis is now an uncommon disease in the United Kingdom . A series of ten cases is reported . In contrast to the pre-chemotherapy era, when the disease was associated with advanced cavitated pulmonary tuberculosis and was highly infectious, it now presents in a manner similar to laryngeal carcinoma except that painful dysphagia is a prominent symptom . All such patients should have a chest X-ray carried out as part of their initial investigation . Sputum is almost always positive for tubercle bacilli on direct films . Direct laryngoscopy and biopsy are necessary if a carcinoma is suspected . The change of pattern of the disease may be due to the fact that the larynx now usually becomes involved by haematogenous spread rather than by direct spread along the airways . Laryngeal tuberculosis is now no more infectious than pulmonary tuberculosis, and responds well to antituberculous chemotherapy . Symptoms resolve completely within three weeks if corticosteroids are given in combination. Chest, 1981 Apr, 79(4), 432 - 7 Bacteriology and treatment of gram-negative pneumonia in long-term hospitalized children; Brook I; Gram-negative bacillary pneumonia was diagnosed in 39 longterm hospitalized children, ranging in age from 4 months to 14 years (mean seven years) . Fifteen had pneumonitis, 18 necrotizing pneumonia, and six lung abscess . An associated empyema was noted in six cases . Specimens for culture were obtained through percutaneous transtracheal aspiration . Five microorganisms were the predominant isolates: P aeruginosa (13 instances), K pneumoniae (11), E coli (7), S marcescens (6), and P mirabilis (2) . There were 112 aerobic and 25 anaerobic isolates recovered from the 39 patients, accounting for 3.5 isolates per specimen . Other aerobic and or anaerobic organisms were mixed with the Gram-negative bacilli in half the patients . All patients were treated with gentamicin for 10 to 26 days (average 19.5 days), and all were cured . In 12 patients in whom other organisms resistant to gentamicin were also present, other antimicrobial agents were concomitantly administered. Acta Pathol Microbiol Scand {B}, 1981 Apr, 89(2), 41 - 7 Conditions relevant to the occurrence of acid-fast bacilli in sphagnum vegetation; Irgens LM et al.; Biotopes with intact sphagnum vegetation were studied in Naustdal, West Norway: the health district with the former highest leprosy incidence rates in Norway . Concentration of acid-fast bacilli and concentration of non-cultivable acid-fast bacilli found in the vegetation fluid were compared with a series of variables related to the local environment and to the samples of vegetation . In bivariate analyses high concentrations were found in biotopes with orientation toward South, with a high coverage of vascular plants and with presence of Ericaceae . High concentrations were also found where dry weight of a vegetation was high, where pH in the fluid was low and where dry weight of the fluid was high . In a multivariate analysis, log-linear model, based on concentration of acid-fast bacilli as the dependent variable and orientation, pH, dry weight of vegetation and dry weight of fluid as the independent variables, all two-factor effects including the dependent variable were retained in the model . Furthermore, orientation versus dry weight of vegetation and dry weight of fluid versus dry weight of vegetation were retained. Acta Pathol Microbiol Scand {C}, 1981 Apr, 89(2), 133 - 8 Effect of BCG vaccination on Mycobacterium lepraemurium infection in a highly susceptible inbred mouse strain; Lovik M et al.; Upon infection with Mycobacterium lepraemurium (MLM) C3H mice develop a disease that has features in common with lepromatous leprosy in man . Intraperitoneal vaccination with a single dose of BCG four weeks before inoculation with MLM in the footpad significantly reduced the total bacillary load of the animals . In vaccinated animals there was a delay in the dissemination of bacilli to the popliteal lymph node, liver, and spleen . The growth rate of MLM in the footpad and the popliteal lymph node was not altered by BCG vaccination . Reduced dissemination of the bacilli seems to be a sensitive parameter of resistance in murine leprosy . The mechanism of the resistance observed is discussed mainly in relation to non-specific macrophage activation and T-cell mediated responses to cross-reactive antigens. Am Rev Respir Dis, 1981 Apr, 123(4 Pt 1), 397 - 401 Persistence of protein, carbohydrate and was components of tubercle bacilli in dermal BCG lesions; Higuchi S et al.; Dermal tuberculous lesions were produced in rabbits with Bacille Calmette Guerin and biopsied on days 4, 14, 21, 35, and 56 . Frozen sections prepared from the biopsy specimens were stained by the peroxidase-antiperoxidase immunocytochemical technique with antisera against whole tubercle bacilli and antisera against the protein B, polysaccharide I, and wax D fractions of tubercle bacilli . In the primary lesions, protein B was often undetectable at 21 days, and polysaccharide I was often undetectable at 35 days . Wax D disappeared more slowly than the other bacillary components evaluated, and some wax D was still found at 56 days (if the lesions had not completely healed) . Antisera against intact tubercle bacilli produced results similar to those produced by antiserum against wax D . These studies suggest that the chronicity of tuberculous lesions is due, at least in part, to the persistence of the wax D-like component of tubercle bacilli. Lepr India, 1981 Apr, 53(2), 160 - 2 Permeability of Mycobacterium leprae to dapsone: alteration by purification procedures; Prabhakaran K et al.; Permeability of Mycobacterium leprae to dapsone in vitro was determined by the ability of the drug to inhibit o-diphenoloxidase of the bacilli . Dapsone showed little effect on the enzyme activity of the intact organisms . When the M . leprae preparations were washed with trypsin, NaOH, or acetone and ether, DDS penetrated the bacillus to inhibit its o-diphenoloxidase . The method might be useful in studying the utilization of added metabolites by purified M . leprae suspensions. Am Rev Respir Dis, 1981 Apr, 123(4 Pt 1), 367 - 71 Experimental models to explain the high sterilizing activity of rifampin in the chemotherapy of tuberculosis; Dickinson JM et al.; Model systems were set up in vitro to explore the reasons why rifampin is a better sterilizing drug than isoniazid in short-course chemotherapy of tuberculosis . When the growth rate of Mycobacterium tuberculosis strain H37Rv was reduced uniformly by lowering the incubation temperature or the pH of the culture medium, the bactericidal activity of rifampin and isoniazid decreased to a similar extent . However, when a culture was maintained at 8 degrees C and incubated for daily periods of 1 or 6 h at 37 degrees C, rifampin killed more rapidly than isoniazid . Maintenance of control cultures without antimicrobials at 8 degrees C with or without periods at 37 degrees C, had little or no effect on their viability, ability to commence logarithmic growth at 37 degrees C, or to incorporate {14C}uridine . Old cultures left undisturbed or to which small additions of fresh culture medium were regularly added were killed more rapidly by rifampin than by isoniazid . These experiments supported the view that the special part of the bacterial population that is killed more rapidly by rifampin than by isoniazid during short-course chemotherapy consists of bacilli dormant much of the time but occasionally metabolising for short periods. Jpn J Antibiot, 1981 Apr, 34(4), 477 - 80 {Clinical studies on cefotaxime (CTX, HR 756) in obstetrics and gynecology (author's transl)}; Ishikawa M et al.; In vivo transfer and therapeutic efficacy of a new cephalosporin derivative, cefotaxime, which is stable against beta-lactamase hydrolysis, have studied in gynecology field . The following results have been obtained . (1) The level of cefotaxime transferred to uterus artery and to uterus was higher than its MIC against majority of Gram-negative bacilli, such as E . coli . (2) Transfer of this drug to umbilical blood was also satisfactory . (3) This drug as demonstrated its efficacy in treating 8 infection cases refractory to CET, CEZ and ABPC, out of which 3 had 'excellent' and 5 had 'good' results . (4) No side effect was evidenced in any of our patients . In conclusion, this drug has satisfactory tissue transfer as well as sufficient safety and excellent efficacy in treatment of gynecological infection cases. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1981 Apr-Jun, 30(2), 79 - 84 {Model for the treatment of cases of chronic pulmonary tuberculosis in the Vîlcea district}; Mihailescu P et al.; Patients with pulmonary tuberculosis are considered to be chronic cases when they continue to eliminate bacilli after one year after registration and start of treatment . The chronic cases are classified in the I B dispensary group . Following the introduction of the chemotherapy program the number of chronic patients with tuberculosis has dropped appreciably after 1974 . However the rate of decrease has diminished between 1978 and 1979 . In view of evaluating the possibilities for recuperation of chronic patients a research was organized in several districts . In one of them, the Vilcea District, it was noted that in spite of the fact that each year a large number of patients from group IB are eliminated, either following negativation of their sputum examinations, or by death, the total number of patients in the group itself does not decrease, since it is continuously fueled by failures of the initial treatments, and by relapses in the first two years after the end of the treatment . The analysis of the chronic cases in evidence on the 1-st of January 1980 showed that there are possibilities for recuperation by chemotherapy in 44,8% of the patients, and by surgery in another 9,5% . Only 23,8% are considered as non-recuperable . The authors review the technical and organizational measures which are indicated in view of solving the existing cases, and for the prevention of other chronicization . The short-term prognosis indicates the possibility for reducing the prevalence of chronic patients by more than 50% over a period of 3 years. Lepr India, 1981 Apr, 53(2), 190 - 6 Evaluation of multiple regimens in leprosy; Ramu G et al.; Assessment of bacteraemia has been made at weekly intervals in 36 lepromatous leprosy patients who were put on different antileprosy drug under four regimens, viz., DDS alone, DDS in combination with rifampicin (DDS + RIF), clofazimine (DDS + CLF) and thiacetazone (DDS + TCT) . In general, with the continuation of treatment the bacillary load in the blood decreased considerably while bacteriological index (BI) of the skin remained constant during the study . No significant difference was noted in M . leprae clearance from blood between the groups treated with DDS alone and groups treated in combination with CLF and TCT . However, DDS + RIF treatment was most efficient in clearing acid-fast bacilli (AFB) from blood as compared to those noted with other drug regimens. Biochim Biophys Acta, 1981 Mar 5, 673(2), 184 - 91 Stimulation of endogenous proteolysis in macrophages exposed to sporulating bacteria; Woodside KH et al.; The relationship between degradation of endogenous macrophage protein and exposure to bacteria at various stages of sporulation was studied . Rabbit pulmonary macrophages were obtained by lavage, attached to plastic tissue culture dishes, and prelabeled with {14C}- or {3H}-phenylalanine for 1 or 20 h, respectively . Bacillus licheniformis (ATCC 14580) was grown in Bacto Marine Broth until at least 50% of the bacilli contained refractile spores (19 h), washed and lyophilized . The lyophilized bacilli were washed, counted and applied for 1.5 h to the washed prelabeled macrophages at a ratio of 300 bacteria/macrophage . Rates of degradation of both rapidly and slowly turning over proteins were increased . The effect was no mediated by soluble components of te incubation medium . Free spores, vegetative cells and autoclaved sporulating bacilli did not affect rates of proteolysis . We propose that proteases from the lyophilized sporulating bacilli participate in endogenous macrophage protein degradation following engulfment. Acta Pathol Jpn, 1981 Mar, 31(2), 189 - 98 Experimental pyelonephritis in mice following ascending infection with E . coli . Chronic phase; Tanaka N et al.; Adhesive and invasive strains of Escherichia coli induced chronic pyelonephritis in mice following the acute phase . The pathological features of the induced chronic pyelonephritis were different between the groups of mice infected with these strains . In piliated adhesive strain (E77156)-infection, the kidneys with viable bacilli showed pyonephrosis with incomplete obstruction or atrophy with coarse scar . Mice with these renal lesions showed high serum antibody levels, but histologically recurrent infection was frequent . On the other hand, in non-piliated invasive strain (633-65)-infection, sterile pyelonephritis developed . This chronic lesion was characterized by the migration of antigen-bearing macrophages and lymphocytes and by a negative serum antibody response . In infections with either strain the predominant lymphocytes in the renal lesions were smooth-surfaced T-lymphocytes. Ann Allergy, 1981 Mar, 46(3), 159 - 63 Different responses of monocytes and active T lymphocytes to in vitro challenge of purified protein derivative (PPD) in patients with active tuberculosis and healthy tuberculin reactors; Hsieh KH et al.; In order to ascertain the roles of phagocytes and T lymphocytes in the defense of tuberculous infection, 21 cases of healthy tuberculin reactors and 45 cases of active tuberculosis were studied with regard to the expression of Fc and complement receptors on phagocytes and changes of surface markers of lymphocytes after in vitro incubation with purified protein derivative (PPD) . After PPD stimulation, the monocytes with Fc and complement receptors tended to increase in tuberculin-positive but not in tuberculin-negative patients in patients . Thus the failure of the monocytes to be activated by PPD in vitro correlates with negative skin test in vivo and the inability of the lymphocytes from patients to respond to in vitro PPD activation with increased active T lymphocytes may account for the establishment of tuberculous infection after exposure to virulent tubercle bacilli. Am J Med, 1981 Mar, 70(3), 739 - 44 A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection; Maki DG et al.; Using a semiquantitative technique for culturing material from vascular catheters, we studied by random allocation the efficacy of three regimens for site care of 827 catheters used in adult patients: an iodophor ointment (PI2), ointment containing polymyxin, neomycin and bacitracin (PNB), and use of no topical agent whatsoever (control) . Even though this is the largest study of this subject, there was not a sufficient number of catheter-related septicemias to permit valid comparisons (two in each group, 0.7 percent) . However, the rate of local catheter-related infection (greater than or equal to 15 CFU on semiquantitative culture), the prelude to related septicemia, was significantly lower in the PNB group (2.2 percent, P = 0.02) as compared with controls (6.5 percent) . Use of PI2-treated catheters resulted in one-half fewer infections (3.6 percent) than use of control catheters (P = NS) . Staphylococcal infections occurred with 15 control catheters, eight treated with PI2 and two with PNB (P = 0.002) . Infections by gram-negative bacilli occurred less frequently in both treatment groups than in controls, but three of four Candida infections, including one septicemia, occurred in the PNB group . Topical antimicrobial agents confer modest benefit in protection against catheter-related infection, primarily for peripheral venous catheters that must remain in place for more than four days . If an ointment is to be used, topical PNB may be preferable for peripheral venous catheters and PI2 ointment for central venous catheters used for parenteral nutrition and for arterial catheters. Nouv Presse Med, 1981 Feb 26, 10(8), 539 - 40 {Cefotaxime: a semi-synthetic cephalosporin of the new generation (author's transl)}; Perronnet J; The important structural feature of the new cephalosporin derivative, cefotaxime, is the conjunction in the acetyl side - chain of the aminothiazolyl ring and the - syn - methoxyimino group . The aminothiazoloacetyl side - chain improves antibacterial properties against Gram negative bacilli, while the adjunction of the methoxyimino substituent is responsible for the further unexpectedly large increase in activity. J Biol Chem, 1981 Feb 25, 256(4), 2067 - 77 Primary structure of the COOH-terminal membranous segment of a penicillin-sensitive enzyme purified from two Bacilli; Waxman DJ et al.; D-Alanine carboxypeptidase is a penicillin-sensitive intrinsic membrane enzyme which is composed of a hydrophilic NH2-terminal catalytic domain (Mr congruent to 45,000 to 47,000) and a COOH-terminal membranous segment (approximately 20 to 30 amino acids in length) (Waxman, D . J., and Strominger, J . L . (1979) J . Biol . Chem . 254, 4863-4875; Waxman, D . J., and Strominger, J . L . (1981) J . Biol . Chem . 256, 2059-2066) . The primary structures of the COOH-terminal 30 amino acids of two D-alanine carboxypeptidase purified from bacterial membranes were determined (residues numbered from the COOH terminus): Bacillus stearothermophilus: (formula see text) Water-soluble fragments of the B . stearothermophilus D-alanine carboxypeptidase were shown to be formed by cleavage after Phe27 or after Leu25 as indicated by carboxypeptidase A and B analysis and by the release of the four COOH-terminal chymotryptic peptides (Val26-Leu25, Ser24-Phe16, Val15-Trp12, and Thr11-Leu1) upon formation of water-soluble chymotrypsin D-alanine carboxypeptidase . This indicates that the membranous fragment is largely contained within the COOH-terminal 24 residues . Thus, this bacterial membrane protein probably does not contain the significant cytoplasmic domain characteristic of transmembrane proteins such as glycophorin . The absence of an uninterrupted stretch of 20 to 25 uncharged residues suggests that the membrane anchoring of D-alanine carboxypeptidase may differ from that of simple transmembrane proteins . Possible structures for the membranous segment of D-alanine carboxypeptidase are discussed. Vet Rec, 1981 Feb 21, 108(8), 166 - 7 Laboratory diagnosis of Johne's disease: a potential source of error; Summers BA; Gastrointestinal tract tissues from cattle with suspected clinical Johne's disease (JD), in which acid-fast bacilli were not identified in mucosal smears, were examined histopathologically . Twenty-two per cent were positive and 4 per cent were suggestive of JD . Failure to identify mycobacteria in mucosal smears appeared to result from the presence of mild, often focal mucosal lesions which contained relatively few bacilli . Ten of the 22 histopathologically positive cases had complement fixation titres for JD but several false-positive titres also occurred. Z Hautkr, 1981 Feb 15, 56(4), 221 - 6 {Tuberculosis of the tongue (author's transl)}; Dimitrowa I et al.; A rare form of lingual tuberculosis in an elderly man is described . It was manifested clinically as nodular infiltration, causing strong pain . The case was diagnosed histologically . Tuberculous bacilli were found . The patient did not react to tuberculin . An X-ray examination showed miliary tuberculous involvement of the lung with excavation. Am J Med, 1981 Feb, 70(2), 449 - 54 Strategies for prevention and control of multiple drug-resistant nosocomial infection; Weinstein RA et al.; Multiple drug-resistant bacteria are common in the hospital and are often isolated from patients on admission . Spread in hospital and occasional epidemics result from transient contamination of the personnel's hands, environmental contamination and excessive use of antibiotics . Traditional control measures have relied on improved asepsis and handwashing, isolation (or cohorting) of infected and colonized patients, antibiotic control and elimination of any significant environmental sources . Newer approaches have focused on ways of preventing (or eliminating) patient carriage of multiple drug-resistant strains . We have tailored selected barrier-type "antibiotic resistance precautions" for everyday use to control endemic aminoglycoside resistant gram-negative bacilli . We detail our multifaceted approach and suggest its ongoing use for key multiple drug-resistant strains, in "epi-centers," such as intensive care units, for potential heavy shedders of multiple drug-resistant strains, and when certain epidemic thresholds are reached. Br J Exp Pathol, 1981 Feb, 62(1), 34 - 40 The contribution of hydrogen peroxide resistance to virulence of Mycobacterium tuberculosis during the first six days after intravenous infection of normal and BCG-vaccinated guinea-pigs; Jackett PS et al.; The course of infection with Mycobacterium tuberculosis strains H37Rv, H37Ra and their isoniazid-resistant, hydrogen peroxide-susceptible mutants in guinea-pig spleen and lung were assessed by measuring changes in number of viable bacteria during the first and second 3-day intervals after i.v . infection of normal and BCG-vaccinated animals . Vaccination had no effect on bacterial survival in the first 3 days of infection . The peroxide-susceptible mutants were killed or inhibited more than their parent strains; in normal animals this enhanced susceptibility was expressed equally during the first and second 3-day intervals while in vaccinated animals the effect was greater in the second 3-day interval . The results suggest that hydrogen peroxide is generated in significant amounts in the environment of tubercle bacilli lodged in normal tissues and in enhanced amounts when acquired immunity becomes expressed after a few days' lodgement in the tissues of vaccinated animals . Thus hydrogen peroxide resistance may contribute to virulence by protecting against both normal resident and immunologically activated macrophages. Lancet, 1981 Jan 24, 1(8213), 171 - 4 Controlled trial of four thrice-weekly regimens and a daily regimen all given for 6 months for pulmonary tuberculosis. {Active tuberculosis unsuspected until autopsy} Andrion A, Bona R, Mollo F. A series of 3195 necropsies performed in cases of natural death at the "S . Giovanni" Hospital in Turin, and covering the years 1969-1978, was studied for the prevalence of active tuberculosis . Active tuberculosis was found in 61 cases (1,9%); in 60 a complete clinical history was available . Forty-two out of these 60 cases (70%) were diagnosed only at autopsy, with higher frequency in the old patients . In the 42 patients with undiagnosed active tuberculosis, the acid fast bacilli resulted to have been searched for only in 3 cases, and a chest-film was recorded in 23 cases; in 27 cases of this group, the period between the admission and the death was longer than 8 days (mean 29 days) . The clinical diagnosis of active tuberculosis displays intrinsic difficulties; however it must be stressed that an higher proportion of cases could be recognized if one keeps in mind the possibility of this polymorphic disease, so that adequate clinical, laboratory and x-ray investigations should carried out. Respir Care, 1981 Feb, 26(2), 127 - 9 Oropharyngeal colonization with aerobic gram-negative bacilli in respiratory therapists: period prevalence; Williams LL et al.; During a 3-month winter period, swab pharyngeal cultures for aerobic gram-negative bacilli were obtained weekly for 3 weeks from 44 hospital-based respiratory therapists and 53 nontherapist control hospital personnel . The swab cultures were inoculated directly onto MacConkey agar plates . Aerobic gram-negative bacilli were isolated from 9.1% of the respiratory therapists and from 9.4% of the control subjects . One respiratory therapist was colonized with the same organism on all three occasions, whereas all other colonized subjects were only transiently colonized . Thus, despite frequent exposure to patients and aerosols likely to contain aerobic gram-negative bacilli, respiratory therapists do no appear to have higher pharyngeal colonization rates than other hospital personnel. Am Rev Respir Dis, 1981 Jan, 123(1), 20 - 4 Fever response of patients on therapy for pulmonary tuberculosis; Kiblawi SS et al.; The course of fever was examined in 75 patients with pulmonary tuberculosis treated with modern chemotherapy . Sixteen patients (21%) were afebrile and differed from 59 febrile patients (79%) by having lower incidences of the following: symptoms (p < 0.02), alcoholism (p < 0.01), lung cavitation (p < 0.01), "far advanced disease" (p < 0.05), and sputum smears containing "numerous" acid-fast bacilli (p < 0.01) . Resolution of fever was variable (mean, 16 days; median, 10 days; range, 1 to 109 days) . Thirty-eight patients (64%) became afebrile within 2 wk (group 1); 21 (36%) had fever for longer than 2 wk (group 2) . Far advanced disease and high temperature (> 38.8 degrees C) on admission were more frequent in group 2 (p < 0.05 and p < 0.01, respectively) . However, the groups did not differ in demographic features or in the frequency of symptoms on admission, alcoholism, lung cavitation, numerous acid-fast bacilli on sputum smears, or coexisting bacterial respiratory infection . Antimicrobial drug treatment of presumed coexistent bacterial infection in 19 febrile patients did not influence the course of fever . Analysis of variance and covariance were used to compare the independent effects of various antituberculosis drug regimens on the course of fever; no significant differences were observed. Am J Med, 1981 Jan, 70(1), 39 - 43 Solitary pulmonary nodules due to nontuberculous mycobacterial infection; Gribetz AR et al.; Resected solitary pulmonary nodules which histologically are granulomas and in which acid-fast bacilli are seen are usually assumed to be due to infection with Mycobacterium tuberculosis . We reviewed the culture results of all resected lung specimens submitted to the mycobacteriology laboratory from 1969 to 1979 . Of the 20 specimens in which acid-fast bacilli were seen and which roentgenographically were solitary pulmonary nodules, 12 (60 percent) were due to infection with M . avium-intracellulare . In five granulomas, acid-fast bacilli were seen but failed to grow on culture . In one instance each, M . tuberculosis, M . fortuitum and M . gordonae grow on culture . Fiberoptic bronchoscopy was not diagnostic in 10 patients, although in one patient M . avium-intracellulare was cultured from the bronchial washings . Lymph nodes removed at mediastinoscopy from 12 patients did not contain granulomas . Since the physician was often unaware that cultures subsequently grew nontuberculous mycobacteria, most patients were treated with two drug regimens for presumed tuberculosis . Postoperative follow-up was available for 14 of the 20 patients, for a period ranging from four months to 10 years . There was no instance of dissemination of the infection to lung or pleura . We conclude that solitary pulmonary "tuberculomas" are often due to nontuberculous mycobacterial infection, particularly M . avium-intracellulare . When the lesion is due to nontuberculous mycobacteria and can be resected in its entirety, drug therapy is not indicated. Med Pediatr Oncol, 1981, 9(5), 501 - 9 Efficacy of amikacin and ticarcillin as empiric therapy in febrile neutropenic children with cancer; Faden HS et al.; Amikacin (600 mg/M2/day IV) and ticarcillin (12 gm/m2/day IV) were administered to 38 children with cancer, neutropenia (less than 1,000 PMN/mm3), and fever (greater than or equal to 38 degrees C) during 46 febrile episodes . Sixty-one percent of the children were severely neutropenic (less than 200 PMN/mm3) . Febrile episodes consisted of 15 documented (E coli 5, K pneumoniae and P aeruginosa 1, P . Aeruginosa 1, S marcescens 1, S aureus 4, S epidermidis 1, S viridans 1, adenovirus 1), 13 clinically apparent, nine possible, and nine doubtful infections . Efficacy of amikacin and ticarcillin was not determined in persons with gram-positive, viral, and doubtful infections . Amikacin and ticarcillin were administered from 3 to 13 days (mean 7.3 days) . Peak serum concentrations of amikacin on days two and five of treatment ranged between 13 and 35 microgram/ml; trough levels remained below 2 microgram/ml in 92% of the samples . Eighty-six percent of evaluable febrile episodes improved and 14% were unchanged . Among eight infections due to gram-negative enteric bacilli, six were cured (75%), and two (25%) improved temporarily . The excellent results observed in this study may be attributed, in part, to the predictably high serum concentrations of amikacin which exceeded the MICs of seven of eight gram-negative pathogens . Renal toxicity was not observed . Two children (9.5%) developed mild, transient, unilateral hearing losses . These data suggest that the combination of amikacin and ticarcillin is an effective and safe empiric regimen in febrile children with cancer. Chemotherapy, 1981, 27(6), 416 - 22 Comparative in vitro activity of 5 cephalosporins with other antibiotics tested against 887 recent clinical isolates; Wasilauskas BL; Five cephalosporins including 3 newer agents were tested along with several aminoglycosides, penicillins and other antimicrobials against 887 recent clinical bacterial isolates . Of the newer cephalosporins, cefotaxime appeared to be the most effective against gram-negative bacilli . However, with gram-positive cocci, cephalothin seemed to be the most effective cephalosporin . Superior antipseudomonal activity still resides with the aminoglycosides although moxalactam and cefotaxime appeared to offer some alternatives. Int Surg, 1981 Jan-Mar, 66(1), 81 - 3 Tuberculosis of the skull; Mohanty S et al.; Twenty-two cases to tuberculosis of the skull (14% of 156 cases of chronic osteomyelitis) verified by demonstration of tubercle bacilli in the discharge of cutaneous sinuses or histological examination of bone or granulation tissue are reported . Most of these patients had multiple operations elsewhere and non-healing sinuses . Three types of radiological lesion were noticed; circumscribed lytic, diffuse lytic and circumscribed sclerotic . Surgical treatment was followed by antituberculous therapy for at least 18 months . Results were excellent. Rev Rhum Mal Osteoartic, 1981 Jan, 48(1), 77 - 81 {Non-tuberculous infectious coxitis in adults}; Rampon S et al.; A multicentric study permitted us to report 94 cases of non-tuberculous infections of the hip joint in the adult (13.4% of the cases of septic arthritis observed over the same period) . A local predisposing factor (37.2%) and/or general predisposing factors (22.6%) were frequently noted . The routine search for bacteria permits identification of the latter in 71.3% of cases; the germ was usually a staphylococcus, arthritis due to Gram negative bacilli were found in 12% of the cases . The authors emphasize the interest of daily joint aspiration and traction on the lower limb associated with bactericidal antibiotic therapy which are the only means able, in their view, to improve the poor functional prognosis in these cases of hip joint infections. Anesth Analg (Paris), 1981, 38(11-12), 689 - 92 {Ornidazole in digestive surgery and surgical intensive care (author's transl)}; Delhumeau A et al.; The authors test the effectiveness of ornidazole in digestive surgery and surgical reanimation . They emphasize the increased frequency of anaerobic bacteria and the role of beta-lactamine and aminoside antibiotics in the selection of these pathogens . Ornidazole was used for a one year period as either a curative or prophylactic treatment . The product is very well tolerated . During the year the authors noted a decreased frequency of bacteroides bacteremia . They highly recommend the association of penicillin G in traumatology to fight gram negative anaerobic bacilli and numerous gram positive bacteria . The association with gentamycin is justified in the presence of an anaerobic gram negative digestive flora . The use of third generation antibiotics has often proved to be futile . It is recommended that they be reserved for the most resistant organisms seen in primary extra-hospital infections . The prescription of ornidazole must procede and follow the surgical eradication of focal intra-abdominal infections, especially if it is an infection of appendicular origine. Rev Neurol (Paris), 1981, 137(8-9), 491 - 501 {Terminal innervation in 3 cases of leprous neuropathy (author's transl)}; Khoubesserian P et al.; Three cases of leprosy are reported . In all patients, the diagnosis was made by finding Hansen bacilli in skin lesions, nasal secretions and ears, and the immunological typing of leprosy was established . Conduction velocity of motor and sensory nerves was measured and muscle biopsies were obtained . Histochemical typing of muscle fibers and measurement of the terminal innervation ratio of motor axon vitally stained with methylene blue were performed . A subclinical involvement of peripheral motor nerves was demonstrated by these investigations. Z Erkr Atmungsorgane, 1981, 156(3), 255 - 66 Comparative studies on detergents - chlorhexidinum gluconicum, ditalan wo hc, sodium-laurylsulphate, laurosept, nekal bx - used for homogenization of diagnostic specimens in the microbiological diagnostic of tuberculosis; Pichula K et al.; Between 1974 and 1978 there were carried out comparative studies concerning the value of several detergents used to homogenization of diagnostic specimens in six countries (Bulgaria, Czechoslovakia, German Democratic Republic, Poland, The Soviet Union and Yugoslavia) . In the first study it was confirmed that the homogenization of diagnostic materials by detergents gives good results and is more economical than conventional Petroff's method . In the majority of centers the highest detection of tubercle bacilli was found after homogenization by Sodium-Laurylsulphated-technique . Remarkable differences in the time of growth of tubercle bacilli after homogenization of the same samples by Laurylsulphate, Laurosept and Petroff's lye method were not observed . While, after homogenization by Nekal BX the time of growth was a little bit retarded . In the lowest percentage of contamination was observed after homogenization by Nekal BX . In the second study the value of Polish detergents (Chlorhexidinum gluconicum and Laurosept) was compared with Ditalan OW hc made in GDR and with other routinely in the participating laboratories used techniques . The best results were obtained after homogenization of specimens by Chlorhexidinum gluconicum . But the comparison to Laurosept and Ditalan WO hc showed no significant differences . Homogenization of sputa was better and number of contaminations lower after using laurosept or Ditalan WO hc than by means of Chlorhexidinum gluconicum. Microbiol Immunol, 1981, 25(8), 801 - 5 In vitro growth of Mycobacterium lepraemurium under the influence of macrophage cultures; Matsuo Y et al.; Elongation and limited multiplication of Mycobacterium lepraemurium was observed extracellularly when the bacilli spotted on a coverslip were placed face to face with cultures of mouse peritoneal macrophages adhering to the inside of a test tube held at an angle of 15 degree . There was no doubt that certain growth-promoting but unstable factors were released from the macrophages. Ann Microbiol (Paris), 1981 Jan-Feb, 132A(1), 41 - 50 Paracrystalline inclusions in Mycobacterium leprae; David HL et al.; The occurrence of paracrystalline inclusions of Mycobacterium leprae infected with the mycobacteriophage D29 or treated with mitomycin C was reported before {5, 6} . In pursuing these studies we have now documented by electron micrography a number of paracrystals we thought sufficient to further describe these inclusions, and to show that they appeared to be formed in association with the intracellular membranous structures of the leprosy bacilli. Microbiol Immunol, 1981, 25(3), 245 - 55 Mitogen-induced DNA synthesis in various mouse strains infected with a large or small dose of murine leprosy bacilli; Yamaura N et al.; Mice of the C57BL strain have been shown to be rather resistant to infection with Mycobacterium lepraemurium, whereas C3H mice are highly susceptible . Accordingly, it seemed to be somewhat paradoxical that enhanced antibody formation coupled with a depressed state of cell-mediated immunity as expressed by negative macrophage migration inhibition tests was observed not in C3H but in C57BL mice when they were inoculated with a large dose of murine leprosy bacilli, as reported in our previous studies . In the present study mitogen-induced DNA synthesis by lymph node cells was examined in 16 strains of mice which had been infected with a large or small dose of M . lepraemurium . According to the response to two kinds of T-cell mitogens, these mouse strains could be roughly divided into three groups consisting of two polar groups represented by C57BL/6J and C3H/HeN, respectively, and one intermediate between them . Furthermore, both humoral and cellular immune responses so far observed in C57BL and C3H mice were substantiated by DNA synthesis by lymph node cells harvested from these strains of mice and then exposed in vitro to B-cell and T-cell mitogens, respectively . However, no correlation was found between mitogen-stimulated DNA synthesis by these 16 strains of mice and their H-2 specificity. Int Surg, 1981 Jan-Mar, 66(1), 79 - 80 Perinephric abscess: report of 19 cases; Merimsky E et al.; Nineteen p