Am J Med Sci, 1977 Mar-Apr, 273(2), 177 - 84 Amikacin therapy of severe infections produced by gram-negative bacilli resistant to gentamicin; Valdivieso M et al.; Amikacin is a new aminoglycoside antibiotic related chemically to kanamycin . It has broad spectrum activity against most gram-negative bacilli . The most important advantage of this aminoglycoside is its activity against gram-negative bacilli which are resistant to gentamicin . Amikacin was given to 22 cancer patients with 24 serious infections produced by gram-negative bacilli resistant to gentamicin and 13 (54 per cent) were cured . Response to amikacin was related to the patients's neutrophil count at the time of infection; neutropenic patients having a lower response rate (30 per cent vs 71 per cent) . Side effects included nephrotoxicity (12 per cent) and audiotoxicity (5 per cent) . Amikacin is an effective new antibiotic for patients with severe infections produced by gram-negative bacilli resistant to gentamicin. J Infect Dis, 1977 Mar, 135 Suppl, S49 - 53 In vitro activity and clinical efficacy of clindamycin in the treatment of infections due to anaerobic bacteria; Levison ME et al.; Clindamycin, rosamicin, josamycin, and metronidazole had similar inhibitory activity against 29 clinical isolates of Bacteroides fragilis, i.e., 100% of strains were inhibited by 0.8 microng of metronidazole or josamycin/ml and 100% by 1.6 microng of clindamycin or rosamicin/ml . Metronidazole was bactericidal against 97% of the isolates, and clindamycin or rosamicin (in concentrations of 1.6 microng/ml) was bactericidal against 80% . Erythromycin and josamicin were the least bactericidal agents in vitro . Thirty-two patients with pleuropulmonary and intraabdominal or pelvic infections caused by anaerobic bacteria were treated with clindamycin . Cure was achieved in 27 patients . In another group of 37 patients treated with parenteral clindamycin, diarrhea developed in 30% and was significantly more common in those patients with abdominal or pelvic infection . Only one patient developed pseudomembranous colitis . These observations suggest that clindamycin is an excellent and relatively safe antibiotic for treatment of infections caused by anaerobes when combined with surgery or with other antibiotics selected for activity against aerobic gram-negative bacilli. Immunology, 1977 Mar, 32(3), 255 - 64 Biphasic pattern of activation of the reticuloendothelial system by anaerobic coryneforms in mice; Otu AA et al.; Macrophage activation as measured by increased rates of clearance of carbon was explored in five inbred and two outbred strains of mice pretreated with anaerobic coryneform bacilli . Constant differences were found according to strain from DBA (lowest response) to Sha-Sha (highest response) . The investigation was continued with mice of CBA strain which also provided highly reproducible and high-level responses . In this strain activation occurred in two phases: an early activation which reached maximum levels at 2 days and attributable to a lipid component of the bacteria, and a late phase reaching maximum at 14 days which appeared to coincide with greatly increased weight of the liver and spleen, due to infiltration by mononuclear cells . Evidence is provided that the early phase of macrophage activation is due to a lipid extract from the anaerobic coryneforms with chemotactic activity. Geriatrics, 1977 Mar, 32(3), 63 - 70, 72 Why tuberculosis is still a health problem in the aged; Kasik JE et al.; Modern chemotherapy has made the treatment of tuberculosis effective and simple . What is required is a high index of suspicion for the disease, particularly in the older members of the population . When tuberculosis is suspected, a skin test should be performed and sputum examined for acid-fast bacilli . If the skin test is positive and the x-ray compatible, therapy with isoniazid and ethambutol should be initiated while evaluation of the patient continues . Therapy need not be complicated, and the patient can be returned to his usual environment promptly if a few simple rules are followed. J Clin Microbiol, 1977 Mar, 5(3), 329 - 31 Smear results in the diagnosis of mycobacterioses using blue light fluorescence microscopy; Pollock HM et al.; Examination of 6,880 sputum specimens from untreated patients disclosed that 3.1% were positive for mycobacteria by fluorescence microscopy, and 92.5% of these has positive cultures . There was a positive correlation between the number of organisms seen on smear and growth on culture . All specimens with positive smears and negative cultures contained rare or few acid-fast bacilli on the smear . Eighty-two percent of the specimens with positive cultures and negative smears yielded less than 25 colonies, whereas there were greater than 25 colonies from 93% of the specimens with positive smears and cultures . In a low prevalence, general hospital population, the primary acid-fast smear continued to be a reliable diagnostic tool. Infect Immun, 1977 Mar, 15(3), 737 - 44 Partial purification and properties of an antibacterial product of peritoneal exudate cell cultures from BCG-infected guinea pigs; Sharma SD et al.; Peritoneal exudates elicited in BCG-infected guinea pigs with caseinate yield cell cultures that have been shown to produce soluble material capable of sterilizing certain bacteria if the cultures are incubated with the specific antigen purified protein derivative or the lectin phytohemagglutinin . This material is now shown to have the following properties: (i) strongly adsorbable to glass; (ii) strongly adsorbable to cation- and not to anion-exchange resins but not elutable with mineral acid or solutions of high ionic strength; (iii) strongly adsorbable to cellulose nitrate membrane filter materials and quantitatively elutable with dilute HCl, providing a convenient method for partial purification; (iv) relatively stable over a wide range of pH and temperature; (v) antagonized by polyanions and by iron ions; (vi) active against the three gram-positive bacilli tested and not against the other organisms tested: (vii) more active in alkaline than in acidic media; and (viii) inactivated by proteolytic enzymes. Am Rev Respir Dis, 1977 Mar, 115(3), 443 - 7 Stability of bacteriophage type of Mycobacterium tuberculosis: absence of variation caused by experimental chemotherapy in mice and analysis of spontaneous variation; Clavel S et al.; The bacteriophage typing of 54 strains isolated from the tissues of mice infected with the strain H37Rv of Mycobacterium tuberculosis and treated with isonazid and rifampin showed that the bacteriophage type did not change . The fluctuation analysis of populations of the tubercle bacilli demonstrated that the rate of mutation from sensitivity to resistance in respect to the bacteriophage DS6A was less than 1.3 X 10(-8) mutations per bacterium per generation. Southeast Asian J Trop Med Public Health, 1977 Mar, 8(1), 7 - 12 Differentiation of nonfermentative gram-negative bacilli in the clinical laboratory; Thong ML; A rapid and simplified system for the differentiation of nonfermentative Gram-negative bacilli, encountered frequently in clinical specimens, is presented for use in the clinical laboratory . Nonfermentative bacteria can be grouped initially by the motility, oxidase and OF glucose reactions . This grouping simplifies the choice of additional tests for further identification . The additional tests included Gram stain, acid production from 10% lactose agar, nitrate reduction, arginine dihydrolase activity, fluorescein production, deoxyribonuclease activity, hydrolysis of aesculin, growth at 42 degrees C, gelatinase activity and susceptibility to antibiotics. J Infect Dis, 1977 Mar, 135 Suppl, S35 - 9 A double-blind comparison of clindamycin with penicillin plus chloramphenicol in treatment of septic abortion; Chow AW et al.; The responses to therapy with either clindamycin alone or penicillin plus chloramphenicol in 77 patients with septic abortions were compared in a randomized, double-blind study . Although fever index and duration of hospitalization were similar for both groups of patients, significantly more patients in the group that received clindamycin developed major complications (P less than 0.05) . This is believed to result from clindamycin's lack of activity against aerobic gram-negative bacilli . Aggressive management that included early uterine evacuation and broad-spectrum antibiotics effective against both aerobic and anaerobic bacteria was the key to reduced morbidity and mortality rates in treatment of septic abortion . For patients treated with clindamycin, early uterine evacuation appeared more important than antibiotic therapy (P less than 0.005) . Bacteremia was documented in a total of 29 patients (38%) . Bacteremia was polymicrobial in eight patients (28%) and involved anaerobes exclusively in 18 (62%), aerobes exclusively in nine (31%), and both aerobes and anaerobes in two (7%) . The organisms most frequently isolated were Bacteroides (other than Bacteroides fragilis), Peptostreptococcus, and Escherichia coli. Am J Pathol, 1977 Mar, 86(3), 623 - 33 Histochemical studies relating the activation of macrophages to the intracellular destruction of tubercle bacilli; Ando M et al.; Dermal tuberculous lesions, both primary and those of reinfection, were produced in rabbits with 14C-labeled BCG and biopsied once at various times . Macrophage activation was evaluated by the indolyl histochemical test for beta-galatosidase, the number of bacilli in macrophages by acid-fast staining, and the breakdown of bacilli by autoradiography . After the rabbits became tuberculin positive, the stongly activated macrophage population contained a) fewer parasitized cell, b) fewer bacilli in each parasitized cell, and c) more "free" 14C-label (not associated with intact bacilli) than the weakly activated macrophage population . These results suggest that the more highly activated macrophages had destroyed many of the bacilli that they once contained and that their power to do so was enhanced by immunologic mechanisms. Tubercle, 1977 Mar, 58(1), 29 - 34 Cross-resistance in M . tuberculosis to kanamycin, capreomycin and viomycin; McClatchy JK et al.; Drug resistant mutants to streptomycin, kanamycin, viomycin, capreomycin, and rifampicin were isolated from four strains of Mycobacterium tuberculosis . The mutants isolated from each parent were then tested for evidence of development of cross-resistance to other drugs . There was no cross-resistance between either streptomycin or rifampicin and any of the other drugs . Complete cross-resistance between viomycin and capreomycin was found . Cross-resistance between kanamycin and capreomycin, and kanamycin and viomycin was variable . A review of the medical histories of 27 patients with kanamycin-resistant tubercle bacilli indicated that cross-resistance with capreomycin and viomycin occurs, but is unpredictable . Because of this variability in cross-resistance and the fact that kanamycin is a more toxic drug than capreomycin, it is suggested that capreomycin be used in the first retreatment regimen for tuberculosis when streptomycin resistance has been demonstrated. J Immunol, 1977 Mar, 118(3), 957 - 62 Induction of cell-mediated immunity to chemically modified antigens in guinea pigs . I . Characterization of the immune response to lipid-conjugated protein antigens; Dailey MO et al.; Bovine serum albumin (BSA) conjugated with a lipid, dodecanoic acid, is capable of inducing strong delayed-type hypersensitivity (DTH) in guinea pigs . This paper reports experiments on the nature and specificity of this hypersensitivity . The response to lipid-conjugated BSA (L-BSA) was found to be classical DTH, as evidenced by its ability to be transferred passively by immune cells, but not by serum . In addition, special histologic examination of skin test sites demonstrated the characteristics of DTH rather than cutaneous basophil hypersensitivity . Similar results were obtained when lipid-conjugated purified protein derivative of tubercle bacilli (L-PPD) was used . The increased immunogenicity of L-BSA was not caused by the presence of protein aggregates, but seemed to be related to the hydrophobic nature of the conjugated side chains . A series of cross-reacting serum albumins was used for a study of the specificity of the antibody and DTH responses to BSA . It was found that the degree of enhancement of immunogenicity for DTH caused by lipid conjugation varied for different antigenic determinants on BSA. Infect Immun, 1977 Mar, 15(3), 745 - 50 Antibacterial product of peritoneal exudate cell cultures from guinea pigs infected with mycobacteria, listeriae, and rickettsiae; Sharma SD et al.; In an in vitro model of cellular immunity, the antibacterial product of immunologically mediated mononuclear cell activation was studied from guinea pigs infected with listeriae and rickettsiae and compared with the product previously described from animals infected with mycobacteria . We found that this product, active against gram-positive bacilli, appeared to be identical in the three different infections with regard to its heat stability, its chromatographic adsorption and elution pattern, its susceptibility to inactivation by proteolytic enzymes, and its antibacterial spectrum JAMA, 1977 Feb 7, 237(6), 562 - 4 Amikacin therapy for serious gram-negative infection; Pollock AA et al.; Amikacin sulfate was administered to 18 patients for the treatment of 19 severe infections . Seventeen infections were caused by gentamicin-resistant Gram-negative bacilli, and 13 patients were bacteremic . Bacteriologic cure was attained in all but one instance, and effective serum, bile, and pleural fluid drug levels were demonstrated . Drug-related fever occurred in one patient, and another experienced a maculopapular rash and monilial intertrigo . In three patients, reversible renal toxicity developed, but none had clinical evidence of ototoxicity . Amikacin sulfate in a dose of 15 mg/kg/day is an effective antibiotic for the treatment of serious Gram-negative infections, particularly those due to gentamicin-resistant organisms. Aust Vet J, 1977 Feb, 53(2), 67 - 71 Tuberculin sensitivity of cattle inoculated with atypical mycobacteria isolated from cattle, feral pigs and trought water; Pearson CW et al.; Each of 12 cattle was inoculated either subcutaneously and intradermally or into a mesenteric lymph node with 1 of 8 species of liver atypical mycobacteria isolated from cattle, cattle trough water and feral pigs . Seventy-eight days after inoculation the cattle were tuberculin tested with bovine PPD, avian PPD and homologous heat-concentrated syntheic medium tuberculins . They were killed 85 days after inoculation . Organisms were cultured from caseous granulomas at all sites in cattle inoculated with M . avium serotype 2 . M . simiae was recovered from a granuloma at the subcutaneous site . Acid-fast bacilli were isolated from the mesenteric lymph node inoculated with trough water organisms . At 72 h, all the cattle had produced skin reactions of 4 mm or more to the homologous tuberculins and all except 1 produced a similar response to avian PPD . Only isolates of bovine origin sensitised cattle to bovine PPD to this degree, and these reactions were less than the corresponding response to avian PPD. Zh Mikrobiol Epidemiol Immunobiol, 1977 Feb, (2), 120 - 5 {Selecting a method of erythrocyte fixation for the passive hemagglutination test according to the nature of the sensitin}; Karal'nik BV et al.; Quantitative methods were applied to the study of the interaction of albumins, fraction I of Plague bacilli, diphtheria toxoid fractions differing by mol wt, flagellin of typhoid bacilli, 19S- and 7S-fractions of normal human, cholera horse, and paratyphoid B donkey sera with erythrocytes, fixed by 10 different methods . Fixation with acetaldehyde proved to be optimal for the binding of all the proteins, including flagellin, but the latter sensitized erythrocytes formalinized after Vainbach better . The significance of the method of erythrocyte fixation and of the nature of sensitin in the process of the erythrocyte loading without any utilization of the conjugating agents was demonstrated. Am Rev Respir Dis, 1977 Feb, 115(2), 221 - 8 Rifampim-combined chemotherapy in coal worker's pneumoconio-tuberculosis; Dubois P et al.; Results of a retrospective study of rifampin-combined chemotherapy in 59 coal miners with pneumoconio-tuberculosis are reported . In 43 patients pneumoconiosis had attained the stage of progressive massive fibrosis . The follow-up period ranged from 24 to 78 months, except in 8 patients who died before the twenty-fourth month . Twenty-seven of the 59 patients were treated for the first time, and 32 were in retreatment . In none of them had rifampin been administered before . Although the objective was to administer rifampin in combination with one, 2, or even 3 companion drugs that had not been administered before and that had proved to be active on the patients' bacilli in vitro, this goal was fully reached only in the first treatment group; in 8 of the 32 retreated patients the drugs combined with rifampin were considered ineffective . The speed and rate of bacteriologic conversion were most impressive . Sputum conversion was obtained in 90 per cent of the patients; in the initial treatment group 100 per cent of the patients converted their sputum on culture at 5 months and in the retreatment group the corresponding figure was 84.4 per cent . These bacteriologic results are nearly as favorable as those obtained in cases of advanced pulmonary tuberculosis without pneumoconiosis treated with the same rifampin-containing drug regimens . It was concluded that rifampin-combined chemotherapy largely eliminates the handicap caused by the coexistence of tuberculosis and pneumoconiosis . Side effects due to rifampin were without practical significance . In 3 patients of 57 treated with ethambutol, visual impairment was observed . Mortality was high (27 per cent) but was caused by nontuberculous diseases, especially cardiorespiratory insufficiency . In 10 of the 16 patients who died, death occurred after bacteriologic conversion. South Med J, 1977 Feb, 70(2), 208 - 12 Mammary tuberculosis: a rare modern disease; Ikard RW et al.; Tuberculosis of the breast has become a rare disease since the advent of antituberculous chemotherapy . The incidence of tuberculous mastitis at Vanderbilt Hospital for the last two decades was 0.025% of surgically treated breast disease . This probably reflects its prevalence in economically developed parts of the world . The pathologic diagnosis of mammary tuberculosis may be difficult . The only diagnostic proof is the demonstration of tubercle bacilli by microscopic smear of culture . Numerous cases have been incorrectly reported as mammary tuberculosis because of nonadherence to this criterion . Definite guidelines for treating breast tuberculosis are not available and may never become so because of its rarity . Drug therapy has been successful and should be tried in all cases . Adequate surgical removal is inevitably corrective of the local disease . Surgically treated patients should receive antituberculous drugs before and after their operations. J Med Microbiol, 1977 Feb, 10(1), 63 - 8 Airborne infection with Mycobacterium leprae in mice; Rees RJ et al.; Although the portal of entry and mode of spread of M . leprae in human leprosy are still uncertain, it is widely held that direct person-to-person skin contact is important . This assumption has ignored the fact that patients with highly bacilliferous leprosy have nasal as well as dermal infection and that, since M . leprae is shed predominantly from the nose, leprosy might be an airborne infection . The present study was designed to investigate this possibility with mice exposed to airborne infection with M . leprae . The conditions are described in which thymectomised-irradiated CBA strain mice exposed to M . leprae aerosols sustained an immediate lung retention of 1 X 10(5) bacteria . Fourteen to 24 months later, 33% (10 of 30) of the mice had countable numbers of acid-fast bacilli (greater than 2 X 10(4)) with the characteristics of M . leprae in one or more homogenates prepared from ears, foot pads, nose or lungs . Evidence is presented from the distribution of M . leprae that the infection had arisen from systemic spresd of bacilli initially entering the lungs rather than from multiplication of organisms locally retained there, or in the nose, at the time of airborne infection . The relevance of these results to the possible route of infection of leprosy in man is discussed. Br J Haematol, 1977 Jan, 35(1), 11 - 7 Monocyte recruitment in tuberculosis and sarcoidosis; Schmitt E et al.; Monocytopoiesis and blood monocytes were investigated in nine patients with active tuberculosis and in six patients with active sarcoidosis in order to obtain information on monocyte consumption in these two types of granuloma . All patients with tuberculosis demonstrated a marked increase in proliferation activity of monocytopoiesis and premature monocyte marrow release . These changes indicate a high monocyte consumption which probably is caused by a high macrophage death rate due to the high macrophage-toxicity of tubercle bacilli . Thus, tuberculous lesions are an example of a "high turnover granuloma" . In sarcoidosis monocytopoiesis showed no significant deviations from the normal . This indicates a low macrophage turnover or "low turnover granuloma" . Thus, any hypothetical agent assumed to be involved in the pathogenesis of sarcoidosis would have to possess low macrophage-toxicity. J Clin Microbiol, 1977 Jan, 5(1), 75 - 80 Cardiobacterium hominis endocarditis: description of two patients and characterization of the organism; Savage DD et al.; Two cases of endocarditis caused by Cardiobacterium hominis are reported . In both instances infection was subacute and characterized by (i) implantation on abnormal valves, (ii) chronic course lasting weeks to months before recognition, and (iii) rapid clinical and bacteriological response to penicillin, as well as other antibiotics commonly used to treat infections caused by gram-negative bacilli . Our isolates of C . hominis are compared with strains in the National Institutes of Health culture collection . Optimal growth requires yeast extract and incubation at 37 degrees C with increased humidity and supplemental CO2 . The production of indole, a positive oxidase reaction, and characteristic sugar fermentation distinguish C . hominis from other slow-growing, gram-negative bacilli. Chemotherapy, 1977, 23 Suppl 1, 180 - 8 A study of the levels of fosfomycin in the cerebrospinal fluid in adult meningitis; Drobnic L et al.; In order to determine the liquor concentration of fosfomycin, we chose 27 patients who were suffering from meningitis with different etiology . According to route, type of administration and doses employed, we classified the patients into five groups . Blood samples were taken from the patients 1 h after concluding the administration of the antibiotic and 2 h after the CSF sample . The concentration of fosfomycin in the serum and the CSF were then determined in the laboratory . In order to evaluate the results we divided our cases into three groups according to the state of their meningeal inflammation . In the first group of patients with active meningitis, we obtained an average concentration of fosfomycin in the serum of 65.20 mug/ml and in the CSF of 10.88 mug/ml . In the second group of patients with meningitis in the remission stage, the concentration of fosfomycin in the serum was 83.58 mug/ml and in the CSF it was 9.63 mug/ml . In the third group of patients with their meningitis cured, the concentration of fosfomycin in the serum was 66.45 mug/ml and in the CSF it was 4.95 mug/ml . On the basis of the concentrations obtained and with regard to the sensitivity in vitro, we concluded that fosfomycin can be useful in the treatment of meningitis caused by Pneumococcus, Staphylococcus, E . coli and other gram-negative bacilli. Chemotherapy, 1977, Suppl 1, 104 - 11 Evolution of sensitivity to fosfomycin in bacteria isolated in 1973, 1974 and 1975 in the Servicio de Microbiologia y Epidemiologia of the 'Clinica Puerta de Hierro', Madrid; Damaso D et al.; The bacteriostatic activity of fosfomycin was studied in vitro against 1,243 clinical isolations of gram-positive cocci and 4,086 isolations of gram-negative bacilli that were obtained in 1973, 1974 and in the period from January to May of 1975 . MIC was determined by the agar diffusion method, quantifying it by means of the standard curve that was worked out with the strain of E . coli NCTC 10,418 . A slight increase in resistance was observed in the gram-positive cocci: 64 mug/ml were inhibitory for 63% of the 249 isolations obtained in 1973, 59.1% of the 716 isolations obtained in 1974, and 57.5% of the 278 isolations from 1975 . A slight loss of sensitivity was also observed in the gram-negative bacilli: the aforementioned concentration of fosfomycin inhibited 36% of the 742 isolations from 1973, 33.6% of the 2,387 isolations from 1974 and 32.6% of the 957 isolations from 1975 . 933 g of this antibiotic were consumed in our hospital in 1973, 4,203 g in 1974 and 957 g in 1975 . The consumption rate per patient per year was 0.15, 0.72 and 0.20 g, respectively . In conclusion, although no change was observed in the sensitivity of some bacterial strains to fosfomycin, the overall study indicates a slight decrease in the sensitivity, although it does not apparently have any relationship to the consumption of fosfomycin in our hospital. Arch Immunol Ther Exp (Warsz), 1977, 25(6), 749 - 56 Comparative studies on activities of gentamicin, sisomicin, tobramycin and amikacin (BB-K8) against Pseudomonas sp; Dzierzanowska D; Activities of gentamicin, sisomicin, tobramycin and amikacin against 561 strains of Pseudomonas sp . bacilli were evaluated . Tobramycin was from two to eight times more active against Pseudomonas sp . than gentamicin . No strains resistant to amikacin were encountered . Correlation between the size of the growth inhibition zone and minimal inhibitory concentration was determined as regression lines for all the tested antibiotics . Sisomicin and tobramycin showed lowest correlation, and gentamicin and amikacin good correlation. J Int Med Res, 1977, 5(2), 91 - 5 A comparative study of epicillin and chloramphenicol in the treatment of enteric fever; Hassau A et al.; One hundred patients with acute enteric fever were randomly assigned to treatment with either chloramphenicol 50 mg/kg body-weight or epicillin 1 g six hourly . Eighty-one patients had a positive blood culture for typhoid or paratyphoid bacilli and nineteen had a positive stool culture with a significant Widal titre . All fifty patients in the group treated with chloramphenicol responded, however there was one relapse with bacteraemia . In the group treated with epicillin, six from the total of fifty patients were considred treatment failures . Treatment was considred as a failure if the patient was febrile after ten days treatment or if there was a deterioration despite antibiotic therapy. Arch Inst Pasteur Alger, 1977, 52, 37 - 53 {Bacteriological aspects of extrarespiratory tuberculosis}; Boulahbal F; 775 strains of extrapulmonary tubercle bacilli isolated during four years (1968-1972) were studied . Our results enabled us to confirm the paucibacillary nature of these tuberculous sites and the variety of their resistance to antibiotics . The comparison between the levels and types of primary resistance in pulmonary and extrapulmonary tuberculosis enabled us to better understand the transmission mechanisms of the tubercle bacilli in the community and its progress in the infected organism. Infection, 1977, 5(4), 224 - 7 Beta lactamase resistance of newer cephalosporins and antimicrobial effectiveness against gram-negative bacilli; Farrar WE et al.; Three newer cephalosporins (cefamandole, cefoxitin and cefazaflur) were investigated, in comparison with three older agents (cephalothin, cephaloridine and cefazolin) to determine their stability to beta-lactamases of gram-negative bacilli, and to correlate this with their antibacterial activity . Nine of the 17 bacterial strains employed produced broadspectrum beta-lactamases; the remaining eight produced cephalosporinases . The cephalosporins were highly active against bacteria producing broad-spectrum beta-lactamases; they were less active against organisms producing cephalosporinases . All of the cephalosporinase-producing strains were resistant to cephalothin anc cephaloridine . With the other cephalosporins the correlation between hydrolysis by cephalosporinases and resistance of the organisms was poor . Four to eight cephalosporinase-producing strains were resistant to cefoxitin, which was completely resistant to hydrolysis by the beta-lactamases . Cefozolin, cefamandole and cefazaflur inhibited several of these strains in spite of destruction by the beta-lactamase . Several cephalosporins need to be used in antimicrobial susceptibility testing of gram-negative bacilli. Adv Clin Pharmacol, 1977, 14, 59 - 65 {Evaluation criteria of antitubercular drugs from microbiological view}; Stur D et al.; In the years from 1954 to 74 sensitivity tests with about 12 000 strains of tubercle bacilli isolated from patients have been performed by the serial dilution method . From the results of the tests shown in the table one can see a remarkable shift in the frequency of strains sensitive against the so-called major drugs Streptomycin and INH, whereas only slight variations have occurred with the recent drugs Ethambutol and Rifampicin . The well known change of clinic and epidemiology of tuberculosis in the past two decades is indeed accompanied by changed results of microbiological tests . In conclusion the present chemotherapeutical situation proves much better than in 1954: to-day a more sensitive and even smaller reservoir of mycobacterium tuberculosis is facing twice as much highly effective drugs than formerly. J Biol Stand, 1977, 5(2), 131 - 8 Approaches to the validation of animal test systems for assay of protective potency of BCG vaccines; Smith DW et al.; Three animal test systems, two in guinea-pigs and one in mice, have been examined to differentiate the ability of three BCG vaccines with respect to their ability to protect the animals against infection when challenged with virulent bacilli . One test system showed great promise and was examined in greater detail in order to explain the mechanism of protection . These studies are continuing in order to test a series of BCG vaccines that will be given to groups of children and their protective effect observed. Z Erkr Atmungsorgane, 1977, 147(1), 3 - 17 {New aspects in the control of tuberculosis in GDR (AUTHOR'S TRANSL)}; Steinbruck P; The development of the epidemiology of tuberculosis in GDR from 1949 is evaluated . The factors deeply influencing incidence and prevalence of tuberculosis in GDR are: the socioeconomic development of a socialist society with continuous increase of living standard and social fonds, the state of the socialist public health system in general, and the special services and methods for the control of tuberculosis in the chest clinics and hospitals . Tuberculosis is no more a common disease in GDR . Tubercle bacilli are more ubiquitous, but are confined to distinct sources . Highest attention must be paid to the sources of infection, among them to those with tubercle bacilli already found by smear examination in the infectious cases . Microscopic examination is a very important method to find these cases . Cough and sputum exist in most cases of pulmonary tuberculosis already positive by smear examination . All these conditions must be regarded in the control of tuberculosis . The risk groups of tuberculosis (patients in the 5 years after treatment, patients with silicosis diabetes, long lasting treatment with corticosteroids, persons with contacts to infectios cases, and the so-called "Gesunde Befundtrager" (healthy carriers of lesions), persons older than 65 years) amount to 7% of the population but yield more than 50% of all new cases . BCG-vaccination is of no more high importance at an annual infection rate of only 0,25% (1975), but newborns will be vaccinated . Mass X-ray examinations are no more important for finding tuberculosis; but other pulmonary diseases including bronchial carcinoma are detected by this way . X-ray examinations will remain of value in the form of aimed examinations in intervals according to the risk of disease (for tuberculosis, bronchial carcinoma) . The most important method in the control of tuberculosis is the immediate treatment of all new cases . The results depend on the quality of therapy . It has to be still improved . It is the aim, to eliminate tuberculosis as a special problem of public health in GDR till 1982, 100 years after the discovery of the tubercle bacilli by ROBERT KOCH. Mikrobiyol Bul, 1977 Jan, 11(1), 29 - 33 {The results in our tuberculosis laboratory with penicillin blood agar medium}; Kilicturgay K et al.; A comparison of Lowenstein - Jensen and penicillin blood agar media, which can be prepared in small laboratories, is made in routine diagnostic cultivations of Mycobacterium tuberculosis . Tuberculosis . Tubercle bacilli grown in Lowenstein - Jensen medium were inoculated in Lowenstein - Jensen and penicillin blood agar media in numbers of 100.000, 10.000, 1000 and 100 bacilli and their growth was detected in each medium . It was found that the growth in both media was the same Inoculations were made from 153 sputum specimens to each medium and 5 positive growth were obtained . 3 out of positive cultures were grown on both media, the other 2 positives were grown only on penicillin blood agar . None of the media showed contaminations . These findings suggest that the penicillin blood agar medium has at least the same, or even better qualities than the Lowenstein - Jensen medium. Infect Immun, 1977 Jan, 15(1), 230 - 8 Hemagglutinating activity of Fusobacterium nucleatum; Falkler WA Jr et al.; Gingival isolates of oral Fusobacterium nucleatum strains (gram-negative anaerobic fusiform bacilli) have shown the characteristic ability to hemagglutinate a variety of erythrocytes (RBC) of human and animal origin . Other members of the genus tested (F . necrophorus, F . varium, and F . mortiferum) displayed little if any ability to hemagglutinate RBC . The hemagglutination (HA) activity could be observed in the F . nucleatum strains with the whole cells and in most instances with sonicated preparations of the organisms . The HA activity was observed in cell wall preparations of the organism and appeared dependent upon a heat-labile protein component of the cell wall . In decreasing order, the RBC that would hemagglutinate with the smallest concentration of HA preparations were rabbit, monkey, human, sheep, horse, and ox . No differences in HA activity of the preparations with cells from the various human blood types were noted . Absorption of the HA preparation of one strain with human cells removed HA moiety was bound to the cells via a Ca2+ binding site interaction since ethylenediaminetetraacetic acid and ethylene glycol-bis-N,N'-tetraacetic acid inhibited binding, and HA could be reestablished by the addition of Ca2+ but not Mg2+ . Rabbit antisera to the F . nucleatum strains inhibited HA activity when tested with the HA preparation in the standard test, whereas anti-Leptotrichia buccalis sera or normal rabbit sera had no effect . A tanned-cell passive HA test with rabbit anti-F . nucleatum sera displayed reactivity between the homologous strains but little reactivity with the other Fusobacterium species tested. Microbios, 1977, 19(76), 117 - 23 In vitro resistance test of human leprosy bacilli to anti-leprous drugs; Ishihara S et al.; Sensitivity to anti-leprous drugs of M . leprae isolated from an L-type leprosy patient was tested using M--Y 14b liquid medium by direct and indirect methods . The results revealed that the strain, SR61-L74, was almost completely resistant to DDS, and responded only to the long-term administration of Streptomycin and Isoniazid . However, the strain was completely sensitive to rifampicin which had never been administered previously . The subsequent administration of rifampicin resulted in a rapid improvement of the patient's clinical symptoms . It can be concluded that the in vitro method, both direct and indirect, to test the sensitivity of M . leprae to anti-leprous drugs is economic, and accordingly available practically as one of the routine examinations in the laboratory of ordinary leprosaria . This must be very beneficial to the treatment of leprosy patients. Arch Immunol Ther Exp (Warsz), 1977, 25(4), 497 - 502 The role of easily released substances (ERS) from bacteria in physiologic solution in natural immunity . VI . Induction of opsonins for different genera of bacteria by ERS from Staph . aureus oxford; Grzybek-Hryncewicz K; ERS obtained from Staph . aureus by mild extraction with physiologic saline solution possess activity of inducing nonspecific opsonins which react with homologous bacteria and with related Gram-negative bacteria . ERS from Staph . aureus weakly stimulated precipitins and antibodies active in passive hemagglutination and induced a marked rise in agglutinin titers especially for the homologous strain and Gram-negative S . typhimurium bacilli . N-acetyl-D-glucosamine absorbed the opsonizing factor for various bacteria with heterologous activity. ORL J Otorhinolaryngol Relat Spec, 1977, 39(1), 1 - 13 The role of plasma cells in scleroma . Electron-microscopic study; Toppozada HH et al.; Three cases of rhinoscleroma in the granulomatous stage were examined under the electrom microscope . The rough endoplasmic reticulum of plasma cells in scleroma displayed cisternal dilatations forming Russell bodies and cytoplasmic vacuolations containing viable and degenerated bacilli forming Mikulicz cells . Thus, they play a double role, producing antibodies and providing protection for the intracellular bacilli . New ultrastructural findings of Klebsiella rhinoscleromatic bacilli were described. Lepr India, 1977 Jan, 49(1), 54 - 8 The infectivity of drug resistant cases; Desai AC et al.; The present study shows that leprosy bacilli resistant to dapsone, multiply in mouse foot-pad as equally as the dapsone sensitive bacilli would multiply suggesting that the dapsone resistant case will be as infective as the dapsone sensitive case. Arch Immunol Ther Exp (Warsz), 1977, 25(1), 69 - 78 Immune processes in the course of infection with dysentery bacilli . III . Protective activity of spleen cells and serum from mice immunized with killed dysentery bacilli; Kowalewska D et al.; Killed dysentery bacilli induce immunity in mice which can be transferred to other mice with serum . Spleen cells do not transfer this immunity, in contrast to spleen cells from mice immunized with live dysentery bacilli . The results of this and previous studies 5,17 suggest that immunity in mice infected with dysentery bacilli depends on two coexisting effector mechanisms--cell-mediated and humoral immunity . Live bacilli induce both, however killed bacilli stimulated humoral immunity and protect mice equally effectively against lethal infection with dysentery bacilli. Dermatologica, 1977, 154(3), 147 - 55 Prolongation of Bacillus firmus survival on human skin by a spore inoculum; Bibel DJ et al.; A case report is presented of an individual who carried vegetative cells of Baccillus firmus on multiple sites of his body for over a year . With the aim of investigating the survival mechanisms of Bacillus species on human skin, vegetative cells or spores of this microorganism were applied to the forearms of volunteers . Whereas vegetative cells were rapidly eliminated, the bacillus was recovered up to 2 weeks following an inoculum of spores . Persistence was not passive since germination, growth, and possible sporulation were demonstrated . We observed strong individual differences in the carriage of bacilli. Jpn J Antibiot, 1977 Jan, 30(1), 69 - 75 {Clindamycin-2-phosphate and surgical infections (author's transl)}; Ishibiki H et al.; Blood levels of clindamycin-2-phosphate in dog at dosis of 10 mg/kg body weight showed the maximum of 21 mug/ml 30 seconds after one-shot i.v . administration . Continuous infusion of the antibiotic at the infusion speed of 150 and 300 ml/hour/10 kg b.w . with 6 mg/ml solution maintained blood levels of 30 and 170 mug/ml respectively . It may be recommended clinically to use lower concentration than 6 mg/ml to avoid cardiocirculatory disturbances . Four cases of surgical mixed infections with gram-positive cocci, gram-negative bacilli and anaerobes were treated with clindamycin-2-phosphate at a daily dosis of 1,200 mg intravenously and 2 of 4 cases revealed good clinical response . There was none of the haematological, hepatic, nephrontic, cardiocirculatory and allergic side effects. Chemotherapy, 1977, 23 Suppl 1, 133 - 40 Fosfomycin and plasmidic resistance; Baquero F et al.; 60 fosfomycin-resistant strains of gram-negative bacilli are submitted to conjugation experiments using as recipient cell E . coli K12 which is nalidixic acid resistant . After mating, the number of fosfomycin-resistant E . coli K2 colonies growing on selection plates containing nalidixic acid and fosfomycin never surpassed the normal rate of mutation for fosfomycin-resistance of the recipient strain . In 65% of the experiments, plasmidic resistance to other antimicrobials was transferred to E . coli K12, but was never accompanied by demonstrable fosfomycin resistance . High rate of normal mutation of recipient strain is signaled as the main problem for detecting the plasmidic nature of fosfomycin resistance . With our criteria regarding this fact we have been unable to confirm the plasmidic nature of fosfomycin resistance. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1977 Jan-Mar, 26(1), 39 - 42 {Frequency of isolation of tuberculous bacilli as a function of some mechanical factors in patients with pulmonary tuberculosis}; Ticau S et al.; A series of mechanical factors, such as postural changes and every day movements, favour mobilization of bronchoalveolar secretions and, hence, offer greater chanses of detecting the tuberculosis bacillus . It is recommended to collect, in out-patient units, two sputum samples, one in the morning and the second several hours later, after beginning the day's work. Immunology, 1977 Jan, 32(1), 33 - 41 Immunologically mediated macrophage aggregation in monolayers of peritoneal cells from BCG-sensitized mice; Preston PM et al.; Aggregation of cultured macrophage monolayers derived from BCG-sensitized mice was produced if nonadherent cells and specific antigen (tuberculin) were present, particularly if the antigen was renewed in the form of tubercle bacilli . The evidence indicated that antigen-stimulated BCG-sensitized lymphocytes in these cultures produced a soluble factor, which in the presence of the renewed supply of antigen caused the aggregation . The phenomenon was irreversible and followed by death of the macrophages . The 'overlays' of aggregated monolayers would aggregate normal macrophages, provided that the recipient cultures contain-d their own (normal) lymphocytes as well as antigen; this suggested that cultures of BCG-sensitized peritoneal cells produced a factor able to effect aggregation via the activity of normal lymphocytes . Overlays from aggregated monolayers were able also to inhibit the migration of normal mouse macrophages; this and other evidence suggested a similar origin for the inhibition factor, but the latter's identity with the aggregation factor remains undecided . We conclude that the aggregation factor depends upon the presence of specific antigen both for its formation and its expression. Arch Immunol Ther Exp (Warsz), 1977, 25(4), 521 - 8 Inductive influence of macrophages on cytotoxic properties of lymphocytes; Nowosielska-Roszkowska E; Normal rat lymphocytes preincubated over syngeneic peritoneal macrophages derived from rats sensitized to tuberculous bacilli and then cultured with PPD showed a cytotoxic effect on sheep red blood cells coated with PPD . This effect was antigen specific and did not involve the nonspecific influence of macrophages. Lepr India, 1977 Jan, 49(1), 10 - 33 Recent advances in microbiology in leprosy; Dharmendra; The recent advances in microbiology of leprosy are reviewed . Till now the leprosy bacillus had not been cultivated in laboratory media; the recent claims of success have not been confirmed . There has been a breakthrough in the experimental transmission of leprosy to experimental animals--the white mice, the immune depressed white mice, and the nine-banded armadillo . Apart from providing definite proof for the causative relationship of the bacillus discovered by Hansen and the disease leprosy, the experimental transmission to animals have considerably advances our knowledge about the disease . The mouse has provided a suitable model for screening of antileprosy drugs, detecting development of drug resistance, ascertaining viability of the bacilli and determining the genuineness of a supposed culture of the leprosy bacillus . The armadillo has provided a model for making basic studies of the disease as it occurs in man . Further, the generalised infection in armadillo has provided large amounts of leprosy bacilli for preparing standardised lepromin, for preparing a specific skin-testing antigen containing the active protein fraction of the bacillus, and a step towards the production of a vaccine against leprosy . It is interesting to note that the fact that the protein fraction of the bacillus was responsible for the positive lepromin reaction was discovered by Dharmendra far back in 1941. Int J Lepr Other Mycobact Dis, 1977 Jan-Mar, 45(1), 49 - 51 A modified allochrome procedure for demonstrating mycobacteria in tissue sections; Harada K; A modified allochrome staining procedure is presented as being the most reliable and sensitive method for demonstrating mycobacteria in tissue sections . The technic is as follows: Deparaffinize formalin fixed sections, oxidize in 10% periodic acid for 24 hours, differentiate in 1% HCl-70% ethanol, stain in Weigert's iron hematoxylin nuclear stain, and counterstain in picro-methyl glue . Mycobacteria stained brilliant red in contrast with the allochrome-stained background tissues, and apparently otherwise chromophobic bacilli are demonstrated. Chemotherapy, 1977, 23(6), 424 - 35 Carfecillin: antibacterial activity in vitro and in vivo; Basker MJ et al.; Carfecillin, the alpha-phenyl ester of carbenicillin, hydrolyses rapidly in the presence of serum or body tissues to liberate carbenicillin but hydrolysis is less rapid in aqueous solution . The activity of carfecillin in antibacterial tests in vitro depends upon the extent of hydrolysis to carbenicillin, and in conventional serial dilution tests carfecillin shows an antibacterial spectrum generally similar to that of carbenicillin due to extensive hydrolysis . However, in tests in which the extent of hydrolysis is reduced, carfecillin displays lesser activity than carbenicillin against gram-negative bacilli and greater activity against gram-positive cocci . In the presence of serum carfecillin is hydrolysed rapidly to carbenicillin and the activity shown is solely that of carbenicillin . Unlike carbenicillin, carfecillin is well absorbed in mice after oral administration, producing significant carbenicillin blood concentrations and the compound is as effective by the oral route in the treatment of various experimental mouse infections as is parenteral carbenicillin. Lancet, 1976 Dec 25, 2(8000), 1379 - 82 Penicillinase-producing Gonococci in Liverpool; Percival A et al.; Gonococci, which had acquired a TEM-type of penicillinase widely distributed among gram-negative bacilli, appeared in February, 1976, and soon accounted for 9% of isolates at a clinic in Liverpool . In 45 patients infected by such gonococci, the frequency of complications did not suggest reduced communicability or invasiveness, and usual forms of treatment with penicillins always failed . Spectinomycin succeeded in 21 (95%) of 22 patients treated, blt tetracyclines succeeded in only 13 (68%) of 19 . Appropriate laboratory tests for recognising penicillinase-producing gonococci must be used since such gonococci have already been transferred to other parts of the U.K . Penicillinase-stable cephalosporins were active in vitro and could prove to be the future treatment of choice. Oral Surg Oral Med Oral Pathol, 1976 Dec, 42(6), 731 - 7 Sarcoidosis with mandibular involvement . Report of a case; Betten B et al.; A case of mandibular involvement in sarcoidosis is presented . The diagnosis was based on positive chest roentgenograms, involvement of superficial and mediastinal lymph nodes of epithelioid tubercles, negative tuberculin test, and negative results of an examination with respect to tubercle bacilli . Mandibular involvement was diagnosed tentatively roentgenographically and verified by histopathologic examination . The mandibular lesion was treated surgically, and the defect healed uneventfully after less than 1 year . Almost complete normalization of the pulmonary lesions had taken place after 2 years. Chest, 1976 Dec, 70(6), 719 - 25 The P blood group system in pigeon breeders and pigeon breeder's disease; Effler D et al.; A blood group P1-like antigen has been found in gram-negative bacilli isolated from pigeon droppings, in pigeon serum, and on pigeon red blood cells . As a probable resident of the environment of the pigeon loft, the antigen stimulated formation of anti-P1 antibody in eight of 11 pigeon breeders who belonged to the P2 blood group . Only one of 11 random hospitalized patients with the P2 blood phenotype had a detectable titer of anti-P1 antibody (P less than 0.01) . The titer of anti-P1 antibody was not significantly different in symptomatic vs asymptomatic breeders . The presence or absence of anti-P1 antibody could not be correlated with any band of immunoprecipitates formed between pigeon breeder's serum and crude extract of pigeon droppings . The P antigen was identified in pigeon-dropping extracts of breeders with the P2 blood phenotype by inhibition of hemagglutination . We conclude that anti-P1 antibodies appear to be a component of the immunologic response to avian antigens of pigeon breeders but are probably unrelated to the pathogenesis of pigeon breeder's disease. Acta Pathol Microbiol Scand {C}, 1976 Dec, 84C(6), 465 - 70 Effect of sodium-salicylate on the function of cultured, human mononuclear cells; Viken KE; The in vitro effect of Na-salicylate on some functions of human mononuclear cells was studied . In therapeutical concentrations the drug was found to interfere both the function of lymphocytes and monocytes/macrophages . Na-salicylate in concentrations of 400-800 mug/ml slightly inhibited the digestion of yeast particles . When the drug was present in the culture medium in doses above 160 mug/ml during the cell differentiation period from 90 minutes to the 8th day of culture, a reduction in the number of adhesive, viable cells was recorded . The remaining cells, however, were found to have a normal phagocytic function . A strong and dose dependent inhibition of the ability of lymphocytes to proliferate after antigenic stimulation with BCG bacilli was recorded . The inhibitory effect on the PHA response, however, was less prominent . The results presented indicate that Na-salicylate has a direct inhibitory effect on lymphocyte proliferation and monocyte differentiation and phagocytosis, which may be part of the explanation of the anti-inflammatory effect of the drug. Tubercle, 1976 Dec, 57(4), 275 - 99 Transmission of tubercle bacilli: The effects of chemotherapy; Rouillon A et al.; The important differences in the infectivity of the various forms of tuberculosis can be explained by quantitative data concerning the behaviour of the tubercle bacillus in man and the number of bacilli in the lesions and sputum . Patients in whom tubercle bacilli can be detected by direct examination of the sputum smear are the main sources of transmission . Moreover the individuals infected by them break down more often with the disease . In the individual patient, the use of antibacterial drugs completely changes the natural history of the disease: not only do patients no longer die but they are cured; their period of infectivity is considerably reduced, relapses are avoided, chronicity disappears . The drugs used prophylactically in individuals of high risk groups prevent development of the disease . The impact of chemotherapy is reflected by a two-to-three-fold increase in the speed of decline of the risk of infection, a decline which had started before the introduction of the drugs . While patients given the right combination of drugs lose their infectivity in a few weeks (probably most often in less than two weeks), treatment must of course be continued much longer and regularly in order to ensure the maintenance of conversion and the absence of relapse . This stresses the importance of providing means to ensure the taking of the drugs by all patients . The future reduction of transmission will essentially depend on the maintenance of an adequate system ensuring the early diagnosis and correct treatment of cases, which will inevitably continue to appear among the already infected portion of the population . Epidemiological surveillance is mandatory as well as the surveillance of the delivery of services, particularly of the quality of diagnosis and therapeutic services . The roles of public health authorities and perhaps still more that of the practising physician, specialized and not specialized, remain considerable both from an epidemiological point of view and from the point of view of the relief of all the suffering still created by the disease. J Clin Microbiol, 1976 Dec, 4(6), 522 - 3 Inoculation of API-20E from positive blood cultures; Blazevic DJ et al.; The API-20E system (Analytab Products, Inc., Plainview, N . Y.) was inoculated from 4- to 6-h tryptic soy broth cultures that had been inoculated from positive blood cultures containing gram-negative bacilli . This method gave the same genus and species identification for 139 of 140 organisms (47 patient and 96 simulated positive cultures) when compared to the Analytab Products, Inc., recommended method of inoculation. Infect Immun, 1976 Dec, 14(6), 1369 - 74 Granulomagenic activity of serologically active glycolipids from Mycobacterium bovis BCG; Reggiardo Z et al.; The granulomagenic properties of serologically active glycolipids A1, B2, B3, and C isolated from Mycobacterium bovis BCG were studied . Glycolipid A1, dissolved in olive and injected intradermally in guinea pigs, was able to elicit a granulomatous response that seemed to be of the nonallergic type . This granulomagenic activity was quite striking since only 2 mug was necessary to elicit the reaction . The B and C glycolipids were milder granulomagenic agents . Glycolipid A1, dissolved in olive oil and injected intraperitoneally, was toxic for mice . Mice lost weight after the injection of as little as 10 mug of A1, although not even a dose of 100 mug was lethal . Glycolipid A1 failed to immunize mice against aerogenic infection with virulent tubercle bacilli. Acta Pathol Microbiol Scand {B}, 1976 Dec, 84B(6), 379 - 85 Acquired resistance against Listeria monocytogenes in red mice and CF1 mice immunized with strains of BCG or Mycobacterium tuberculosis; Jespersen A; Groups of red mice and CF1 mice immunized intravenously with varying doses of a weak or a strong strain of BCG or a strain of Mycobacterium tuberculosis were challenged 3 weeks after immunization with 0.1 or 0.2 ml 10(-2) Listeria monocytogenes injected intravenously, simultaneously with a non-immunized control group . The acquired resistance was determined on the basis of the number of survivors and the survival times of the animals that died spontaneously . In the red mice, the strong BCG strain induced a definitely higher resistance than the weak strain, and the M . tuberculosis strain a slightly higher resistance than the BCG strains . As in red mice, the resistance of CF1 mice was higher in animals immunized with M . tuberculosis than in those immunized with the BCG strains . However, the difference in the survival times of mice immunized with the two strains of BCG was much less than in red mice, and was only clearly significant as regards one of the doses used . The relationship between the virulence of a mycobacterial strain and its ability to induce acquired resistance against an infection with listeria or against an infection with virulent tubercle bacilli is discussed . It is concluded that red mice are more suitable than CF1 mice for evaluation of the protective potency of a BCG strain. J Infect Dis, 1976 Dec, 134(6), 531 - 9 Role of B-lymphocytes in nonspecific resistance to Klebsiella pneumoniae infection of endotoxin-treated mice; Parant M et al.; Lipopolysaccharides (LPS) of gram-negative bacilli are known to protect mice against unrelated bacterial infections and to be nonspecific mitogens of murine bone marrow-derived (B-) lymphocytes . For assessment of the role of these cells in the mechanism of LPS-induced resistance to infection with Klebsielia, various nontoxic mitogens were assayed . In contrast to LPS or lipid A, the nontoxic mitogens did not protect mice . Experiments were also performed with LPS in nude mice and in mice treated with immunosuppressants . Stimulation by LPS was decreased after administration of hydrocortisone or cyclophosphamide under conditions that inhibited the in vitro activation of lymphocytes by mitogens . Moreover, nude mice and mice treated with 6-mercaptopurine were more resistant to Klebsiella than were control mice. Eur J Pediatr, 1976 Nov 3, 123(4), 243 - 54 Septicemia in the newborn due to gram-negative bacilli . Risk factors, clinical symptoms, and hematologic changes; Tollner U et al.; The case histories of 17 newborns developing septic shock due to gram-negative bacilli were studied for pre- and perinatal risk factors, clinical symptoms, and hematologic changes . Immaturity, resuscitation procedures, and hypothermia on admission were found to be the risk factors most frequently preceding septicemia . A skin color fading and changing from reddish-pink to yellow-green was the most early noticeable clinical symptom in all patients . The total leukocyte counts as well as the relative proportion of bands increased significantly at the onset of illness . When septicemia advanced, a marked drop of leukocytes was found, while the relative proportion of bands increased further . Only 1 in 12 cases showed a decrease in the platelet counts at the height of septicemia . A procedure for the early diagnosis of a neonatal septicemia is proposed: (1) Registration of perinatal risk factors . (2) With perinatal risk factors a skilled and attentive clinical observation is necessary . Particular attention should be paid to changes of skin color . (3) White blood cell picture: (a) every day in patients with perinatal risk factors and (b) every 6 h in patients showing suspicious symptoms. Acta Radiol Diagn (Stockh), 1976 Nov, 17(6), 845 - 55 Radiologic aspects of BCG-osteomyelitis in infants and children; Mortensson W et al.; An account is given of results of the radiologic examination of 29 infants and children with bone tuberculosis caused by the Bacilli Calmette-Guerin (BCG) as a complication to intradermal vaccination . The diagnosis is based on radiologic appearances, microscopy and bacteriologic examination of specimens obtained from the bone lesions . The radiologic appearance of the bone lesions is in most cases characteristic and differs decisively from that of pyogenic osteomyelitis and malignant disease. J Am Vet Med Assoc, 1976 Nov 1, 169(9), 920 - 7 Tuberculosis in captive exotic birds; Montali RJ et al.; Avian tuberculosis was studied clinically and pathologically in 137 affected birds from the National Zoological Park during a 7-year period (1969-1975) . Twelve of 22 orders exhibited were affected by the disease, and the highest annual mortality was 4% (in 1975) . Antemortem diagnosis of early cases of the disease, based on tuberculin testing, and serologic, hematologic, and radiographic studies, was inconsistent and often not conclusive . Pathologically, the diseases primarily involved digestive organs and spleen . There was a spectrum of lesions consisting of nodules of large foamy histiocytes packed with acid-fast bacilli to giant cell-containing granulomas that were often caseous but not cavitated or calcified . Amyloidosis was seen in approximately 20% of the cases . Mycobacterium avium serotype 1 was isolated from 30 tuberculous birds cultured . There was no sex predilection, and most of the affected birds were adults ranging from 1 to 10 years of age. J Am Vet Med Assoc, 1976 Nov 1, 169(9), 912 - 4 Mycobacterium tuberculosis infection in two East African oryxes; Lomme JR et al.; Tuberculous lesions were observed at necropsy of 2 East African oryxes (Oryx gazella beisa) at a municipal zoological park in Jackson, Ms . Microscopic examination revealed granulomas containing acid-fast bacilli in the lungs and liver of both animals, as well as in the uterus and mediastinal lymph nodes of 1 animal . Mycobacterium tuberculosis was isolated from the tissues of both oryxes and from fluid aspirated from the mammary gland of 1 oryx; the organism was pathogenic for guinea pigs but not for rabbits. J Infect Dis, 1976 Nov, 134 SUPPL, S433 - 40 Comparative effectiveness of combinations of amikacin with penicillin G and amikacin with carbenicillin in gram-negative septicemia: double-blind clinical trial; Klastersky J et al.; Preliminary results are presented for an ongoing, double-blind, clinical trial, in which the efficacy of amikacin plus penicillin G (Amik-Pen) and amikacin plus carbenicillin (Amik-Carb) is compared in treatment of severe gram-negative infections superimposed on serious underlying disease . All clinical isolates were sensitive to amikacin in vitro (minimal inhibitory concentration, less than 12 mug/ml) . Results in 50 patients with cancer and documented gram-negative infection, 29 of which involved septicemia, were analyzed . In the Amik-Pen group, 40% of 15 cases of septicemia responded favorable to therapy, as compared with 86% of 14 cases of septicemia in the Amik-Carb group; this difference is statistically significant (P less than 0.02) . When all patients were considered together, the outcome appeared more favorable (1) in infections caused by pathogens sensitive to both antibiotics used then in those caused by organisms sensitive to amikacin only (83% vs . 43%); (2) when the combined antibiotics demonstrated synergy in virto against the offending pathogen than when the combination was nonsynergistic (83% vs . 38%); and (3) when the peak serum antimicrobial dilution titer was larger than or equal to 1:8 than when titers were lower . The results of this study suggest that routine use of an antibiotic combination that has demonstrable in vitro synergy against the offending pathogen should be considered for the treatment of proven or suspected severe infections due to gram-negative bacilli. Am J Public Health, 1976 Nov, 66(11), 1101 - 6 Tapering off of tuberculosis among the elderly; Myers JA; Tuberculosis has long been prevalent among elderly people . When tubercle bacilli first enter human bodies they usually remain through the rest of their hosts' lives and are capable of causing clinical disease any time, even in old age . In 1900, a large percentage of people of all ages were harboring tubercle bacilli and high mortality and case rates obtained among elderly people . The only way to solve the problem among future old people was to protect infants, children, and youths from becoming infected and remain so throughout life . As far as possible that was accomplished by isolating and treating tuberculosis patients in sanatoriums and hospitals, with anti-tuberculosis drugs after 1946, and controlling the disease among cattle . In due time, large numbers of children entered adulthood uninfected . From year to year, they replaced those heavily infected as they advanced in years . By 1973 the mortality rate was only a fraction of 1.0 per 100,000 among people under 34 years but of those of 65 to 84 years it was 9.7 . The case rate was 28.1 for those older than 45 years . Although tuberculosis among the elderly has tapered off phenomenally, much time and work are necessary to accomplish eradication. Lepr India, 1976 Oct, 48(4 Suppl), 703 - 8 Clinical trial with clofazimine in leprosy; Ganapati R et al.; This paper summarises our clinical experience with clofazimine in the treatment of 25 cases of reactive states of lepromatous and borderline leprosy and 7 lepromatous patients not responding to dapsone . Corticosteroids, which had to be given for the control of reactions, could be withdrawn and daspone therapy reintroduced during the period of administration of clofazimine . A schedule for the management of moderately severe reactions is recommended . The results of clofazimine treatment were also equally impressive in the group of patients, possibly harbouring dapsone resistant bacilli (in view of their lack of improvement in spite of administration of dapsone under controlled conditions) . Clinical regression was associated with a fall in the mean levels of morphological index from 6.8 to 0.5 . The need to realise the real indications of this highly useful drug in the treatment of leprosy is stressed. Pediatrics, 1976 Oct, 58(4), 561 - 3 Hemolytic-uremic syndrome: absence of circulating endotoxin; van Wieringen PM et al.; In children with hemolytic-uremic syndrome endotoxin determinations were carried out in the peripheral circulation in order to get evidence for the hypothetical role of endotoxin in the pathogenesis of the disease . For this purpose the Limulus test was used to determine endotoxin activity in 16 patients with hemolytic-uremic syndrome . In the plasma of these patients no endotoxin could be detected above the lower detection limit of 100 pg/ml, although in all patients with septicemia due to gram-negative bacilli the test was positive. Int J Lepr Other Mycobact Dis, 1976 Oct-Dec, 44(4), 435 - 42 Oxidation of 3,4-dihydroxyphenylalanine by connective tissue constituents . Identification of Mycobacterium leprae not related to phenolase activity; Kato L et al.; The oxidation of 3,4-dihydroxyphenylalanine (DOPA) was studied by spectrophotometric methods at pH 6.8 . In the presence of L- or D-DOPA, a color development occurred in the presence of the following substances as measured by increase in absorption both at 540 nm and 480 nm: hyaluronic acid, trypsinized human skin and umbilical cord extract, trypsin treated rat tissue from subcutaneous rat leproma, trypsin treated M . lepraemurium isolated from rat lepromata, and trypsinized M . leprae isolated from non-treated lepromatous leprosy cases . Normal human skin and connective tissue extract and nontrypsinized connective tissue of rat leprosy granuloma did not oxidize DOPA . While the trypsin-treated partially purified M . leprae suspension oxidized DOPA at both wave-lengths, the hyaluronidase-treated same suspension of M . leprae failed to oxidize these phenolic compounds . Mushroom tyrosinase oxidized D-DOPA, L-DOPA, epinephrine and norepinephrine at 480 nm . Hyaluronic acid also oxidized epinephrine and norepinephrine at both wave-lengths . Since it is known that M . leprae in the human host is closely associated with the presence of the acid mucopolysaccharides of the skin, and since acid mucopolysaccharides and skin constituents strongly oxidized DOPA, and since the hyaluronidase treated M . leprae failed to oxidize DOPA, it became evident that hyaluronic acid and not M . leprae is responsible for DOPA oxidation, and phenolase activity is not associated with the metabolism of M . leprae . Evidence is presented that DOPA is not a unique characteristic of the human leprosy bacillus . For instance, trypsin-treated murine leprosy bacilli from the rat strongly oxidized DOPA . The reaction of DOPA oxidation, therefore, must be rejected as a test for the identification of M . leprae . The obtained results confirmed the pertinent findings of Skinsnes and his co-workers. Lab Anim Sci, 1976 Oct, 26(5), 807 - 10 Chromobacterium violaceum infection in a nonhuman primate (Macaca assamensis); McClure HM et al.; Chromobacteriosis caused by Chromobacterium violaceum was diagnosed as an Assam macaque, Macaca assamensis, that died 4 days after receipt of the Yerkes Primate Center, It was received from a primate facility in Florida where it has been housed with a group of rhesus monkeys for 5 years . The animal died suddenly without showing any signs of clinical illness . Necropsy findings included extensive hepatic necrosis with the formation of multiple large cavitary lesions . Foci of necrosis were also found in the lungs and lymph nodes . Numerous gram-negative bacilli were demonstrable in the lesions and Chromobacterium violaceum was isolated from the blood, liver, lungs, spleen and kidneys. Am Rev Respir Dis, 1976 Oct, 114(4), 807 - 11 Dynamics of submerged growth of Mycobacterium tuberculosis under aerobic and microaerophilic conditions; Wayne LG; When Mycobacterium tuberculosis is grown in detergent-containing medium under continous agitation, multiplication is known to follow a logarithmic mode . When the cultures are not continuously shaken, but only agitated a few times a week to resuspend the bacilli and permit turbidity to be measured, the net increase suggests an arithmetic growth mode . It is shown here that a single pulse of aeration of an unshaken submerged culture of M . tuberculosis causes an almost instantaneous acceleration of growth, followed rapidly by a cessation of growth . Whether or not the bacilli will subsequently resume growth depends on the bacillary population density of the cuture at the time of application of the pulse of aeration . If the bacilli are permitted to grow in the depths of Dubos Tween Albumin broth without any agitation, they exhibit net arithmetic growth and attain a maximal population density greater than is seen in cultures exposed to occasional pulses of aeration . By the use of isotopically labeled cells, it has been shown that replication occurs ar a logarithmic rate amoung the small proportion of the bacilli that remain suspended in nonagitated cultures . This replication is balanced by settling of cells, resulting in a net appearance of arithmetic multiplication . The cells that have settled into the sediment replicate at a very slow rate, if at all, but do retain their viability for 4 weeks or longer . This suggests a possible analogy to quiescent tubercle bacilli in vivo. Lepr India, 1976 Oct, 48(4), 413 - 8 Bacillaemia in reactive states of leprosy; Padma MN et al.; 35 cases of lepromatous and near-lepromatous cases of laprosy in Reaction have been investigated for the presence of acid-fast bacilli in blood at the height of the reaction as well as at its subsidence . Only 3 cases exhibited bacillaemia during reaction . It is therefore unlikely that dissemination of the disease is accentuated during reaction as commonly believed . Further, the immune complexes demonstrated to be circulating during reaction are possibly formed by bacillary products and not by whole or fragmented bacilli. Lepr India, 1976 Oct, 48(4), 391 - 7 Correlation of morphology with viability of Mycobacterium leprae; Desikan KV; A concept has been developed in the recent years that the evenly stained 'solid' bacilli are living and the 'non-solid' forms are degenerate and dead . This communication presents the findings in experimental mice inoculated with material containing 1 to 10% solid evenly stained M . leprae and also with material containing 0% solid organisms . There was multiplication of the bacilli in both the groups . Quantitatively, the yield also was not significantly different . These fundings do not support the belief that the non-solid bacilli are necessarily dead . The non-solid bacilli were further classified on the basis of their morphology to the following forms:-- (a) short but evenly stained (b) indented (c) beaded (d) dumb-bell shaped (e) coccoid and (f) fragmented . Material without solid bacilli, but containing different proportions of the above types of bacilli also gave similar results, making it diffcult to say which types of morphological forms are non-living . It appears, therefore, that the recognition of the living status of M . leprae by its morphology is highly equivocal and subject to error. Int J Lepr Other Mycobact Dis, 1976 Oct-Dec, 44(4), 431 - 4 A simplified hyaluronic acid based culture medium for mycobacteria isolated from human lepromata; Kato L et al.; Acid-fast bacilli multiplied in liquid culture media containing hyaluronic acid when inoculated with mycobacteria from a lepromatous leprosy nodule . The culture was readily subcultured at ten day intervals in the homologue media, but failed to grow in the Dubos, Middlebrook and Lowenstein media . These findings confirm the results of Skinsnes et al (1975) . Identification of this culture is not yet available, however it gives positive immunofluorescence with authentic anti-M . leprae serum . The obtained culture also grows as a chromogenic culture at 34 degrees C on a simple medium prepared from trypsin digested human umbilical cord, yeast extract powder and glycerol . This medium can be sterilized in an autoclave, but filter sterilized sheep, bovine or horse serum must be added aseptically as an essential ingredient . The medium does not differ considerably from the hyaluronic acid medium proposed by Skinsnes et al, but it is easier to prepare, it is inexpensive and permits a logarithmic growth within seven days of the so far unidentified culture isolated from leprotic nodules. Int J Lepr Other Mycobact Dis, 1976 Oct-Dec, 44(4), 427 - 30 Activity of ascorbic acid in inhibiting the multiplication of M . leprae in the mouse foot pad; Hastings RC et al.; Ascorbic acid was fed to mice in concentrations of 0.05%, 0.15%, and 0.45% w/w in the diet . Six months after inoculation of M . leprae into the foot pads, there were significantly fewer acid-fast bacilli harvested from animals receiving 0.15% and 0.45% w/w ascorbic acid than from control mice . On the other hand, M . leprae did multiply in mice fed ascorbic acid while no multiplication at all was observed in animals fed dapsone, clofazimine or rifampin . No toxic effects of ascorbic acid were noted in these mice. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1976 Oct-Dec, 25(4), 229 - 36 {Results of intermittent treatment with antitubercular agents in cavernous pulmonary tuberculosis in adults}; Moisescu V et al.; The effectiveness of the intermittent treatment (2/7) with Rifampicin + Etambutol, administered over periods of 3 to 24 months, was tested in a log of 229 out-patients suffering from tuberculosis (bacilli carriers) . Negativation of the cultures was obtained in 88.4% of the cases, most of the failures being recorded in the aged patients from rural areas, suffering from various other associated diseases and in those who did not cooperate . As these patients raise particular problems concerning the therapeutical attitude, the authors consider they should be admitted to hospital, at least during the critical periods of the disease. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol, 1976 Oct-Dec, 25(4), 209 - 16 {Current incidence of tubercular infection in children in the Dolj district}; Golli V; A lot of 122459 children under the age of 14 were tested intradermally with 2 U PPD . Most of them had been vaccinated at birth and some revaccinated later during the 1966-1967 period, which does not represent interpretation of the prevalance of tuberculosis today, bearing in mind the low postvaccinal allergy of young children and the interval after the last vaccination, only the children with a reaction of more than 10 mm in diameter were taken into consideration as they represented the highest probability of the actual spread of the infection . In the age group up to 6 years 6.82% of the children were infected and 17.12% of the school children of grades II to VIII, i.e . less than the mean values recorded in the whole country . This was attributed to the intensive specific chemotherapy applied within the area . The prevalence gradually increased from 3.93% at the age of l year to 4.90% at 3 years, then sharply to 6.93% at 4 years (when the child's relations are extended) and 10.46% at 5 years . The proportion of infections was of 12--13% in grades II--IV (7-9 years), 16.63% in grade V, 20% in grade VI and 23.21% in grade VIII (13-14 years) . The present values are much lower than those recorded in 1966 . The present risk of infection is of 1%, with an annual decrease rate of 7%, starting in 1956 . By comparison with the published data it is considered that neutralization by chemotherapy of all bacilli carriers will accelerate the rate of decrease of infection. Jpn J Microbiol, 1976 Oct, 20(5), 365 - 73 In vitro studies on the mechanism of acquired resistance to tuberculous infection . II . The effects of the culture supernatants of specifically stimulated-sensitized lymphocytes on the growth of tubercle bacilli within macrophages; Muraoka S et al.; Immune lymph node cells were obtained from mice immunized with bovine gamma globulin (BGG) in complete Freund's adjuvant or allogeneic MH134 tumor cells . They showed the capacity of conferring bactericidal activity on macrophages infected with Mycobacterium tuberculosis, H37Rv, when they were incubated on macrophage monolayers together with the corresponding antigen, i.e., BGG or solubilized cellular antigen of the tumor cells . However, such capacity was lower than that of tubercle bacilli-immune lymph node cells . Culture supernatants were harvested after incubation of tubercle bacilli-immune, BGG-immune or allogeneic tumor-immune lymph node cells with the corresponding antigen for 24 hr . Macrophages were altered so as to suppress intracellular bacillary growth when macrophage monolayers were exposed to the supernatants for more than 2 days . When normal lymph node cells were incubated on normal macrophage monolayers together with a mitogen such as PHA or concanavalin A, growth of tubercle bacilli within the macrophages was slightly but difinitely suppressed . The mechanism of elicitation of cellular immunity to the infection with tubercle bacilli is discussed on the basis of results presented in this and the preceding paper. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1976 Oct-Dec, 21(4), 227 - 32 {Typhoid bacilli resistant to chloramphenicol and multiresistant to antibiotics isolated at the beginning of 1971}; Duca E et al.; The sensitivity of chloramphenicol (C) of 286 S . typhi strains, isolated during the last 15 years in Moldavia, was tested . The minimum inhibitory concentration (MIC) of C with regard to most of the strains ranged between 1.5 and 3 mcg/ml . The following stains were identified: strain W isolated from the feces of a carrier in 1971, with a ACKSSuT-Cl2Hg resistance spectrum transferable to E . coli K12(MIC of C less than or equal to 200 mcg/ml), 2 strains (phage type A and C1, isolated from patients, one from the feces in 1972 and the other haemoculture in 1973) with a non-transferable CSu resistance spectrum (MIC of C less than or equal to 6 and less than or equal 12 mcg/ml respectively), and 18 strains (13 phage type D9, 3 phage type Ci and 2 phage type A), isolated from 3 epidemic foci, which proved to contain variants selectable in vitro by C (MIC up to 50 mcg/ml) . The resistance spectrum of the variants was not CSU transferable . Conclusions are drawn concerning the necessity of a restricted utilization of chloramphenicol. J Clin Pathol, 1976 Oct, 29(10), 931 - 3 Comparison of machine and manual staining of direct smears for acid-fast bacilli by fluorescence microscopy; Clancey JK et al.; Comparisons were made in Lusaka and in London between manual staining and staining in an automatic machine with auramine-phenol of direct smears of sputum and other types of specimen for acid-fast bacilli . No evidence was obtained of carry-over of acid-fast bacilli from positive to negative smears during machine staining . There was improved contrast between bacilli and the background in smears prepared with the machine. Infect Immun, 1976 Oct, 14(4), 919 - 28 Immunity to Mycobacterium leprae infections in mice stimulated by M . leprae, BCG, and graft-versus-host reactions; Shepard CC et al.; Infections of mice with Mycobacterium leprae in one rear foot pad immunized them against a second infection in the other rear foot pad . Purified bacilli harvested from the first infection also produced immuniy when injection into the foot pads of previously uninfected mice . Injections of BCG afforded similar protection, but had no adjuvant effect on M . leprae . M . duvali, a cultivable mycobacterium that is reported to be more closely related antigenically to M . leprae than BCG is, provided much less protection against M . leprae challenge than BCG did . Moreover, when M . duvali was mixed with BCG, it was not any more effective than BCG alone . Graft-versus-host reactions, induced by injections of parental spleen cells into F1 hybrids, provided no protection against M . tuberculosis and M . marinum challenge . They gave moderate protection against M . leprae in one experiment but not in another with a different schedule . Allogenic spleen cells had a protective effect when injected locally into the infected foot pad . The effect produced by these injections of spleen cells was a delay in the appearance of bacterial growth; however, there was no decrease in the rate of logarithmic growth when it did appear and no reduction in the eventual plateau level. Acta Neuropathol (Berl), 1976 Sep 15, 36(1), 31 - 8 Whipple's disease of the central nervous system; Silbert SW et al.; Whipple's disease presenting as a neurological disease without gastrointestinal symptoms is an unusual occurrence . A 40 year old man suffered hypersomnia, memory loss and progressive ophthalmoplegia for 6 months prior to death . The nature of this disease was not established during life . Extensive granulomatous inflammation affecting the hypothalamus, hippocampus and periaqueductal gray matter of the brain was found to represent Whipple's disease by electron microscopy . Characteristic lesions were also present in spleen, mesenteric lymph nodes, small intestine and myocardium . Bacillary bodies and membranous inclusions similar to those seen in visceral lesions of Whipple's disease were present in macrophages . The findings supported the theory of direct involvement of the central nervous system by bacilli rather than a metabolic origin for the lesions. Southeast Asian J Trop Med Public Health, 1976 Sep, 7(3), 411 - 4 Absence of plague in certain mammals from Java and Kalimantan (Borneo); Van Peenen PF et al.; Antibodies against plague were lacking in 237 wild mammal sera from Java and 103 from Kalimantan . Wild mammal spleens, 114 from Java and 18 from Kalimantan were negative for plague bacilli . A variety of mammalian species and areas was examined. Z Erkr Atmungsorgane, 1976 Sep, 146(3), 251 - 62 {Results of the systematic control of tuberculosis in the People's Republic of Poland according to the development of the epidemiological data till 1975 (author's transl)}; Leowski J et al.; After the second World War a marked improvement of the epidemiological situation in the field of tuberculosis has been achieved in Poland . In 1952 the incidence of tuberculosis amounted to 490 per 1000 000 of the population; the prevalence to 1400 . The mortality rate was 105.8 in 1950 . In 1974 the incidence rate has been reduced to 81.4 (among them 49.4 excretors of tubercle bacilli), the prevalence rate was only 248.9 (among them 78.3 with excretion of tubercle bacilli and 11.7 with chronic tuberculosis--persons excreting tubercle bacilli for more than 2 years) . The mortality rate from tuberculosis amounted to 13.8 at this time . The most sensible reduction of all indices was found among children 0-14 years old . Tuberculosis in Poland is still a problem of medico-social importance in adults and before all in old people, being that part of the population in past times only in a low degree vaccinated or revaccinated and in a higher degree exposed to severe infections with tubercle bacilli . The comprehensive complex programme of tuberculosis control passed by the Sejm of the Polish People's Republic, includes three approaches since 1960: the epidemiological, the integrating and the phthisiopneumological direction . Prerequisites for the scheduled realisation of the programme are the case-finding as early as possible, the quick and correct diagnosis and the immediate onset of a specific treatment, further on the dispensary care of all contacts of the patient (his surroundings) and optimal prophylactic measures against tuberculosis. Stain Technol, 1976 Sep, 51(5), 255 - 60 The nature of mycobacterial acid-fastness; Harada K; Phenol is not essential to acid-fast staining, for it will occur in the absence of phenol where such lipoid-soluble basic dyes as night blue, Victoria blue B or Victoria R are used; it is essential for acid-fast staining with water soluble basic dyes such as basic fuchsin . When phenol is added to the staining solution, such water soluble basic dyes behave in effect like their lipid-soluble counterparts . The loss of mycobacterial acid-fastness with carbol-fuchsin after bromination or chromation indicates that this phenomenon is related to the presence of unsaturated lipids in the bacterial cells . Within the cells these acid-fast lipids are bound in such a way that they are easily removed from all mycobacteria by hot dilute HCl; from leprosy bacilli alone they are easily removed with hot pyridine . From the results of various blocking reactions it appears that carboxyl and especially hydroxyl groups of these cellular lipids are essential to the acid-fast reaction of mycobacteria. Tubercle, 1976 Sep, 57(3), 207 - 25 A system for the examination of tubercle bacilli and other mycobacteria; Marks J; Methods are described for the examination of mycobacteria cultured from clinical specimens . In the "screening" procedure used for new isolates tubercle bacilli are non-pigmented, do not grow at 25 degrees C and are sensitive to p-nitrobenzoic acid as well as normally to anti-tuberculosis drugs . Classification is extended when necessary by the use of four tests--temperature requirements, pigmentation, oxygen preference and Tween hydrolysis . These define 15 species or groups meeting the needs of clinical bacteriology . Drug-sensitivity tests are described which relate the end-points of titrations to the modal response of normal wild strains of M . tuberculosis . They are used not only as a guide to chemotherapy but also to support and amplify classification. Lancet, 1976 Aug 14, 2(7981), 357 - 9 Tuberculosis in the Potteries 1971-74; Prowse K et al.; Notification rates of all forms of tuberculosis have increased in all age-groups in the Potteries, in a stable population which includes only a small immigrant community . The increase is greatest in both males and females over the age of 65 years and under 15 years . High notification rates have been recorded in workers in the pottery and mining industries and were unrelated to pneumoconiosis . Discrepancies have been found between the numbers of notified cases and the numbers of laboratory isolates of tubercle bacilli, particularly in cases of non-respiratory disease . This indicates that not all proven cases of tuberculosis are notified . The study has revealed serious deficiencies in the contact-tracing procedure in certain areas of the Potteries consequent upon the closure and reorganisation of outlying chest clinics. No Shinkei Geka, 1976 Aug, 4(8), 785 - 90 {Two cases of craniolacunia associated with meningocele and meningoencephalocele (author's transl)-a1}; Shigemori M et al.; Craniolacunia (lacunar skull, Luckenschadel) is characterized by multiple, round or oval, radiolucent defects, sharply separated by dense strip of bone (honey comb like configuration) which tend to cluster in the cranial vault on plain skull film . Craniolacunia is present at birth and frequently associated with myelomeningocele, encephalocele or other congenital abnormalities of the central nervous system . Patients with carniolacunia have high mortality due to these associated lesions, and to the secondary effects of these neurological lesions . Recently, it is interested that the presence of carniolacunia can be used as an early indicator of intellectual capacity or recommendation of early indicator of intellectual capacity or recommendation of early surgery for associated lesions . Two cases of craniolacunia with meningocele in the lumbar region and encephalocele in the frontal region are presented and the etiology, clinical significance, prognosis of craniolacunia are discussed . Case 1 (Fig . 1, 2, 3), who had a soft tumor in the lumbar region since birth, was admitted to Saiseikai Yahata Hospital under the diagnosis of meningocele on October 26, 1973 . The circumference of the head was 32.5 cm, and the lumbar tumor was infant fist growth, oval, brownish and soft in appearance . The patient had no neurological positive signs or other abnormalities including chest, abdomen and extremities . Plain skull film showed typical craniolacunia in the parietal, frontal and occipital region of the vault . Three days after admission, the patient had opisthotonus like posture at times and convulsive seizure of extremities . Suspected of meningitis, ventricle tap was performed . From the findings of obtained cloud xanthchromic cerebrospinal fluid which was revealed pleocytosis and many Klebsiella or other Gram (-) bacilli on bacterial culture, the diagnosis of ventriculitis was made... South Med J, 1976 Aug, 69(8), 979 - 85 The diagnosis and treatment of leprosy; Jacobson RR et al.; Leprosy is a complex disease, but recent research and the Ridley-Jopling classification which emphasize its immunologic aspects have greatly aided our understanding of and approach to the problem . The diagnosis should be considered whenever skin lesions and sensory loss occur . Dapsone remains the treatment of choice, but several newer drugs show great promise, especially in those cases whose bacilli have become sulfone resistant . Immunotherapy may play an increasingly prominent role in the future . Reactive episodes continue to be a serious complication, but the availability of thalidomide to control erythema nodosum leprosum has markedly improved the prognosis . Physicians of the US Public Health Service Hospital at Carville, Louisiana, are available at all times for consultation on these and other matters related to leprosy. Am J Med, 1976 Aug, 61(2), 277 - 82 Tuberculous arthritis: A report of two cases with review of biopsy and synovial fluid findings; Wallace R et al.; Two cases of tuberculous arthritis with synovial fluid findings are presented, and the major series with culture results and synovial fluid analyses are reviewed . Synovial fluid cultures are positive for tuberculosis in almost 80 per cent of proved cases . Specimens obtained by open synovial biopsy are positive by histology or culture in over 90 per cent of proved cases . Little experience with closed needle biopsy has been published . About one-fifth of the patients with tuberculous arthritis will have a positive synovial fluid acid-fast smear for tubercle bacilli . The tuberculous synovial effusion invariably has an elevated protein level, fair to poor mucin clot formation and usually a low joint fluid sugar level . The synovial fluid white cell count is usually in the range of 10,000 to 20,000 cells/mm3, but it varies widely . Most fluids exhibited a predominance of polymorphonuclear leukocytes . The importance of bacteriologic or histologic study of the synovial fluid and membrane in establishing the diagnosis is emphasized . In general, this disease is different from tuberculous involvement of serous membranes both in the frequency of positive cultures and in the difference in cellular response. Cutis, 1976 Aug, 18(2), 221 - 3 Lupus vulgaris: recovery of living tubercle bacilli 35 years after onset; Schmitt CL et al.; Recovery of living tubercle bacilli in a lesion of 35 years' duration is intriguing if not novel, and creates many possible rationalizations relative to the relentless progressive course of lupus vulgaris . That the histopathological picture is not always diagnostic is exemplified in this case. Jpn J Med Sci Biol, 1976 Aug, 29(4), 199 - 201 A suggested role of a host-parasite lipid complex in mycobacterial infection; Kondo E et al.; On the basis of our previous observations and related literatures, was assumed tht cholesterol esters of host origin and phthiocerol dimycocerosate of bacterial origin are located as a lipid mixture around the periphery of pathogenic mycobacteria growing in vivo, probably within the phagocytic vacuole of macrophages . To examine the role of such a postulated lipid complex in mycobacterial infection, a model experiment was made in which tubercle bacilli grown in vitro were "coated" with both lipids and then suspended homogenously in water to serve as an inoculum to infect mice intravenously . Their fate in mouse tissue was compared with that of untreated control bacilli . The results indicated that the lipid "coating" had an infection-promoting effect as revealed by the longer persistence of the treated avirulent bacilli at higher levels of viable counts . When virulent tubercle bacilli were "coated" with the lipid mixture, they became less sensitive to the protective mechanism of BCG-immunized mice. Am Rev Respir Dis, 1976 Aug, 114(2), 353 - 8 Phage type of tubercle bacilli isolated from patients with two or more sites of organ involvement; Bates JH et al.; To evaluate the possibility of separate pulmonary infections in human beings by different strains of Mycobacterium tuberculosis, a search for multiple phage types within a single host was under-taken . Culture isolates from 2 or more distinct anatomic sites of infection in the same patient were obtained from 87 persons . In 3 subjects, 2 distinct phage types were found . The possible explanations for 2 types in the same patient and the epidemiologic implications are discussed. Am Rev Respir Dis, 1976 Aug, 114(2), 407 - 9 A new heat-stable acid phosphatase test for mycobacteria; Saito H et al.; The heat-stable (70degrees C) acid phosphatase test performed by the method of Kind and King is a simple method for differentiating Mycobacterium kansasii, M . marinum, M . gastri, M . nonchromogenicum, and M . triviale from other slowly growing mycobacteria, and M . fortuitum from other rapidly growing acid-fast bacilli. Zh Mikrobiol Epidemiol Immunobiol, 1976 Aug, (8), 66 - 9 {Blood groups of the ABO system of chronic carriers of typhoid bacteria and typhoid patients in Uzbekistan}; Nevskii MV et al.; Blood groups of the ABO system were studied in 186 chronic carriers of typhoid bacilli and in 392 patients with typhoid fever from various districts of the Uzbek SSR . In comparison with control (healthy persons), carriers displayed a higher percentage of persons with A (II) blood group (50.88 and 42.64 against 37.51 and 32.13 in control) and a lesser percentage of persons with the O (I) blood group (21.05 and 22.48 against 32.93 and 32.07 in control) . These data demonstrated that predisposition of persons with the A (II) blood group to chronic typhoid carrier state was characteristic of the Asian part of the country . In comparison with control, there were significantly less persons with the O (I) blood group and more with the AB (IV) blood group . Possible correlative mechanisms between the blood group and the typhoid infection and the development of chronic typhoid carrier state is discussed. South Med J, 1976 Aug, 69(8), 993 - 6 Recent advances in experimental leprosy; Kirchheimer WF; Within the last 15 years we have learned to identify Mycobacterium leprae, determine its viability, screen the efficacy of antileprosy drugs, and monitor the bacilli for drug sensitivity . We have evidence that subclinical infections occur frequently among contacts of patients with leprosy and that the different manifestations of leprosy reflect differences in resistance to M leprae . We are developing hypotheses about the mechanism of these differences . We have experimentally transmitted lepromatous leprosy to normal armadillos, and from these we can obtain amounts of leprosy bacilli which fully substitute for harvests from in vitro cultures . Furthermore, if susceptibility of armadillos can be determined without infecting them and if we can breed them under controlled conditions, we would have an animal model for investigating fundamental and applied areas of leprosy which otherwise are intractable . How much our knowledge has advanced is illustrated by a project of the World Health Organization which calls for the preparation of pure, specific antigens from the now available abundance of leprosy bacilli, which might become valuable as diagnostic and epidemiologic tools and as immunoprophylactic and even immunotherapeutic weapons. No Shinkei Geka, 1976 Jul, 4(7), 707 - 13 {Successfully operated case of posterior fossa tuberculoma in childhood (author's transl)}; Ottomo M et al.; A case of intracerebellar tuberculoma is described in which a tuberculoma was removed successfully through the administration of antituberculous agents, and a full recovery was obtained . The patient was a 3-year-old boy who had been receiving antituberculous agents for about 4 months because of acute inflammation followed by osteomyelitis of his right big toe, which was suspected to be tuberculous, and because of pulmonary tuberculosis diagnosed in a chest roentgenogram taken about 1 month after osteomyelitis was cured . While his osteomyelitis was being treated, disturbance in his gait, due to progressive spastic paraparesis, was not iced, and thereafter left cerebellar symptoms with impairment of equilibrium appeared additionally . Then, he was reffered to our clinic for further neurosurgical examination, and was admitted on November 1, 1974 after right carotid and vertebral angiography was performed via the right axillar artery, in which findings suggesting left cerebellar tumor and internal hydrocephalus were obtained . After he was admitted to our clinic, a diagnosis of tumor of the left cerebellum and internal hydrocephalus was more precisely confirmed by pneumoventriculography . Suboccipital craniectomy was then carried out and the tumor, weighing 60 gm, was completely removed from the left cerbellar hemisphere . The tumor was confirmed as tuberculoma not only by histological findings but also by the vertification of tuberculous bacilli in it . Though, moderate fever lasted for about 2 weeks postoperatively, no obvious meningitic signs or new neurological deficits were noted . The patient showed marked improvement especially in his gait disturbance, and was discharged ambulatory 40 days after the operation, and has since been asymptomatic except for slight ataxic gait . The antituberculous agents have been continuously administered postoperatively. Avian Dis, 1976 Jul-Sep, 20(3), 587 - 92 Isolation of Mycobacterium avium serotype 3 from a white-headed tree duck (Dendrocygna viduata); Thoen CO et al.; Tuberculous lesions were observed at necropsy in the liver of 1 of 10 White-headed Tree ducks (Dendrocygna viduata) imported from Nigeria . Microscopic examination revealed granulomas with acid-fast bacilli; Mycobacterium avium serotype 3 was isolated . Two chickens inoculated intraperitoneally with the isolant had gross and microscopic granulomas in the liver at necropsy 62 days after inoculation . Isolants from chickens were serologically similar to the strain isolated from the duck. Res Vet Sci, 1976 Jul, 21(1), 117 - 8 Aggregation and anticomplementary activity of an antigen used in the complement fixation test for Johne's disease; Morris JA et al.; Exhaustive lipid extraction of the Johne's bacilli before preparing the Maltaner-Wadsworth antigen removed both the anticomplementary activity of the preparation and its ability to fix complement . Gel filtration temporarily removed anticomplementary activity but tended to reduce the antigenic activity of the extract . Sonication significantly reduced the anticomplementary activity of the antigen without affecting its capacity to fix complement but the effects were only temporary . It is suggested that the antigen exists as micelles which gradually aggregate and re-arrange thereby exposing anticomplementary sites hitherto masked in the dispersed micelles. Crit Care Med, 1976 Jul-Aug, 4(4), 211 - 4 Airway maintenance in patients with long-term endotracheal intubation; Comer PB et al.; Long-term endotracheal intubation in seriously ill patients is frequently complicated by nosocomial infection of the tracheobronchial tree, especially with aerobic gram negative bacilli . A further complication is drying of pulmonary secretions unless the medical gases given are humidified . The performance characteristics of humidifying system used in spontaneously breathing, intubated patients is described . This system possesses the potential to decrease infection, provides physiologic humidification without nebulization, and, by avoiding air dilution, allows the administration of a precisely regulated FIO2. Arch Ophthalmol, 1976 Jul, 94(7), 1173 - 4 Penetration of tobramycin sulfate in the aqueous humor of the rabbit; Uwaydah MM et al.; The intraocular penetration of tobramycin sulfate, a new aminoglycoside antibiotic, was evaluated in rabbits following subconjunctival injection . The mean tobramycin sulfate concentration in the aqueous humor 60 minutes after a single 5-mg dose was 5.5 mug/ml, as compared to a mean concentration of 6.7 mug/ml following a single 10-mg dose . These levels exceed the minimal inhibitory concentration (MIC) for most Pseudomonas species and a variety of other Gram-negative bacilli recovered from clinical infection . No anterior segment changes that may be attributed to the antibiotic could be demonstrated in the injected eye. Ann Intern Med, 1976 Jul, 85(1), 64 - 6 Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis; Koonitz CH et al.; In a prospective study at two medical centers, 42 consecutive patients with suspected sarcoidosis underwent transbronchial lung biopsy during fiberoptic bronchoscopy . Transbronchial biopsy revealed noncaseating granulomas in 24 of the 38 cases (63%) in which adequate tissue was obtained . Special stains and cultures for acid-fast bacilli and fungi were negative, and sarcoidosis was subsequently diagnosed in all 42 cases . Positive biopsies were obtained in 11 of 20 patients with radiographic stage I disease, in 11 of 15 with stage II disease, and in 2 of 3 with stage III disease . There was a higher probability of a positive biopsy in patients with high symptom scores for cough, wheezing, and dyspnea, and in those with a vital capacity of less than 80% of predicted . The only complication was one small pneumothorax, which spontaneously resolved . Transbronchial lung biopsy is an attractive initial procedure for obtaining histologic confirmation of sarcoidosis. Am J Vet Res, 1976 Jul, 37(7), 775 - 8 Tuberculosis in brood sows and pigs slaughtered in Iowa; Thoen CO et al.; Mycobacterium avium was isolated from 21 of 23 lymph nodes with lesions collected from 23 brood sows and from 17 lymph nodes with lesions of 17 pigs slaughtered at an abattoir in north central Iowa . Mycobacterium avium serotype 2 accounted for more than 65% of the isolations in sows and in pigs . Granulomas with acid-fast bacilli were found in 15 of 23 tissues from brood sows and in 13 of 17 lymph nodes from pigs . Similar microscopic lesions were observed in the sows and pigs. Int J Lepr Other Mycobact Dis, 1976 Jul-Sep, 44(3), 346 - 58 The role of protein malnutrition in the pathogenesis of ulcerative "Lazarine" leprosy; Skinsnes LK et al.; 1 . Clinical and necropsy observations in lepromatous leprosy associated with severe emaciation and accompanying hypoproteinemia suggest that protein deprivation may be of pathogenic significance in the ulcerative phenomenon that is designated "Lazarine leprosy" . 2 . An experimental utilizing Wiersung rats infected with Mycobacterium lepraemurium and maintained on a protein-free diet was developed for the purpose of studying the effect of protein starvation on the course of chronic mycobacterial disease similar to lepromatous leprosy with respect to pathogen and host inflammatory response . 3 . It was possible to maintain the experimental animals on a protein-free diet for up to 18 weeks of concomitant M . lepraemurium infection . This was long enough for the infection to disseminate to a degree that was evident in control animals only several weeks later . 4 . The protein-deprived animals showed decreased inflammatory response to the pathogen, presented more rapid dissemination of the infection and harbored more bacilli per macrophage than did animals similarly infected but maintained on a protein adequate diet . This indicates impairment of native cellular immunity by protein deprivation through decrease in ability of macrophages to inhibit bacillary multiplication . 5 . There was no evidence of impairment of macrophage ability to phagocytose the pathogens . 6 . Morphologically the increased dissemination of pathogens and decrease in inflammatory response was similar to the increase in number and extent of visceral lesions seen in Lazarine leprosy . Decreased ability to dispose of the infecting bacilli was similar in the two models, human and animal . The animal model does not, as does lepromatous leprosy, involve the skin in the infection . Hence comparable ulcerative phenomena were not replicated in the animals . 7 . It is suggested that Lazarine leprosy may result from enhanced lepromatous leprous infection occurring as a result of protein malnutrition . The pathogenic mechanism appears to be impairment of cellular immunity probably enhanced by concomitant impairment of humoral antibody immunity resulting also in decreased resistance to pyogenic and other secondary pathogens . The tissue edema attendant on decreased serum osmotic pressure due to lowering of the serum protein fractions enhances the probability of ulceration. Proc Natl Acad Sci U S A, 1976 Jul, 73(7), 2510 - 4 Prevention of phagosome-lysosome fusion in cultured macrophages by sulfatides of Mycobacterium tuberculosis; Goren MB et al.; Intracellular parasites (e.g., Mycobacterium tuberculosis, Toxoplasma gondii, and some Chlamydiae) may promote their survival within the host by acting from within phagosomes to prevent phagolysosome formation, thus avoiding exposure to the lysosomal hydrolases . The present studies demonstrate that when sulfatides of M . tuberculosis (anionic trehalose glycolipids largely responsible for the neutral red reactivity of virulent strains) are administered to cultured mouse peritoneal macrophages, they accumulate in the secondary lysosomes, which are rendered incompetent for fusion with phagosomes containing suitable target particles such as viable yeasts . This antifusion effect is also exhibited when small amounts of sulfatide are introduced directly into phagosomes by attachment to the target yeasts prior to their ingestion . The sulfatides evidently exert a selective inhibitory influence on membrane fusion, analogous to what occurs typically when macrophage cultures are infected with tubercle bacilli . This effect may be due to ionic interaction between the polyanionic micelles of bacterial sulfatide and organelle membranes, modifying the latter and inducing dysfunction. Health Lab Sci, 1976 Jul, 13(3), 179 - 83 Three simple tests as an adjunct to the niacin test for the small mycobacteriology laboratory; Gruft H; With the change in the management of tuberculosis, many bacteriology laboratories should be prepared to examine sputum for the presence of acid-fast bacilli . The niacin test is the most reliable test that can be performed in any mycobacteriology laboratory to differentiate Mycobacterium tuberculosis from the other acid-fast bacilli, but it is not perfect . Other tests can be used to supplement it are cord formation, growth at 24 C, and the catalase test at 68