Tubercle最新文献

Adenosine deaminase activity was measured in cerebrospinal fluid of patients with confirmed tuberculous and bacterial meningitis. The values were compared with those of control subjects without meningitis. A statistically significant increase in the level of this enzyme was noted in the two types of meningitis, but no definite demarcation in the levels was observed between the two types. Therefore increases in adenosine deaminase activity may not be of such diagnostic significance as reported elsewhere.

We reviewed 25 patients submitted to transthoracic fine-needle aspiration (TFNA) who had a final diagnosis of pulmonary tuberculosis. In all cases, bacteriological stains and cultures of sputum and bronchial washing had been performed before admission and were negative. According to the material obtained from the procedure, the aspirates were divided in three groups: diagnostic (Ziehl-Neelsen and/or culture positive, n = 8, 32%), suggestive (granulomatous inflammatory changes, n = 10, 40%) and inconclusive (nonspecific inflammatory changes, isolated giant cells and/or blood, n = 7, 28%). On chest X-ray, 12 patients had opacities with the greatest diameter not exceeding 4 cm. All aspirates in the diagnostic group were from patients with this type of lesion, while all the inconclusive aspirates belonged to patients with larger lesions. As complications, 1 patient needed thoracic drainage for pneumothorax and 3 patients had haemoptyses.

Thus TFNA has a place in the diagnosis of suspected pulmonary tuberculosis when more simple methods have failed, and its effectiveness seems to be increased when the lesions do not exceed 4 cm in diameter.

Mycobacterium malmoense was isolated from sputum and gastric lavage from a 68-year-old man with gastric adenocarcinoma. The patient meets the criteria for diagnosis of pulmonary mycobacteriosis. The cultural, physiological and biochemical properties of the isolates were compared with other slowly growing myoobacterial species. Fatty and mycolic acid analyses revealed the presence of 2-methyleicosanoic and 2,4,6-trimethyltetracosanoic acids and α-, α′-and ketomycolates, all regarded as typical for M. malmoense. The possible origin of M. malmoense infections and methods for laboratory diagnosis are discussed. This is the first case of documented infection due to this organism in of documented infection due to this organism in Belgium.

96 AIDS patients with fever and either acid-fast bacilli on microscopic examination of bacteriological samples or mycobacteria isolated by culture were treated with a daily 4-drug combination of 7–10 mg/kg rifabutin, 5 mg/kg isoniazid, 20 mg/kg ethambutol and 100 mg clofazimine.

46 patients were excluded from efficacy assessment: 13 died before or within the first days of treatment, 5 had negative initial cultures, 14 had initial cultures positive for M. tuberculosis, 4 for M. kansasii, 1 for M. flavescens, 1 for M. gordonae, 7 were lost to follow-up and 1 received no rifabutin.

In the 50 remaining patients, 31 had disseminated disease due to M. avium intracellulare complex (MAIC) and 19 had apparently localised disease, due to MAIC in 15 cases and to M. xenopi in 4 cases. Side-effects led to withdrawal of isoniazid in 1 case (hepatic enzymes increased) and rifabutin in another (thrombocytopenia). After 1 month of treatment, fever decreased from 38.4 ± 0.6 °C to 37.7 ± 0.5 °C (p < 0.01) and patients stopped losing weight. After 3 months treatment, only 37 patients were alive and still under treatment. Cultures became negative in 16 of 23 patients with available bacteriological data (9 of 14 patients with disseminated disease and 7 of 9 patients with localised disease), relapse occurred before death in 4 patients. 34 patients died before treatment was completed. Death was considered to be related to mycobacterial infection in 5 cases.

We conclude that the 4-drug combination is safe and, in some cases, it appears to be effective.

Mycobacterium avium-intracellulare (MAI) can utilize paraffin wax as the sole carbon source in basal media. Paraffin slide culture (Para SL/C) has been employed for isolation and speciation of MAI derived from clinical sources. We have evaluated an adaptation of this method for antimicrobial sensitivity testing. Sixteen clinical isolates of MAI were tested against ciprofloxacin amikacin, and azithromycin by Para SL/C and compared with sensitivities obtained with a conventional troth microtiter procedure. The system can be performed rapidly over a median time interval of 6–8 days. The MIC was defined as the lowest concentration of antimicrobial agent necessary to inhibit growth on paraffin wax coated slides. With Para SL/C, the MIC values were determined at the time when the corresponding control tubes showed confluent growth. The procedure was reproducible with all of the agents tested. The MIC₅₀ and MIC₉₀ values obtained from the Para SL/C assay and from serial broth microtiter dilutions correlated well for ciprofloxacin and amiacin. However, results of the MIC₅₀ and MIC₉₀ for azithromycin did not correlate.

This review, the third in the series on cellular immune reactivity to tubercle bacilli in the centenary year of Koch's classical paper describing this phenomenon and its possible implications [1], represents an immunogenetic point of view. In fact this will be quite a broad point of view by an immunogeneticist who is not hampered by specific knowledge on therapy or prevention of tuberculosis. In this respect I probably do not differ very much from Robert Koch 100 years ago! An important difference, however, is that we think we now understand a great deal of the cellular and molecular basis of the immunological phenomena observed by Koch. Immunogenetics has contributed considerably to our current understanding and I will try to review that contribution here. Because thus far my main research interest has been in another mycobacterium, namely Mycobacterium leprae, I will use M. leprae and leprosy as an example to illustrate some ideas. The message of this review is that there is a reason for optimism: the knowledge recently gained by cellular and molecular immunologists as well as immunogeneticists has straightforward implications for the rational development of subunit vaccines and immunotherapeutic strategies.

In vitro antimicrobial activity of fleroxacin (6,8- difluoro-1-(2-fluoroethyl)-1, 4-dihydro-7- (4-methyl-1 -piperazinyl) -4-oxo-3-quinolinecarboxylic acid) and ofloxacin against representative pathogenic mycobacteria was evaluated by the agar dilution method, using 7H11 agar medium. Fleroxacin showed appreciable antimicrobial activity against Mycobacterium tuberculosis (MIC₉₀=6.25 mg/l), M. kansasii (MIC₉₀=3.13 mg/l), and M. fortuitum (MIC₉₀=6.25 mg/l), whereas M. marinum, M. scrofulaceum, M. avium, M. intracellulare, and M. chelonae were highly resistant to the agent. The activity of fleroxacin was comparable to that of ofloxacin. Fleroxacin showed antimicrobial activity against M. intracellulare phagocytosed in murine peritoneal macrophages at a concentration of 10 mg/l in the culture medium, but its activity was considerably lower than that of ofloxacin. On the other hand, the therapeutic activity of fleroxacin against M. fortuitum infection induced in mice was higher than that of ofloxacin. Neither fleroxacin nor ofloxacin was efficacious against M. intracellulare infection. Fleroxacin significantly depressed the growth of M. leprae in the mouse footpad.

The aim of this study was to determine whether simultaneous and sequential skin testing with tuberculin and sensitins give consistent results. A total of 475 8- or 9-year-old schoolchildren were skin tested sequentially, at an interval of 3 days, with PPD tuberculin and with either Mycobacterium scrofulaceum or M. avium sensitin. The results were compared with those of 470 simultaneously tested children chosen from the same living area.

There were no statistically significant differences between the frequencies of the reactions of sequentially and simultaneously tested children. When the sequential testing procedure was employed, 3.1% reacted to tuberculin, 19% to M. avium sensitin and 30% to M. scrofulaceum sensitin, taking a 6 mm cut-off. The corresponding figures for the simultaneously tested children were 4.7, 21 and 36%, respectively. Thus, there was no indication that the simultaneous testing procedure in itself influenced the results, neither was there any sign of a booster effect when testing in sequence with an interval of 3 days in non-BCG-vaccinated children.