TUBERCULOSIS
Diagnosis, Diagnostics, Immunodiagnosis
& Immunodiagnostics:
ABSTRACT
3478.
Abbadi S.
Rashed HG. Morlock GP. Woodley CL.
El Shanawy O. Cooksey RC.
Characterization of IS6110 restriction fragment length polymorphism patterns
and mechanisms of antimicrobial resistance for multidrug-resistant isolates of
Mycobacterium tuberculosis from a major reference hospital in Assiut, Egypt.
Journal of Clinical Microbiology.
39(6):2330-4, 2001 Jun.
Abstract
We
evaluated 25 Mycobacterium tuberculosis isolates from patients at a major
Egyptian reference hospital in Assiut, Egypt, who had been treated for at least
1 year for tuberculosis. Typing patterns (IS6110) were diverse, and multidrug
resistance was found among 11 (44%) of the isolates. Mutations associated with
antimicrobial drug resistance were found in rpoB, katG, rpsL, and embB in the
resistant isolates.
3479.
Abe C.
Hirano K. Wada M. Aoyagi T. Resistance of Mycobacterium
tuberculosis to four first-line anti-tuberculosis drugs in Japan, 1997.
International Journal of Tuberculosis & Lung Disease. 5(1):46-52, 2001 Jan.
Abstract
SETTING:
Five years after the last survey of drug-resistant tuberculosis in Japan, a
nationwide survey was conducted by the Tuberculosis Research Committee.
OBJECTIVE: To determine the prevalence of and risk factors for resistance to
four first-line anti-tuberculosis drugs. DESIGN: Cultures were obtained from
patients hospitalized at 78 hospitals in different districts of Japan throughout
a 6-month period, 1 June-30 November 1997. Drug susceptibility testing was
carried out at the Research Institute of Tuberculosis, Tokyo, one of the
supranational reference laboratories of the WHO/IUATLD global project. RESULTS
AND CONCLUSION: Among patients with no prior treatment, resistance to any of
the four drugs was found in 10.3%, and the prevalence of primary multidrug
resistance (MDR) was 0.8%. The prevalence of acquired resistance was 42.4% for
any of the four drugs and 19.7% for MDR, indicating a high prevalence rate
compared with those reported in the WHO/IUATLD global project. About 73% of
resistant isolates from new cases were resistant to one drug, while 64.3% of
resistant isolates from the re-treatment cases were resistant to two or more
drugs (P < 0.0001). No significant differences in resistance rates by sex,
age group, nationality, district, and/or accompanying diseases were observed in
any of the new or re-treatment cases. Other factors associated with the high
prevalence in re-treatment cases remain to be determined.
3480.
Agger EM.
Andersen P. Tuberculosis subunit vaccine development: on the role of
interferon-gamma. Vaccine. 19(17-19):2298-302, 2001 Mar 21.
Abstract
Tuberculosis (TB) remains a major global health problem and subunit vaccines for the control of the disease are presently under development. This vaccine strategy requires an in vitro correlate of protection for the identification of relevant vaccine candidate antigens and for monitoring the induction of a protective cell-mediated immune response after vaccination. New studies of experimental vaccines in the mouse model of TB support interferon-gamma as a relevant marker for the induction of a protective immune response. In contrast, searching for immunodominant antigens capable of inducing strong interferon-gamma responses in PPD positive healthy or TB infected individuals may not identify all relevant candidate antigens for inclusion in a novel TB subunit vaccine.
3481.
Agrawal S.
Thomas NS. Dhanikula AB. Kaul CL.
Panchagnula R. Antituberculosis drugs and new drug development. [Review]
[31 refs] Current Opinion in Pulmonary Medicine. 7(3):142-7, 2001 May.
Abstract
Tuberculosis affects more than 8 million people and has serious repercussions on economic, psychologic, and social status. Since its declaration as a global emergency in 1993 by the World Health Organization, significant development in the treatment and control of tuberculosis has been the implementation of the short-course directly observed treatment along with fixed dose combinations of existing drugs. However, the currently available therapeutic regimens have inherent disadvantages of long treatment duration, patient noncompliance, and risk of drug resistance. Hence, new antituberculosis drugs that are potent, are active against resistant strains and latent forms, and reduce the treatment period are needed to combat this disease. In this review, the authors discuss new chemical entities that in their opinion have a potential to become new antituberculosis drugs. This article emphasizes the role of biopharmaceutics and pharmacokinetics as an indispensable part in the development of new antituberculosis drugs to overcome the common hurdles such as exorbitant cost, time, and attrition rate involved in the process. [References: 31]
3482.
Ahmed A.
Pereira SP. Steger A. Starke I. Abdominal tuberculosis: the great
mimic. [see comments]. Hospital Medicine (London). 62(6):368-9, 2001 Jun.
3483.
Ahuja A.
Ying M. Yuen YH. Metreweli C. Power Doppler sonography to
differentiate tuberculous cervical lymphadenopathy from nasopharyngeal
carcinoma. Ajnr: American Journal of Neuroradiology. 22(4):735-40, 2001 Apr.
Abstract
BACKGROUND AND PURPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcinoma are common in Asians and are often indistinguishable clinically. Because their treatment depends on prompt diagnosis, we undertook this study to evaluate if power Doppler sonography could distinguish these two pathologic abnormalities. The intranodal vascular appearances of tuberculous neck nodes are compared with benign reactive neck nodes and metastatic nodes from nasopharyngeal carcinoma. METHODS: The appearances of power Doppler sonograms of 42 tuberculous nodes were compared with 28 metastatic nodes from nasopharyngeal carcinoma and 27 benign reactive nodes. The intranodal distribution of vessels and the intranodal vascular resistance of vessels were compared among these three groups. All examinations were performed by the same sonologist (A.A.), who had more than 3 years' scanning experience, and all data analysis was performed by the same investigator (M.Y.). RESULTS: The intranodal vascular distribution in tuberculous nodes was varied and simulated both benign and malignant disease. Avascularity of nodes and displacement of hilar vascularity were frequent in tuberculous nodes. Metastatic nodes from nasopharyngeal carcinoma (resistive index [RI], 0.81+/-0.09; pulsatile index [PI], 1.91+/-0.81) had a higher vascular resistance than did tuberculous nodes (RI, 0.71+/-0.11; PI, 1.34+/-0.55). Tuberculous nodes had a higher vascular resistance than did reactive nodes (RI, 0.66+/-0.09; PI, 1.10+/-0.26). CONCLUSION: Avascularity, displaced hilar vessels, and low intranodal vascular resistance are clues that may suggest the tuberculous nature of neck nodes. However, there is overlap of appearance between tuberculous nodes, benign reactive neck nodes, and metastatic nodes. Thus, histologic analysis is often required for a definitive diagnosis.
3484.
Akpede GO.
Akenzua GI. Management of children with prolonged fever of unknown
origin and difficulties in the management of fever of unknown origin in
children in developing countries. [Review] [90 refs] Paediatric Drugs. 3(4):247-62, 2001.
Abstract
This is Part II of a 2-part paper on fever of unknown origin (FUO) in children. It examines the aetiology and management of prolonged FUO in children and the difficulties in the management of FUO in children in developing countries. Part I of this paper discussed acute FUO in children and was published in the March 2001 issue of Paediatric Drugs. Prolonged FUO is documented fever of more than 7 to 10 days which has no apparent source and no apparent diagnosis after 1 week of clinical investigations. About 34% of cases of prolonged FUO are caused by infections, with bacterial meningitis and urinary tract infection accounting for about 6.5 and 11.4%, respectively, of cases attributable to infections. Chronic infections, particularly tuberculosis and 'old' disorders such as Kawasaki disease, cat-scratch disease and Epstein-Barr virus infection presenting with 'new' manifestations, collagen-vascular diseases and neoplastic disorders are the other issues of major concern in prolonged FUO. Overall, however, there is a trend towards an increased number of undiagnosed cases. This is due to advancements in diagnostic techniques, such that illnesses which were previously common among the causes of prolonged FUO are now diagnosed earlier, before the presentation becomes that of prolonged FUO. Clinical examination supplemented with laboratory tests to screen for serious bacterial infections should be the mainstay of initial evaluation of children with prolonged FUO. Use of scanning techniques (such as computerised tomography and ultrasound) as additional supplements to this clinical examination may allow for the earlier diagnosis of causes of prolonged FUO in children such as 'occult' abdominal tumours. A common error in management of children with prolonged FUO is the failure to perform a complete history and physical examination; repeated clinical examination and continued observation are of paramount importance in the diagnosis of difficult cases. Major difficulties in the management of FUO in children in developing countries include constraints in the availability and reliability of laboratory tests, cost, misuse of antibiotics and difficulties encountered in the diagnosis of malaria and typhoid fever. Malaria and typhoid fever are major aetiological considerations in both acute and prolonged FUO in children in developing countries. The newer quinolones may hold great promise for the treatment of serious bacterial infections, including meningitis, which are associated with prolonged FUO in developing countries. [References: 90]
3485.
Al-Serhani AM. Al-Mazrou
K. Pharyngeal tuberculosis. American Journal of Otolaryngology. 22(4):236-40, 2001 Jul-Aug.
Abstract
PURPOSE: To increase awareness of tuberculosis (TB) as an important differential diagnosis of lesions in the pharynx and discuss its presentation. PATIENTS AND METHODS: The study included nine patients (2 males and 7 females); each with a diagnosis of primary pharyngeal tuberculosis (PTB). Of these, 3 had nasopharyngeal TB, 5 had tonsillar TB, and 1 had hypopharyngeal TB. The diagnostic criteria were either positive culture, positive smear, or histopathologic features of caseating granuloma consistent with TB in the biopsy specimen and a response to treatment. RESULTS: All patients had primary infection. The main presenting symptom in all nasopharyngeal TB was neck mass, whereas tonsillar TB patients presented with sore throats or discomfort. Dysphagia was the presenting symptom in hypopharyngeal TB. Six patients (3 with nasopharyngeal TB and 3 with tonsillar TB) had cervical adenopathy. The smear for acid-fast bacillus was positive in 4 patients (44.4%); culture was positive in 2 patients (22.2%). Histopathologic features of caseating granuloma, consistent with TB, were positive in all patients who received antituberculous medications. CONCLUSION: Otolaryngologists should consider pharyngeal TB as one of the differential diagnosis of lesions of the pharynx especially in those countries where TB is endemic.
3486.
Altare
F. Ensser A. Breiman A. Reichenbach
J. Baghdadi JE. Fischer A.
Emile JF. Gaillard JL. Meinl E.
Casanova JL. Interleukin-12 receptor beta1 deficiency in a patient with
abdominal tuberculosis. Journal of
Infectious Diseases. 184(2):231-6, 2001
Jul 15.
Abstract
Two siblings with interleukin-12 receptor beta1 (IL-12Rbeta1) deficiency but different clinical phenotypes were studied. Both are homozygous for an IL12RB1 missense mutation that prevents receptor expression and abolishes cellular responses to IL-12. Transfection of the patients' T cells with wild-type IL12RB1 restored IL-12Rbeta1 expression and function. One patient had the expected phenotype of disseminated bacille Calmette-Guérin (BCG) infection in early childhood, whereas the other did not develop BCG infection, despite 3 inoculations with live BCG. Abdominal tuberculosis was diagnosed in this second patient at age 18 years. To date, neither of them has had clinical disease caused by environmental mycobacteria. These observations show unexpected interfamilial and intrafamilial heterogeneity of the clinical phenotype associated with IL-12Rbeta1 deficiency. The patients may be resistant to BCG but remain vulnerable to Mycobacterium tuberculosis. A diagnosis of IL-12Rbeta1 deficiency should therefore be considered in selected patients with severe tuberculosis, despite their resistance to BCG and a lack of atypical mycobacteriosis.
3487.
Antinori
S. Galimberti L. Parente F. Intestinal tuberculosis as a
cause of chronic diarrhoea among patients with human immunodeficiency virus
infection: report of two cases. Digestive & Liver Disease. 33(1):63-7, 2001 Jan-Feb.
Abstract
In Western countries human immunodeficiency virus infection is considered the main risk factor of tuberculous disease, its incidence being 500 times higher in HIV-infected patients than in the general population. Despite the disease frequently present in these patients with extraintestinal manifestations, intestinal localization is rarely observed and often as a consequence of complications such as acute gastrointestinal bleeding or perforation. The diagnosis of intestinal tuberculosis is difficult and is often delayed due to the lack of specific signs and symptoms as well as the low sensitivity of routine methods. A review of the literature is made and personal experience in the diagnosis of two cases is reported.
3488.
Asai S.
Miyachi H. Suzuki K. Shimamura K. Ando Y. Ultrasonographic differentiation between tuberculous
lymphadenitis and malignant lymph nodes. Journal of Ultrasound in
Medicine. 20(5):533-8, 2001 May.
Abstract
OBJECTIVE: To assess the usefulness of ultrasonography in the differential diagnosis of cervical tuberculous lymphadenitis versus malignant lymph nodes. METHODS: Ultrasonography of cervical lymph nodes was performed with a real-time linear scanner using a 7.5- or 11-MHz probe or both. Ultrasonographic findings were retrospectively reviewed in 73 patients: 49 with malignant lymphoma, 15 with tuberculous lymphadenitis, and 9 with metastatic lymph nodes. RESULTS: Ultrasonographic features specific to cervical tuberculous lymphadenitis were strong echoes (33.3%) and an echogenic thin layer (86.7%). When the lymph nodes had at least 1 of these 2 features, tuberculous lymphadenitis was diagnosed with a sensitivity of 100% and a specificity of 100%. CONCLUSIONS: Ultrasonographic evaluation of cervical lymph nodes can be useful in the diagnosis of cervical tuberculous lymphadenitis.
3489.
Ashford DA.
Whitney E. Raghunathan P. Cosivi O. Epidemiology of selected mycobacteria
that infect humans and other animals. [Review] [156 refs] Revue Scientifique et
Technique. 20(1):325-37, 2001 Apr.
Abstract
This paper provides a summary of salient clinical and epidemiological features of selected mycobacterial diseases that are common to humans and other animals. Clinical and diagnostic issues are discussed and related to estimates of the incidence and prevalence of these diseases among humans. Source of infection, route of transmission and control measures are also presented. The mycobacteria discussed in this paper are Mycobacterium bovis, M. ulcerans, M. leprae and M. avium complex, although this is by no means a complete list of the mycobacteria common to humans and other animals. Certain generalities can be made regarding these species of mycobacteria and their occurrence in humans and other animals; firstly, current understanding of the epidemiology and control of many of the resultant diseases is incomplete; secondly, environmental sources other than animal reservoirs may play a role in transmission (with M. leprae perhaps being the exception); and thirdly, the incidence and prevalence of these diseases in many countries of the world are unclear, principally because of the complexity of diagnosis and lack of reporting systems. [References: 156]
3490.
Bedwell
J. Kairo SK. Behr MA. Bygraves JA.
Identification of substrains of BCG vaccine using multiplex PCR. Vaccine. 19(15-16):2146-51, 2001 Feb 28.
Abstract
Current
methods for determining the identity of substrains of Mycobacterium bovis BCG
(BCG) vaccine are labour intensive, or provide only limited substrain
differentiation. In this paper we describe a multiplex PCR that distinguishes
between M. tuberculosis (TB) and M. bovis and the non-pathogenic BCG strain,
and also subdivides the BCG vaccine substrains investigated into seven distinct
fingerprints based on six target regions in the DNA. This test is specific,
rapid, reproducible and portable and is proposed as a novel test for BCG
vaccine control. It offers substantial advantages over the methods currently in
use. Using this test we have characterised a number of commercial BCG vaccines.
3491.
Behr MA. Comparative genomics of BCG vaccines.
[Review] [30 refs] Tuberculosis.
81(1-2):165-8, 2001.
Abstract
Bacille Calmette-Guérin (BCG)
vaccines have been given to more people than any other vaccine. They have also
probably resulted in as much controversy as any other vaccine. In clinical
trials, the efficacy of BCG vaccination against pulmonary TB has been widely
variable. At the same time, a number of investigators have observed phenotypic
differences between BCG daughter strains, raising the possibility that
differences between BCG products may in some way translate into different
outcomes. With recent genomic analysis of BCG strains, it has become possible
to piece together the molecular events that have resulted in current BCG
vaccines. Between the derivation of BCG in 1921 and the lyophilization of BCG
Pasteur 1173 in 1961, there have been at least seven genetic events, including
deletions, duplications and a single nucleotide polymorphism. The phenotypic
relevance of these changes in BCG vaccines remains to be explored. Copyright
2001 Harcourt Publishers Ltd. [References: 30]
3492.
Bhat S,
Singal N, Aggrawal C S, Jain R C. Knowledge, attitudes and practices of newly
diagnosed sputum positive cases of pulmonary tuberculosis. J Commun Dis.
31(4):247-52, 1999. No Abstract.
3493.
Boudiaf M.
Soyer P. Terem C. Pelage JP.
Maissiat E. Rymer R. Ct
evaluation of small bowel obstruction. [Review] [36 refs] Radiographics. 21(3):613-24, 2001 May-Jun.
Abstract
Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed. [References: 36]
3494.
Brock I.
Munk ME. Kok-Jensen A. Andersen P. Performance of whole blood
IFN-gamma test for tuberculosis diagnosis based on PPD or the specific antigens
ESAT-6 and CFP-10. International Journal of Tuberculosis & Lung
Disease. 5(5):462-7, 2001 May.
Abstract
OBJECTIVE: To evaluate the QuantiFERON-TB test in BCG-vaccinated, non-BCG-vaccinated and tuberculosis (TB) patient donor groups, and to compare its diagnostic performance with that of a blood test based on the Mycobacterium tuberculosis specific antigens ESAT-6 and CFP-10. DESIGN: Analysis of the IFN-gamma responses of whole blood cells from BCG-vaccinated or non-BCG-vaccinated donors or patients with tuberculosis, stimulated with PPD, ESAT-6 or CFP-10 antigens, and evaluation of the specificity and sensitivity of the test. RESULTS: None of the non-vaccinated donors showed positive responses to M. tuberculosis-PPD, ESAT-6 or CFP-10. In BCG-vaccinated donors, 9/19 (47%) donors responded to the QuantiFERON-TB test based on M. tuberculosis-PPD, whereas 2/19 (10.5%) responded to either ESAT-6 or CFP-10. Comparable levels of sensitivity were obtained with the QuantiFERON-TB test based on M. tuberculosis-PPD (79%) and ESAT-6 or CFP-10 antigens (72%). CONCLUSION: Our results demonstrate that the whole blood test based on M. tuberculosis-PPD did not efficiently distinguish BCG-vaccinated donors from individuals with disease due to M. tuberculosis. The introduction of new recombinant antigens specific for M. tuberculosis, such as ESAT-6 or CFP-10, should increase the specificity of the whole blood test and enable discrimination between TB infection, atypical mycobacterial reactivity and reactivity due to BCG vaccination. Such a test would provide a quantum improvement over the current practice of using the tuberculin skin test for TB control and elimination.
3495.
Burgess LJ.
Swanepoel CG. Taljaard JJ. The
use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis.
Tuberculosis. 81(3):243-8, 2001.
Abstract
SETTING: Tygerberg Hospital, an academic hospital in the Western Cape, South Africa.Objective: To determine the diagnostic utility of ascitic fluid adenosine deaminase (ADA) in the diagnosis of tuberculous peritonitis. DESIGN: A prospective study, carried out from February 1995 to February 1998, resulted in 178 paired ascites and serum specimens being collected from adult patients. Specimens were evaluated for biochemistry, ADA, microbiology and cytology; further investigations were done at the treating clinician's discretion. Diagnoses were made according the pre-determined criteria. RESULTS: The median (range) ADA activity in the tuberculous group was 61.6 (17.5--115.0) U/L and was significantly higher than in any other diagnostic group (p<0.05). Using ROC curves, a cut-off level of 30 U/L for the diagnosis of tuberculous peritonitis was found to yield the best results; corresponding sensitivity and specificity was 94% and 92%, respectively. No statistically significant difference in ADA activity was observed when tuberculous ascites occurred in the absence or presence of cirrhosis. CONCLUSIONS: Ascitic fluid ADA activity is useful in identifying those patients in whom the diagnosis of tuberculous peritonitis should be actively pursued to justify its routine use, at least in areas such as South Africa where TB is endemic. The presence or absence of underlying cirrhosis does not appear to distract from its diagnostic utility. Copyright 2001 Harcourt Publishers Ltd.
3496.
Cayli SR.
Onal C. Kocak A. Onmus SH.
Tekiner A. An unusual presentation of neurotuberculosis: subdural empyema.
Case report. Journal of Neurosurgery.
94(6):988-91, 2001 Jun.
Abstract
Tuberculosis continues to be a major public health concern, especially in developing countries. Many types of neurotuberculosis have been described, but there is only one previously reported case of subdural empyema caused by tuberculous bacilli. A 1-year-old boy who had been treated for pulmonary tuberculosis was referred to the authors' institution with a diagnosis of right frontoparietal extraaxial abscess formation. Computerized tomography and magnetic resonance imaging revealed an extraaxial abscess with no evidence of calvarial infection. A craniotomy was performed to drain the pus, which was located subdurally. A polymerase chain reaction test yielded positive results, and histopathological examination revealed caseation. Antituberculous treatment was started after a diagnosis of subdural empyema with related neurotuberculosis had been made. At the end of a 12-month course of medical therapy, the patient was well with no evidence of tuberculosis.
3497.
Cheng
WF. Hung CF. Chai CY. Hsu KF. He L.
Rice CM. Ling M. Wu TC. Enhancement of Sindbis virus
self-replicating RNA vaccine potency by linkage of Mycobacterium tuberculosis
heat shock protein 70 gene to an antigen gene. Journal of Immunology. 166(10):6218-26, 2001 May 15.
Abstract
Recently, self-replicating RNA vaccines (RNA replicons) have emerged as an effective strategy for nucleic acid vaccine development. Unlike naked DNA vaccines, RNA replicons eventually cause lysis of transfected cells and therefore do not raise the concern of integration into the host genome. We evaluated the effect of linking human papillomavirus type 16 E7 as a model Ag to Mycobacterium tuberculosis heat shock protein 70 (HSP70) on the potency of Ag-specific immunity generated by a Sindbis virus self-replicating RNA vector, SINrep5. Our results indicated that this RNA replicon vaccine containing an E7/HSP70 fusion gene generated significantly higher E7-specific T cell-mediated immune responses in vaccinated mice than did vaccines containing the wild-type E7 gene. Furthermore, our in vitro studies demonstrated that E7 Ag from E7/HSP70 RNA replicon-transfected cells can be processed by bone marrow-derived dendritic cells and presented more efficiently through the MHC class I pathway than can wild-type E7 RNA replicon-transfected cells. More importantly, the fusion of HSP70 to E7 converted a less effective vaccine into one with significant potency against E7-expressing tumors. This antitumor effect was dependent on NK cells and CD8(+) T cells. These results indicated that fusion of HSP70 to an Ag gene may greatly enhance the potency of self-replicating RNA vaccines.
3498.
Chiang CY.
Yu MC. Bai KJ. Suo J.
Lin TP. Lee YC. Pulmonary
resection in the treatment of patients with pulmonary multidrug-resistant
tuberculosis in Taiwan. International
Journal of Tuberculosis & Lung Disease.
5(3):272-7, 2001 Mar.
Abstract
SETTING: Chronic Disease Control Bureau, Department of Health, Taiwan. OBJECTIVE: To evaluate the role of pulmonary resection in the treatment of pulmonary tuberculosis resistant to isoniazid and rifampin (MDR-TB). DESIGN: In a retrospective cohort study, 27 MDR-TB patients who underwent pulmonary resection between December 1990 and March 1999 were reviewed. Individually-tailored treatment regimens were selected at a once-weekly staff conference following review of the patient's case history and drug susceptibility results. Surgery was performed for selected patients, essentially those: 1) whose medical treatment had failed, or for whom treatment failure seemed highly likely, or for whom post-treatment relapse seemed likely, 2) with predominantly localised disease, 3) with adequate cardiopulmonary reserve, and 4) whose treatment regimen had been composed of at least two effective drugs to diminish the mycobacterial burden. RESULTS: There was no surgical mortality apart from one peri-operative death (4%). Three patients (11%) developed complications, and 24 (92%) patients demonstrated sputum conversion and/or remained negative after surgery. Twenty-three patients have already completed treatment, and during a mean of 42 +/- 18 follow-up months (range 15-80 months), one patient relapsed. This patient was disease-free after another course of treatment. CONCLUSION: For selected patients, pulmonary resection may improve the outcome of pulmonary MDR-TB.
3499.
Cho SN.
Choi BW. Ra SY. Hong YK.
Park JS. Kim SC. Kim JD.
Choe KO. Prevalence of antibodies to PPD and lipoarabinomannan of
Mycobacterium tuberculosis among patients with an indication of fine needle
aspiration biopsy. Yonsei Medical Journal.
42(3):324-32, 2001 Jun.
Abstract
Recent increase in the incidence of lung cancer often makes it difficult to differentiate between lung cancer and tuberculosis (TB), due to their radiologic similarities. Fine needle aspiration biopsy (FNAB) has been widely employed for the diagnosis of lung cancer and TB, but the diagnostic accuracy of TB is not high enough. As a rapid screening test for tuberculosis, we evaluated serological tests using Mycobacterium tuberculosis PPD and lipoarabinomannan (LAM) antigens. A total of 95 patients with indication of FNAB cytology from initial CT findings were enrolled. 25 patients had TB, 76 thoracic malignancy, and six (7.9%) of the lung cancer patients also had TB, indicating much higher prevalence of TB in thoracic tumor patients. Antibodies to PPD were elevated in 18 (72.0%) of 25 TB patients and in 22 (31.4%) of 70 patients with thoracic malignancy. In contrast, only 3 (4.7%) of 64 healthy controls aged 40 or above were seropositive to PPD antigen. The prevalence of anti-PPD antibodies in thoracic tumor patients was therefore significantly greater than that amongst the healthy controls (p<0.001, chi-square test). However, no significant difference in the prevalence of anti-LAM antibodies was found between study subjects and controls. This study demonstrates that thoracic tumor patients have significantly elevated antibodies to PPD; therefore, high anti-PPD seroreactivity in thoracic tumor patients should be cautiously interpreted. A longitudinal investigation on seropositive thoracic tumor patients is required to determine the role of the serological test for TB in lung cancer patients.
3500.
Chowdhury A.
Santra A. Kundu S. Mukherjee A. Pandit A. Chaudhuri
S. Dhali GK. Induction of oxidative
stress in antitubercular drug-induced hepatotoxicity. Indian Journal of Gastroenterology. 20(3):97-100, 2001 May-Jun.
Abstract
BACKGROUND AND AIM: Oxidative stress could play a role in the pathogenesis of antitubercular drug (ATD)-induced hepatotoxicity. We therefore studied the plasma level of reduced glutathione (GSH) and malondialdehyde (MDA) in patients with ATD-induced hepatotoxicity (cases), ATD-treated controls (disease controls) and in healthy volunteers. METHODS: This study was carried out in a case-control design. Twenty-one cases, 21 age- and sex-matched disease controls, and 10 healthy volunteers were enrolled. Plasma levels of GSH and MDA were measured. RESULTS: Plasma levels of GSH (median [range] 11.5 [6.2-21.2] mmol/dL) and MDA (1390 [560-2310] nmol/dL) of cases were significantly different (p<0.01) from GSH (18.4 [10.5-24.4]) and MDA (290 [240-550]) of disease controls. Further, plasma GSH and MDA levels of both the ATD-treated groups were different from those in healthy controls. CONCLUSION: Lower levels of plasma GSH and higher levels of MDA may be due to oxidative stress resulting from ATD therapy.
3501.
Chugh K. Clinical approach to a patient with
cough. Indian Journal of Pediatrics. 68
Suppl 2:S11-9, 2001 Apr.
Abstract
A number of disorders of the respiratory tract and some even outside the respiratory tract can cause cough. A systematic approach towards a patient of chronic cough consisting of detailed history, physical examination of upper as well as lower respiratory tract, complete blood counts, tuberculin test, chest X-ray, and peak flow rate testing will give the diagnosis in majority of children. Pulmonary tuberculosis and asthma are the two commonest conditions diagnosed. If the initial work up is inconclusive, further laboratory testing and imaging studies should be considered. Thus, radiolabelled milk scan, barium swallow and 24-hour pH monitoring would diagnose gastroesophageal reflux. Spirometry, methacholine/exercise challenge test or a therapeutic trial may be required for confirming bronchial asthma. Flexible bronchoscopy is useful for evaluation for suspected aspiration syndromes and any anatomical or dynamic problem of the airway (e.g. tracheomalacia). Spiral and high resolution computed tomography (HRCT) along with magnetic resonance imaging are the modern day imaging techniques used for studying mediastinal masses, airway obstruction and even lung parenchyma (HRCT). Sputum examination for type of cells and bacteria can be useful, especially if pseudomonas or acid-fast bacilli are identified. Pseudomonas suggests cystic fibrosis (an uncommon disease in India) which can be confirmed by sweat chloride test and gene mutation studies.
3502.
Colaco C. Stressed bacteria and TB vaccines.
Trends in Immunology. 22(8):418, 2001
Aug.
3503.
Dabiri S.
Meymandi SS. Nadji M. Kharazmi A. A description of
parasite-harbouring cells in localized lymphadenitis in dry type cutaneous
leishmaniasis. Acta Tropica. 79(2):129-33, 2001 May 25.
Abstract
Lymphadenitis with or without dry-type cutaneous leishmaniasis is rare. The lesion might self heal or show excellent response to antimonial therapy. Routine histopathological changes of localized leishmaniasis lymphadenitis are non-caseating to suppurative granulomata mostly in paracortical areas, some with extension to germinal centres, medullary cords and/or pericapsular spaces which have to be distinguished from other causes of lymphadenitis such as tuberculosis, cat-scratch disease and toxoplasmosis. Dense lymphoplasmocytic infiltrate was observed surrounding the necrotizing granuloma together with dense capsular fibrosis with multiple granulomata in subcapsular and pericapsular areas. Immunostaining of lymph nodes showed that a few macrophages were harbouring Leishman bodies. Dispersed Langerhans cells were also harbouring Leishman bodies in the parasitophorous vacuoles between their cytoplasmic pseudopods. In conclusion multiple noncaseating to suppurative granulomata with dense pericapsular and capsular granulomo-sclerotic changes should be considered in the differential diagnosis of leishmaniasis lymphadenitis.
3504.
Dannenberg AM Jr. Collins
FM. Progressive pulmonary tuberculosis is not due to increasing numbers of
viable bacilli in rabbits, mice and guinea pigs, but is due to a continuous
host response to mycobacterial products. [Review] [107 refs] Tuberculosis. 81(3):229-42, 2001.
Abstract
Tuberculosis (TB) kills more people in the world today than any other infectious disease. A better vaccine to prevent clinical tuberculosis is greatly needed. Candidate vaccines are often evaluated by infecting rabbits, mice and guinea pigs by an aerosol of virulent tubercle bacilli and culturing their lungs for viable bacilli at various times thereafter. In all three species, however, the number of viable bacilli usually does not continuously increase until the host succumbs. The number of viable bacilli increases logarithmically for only about 3 weeks. Then, the host develops delayed-type hypersensitivity (DTH) and cell-mediated immunity (CMI), which keep the number of viable bacilli rather constant during the subsequent weeks. In the immunized host, DTH and CMI stop the logarithmic increase sooner than in the unimmunized controls, so that the stationary bacillary levels that follow are lower. This review analyzes host-parasite interactions in the lungs of rabbits, mice and guinea pigs. All three species cannot prevent inhaled fully virulent tubercle bacilli from establishing an infection, but they differ markedly in the type of the disease produced once it is established. Copyright 2001 Harcourt Publishers Ltd. [References: 107]
3505.
Dannenberg AM Jr. Pathogenesis of pulmonary Mycobacterium bovis infection: basic
principles established by the rabbit model. [Review] [39 refs]
Tuberculosis. 81(1-2):87-96, 2001.
3506.
de Lisle
GW. Mackintosh CG. Bengis RG.
Mycobacterium bovis in free-living and captive wildlife, including
farmed deer. [Review] [151 refs] Revue Scientifique et Technique. 20(1):86-111, 2001 Apr.
Abstract
Mycobacterium bovis has been isolated from a wide range of wildlife species, in addition to domestic animals. This review examines the role played by various species in the maintenance of M. bovis in wildlife communities and the spread to domestic animals. Badgers (Meles meles), brushtail possums (Trichosurus vulpecula), deer (Odocoileus virginianus), bison (Bison bison) and African buffalo (Syncerus caffer) are examples of wildlife that are maintenance hosts of M. bovis. The importance of these hosts has been highlighted by the growing realisation that these animals can represent the principal source of infection for both domestic animals and protected wildlife species. The range of methods for controlling M. bovis in wildlife is limited. While population control has been used in some countries, this approach is not applicable in many situations where protected wildlife species are concerned. Vaccination is a potential alternative control method, although as yet, no practical, effective system has been developed for vaccinating wildlife against bovine tuberculosis. Tuberculosis caused by M. bovis has also been a problem in captive wildlife and in recently domesticated animals such as farmed deer. Control of M. bovis in this group of animals is dependent on the judicious use of diagnostic tests and the application of sound disease control principles. The advances in the development of bovine tuberculosis vaccines for cattle and farmed deer may offer valuable insights into the use of vaccination for the control of tuberculosis in a range of captive wildlife species. [References: 151]
3507.
Delogu
G. Brennan MJ. Comparative immune
response to PE and PE_PGRS antigens of Mycobacterium tuberculosis. Infection
& Immunity. 69(9):5606-11, 2001
Sep.
3508.
Desarkar
S, Chaudhiri T K, Datta K B. Certain facts and findings about immunodiagnostics
of human pulmonary tuberculosis. Perspective Cytol Genet.(10):95-101, 2001. No Abstract.
3509.
Dixit R,
Gupta R.C, Gupta M.L, Gupta N: Asmptomatic duodenal tuberculosis in HIV
positive patient. Cure med Trends 4(3):729-4,2000. No Abstract.
Abstract
Sequencing of the entire genome of Mycobacterium tuberculosis identified a novel multigene family composed of two closely related subfamilies designated PE and PE_PGRS. The major difference between these two families is the presence of a domain containing numerous Gly-Ala repeats extending to the C terminus of the PE_PGRS genes. We have used a representative PE_PGRS gene from M. tuberculosis, Rv1818c (1818PE_PGRS), and its amino-terminal PE region (1818PE), to investigate the immunological response to these proteins during experimental tuberculosis and following immunization with DNA constructs. During infection of mice with M. tuberculosis, a significant humoral immune response was observed against recombinant 1818PE_PGRS but not toward the 1818PE protein. Similarly, immunization with a 1818PE_PGRS DNA construct induced antibodies directed against 1818PE_PGRS but not against 1818PE proteins, and no humoral response was induced by 1818PE DNA. These results suggest that certain PE_PGRS genes are expressed during infection of the host with M. tuberculosis and that an antibody response is directed solely against the Gly-Ala-rich PGRS domain. Conversely, splenocytes from 1818PE-vaccinated mice but not mice immunized with 1818PE_PGRS secreted gamma interferon following in vitro restimulation and demonstrated protection in the mouse tuberculosis challenge model. These results suggest that the PE vaccine can elicit an effective cellular immune response and that immune recognition of the PE antigen is influenced by the Gly-Ala-rich PGRS domain.
3510.
Dowdy
L. Ramgopal M. Hoffman T.
Ciancio G. Burke G. Roth D.
Mies C. Jones B. Miller J. Genitourinary tuberculosis after renal
transplantation: report of 3 cases and review. [Review] [8 refs] Clinical
Infectious Diseases. 32(4):662-6, 2001
Feb 15.
Abstract
Mycobacterium tuberculosis infection of the genitourinary tract is an uncommon disease in renal transplant recipients and presentation is atypical. Genitourinary tuberculosis is associated with graft rejection, and this diagnosis should be considered for renal transplant recipients with unexplained fever and constitutional symptoms. [References: 8]
3511.
No Abstract.
3512.
No Abstract.
3513.
E Raji Nair, S Banerjee, MVR
Reddy, S Kumar & BC Harinath. Isolation of Mycobacterium tuberculosis 31 kDa antigen protein of diagnostic
interest from culture filtrate using anti ES-31 antibody by affinity
chromatography. Ind. J. Clin. Biochem.
2001; 16: 132-135.
Abstract
Proteins secreted into the
culture medium by Mycobacterium
tuberculosis are shown to be source of antigens of immunodiagnostic
interest. An in vitro released 31 kDa
antigen ESAS-7F isolated from M.tb H37Ra
culture filtrate by salt precipitation, SDS-PAGE and cation exchange fast
protein liquid chromatography (FPLC) was shown earlier to be a diagnostically
important antigen fraction. In this report, we describe the isolation of
ESAS-7F antigen using monospecific antibody coupled to sepharose CL-4B
column.The percentage recovery of ESAS-7F antigen using affinity chromatography
was approximately 8% of the total ES antigen proteins compared to 0.05%
obtained by conventional purification steps using salt precipitation, SDS-PAGE
and FPLC. Similar seroreactivity was observed by the antigen isolated by both
the methods in indirect ELISA. Affinity chromatography helped in an increased
recovery of ESAS-7F antigen and obviates the need for time consuming
conventional purification steps .
3514.
E Raji Nair, Swati Banerjee, Satish Kumar, MVR Reddy & BC Harinath. Purification and
characterization of a 31 kDa mycobacterial excretory-secretory antigenic
protein with a diagnostic potential in pulmonary tuberculosis. Indian J Chest Dis Allied Sci 2001;
43:81-90.
3515.
Eastwood JB.
Corbishley CM. Grange JM.
Tuberculosis and the kidney. [Review] [49 refs] Journal of the American Society
of Nephrology. 12(6):1307-14, 2001 Jun.
3516.
Emler S.
Feldmann K. Giacuzzo V. Hewitt PL.
Klapper PE. Lagrange PH. Wilkins EW.
Young KK. Herrmann JL.
Multicenter evaluation of a pathogenic mycobacterium screening probe. Journal
of Clinical Microbiology. 39(7):2687-9,
2001 Jul.
Abstract
The introduction of nucleic acid amplification assays into the clinical laboratory has reduced the time needed to diagnose diseases caused by members of the Mycobacterium tuberculosis complex (MTBC). However, several mycobacterial species other than those of the MTBC are known to cause disease, especially in immunocompromised individuals. A screening assay has been developed for the detection of the major pathogenic mycobacterial species. The assay utilizes pan-genus primers to amplify mycobacterial DNA and a screening probe (KY493) that detects all major pathogenic mycobacteria. A multicenter European study was conducted to assess the performance of the screening probe in the clinical laboratory. The screening probe was evaluated against individual probes specific for M. tuberculosis, M. avium, and M. intracellulare, a genus-specific probe with broader species coverage, and culture. The screening probe had a sensitivity equivalent to that of the species-specific probes; all specimens positive with any of the species-specific probes were also positive with the screening probes. Compared to culture, the sensitivity of the screening probe was 89% (154 of 173) for all culture-positive specimens tested. This value was 89.6% for the genus-specific probe. The screening probe was more specific than the genus-specific probe. Specificity was 93.9% (661 of 704) compared to culture results alone. The comparable specificity value for the genus-specific probe was 84.8%. When clinical data were taken into consideration, the sensitivity of the screening assay was similar to that of culture (81% versus 76.2%) but the positive predictive value of the test was lower (76.2% versus 100% for culture). However, the screening probe was more sensitive than smear and may be a useful tool in the rapid diagnosis of mycobacterial disease.
3517.
Enserink M.
Driving a stake into resurgent TB. Science. 293(5528):234-5, 2001 Jul 13.
3518.
Farrington DM.
Melini de Paz F. Moral Pinteno
JC. Slipped capital femoral epiphysis associated with peripheral osteoarticular
tuberculosis. Journal of Pediatric Orthopaedics. Part B. 10(2):96-100, 2001 Apr.
Abstract
We report a case of slipped capital femoral epiphysis that developed associated with a peripheral osteoarticular tuberculosis lesion located at the proximal metaphysis of the femur in contact with the growth plate in a 12-year-old boy. Multiple factors have been involved in slipped capital femoral epiphysis pathogenesis, but we believe an osteoarticular tuberculosis lesion is not a common finding as a possible etiological factor causing weakness of the growth plate and, therefore, the femoral head displacement.
3519.
Fietta A.
Morosini M. Cascina A. Effects
of continuous or pulsed exposure to rifabutin and sparfloxacin on the
intracellular growth of Staphylococcus aureus and Mycobacterium
tuberculosis. Journal of
Chemotherapy. 13(2):167-75, 2001 Apr.
Abstract
The time-kinetics of the intracellular bioactivity and intracellular post-antibiotic effect (PAE) of rifabutin and sparfloxacin against Staphylococcus aureus and Mycobacterium tuberculosis, grown in human monocytes, were evaluated. Intracellular bactericidal activity against staphylococci was shown in the presence of extracellular drug concentrations equal or superior to 1/10 plasma Cmax. The bactericidal activity of rifabutin was dependent on both its extracellular concentrations and the exposure time. In contrast, the pattern of the intracellular activity of sparfloxacin was characterized by a minimal concentration dependent killing. Both antibiotics (from 1/10 to the expected lung Cmax) showed intracellular bioactivity against M. tuberculosis H37Ra and H37Rv strains. A long intracellular PAE on staphylococci (>4 hours) was demonstrated when drugs were removed from the infected monocytes after 1 h treatment. Our findings suggest that rifabutin and sparfloxacin may be useful in the treatment of lower respiratory tract infections due to intracellular pathogens.
3520.
Fine PE. BCG: the challenge continues. [Review]
[16 refs] Scandinavian Journal of Infectious Diseases. 33(4):243-5, 2001.
Abstract
It is widely recognized that BCG provides
inconsistent and often inadequate protection against tuberculosis; however,
simple estimates of efficacy fail to reflect the complexity of protection
within, let alone between, populations. A decline in protection with an
increase in age at vaccination has been seen in many studies. This may reflect
2 things: (i) that as people age they are exposed to a variety of mycobacterial
challenges which may interfere with, or mask, the protection of BCG; and/or
(ii) that the vaccine is better at protecting against primary disease than
against either reactivation- or reinfection-type disease. These factors need to
be taken into consideration when interpreting the results obtained with
screening vaccines in animal models, as most of these models mimic acute
primary-type disease. In addition, we have no evidence that the protection
induced by BCG lasts for > 15 y, in any population. Recent data from South
India indicate a complex interaction of age and time effects: BCG imparted
consistent protection in children, but no protection for subjects > 15 y
old, and may even have imparted negative protection among these older
individuals. If true, these findings have important implications for efforts to
develop a vaccine against adult pulmonary tuberculosis. [References: 16]
3521.
Floros J.
Wang G. A point of view: quantitative and qualitative imbalance in
disease pathogenesis; pulmonary surfactant protein A genetic variants as a
model. [Review] [62 refs] Comparative Biochemistry & Physiology. Part A,
Molecular & Integrative Physiology. 129(1):295-303, 2001 May.
Abstract
The high degree of similarity at the molecular level, between humans and other species, has provided the rationale for the use of a variety of species as model systems in research, resulting in enormous advances in biological sciences and medicine. In contrast, the individual variability observed among humans, for example, in external physique, organ functionality and others, is accounted for, by only a fraction of 1% of differences at the DNA level. These small differences, which are essential for understanding disease pathogenesis, have posed enormous challenges in medicine, as we try to understand why patients may respond differently to drugs or why one patient has complications and another does not. Differences in outcome are most likely the result of interactions among genetic components themselves and/or the environment at the molecular, cellular, organ, or organismal level, or the macroenvironment. In this paper: (1) we consider some issues for multifactorial disease pathogenesis; (2) we provide a review of human SP-A and how the knowledge gained and the characteristics of the hSP-A system may serve as a model in the study of disease with multifactorial etiology; and (3) we describe examples where hSP-A has been used in the study of disease. [References: 62]
3522.
Freeman R.
Magee J. Barrett A. Identifying
sputum specimens of high priority for examination by enhanced mycobacterial
detection, identification, and susceptibility systems (EMDISS) to promote the
rapid diagnosis of infectious pulmonary tuberculosis. Journal of Clinical
Pathology. 54(8):613-6, 2001 Aug.
Abstract
AIMS: To compare clinical information and sputum microscopy as methods for the selection of samples for enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of patients with infectious pulmonary tuberculosis. METHODS: Two thousand, two hundred and sixty four specimen request forms were examined for clinical details, which were then used to identify specimens likely to yield Mycobacterium tuberculosis on culture. These results were compared with the results of sputum microscopy for acid fast bacilli (AFB). Both methods were assessed against the results of culture using a combination of continuous automated mycobacterial liquid culture (CAMLiC) and conventional solid culture. RESULTS: Classification based on clinical details was an inefficient method of identifying high priority specimens for EMDISS. Although, when given, clinical details were often consistent, a substantial proportion of specimens arrived with no details. This approach would result in the referral of at least 16% of the workload but lead to the detection by culture of only 46% of the M tuberculosis present within it. In contrast, microscopy for AFB defined a much smaller number of specimens (4.8% of the total), which contained 90% of the M tuberculosis isolates. CONCLUSIONS: Microscopy for AFB is the most efficient method for defining sputum specimens suitable for referral for enhanced mycobacteriological techniques. However, it is essential that the methods used for smear preparation and microscopy are of the highest possible standard, otherwise some patients with infectious pulmonary tuberculosis will be denied, unnecessarily, the benefits of important advances in mycobacteriology.
3523.
Garg P.
Godara R. Karwasra RK. Jain R.
Yadav V. A palpably enlarged hard gall bladder can be tubercular. Indian
Journal of Gastroenterology. 20(3):120,
2001 May-Jun.
3524.
Gennaro MC.
Calvino R. Abrigo C. Ion
interaction reagent reversed-phase high-performance liquid chromatography
determination of anti-tuberculosis drugs and metabolites in biological fluids.
Journal of Chromatography. B, Biomedical Sciences & Applications. 754(2):477-86, 2001 Apr 25.
Abstract
New methods of ion interaction reagent (IIR) RP-HPLC are presented for the determination of anti-tuberculosis drugs and their metabolites, singly or in multi-component mixtures, in biological fluids. The following analytes are considered: isoniazid, ethionamide, pyrazinamide, morphazinamide, p-aminosalicylic acid, nicotinic and isonicotinic acids. Aqueous solutions of three different ion interaction reagents are alternatively or comparatively used as the mobile phases, namely: (A) 5.00 mM octylamine at pH 3.00 for o-phosphoric acid, (B) 5.00 mM octylamine at pH 8.00 for o-phosphoric acid, and (C) 5.00 mM 1,6 diaminohexane at pH 6.00 for o-phosphoric acid. The response linearity between peak area and analyte concentration is verified for all the analytes in the concentration range within the determination limits and 2.00 mg/l. Detection limits are always lower than 82 microg/l for standard solutions; in the analysis of samples of rat serum, rat plasma and human serum, the matrix effect is negligible, the detection limits are always lower than 94 microg/l and the average recovery yield is always greater than 96%.
3525.
Gladych
E. Goland S. Attali M. Somin M. Malnick SD. Cardiac tamponade as a
manifestation of tuberculosis. [Review] [29 refs] Southern Medical
Journal. 94(5):525-8, 2001 May.
Abstract
Tuberculosis has been increasing in incidence in recent years. Pericardial involvement and pericardial effusions are well-documented and may result in pericardial tamponade. Despite this, large pericardial effusions are uncommon, and manifestation as cardiac tamponade is rare. We report two cases of tuberculous pericarditis in which the initial feature was tamponade. Since the diagnosis of tuberculosis may be delayed due to the slow-growing nature of the bacterium, physicians need to be aware of this possibility and consider the use of modern diagnostic techniques that may permit an earlier diagnosis. [References: 29]
3526.
Goloubeva
V. Lecocq M. Lassowsky P. Matthys
F. Portaels F. Bastian I. Evaluation of mycobacteria growth
indicator tube for direct and indirect drug susceptibility testing of
Mycobacterium tuberculosis from respiratory specimens in a Siberian prison
hospital. Journal of Clinical Microbiology.
39(4):1501-5, 2001 Apr.
Abstract
The manual Mycobacteria Growth Indicator Tube (MGIT) method was evaluated for performing direct and indirect drug susceptibility testing (DST) of Mycobacterium tuberculosis for isoniazid and rifampin on 101 strongly smear-positive sputum specimens in a Siberian prison hospital. Using the indirect method of proportion (MOP) as the "gold standard," the accuracies of isoniazid and rifampin susceptibility testing by the direct MGIT system were 97.0 and 94.1%, respectively. The accuracy of the indirect MGIT system was 98.0% for both drugs. The turnaround times from specimen processing to reporting of the DST results ranged between 4 and 23 (mean, 9.2) days by the direct MGIT method, 9 and 30 (mean, 15.3) days by the indirect MGIT method, and 26 and 101 (mean, 59.6) days by the indirect MOP. MGIT appears to be a reliable, rapid, and convenient method for performing direct and indirect DSTs in low-resource settings, but further studies are required to refine the direct DST protocol. Cost is the only factor prohibiting widespread implementation of MGIT.
3527.
Govender
S. Parbhoo AH. Kumar KP.
Annamalai K. Anterior spinal decompression in HIV-positive patients with
tuberculosis. A prospective study.
Journal of Bone & Joint Surgery - British Volume. 83(6):864-7, 2001 Aug.
Abstract
total of 39 HIV-infected adults with spinal tuberculosis underwent anterior spinal decompression for neurological deficit. Fresh-frozen allografts were used in 38 patients. Antituberculous drugs were prescribed for 18 months, but antiretroviral therapy was not used. Six patients died within two years of surgery. Neurological recovery and allograft incorporation were observed at follow-up at a mean of 38 months, although the CD4/CD8 ratios were reversed in all patients. Adequate preoperative nutritional support and compliance with antituberculous treatment are essential in ensuring a satisfactory outcome.
3528.
Graham
SM. Coulter JB. Gilks CF. Pulmonary disease in HIV-infected
African children. [Review] [93 refs] International Journal of Tuberculosis
& Lung Disease. 5(1):12-23, 2001
Jan.
Abstract
Childhood human immunodeficiency virus (HIV) infection is common in most regions of sub-Saharan Africa. Acute and chronic respiratory diseases are major causes of morbidity and mortality in HIV-infected children. They represent a significant added burden in a region where diagnostic capabilities are limited and management decisions are often made on the basis of clinical guidelines alone. Pneumocystis carinii pneumonia is now recognised as an important cause of acute severe pneumonia and death in HIV-infected infants. However, there are few data on incidence and aetiology for more treatable conditions such as bacterial pneumonia. The association of pulmonary tuberculosis and HIV infection is uncertain, and the diagnosis is further confused by the presence of lymphoid interstitial pneumonitis and other chronic HIV-related pulmonary disease. This article reviews the literature and highlights the urgent need for further research in order to improve clinical management and appropriate interventions. [References: 93]
3529.
No
Abstract.
3530.
No
Abstract.
3531.
Gupta R.
Kim JY. Espinal MA. Caudron JM.
Pecoul B. Farmer PE. Raviglione MC. Public health. Responding to
market failures in tuberculosis control. Science. 293(5532):1049-51, 2001 Aug 10.
3532.
No
Abstract.
3533.
No
Abstract.
3534.
Hawken MP.
Muhindi DW. Chakaya JM. Bhatt SM.
Ng'ang'a LW. Porter JD.
Under-diagnosis of smear-positive pulmonary tuberculosis in Nairobi, Kenya.
International Journal of Tuberculosis & Lung Disease. 5(4):360-3, 2001 Apr.
Abstract
SETTING: Nairobi City Council Chest Clinic, Nairobi, Kenya. OBJECTIVE: To determine if under-reading of sputum smears is a contributing factor in the disproportionate increase in smear-negative tuberculosis in Nairobi, Kenya. METHODOLOGY: Between October 1997 and November 1998, patients fulfilling the local programme definition of smear-negative presumed pulmonary tuberculosis were enrolled in the study. Two further sputum specimens were collected for examination in a research laboratory by fluorescence microscopy. RESULTS: Of 163 adult subjects enrolled, 55% were seropositive for the human immunodeficiency virus type 1 (HIV-1). One hundred subjects had had two pre-study sputum smears assessed before recruitment and produced two further sputum specimens for re-examination in the research laboratory; of these 19 (19%) were sputum smear-positive on re-examination and a further seven (7%) became smear-positive on second re-examination. CONCLUSIONS: Of those patients with smear-negative presumed pulmonary tuberculosis by the local programme definition, 26% were smear-positive when reexamined carefully with two repeat sputum smears. This suggests that the high rates of smear-negative tuberculosis being seen may in part be due to under-reading. This is probably as a result of the overwhelming burden of tuberculosis leading to over rapid and inaccurate sputum examination. Retraining of existing technicians and training of more technicians is likely to reduce underreading and increase the yield of smear-positive tuberculosis. This finding also stresses the need for regular quality assurance.
3535.
Hodsdon WS.
Luzze H. Hurst TJ. Quigley MA.
Kyosiimire J. Namujju PB. Johnson JL.
Kaleebu P. Okwera A. Elliott AM. HIV-1-related pleural
tuberculosis: elevated production of IFN-gamma, but failure of immunity to
Mycobacterium tuberculosis. AIDS.
15(4):467-75, 2001 Mar 9.
Abstract
BACKGROUND: Pleural tuberculosis can resolve spontaneously, suggesting that the inflammatory process may represent a protective immune response. However, pleural tuberculosis is strongly associated with HIV infection. It has been suggested that cell-mediated immune responses may be reduced, and direct bacterial invasion may have a role in pathogenesis, in HIV-positive cases. To test this hypothesis, we compared production of the pro-inflammatory cytokines, interferon (IFN)-gamma and tumour necrosis factor(TNF)-alpha, production of the immunosuppressive cytokine, interleukin (IL)-10, and mycobacterial culture positivity, in HIV-negative and HIV-positive patients with pleural tuberculosis. METHODS: Cytokine levels were measured in serum and pleural fluid, and in supernatants of blood and pleural fluid stimulated in vitro using mycobacterial antigens. Intracellular IFN-gamma and TNF-alpha production was measured after stimulation with phorbol myristate acetate and ionomycin in vitro. RESULTS: IFN-gamma was strikingly elevated in serum and pleural fluid in HIV-positive, compared to HIV-negative subjects (P < or = 0.02). TNF-alpha was elevated, but this was not statistically significant. IL-10 levels were higher in serum (P < 0.001), but similar in pleural fluid. IFN-gamma responses to soluble mycobacterial antigen in vitro were reduced in peripheral blood (P = 0.006), but not pleural fluid, of HIV-positive subjects. Intracellular cytokine staining suggested that CD8+ T cells were a major source of IFN-gamma in HIV-positive subjects. The proportion of subjects with a positive culture for Mycobacterium tuberculosis from pleural fluid was higher in the HIV-positive group. CONCLUSIONS: HIV-positive patients with pleural tuberculosis show elevated production of IFN-gamma, for which CD8+ T cells may be a major source. Mycobacterium tuberculosis can proliferate despite high levels of pro-inflammatory cytokines.
3536.
Hup
AK. Haitjema T. de Kuijper G. Primary nasal tuberculosis.
Rhinology. 39(1):47-8, 2001 Mar.
Abstract
We present a case of a patient with primary nasal tuberculosis. Although this is a rare finding, it should be considered when a patient presents with a nasal obstruction. Smears for acid fast bacilli and cultures tend to be negative in nasal tuberculosis. Diagnosis is often based on histo- pathologic findings. Nasal TB is known to respond well to the regular treatment for (pulmonary) tuberculosis.
3537.
Jaruratanasirikul S.
Sriwiriyajan S. Effect of indinavir on the pharmacokinetics of
rifampicin in HIV-infected patients. Journal of Pharmacy &
Pharmacology. 53(3):409-12, 2001 Mar.
Abstract
Indinavir, an antiretroviral agent, has an influence on the pharmacokinetics of other drugs by acting as an inhibitor of cytochrome P450-mediated drug metabolism. The incidence of tuberculosis has increased dramatically in the past decade because of an epidemic of HIV infection. Rifampicin is still one of the most valuable drugs for the standard treatment of tuberculosis. The objective of this study was to investigate the effects of indinavir on the pharmacokinetics of rifampicin in man. Our study was conducted in eleven HIV-infected patients. All patients received a 600-mg single dose of oral rifampicin on day 1 and 15- and 800-mg oral indinavir three times a day from day 2 to day 15. Rifampicin pharmacokinetic studies were carried out on day 1 and day 15. The results showed that rifampicin concentrations were higher when it was administered with indinavir than when it was administered alone. With concomitant indinavir medication, the mean AUC0-24 of rifampicin was increased by 73%. Therefore, we conclude that indinavir has an inhibitory effect on the metabolism of rifampicin.
3538.
Jensen-Cain DM. Quinn
FD. Differential expression of sigE by
Mycobacterium tuberculosis during intracellular growth. Microbial
Pathogenesis. 30(5):271-8, 2001 May.
Abstract
The Mycobacterium tuberculosis sigE gene encodes a sigma factor that is a member of the extracytoplasmic function subfamily of sigma factors. Using RT-PCR we demonstrated that sigE is expressed in M. tuberculosis bacilli during growth in human macrophages beginning after 30 min but before 6 h after infection through at least 5 days after infection, but that sigE is not expressed by M. tuberculosis bacteria during growth in Middlebrook 7H9 broth medium. However, sigE expression can be induced by treatment of broth cultures with hydrogen peroxide. Further, sigE is not expressed by M. tuberculosis bacilli during attachment or growth in type II pneumocytes. Using a green fluorescent protein (GFP) reporter gene fused to the sigE promoter, we observed induction of GFP expression following macrophage infection. Western blotting confirmed that sigE protein expression correlated with mRNA expression in induced systems. Analysis of the region of the M. tuberculosis genome encoding sigE suggested it is part of an operon consisting of sigE-orf1-htrA-orf2. The data presented in this report showed that sigE is differentially expressed by M. tuberculosis bacilli in macrophages and might play a role in the pathogenesis of this organism. Copyright 2001 Crown Copyright.
3539.
Jepson A.
Fowler A. Banya W. Singh M.
Bennett S. Whittle H. Hill AV. Genetic regulation of acquired
immune responses to antigens of Mycobacterium tuberculosis: a study of twins in
West Africa. Infection &
Immunity. 69(6):3989-94, 2001 Jun.
Abstract
The role of genetic factors in clinical tuberculosis is increasingly recognized; how such factors regulate the immune response to Mycobacterium tuberculosis in healthy individuals is unclear. In this study of 255 adult twin pairs residing in The Gambia, West Africa, it is apparent that memory T-cell responses to secreted mycobacterial antigens (85-kDa antigen complex, "short-term culture filtrate," and peptides from the ESAT-6 protein), as well as to the 65-kDa heat shock protein, are subject to effective genetic regulation. The delayed hypersensitivity response to intradermal tuberculin also demonstrates significant genetic variance, while quantitative T-cell and antibody responses to the 38-kDa cell membrane protein appear to be determined largely by environmental factors. Such findings have implications for vaccine development.
3540.
John
MA. Coovadia YM. Shortfalls in the use
of adenosine deaminase in tuberculous meningitis. Tropical Doctor.
31(3):138-9, 2001 Jul.
3541.
Jungblut
PR. Muller EC. Mattow J.
Kaufmann SH. Proteomics reveals open reading frames in Mycobacterium
tuberculosis H37Rv not predicted by genomics. Infection & Immunity. 69(9):5905-7, 2001 Sep.
Abstract
Genomics revealed the sequence of 3924 genes of the H37Rv strain of Mycobacterium tuberculosis. Proteomics complements genomics in showing which genes are really expressed, and here we show the expression of six genes not predicted by genomics, as proved by two-dimensional electrophoresis and matrix-assisted laser desorption ionization and nano-electrospray mass spectrometry.
3542.
No
Abstract.
3543.
No
Abstract.
3544.
Karcic
AA. Maudar V. Karcic E. An elderly woman with chronic knee pain and abnormal
chest radiography. Postgraduate Medical Journal. 77(911):600, 606-7, 2001 Sep.
3545.
No Abstract.
3546.
Kataria
YP. Khurshid I. Adenosine deaminase in
the diagnosis of tuberculous pleural effusion. [letter; comment]. Chest. 120(2):334-6, 2001 Aug.
3547.
Kaul KL.
Molecular detection of Mycobacterium tuberculosis: impact on patient care.
Clinical Chemistry. 47(8):1553-8, 2001
Aug.
Abstract
BACKGROUND: Nucleic acid amplification technologies such as PCR are revolutionizing the detection of infectious pathogens such as tuberculosis (TB). Amplification technology offers the potential for the diagnosis of TB in a few hours with a high degree of sensitivity and specificity. However, molecular assays neither replace nor reduce the need for conventional smear and culture, speciation, and antibiotic sensitivity assays. METHODS: We undertook prospective studies of sputum samples to assess the performance of two PCR-based assays for the detection of TB as well as the impact of more rapid availability of test results on patient care. RESULTS: The sensitivity of both the in-house and Amplicor PCR assays was 100% for smear-positive sputa. For smear-negative sputa (two sputum samples collected during the first 24 h of hospitalization), the sensitivity was 85% for our in-house PCR assay and 74% for the Roche PCR assay. Approximately 10% of the smear- and culture-negative sputa yielded positive PCR results; however, more than one-half of these were positive with both the in-house and Amplicor assays, suggesting the presence of TB DNA or organisms. Several of these came from patients whose other samples grew Mycobacterium tuberculosis during the same admission, and others came from patients who had previously treated TB. Overall, the specificities of the in-house and Amplicor PCR assays in smear-negative patients were 86% and 93%, respectively. CONCLUSIONS: Molecular detection of slow-growing pathogens such as M. tuberculosis have the potential to improve clinical care through a dramatic reduction in the time required for detection and may provide substantial savings in the overall cost of care of a patient compared with conventional smear, culture, and speciation alone, despite the fact that conventional assays must still be performed for speciation of nontuberculous mycobacteria and for full assessment of antibiotic sensitivity.
3548.
Khan
MY. Kinsara AJ. Osoba AO.
Wali S. Samman Y. Memish Z. Increasing resistance of M.
tuberculosis to anti-TB drugs in Saudi Arabia. International Journal of
Antimicrobial Agents. 17(5):415-8, 2001
May.
Abstract
The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). Resistance was most common to isoniazid (28.7%), followed by streptomycin (22.8%) and rifampicin (20.8%). Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.
3549.
Kindler
T. Schindel C. Brass U.
Fischer T. Fatal sepsis due to
mycobacterium tuberculosis after allogeneic bone marrow transplantation. Bone
Marrow Transplantation. 27(2):217-8,
2001 Jan.
Abstract
Mycobacterium tuberculosis is a serious, but rare infectious complication after allogeneic bone marrow transplantation. We describe a case of fatal sepsis due to Mycobacterium tuberculosis after allogeneic bone marrow transplantation for Philadelphia chromosome-positive ALL. The diagnosis was made after BAL. Although broad-spectrum antituberculous therapy was started immediately after diagnosis, blood cultures became positive for Mycobacterium tuberculosis. The patient developed severe pyrexias and finally died of multi-organ failure. Rapid progression of mycobacterial infection should be considered in patients post BMT with unexplained fever, particularly in patients from endemic areas.
3550.
Kotnis
R. Simo R. Tuberculous meningitis
presenting as sensorineural hearing loss. Journal of Laryngology &
Otology. 115(6):491-2, 2001 Jun.
Abstract
We report a 60-year-old male who presented to the Otorhinolaryngology department with an acute unilateral sensorineural hearing loss associated with fever and night sweats. The diagnosis of tuberculous meningitis was made. Unilateral sensorineural hearing loss as a presenting symptom of tuberculous meningitis has not been previously reported.
3551.
Krayem
AB. Abdullah LS. Raweily EA.
Wali SO. Rawas MM. Samman YS.
Batouk AA. The diagnostic challenge of pulmonary Kaposi's sarcoma with
pulmonary tuberculosis in a renal transplant recipient: a case report.
Transplantation. 71(10):1488-91, 2001
May 27.
Abstract
We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.
3552.
No Abstract.
3553.
Kuo PH.
Yang PC. Kuo SS. Luh KT. Severe immune hemolytic anemia in disseminated
tuberculosis with response to antituberculosis therapy. Chest. 119(6):1961-3, 2001 Jun.
Abstract
Severe hemolytic anemia in patients with disseminated tuberculosis is exceedingly rare. We report an episode of Coombs'-positive hemolytic anemia in a previously healthy young man with miliary tuberculosis, resulting in a hemoglobin level of 5 g/dL and an undetectable haptoglobin level. The patient responded well to treatment with antituberculosis drugs, and the results of the direct Coombs' test became negative without the need of blood transfusion or steroid therapy.
3554.
Lalvani
A. Pathan AA. Durkan H. Wilkinson
KA. Whelan A. Deeks JJ. Reece WH. Latif M.
Pasvol G. Hill AV. Enhanced
contact tracing and spatial tracking of Mycobacterium tuberculosis infection by
enumeration of antigen-specific T cells. Lancet. 357(9273):2017-21, 2001 Jun 23.
Abstract
BACKGROUND: Identification of individuals latently infected with Mycobacterium tuberculosis is an important part of tuberculosis control. The current method, the tuberculin skin test (TST), has poor specificity because of the antigenic cross-reactivity of purified protein derivative (PPD) with M bovis BCG vaccine and environmental mycobacteria. ESAT-6 is a secreted antigen that is highly specific for M tuberculosis complex, but is absent from M bovis BCG. With an enzyme-linked immunospot (ELISPOT) assay for interferon gamma, we have identified ESAT-6-specific T cells as an accurate marker of M tuberculosis infection. METHODS: We did a prospective, masked study of 50 healthy contacts, with varying but well defined degrees of exposure to M tuberculosis, who attended an urban contact-tracing clinic. We assessed and compared the efficacy of our assay and TST for detection of symptomless infected individuals by correlation of test results with the degree of exposure to an infectious index case. FINDINGS: The ESAT-6 ELISPOT assay results had a strong positive relation with increasing intensity of exposure (odds ratio=9.0 per unit increase in level of exposure [95% CI 2.6--31.6], p=0.001), whereas TST results had a weaker relation with exposure (1.9 [1.0--3.5], p=0.05). By contrast, ELISPOT results were not correlated with BCG vaccination status (p=0.7), whereas TST results were significantly more likely to be positive in BCG-vaccinated contacts (12.1 [1.3--115.7], p=0.03). INTERPRETATION: This new antigen-specific T cell-based assay could allow more accurate identification of symptom-free individuals recently exposed to M tuberculosis, and thereby help to improve tuberculosis control.
3555.
Landowski CP.
Godfrey HP. Bentley-Hibbert
SI. Liu X. Huang Z. Sepulveda
R. Huygen K. Gennaro ML. Moy FH. Lesley SA.
Haak-Frendscho M. Combinatorial use of antibodies to secreted
mycobacterial proteins in a host immune system-independent test for
tuberculosis. Journal of Clinical Microbiology. 39(7):2418-24, 2001 Jul.
Abstract
Laboratory diagnosis of tuberculosis is often difficult. Immunodetection of circulating Mycobacterium tuberculosis proteins shed during active infection would not depend on an intact host immune response and could take advantage of the speed and low costs afforded by antibody-based assays. We previously showed that patients with active tuberculosis had increased levels of circulating antigen 85 (Ag85) proteins independent of their tuberculin skin test status (S. I. Bentley-Hibbert, X. Quan, T. Newman, K. Huygen, and H. P. Godfrey, Infect. Immun. 67:581-588, 1999). To extend these observations to a Mycobacterium bovis BCG-vaccinated population and to another secreted mycobacterial protein, Ag85 and PstS-1 (protein antigen B, p38 antigen) were quantified in sera from 97 Chilean tuberculosis patients and healthy controls (many of whom had received BCG as children) using dot immunobinding, mouse monoclonal anti-BCG Ag85 complex antibody, and chicken antipeptide antibodies reactive with M. tuberculosis Ag85B and PstS-1. The latter antibodies had been raised to peptide-derived immunogens expressed on a novel proprietary protein carrier in Escherichia coli. Median serum Ag85 levels measured by using either anti-Ag85 antibody were significantly higher in patients with active tuberculosis than in healthy controls (P, <0.001 to 0.01); the median serum PstS-1 levels were similar in patients and controls. The sensitivity of significantly elevated circulating Ag85 levels in patients with pulmonary tuberculosis measured by anti-Ag85 complex or anti-Ag85B antibodies was 60 and 55%, respectively, but increased to 77% when results obtained with both anti-Ag85 antibodies were considered jointly (P < 0.02). The corresponding specificities for individual and joint consideration were 95, 85, and 80%, respectively. These results indicate that elevated Ag85 levels can be detected in patients with active tuberculosis even after BCG vaccination and suggest that combinatorial use of antibodies directed at different epitopes of this protein could provide a viable strategy for developing new host immune response-independent diagnostic tests for tuberculosis.
3556.
Laserson
KF. Kenyon AS. Kenyon TA.
Layloff T. Binkin NJ.
Substandard tuberculosis drugs on the global market and their simple detection.
International Journal of Tuberculosis & Lung Disease. 5(5):448-54, 2001 May.
Abstract
SETTING: The prevalence of substandard anti-tuberculosis drugs is unknown. To maximize the effectiveness of tuberculosis (TB) control efforts, simple, inexpensive drug quality screening methods are needed. DESIGN: Isoniazid (INH) and rifampin (RMP) single- and fixed-dose combination (FDC) formulations were collected from selected TB programs and pharmacies in Colombia, Estonia, India, Latvia, Russia and Vietnam. Samples were screened using a recently developed thin-layer chromatography (TLC) kit. All abnormal samples and a 40% random sample of normal formulations were further analyzed using confirmatory techniques. Samples outside of 85% to 115% of stated content, and/or containing compounds other than the stated drug, were defined as being substandard. RESULTS: Overall, 10% (4/40) of all samples, including 13% (4/30) RMP samples, contained <85% of stated content. More FDCs (5/24, 21%) than single-drug samples (2/16, 13%) were substandard. A comparison of TLC with the confirmatory analysis for RMP analysis showed a sensitivity of 100% (4/4), a specificity of 92% (24/26), a positive predictive value (PPV) of 67% (4/6), and a negative predictive value (NPV) of 100% (24/24). An analysis of INH showed a specificity of 90% (9/10). However, sensitivity, PPV, and NVP could not be determined. CONCLUSION: A substantial number of anti-tuberculosis drugs from several countries, in particular FDCs, were found to be substandard. Such drugs may contribute to the creation of drug-resistant TB. TLC is an effective, convenient, and inexpensive method for the detection of substandard drugs.
3557.
Lawn
SD. Griffin GE. The irreversible cost
of delayed diagnosis of tuberculosis in HIV co-infected persons in sub-Saharan
Africa. International Journal of Tuberculosis & Lung Disease. 5(2):200-1, 2001 Feb.
3558.
Lee
DG. Choi JH. Kim YJ. Lee S. Min CK.
Kim DW. Lee JW. Min WS.
Shin WS. Kim CC. Hepatosplenic
tuberculosis mimicking disseminated candidiasis in patients with acute
leukemia. International Journal of Hematology.
73(1):119-21, 2001 Jan.
Abstract
Two cases of hepatosplenic tuberculosis in patients with acute leukemia during or after chemotherapy following prolonged neutropenia are presented. Tuberculosis should be considered as one cause of hepatosplenic abscesses during prolonged neutropenia, especially in countries where the disease is endemic.
3559.
Lee
YC. Rogers JT. Rodriguez RM. Miller KD. Light RW. Adenosine deaminase levels in
nontuberculous lymphocytic pleural effusions. [see comments]. Chest. 120(2):356-61, 2001 Aug.
Abstract
OBJECTIVES: Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. We studied the ADA levels in a variety of nontuberculous lymphocytic effusions and analyzed the relationships between ADA and conventional hematologic and biochemical parameters. METHODS: One hundred six lymphocytic pleural fluid samples (lymphocyte count > 50%) were analyzed. These included post-coronary artery bypass grafting (CABG) effusions (n = 45), malignant effusions (n = 27), miscellaneous exudative effusions (n = 10), and transudative effusions (n = 24). ADA levels were determined using the Giusti method. In 22 randomly selected cases, ADA was measured again on the same sample 6 weeks later. RESULTS: The ADA level reached the diagnostic cutoff for tuberculosis (40 U/L) in only three cases (2.8%): two lymphomas and one complicated parapneumonic effusion. There was no significant correlation between effusion ADA levels and the total leukocyte (r = 0.08), differential lymphocyte (r = 0.18) or monocyte (r = - 0.18) counts. ADA levels were significantly lower in the transudative effusions (7.2 +/- 3.5 U/L) than in post-CABG (16.6 +/- 7.2 U/L), malignant (15.3 +/- 11.2 U/L), and other exudative (15.4 +/- 13.1 U/L) effusions (p < 0.001). ADA measurements were consistent when assayed 6 weeks apart (r = 0.95; p < 0.00001; coefficient of variation, 14%). CONCLUSIONS: ADA levels in nontuberculous lymphocytic effusions seldom exceeded the diagnostic cutoff for TB. Effusion ADA levels cannot be predicted from total or differential leukocyte counts. Post-CABG pleural fluids had ADA levels similar to other nontuberculous lymphocytic effusions. ADA is stable in effusion fluids, and its measurement is reproducible.
3560.
Lodes MJ. Dillon DC.
Mohamath R. Day CH. Benson DR.
Reynolds LD. McNeill P. Sampaio DP.
Skeiky YA. Badaro R. Persing DH.
Reed SG. Houghton RL.
Serological expression cloning and immunological evaluation of MTB48, a novel
Mycobacterium tuberculosis antigen. Journal of Clinical Microbiology. 39(7):2485-93, 2001 Jul.
Abstract
Improved diagnostics are needed for the detection of Mycobacterium tuberculosis, especially for patients with smear-negative disease. To address this problem, we have screened M. tuberculosis (H37Rv and Erdman strains) genomic expression libraries with pooled sera from patients with extrapulmonary disease and with sera from patients with elevated reactivity with M. tuberculosis lysate. Both serum pools were reactive with clones expressing a recombinant protein referred to here as MTB48. The genomic sequence of the resulting clones was identical to that of the M. tuberculosis H37Rv isolate and showed 99% identity to the Mycobacterium bovis and M. bovis BCG isolate sequences. The genomic location of this sequence is 826 bp upstream of a region containing the esat-6 gene that is deleted in the M. bovis BCG isolate. The mtb48 1,380-bp open reading frame encodes a predicted 47.6-kDa polypeptide with no known function. Southern and Western blot analyses indicate that this sequence is present in a single copy and is conserved in the M. tuberculosis and M. bovis isolates tested but not in other mycobacterial species tested, including Mycobacterium leprae and Mycobacterium avium. In addition, the native protein was detected in the cytoplasm, as was a processed form that was also shed into the medium during culture. Serological analysis of recombinant MTB48 and the M. tuberculosis 38-kDa antigen with a panel of patient and control sera indicates that the inclusion of recombinant MTB48 in a prototype serodiagnostic test increases assay sensitivity for M. tuberculosis infection when it is combined with other known immunodominant antigens, such as the 38-kDa antigen.
3561.
Manji
KP. Msemo G. Tamim B. Thomas E.
Tuberculosis (presumed congenital) in a neonatal unit in Dar-es-Salaam,
Tanzania. Journal of Tropical Pediatrics.
47(3):153-5, 2001 Jun.
Abstract
This is the first report of congenital tuberculosis from Tanzania. It discusses the problems of diagnosis in a typical neonatal unit in a developing country. Three cases are reported within 1 year. Failure to thrive was the most common symptom. We speculate that congenital tuberculosis is not rare and carries a high mortality. There is need to have a high index of suspicion especially where maternal HIV and tuberculosis are highly prevalent.
3562.
No Abstract.
3563.
Mathai A.
Radhakrishnan VV. George
SM. Sarada C. A newer approach for the
laboratory diagnosis of tuberculous meningitis. Diagnostic Microbiology &
Infectious Disease. 39(4):225-8, 2001
Apr.
Abstract
In this prospective study, a simple method was standardized for measuring circulating mycobacterial antigen in the cerebrospinal fluid (CSF) for the laboratory diagnosis of tuberculous meningitis (TBM). The heat-inactivated CSF specimens from tuberculous and non-tuberculous patients were subjected to sodium dodecyl sulfate (SDS) - polyacrylamide gel electrophoresis (PAGE) (SDS-PAGE) and they were subsequently transferred onto nitrocellulose membrane (NCM) Using a rabbit polyvalent antibody to M tuberculosis, a heat stable 82 kDa mycobacterial antigen was demonstrated in the CSFs of patients with TBM. This antigen was conspicuous by its absence in the CSFs of non-tuberculous subjects. Due to inactivation of CSF specimens, there is a minimal risk of handling of infectious material in the laboratory. Besides, this newer approach is simple, inexpensive and can be readily applied in any routine clinical laboratory and it is particularly suited to developing countries.
3564.
Mazade MA.
Evans EM. Starke JR. Correa AG. Congenital tuberculosis
presenting as sepsis syndrome: case report and review of the literature.
[Review] [19 refs] Pediatric Infectious Disease Journal. 20(4):439-42, 2001 Apr.
Abstract
We report an infant with congenital tuberculosis who presented with fulminant septic shock, disseminated intravascular coagulation and respiratory failure. Aggressive resuscitation and supportive care and prompt initiation of antituberculosis medications led to resolution of the shock state. We reviewed six other cases with a similar presentation. Congenital tuberculosis should be in the differential of the infant presenting acutely with sepsis syndrome. [References: 19]
3565.
McMurray DN. A coordinated strategy for
evaluating new vaccines for human and animal tuberculosis. [Review] [37 refs]
Tuberculosis. 81(1-2):141-6, 2001.
Abstract
There is a remarkable convergence in the current efforts to develop and evaluate new tuberculosis (TB) vaccine candidates for use in humans, domestic animals, and wild animal reservoirs. It is quite likely that similar vaccination strategies will prove useful in these diverse host species. Many TB vaccine candidates are being screened for protective efficacy in conventional laboratory animals (e.g. mouse, guinea pig), in captive wild species under laboratory conditions (e.g. brushtail possum), and in the target hosts (e.g. cattle, deer). These systems share some important features, e.g. direct challenge infection of the lung by intratracheal or aerosol exposure, and the use of bacterial enumeration, and gross and microscopic histopathology, as the readouts. Some TB vaccine candidates have been tested in many models, yielding important insights into common mechanisms of resistance to Mycobacterium tuberculosis and M. bovis, and providing evidence of the vaccine's ability to induce protection under widely different circumstances. Coordination of this global search for better TB vaccines, irrespective of target species, would facilitate the rapid application of new technologies and maximize the sharing of materials and experiences between human and veterinary TB researchers. The creation of liaisons between TB vaccine research efforts of government-sponsored medical and agricultural research programs, international bodies such as the World Health Organization (WHO) and the European Community (EC), private foundations and the vaccine industry, will yield a high return. Copyright 2001 Harcourt Publishers Ltd. [References: 37]
3566.
Mehra
V. Khanna H. Chandra R. Singh Y.
Anthrax-toxin-mediated delivery of a 19 kDa antigen of Mycobacterium
tuberculosis into the cytosol of mammalian cells. Biotechnology & Applied
Biochemistry. 33(Pt 2):71-4, 2001 Apr.
Abstract
PA63, the proteolytically activated 63 kDa fragment of protective antigen (PA, 83 kDa), mediates translocation of lethal factor (LF) and oedema factor into the cytosol. The N-terminal 254 amino acids of LF (LFn) are required for binding to PA63 and mediating translocation of active ligands fused to either the N- or C-terminus. Here we report translocation of a 19 kDa antigen of Mycobacterium tuberculosis into the cytosol of mammalian cells when fused to the C-terminus of LFn (LFn-19kDa). The fusion protein was non-toxic to J774A.1 macrophage cells in combination with PA and retained the ability to bind to PA63 when incubated with Chinese hamster ovary K1 cells. The data show the efficacy of anthrax toxin to mediate translocation of M. tuberculosis antigens into the cytosol of mammalian cells and may prove useful in delivering proteins and peptides carrying immunodominant mycobacterial antigens into the cytosol.
3567.
Merino
JM. Alvarez T. Marrero M.
Anso S. Elvira A. Iglesias G.
Gonzalez JB. Microbiology of pediatric primary pulmonary tuberculosis.
Chest. 119(5):1434-8, 2001 May.
Abstract
OBJECTIVE: To determine the sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis. PATIENTS AND METHODS: Between January 1988 and December 1996, 104 consecutive patients aged 0 to 18 years received a diagnosis of primary pulmonary tuberculosis at our institution. Demographic, clinical, laboratory, and bacteriologic data were collected. Clinical specimens were studied for acid-fast bacilli detection by Ziehl-Neelsen stain and cultured for Mycobacterium recovery by Lowenstein-Jensen culture medium. Statistical analysis was performed utilizing chi(2), t tests, and multivariate logistic regression analysis. RESULTS: Bacteriologic results were available for 57 patients (54.8%). A positive smear or culture result for Mycobacterium tuberculosis was obtained in 9 of 54 patients (16.6%) and 25 of 50 patients (50%), respectively. Confirmation of M tuberculosis disease was achieved in 28 patients (49.1%). Ziehl-Neelsen stain and Lowenstein-Jensen culture recovery rates were 10.3% (14 of 135) and 52% (48 of 92) of specimens studied, respectively. Sputum, pleural fluid, and biopsy material cultures yielded M tuberculosis in 55%, 75%, and 63% of patients, respectively. Mean +/- SD age (13.7 +/- 4.5 years vs 9.6 +/- 4.5 years) and number of samples submitted for culture (1.93 +/- 0.94 vs 1.31 +/- 0.97) were significantly higher in the confirmed tuberculosis disease group (p < 0.05). The presence of a pleural effusion was also more commonly found in the confirmed tuberculosis disease group (p < 0.05). CONCLUSION: The sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis disease was 49.1%. Age is the main factor associated with the positivity of culture results.
3568.
Milburn HJ.
Primary tuberculosis. [Review] [52 refs] Current Opinion in Pulmonary
Medicine. 7(3):133-41, 2001 May.
Abstract
The natural history of tuberculosis is complex. Primary infection, the initial phase, occurs in people without specific immunity, generally normal children and young adults who have not previously been exposed to Mycobacterium tuberculosis. The initial infection can occur at any time during childhood, but adolescence is the peak time of risk. Primary disease develops within 5 years of the initial infection, which stimulates specific immunity, demonstrated by the development of a positive skin response to purified protein derivative of tuberculin. Although symptoms of primary disease may be few, early detection and treatment are important for both preventing the development of immediate complications, which carry a high risk of morbidity and mortality, and preventing spread of infection following later reactivation of disease. Our understanding of the host's immune response to the primary infection is increasing, and it is hoped this will lead to improved possibilities for vaccines in the future. [References: 52]
3569.
Mohapatra PR. Direct observation of tuberculosis
treatment. Lancet. 357(9269):1708, 2001
May 26.
3570.
Montali
RJ. Mikota SK. Cheng LI. Mycobacterium tuberculosis in zoo
and wildlife species. [Review] [78 refs] Revue Scientifique et Technique. 20(1):291-303, 2001 Apr.
Abstract
Tuberculosis caused by Mycobacterium tuberculosis and M. tuberculosis-like organisms has been identified in a wide range of species, including non-human primates, elephants and other exotic ungulates, carnivores, marine mammals and psittacine birds. Disease associated with M. tuberculosis has occurred mostly within captive settings and does not appear to occur naturally in free-living mammals. Mycobacterium tuberculosis probably originated as an infection of humans, but from the zoonotic standpoint, non-human primates, Asian elephants and psittacine birds have the potential to transmit this disease to humans. However, the overall prevalence of disease in these susceptible species is low and documented transmissions of M. tuberculosis between animals and humans are uncommon. Mycobacterium tuberculosis causes progressive pulmonary disease in mammals and a muco-cutaneous disease in parrots. In all cases, the disease can disseminate and be shed into the environment. Diagnosis in living animals is based on intradermal tuberculin testing in non-human primates, culturing trunk secretions in elephants, and biopsy and culture of external lesions in parrots. Ancillary testing with deoxyribonucleic acid probes and nucleic acid amplification, and enzyme-linked immunosorbent assays have been adapted to some of these species with promising results. Additionally, new guidelines for controlling tuberculosis in elephants in the United States of America, and programmes for tuberculosis prevention in animal handlers have been established. [References: 78]
3571.
Moran
AJ. Treit JD. Whitney JL. Abomoelak
B. Houghton R. Skeiky YA.
Sampaio DP. Badaro R. Nano FE.
Assessment of the serodiagnostic potential of nine novel proteins from
Mycobacterium tuberculosis. FEMS Microbiology Letters. 198(1):31-6, 2001 Apr 20.
Abstract
To identify antigens that would improve the accuracy of serological diagnosis of active tuberculosis, we cloned the genes encoding nine potentially immunogenic secreted or surface-associated proteins of Mycobacterium tuberculosis. Recombinant proteins were reacted with sera from HIV-negative individuals with extrapulmonary tuberculosis (EP-TB) or HIV-positive individuals with pulmonary tuberculosis (TBH). Specific and high level antibody responses were obtained for four recombinant proteins, of which antigen GST-822 was recognized by 60% of EP-TB and 42% of TBH and antigen MBP-506 was recognized by 45% of EP-TB and 61% of TBH. These results suggest that these proteins are strong candidates as subunits in a polyvalent serodiagnostic test.
3572.
No Abstract.
3573.
Murthy KJ.
Frieden TR. Yazdani A. Hreshikesh P. Public-private partnership in
tuberculosis control: experience in Hyderabad, India. International Journal of
Tuberculosis & Lung Disease.
5(4):354-9, 2001 Apr.
Abstract
SETTING: Hyderabad, India. OBJECTIVE: To determine whether private practitioners and the government can collaborate with a nongovernmental intermediary to implement DOTS effectively. DESIGN: A non-profit hospital provided DOTS services to a population of 100000 for 3 years, then expanded coverage to 500000 in October 1998. A hospital physician visited all private practitioners, encouraged them to refer patients, and gave feedback on each patient referred. After diagnosis, patients received directly observed treatment free of charge at the trust hospital or at 30 conveniently located small hospitals operated by local private practitioners. No financial incentives were used to encourage physicians to refer patients or to provide treatment observation. Diagnosis, treatment, and case and outcome definitions were performed as per DOTS policies; medicines and laboratory reagents were provided by the government. RESULTS: All 244 allopathic and 114 non-allopathic physicians practising in the area agreed to participate; 59% referred at least one patient. Of 2244 persons referred, 969 (43%) had tuberculosis. Physicians had obtained chest radiographs on 80% of patients before referral for sputum microscopy. The detection rate increased from 50 to 200/100000 over the first 2-3 years of the project, and has increased gradually since expansion; 90% of new smear-positive patients and 77% of re-treatment patients were successfully treated. Compared with those treated at a neighbouring government DOTS centre, patients in this project paid less for diagnosis ($5 vs. $20) and treatment ($1 vs. $11), largely due to lower transport costs. CONCLUSIONS: Collaborative efforts between private practitioners and the government can achieve moderate-high rates of case detection and high rates of treatment success. Public-private services appeared to be more convenient to patients, who paid less for care and were less likely to miss work in order to participate in DOTS. Clearly defined roles and expectations and frequent communication are essential to success. An institution such as a non-profit hospital can serve as an effective intermediary between the government DOTS programme and private practitioners.
3574.
Naga MI.
Okasha HH. Ismail Z. El-Fatatry M. Hassan S. Monir BE.
Endoscopic diagnosis of colonic tuberculosis. Gastrointestinal Endoscopy. 53(7):789-93, 2001 Jun.
Abstract
BACKGROUND: GI tuberculosis is a diagnostic challenge, particularly in the absence of evidence of pulmonary infection. It may mimic many other abdominal diseases such as other infectious processes, tumors, and Crohn's disease. In the absence of positive laboratory and radiologic tests, the diagnosis is often established definitively by obtaining a surgical specimen. Colonoscopy, however, has been used successfully to diagnose the disease and thus avoid the morbidity and mortality associated with exploratory laparotomy. METHODS: An evaluation was conducted of colonoscopic features in 10 patients with colonic tuberculosis. OBSERVATIONS: In all cases there was ileocecal involvement; total colonic involvement was found in only 1 case. The colonoscopic appearance included the following: ulcerated lesions, sessile firm polyps, masses, and small diverticula, ranging from 3 to 5 mm in diameter. In 5 of our patients the diagnosis was confirmed bacteriologically, in 3 with endoscopic biopsy material, and in 2 by sputum examination. In all cases antituberculous therapy produced remarkable symptom and endoscopic improvement. CONCLUSION: This report highlights the importance of colonoscopy in the diagnosis of tuberculous involvement of the GI tract.
3575.
Nagesh BS.
Sehgal S. Jindal SK. Arora SK. Evaluation of polymerase chain
reaction for detection of Mycobacterium tuberculosis in pleural fluid.
Chest. 119(6):1737-41, 2001 Jun.
Abstract
OBJECTIVES: Tuberculosis, a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic. The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections. The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosis in pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation and acid-fast bacilli (AFB) screening. METHODS: The sensitivity and specificity of PCR in detection of mycobacterial DNA in 20 samples of tuberculous pleural effusion were evaluated using 40 samples of nontubercular pleural effusion as controls. The results were correlated with the ADA in all 60 pleural fluids. In addition, AFB detection by Ziehl-Neelsen staining on cytospin smears of all pleural fluids was also compared. RESULTS: Of the 20 samples of tuberculous pleural effusion, mycobacterium could be detected by AFB staining in 4 samples. Fourteen samples were PCR positive. None of the samples from the control group were AFB or PCR positive. The sensitivity of PCR, therefore, was 70.0% with specificity of 100% (positive predictive value, 100%; negative predictive value, 86.95%). The sensitivity of AFB screening was at best 20%. The mean of ADA values in tubercular pleural effusions was 63.21 U/L (SD, 33.01), and the mean in the control samples was 51.1 U/L (SD, 29.71). Taking a cut-off value of 50 U/L, both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were only 55%. CONCLUSION: PCR represents a rapid and sensitive method for the detection of mycobacterial DNA in tuberculous pleural effusions. AFB screening has low sensitivity, and ADA estimation has both low sensitivity and specificity. Therefore, when the clinical suspicion is high and smear result is negative, but the signs and symptoms of M tuberculosis are apparent, PCR is the method of choice for identifying the infection.
3576.
Nair
ER. Banerjee S. Kumar S.
Reddy MV. Harinath BC.
Purification and characterization of a 31 kDa mycobacterial excretory-secretory
antigenic protein with a diagnostic potential in pulmonary tuberculosis. Indian
Journal of Chest Diseases & Allied Sciences. 43(2):81-90, 2001 Apr-Jun.
3577.
No
Abstract.
3578.
No
Abstract.
3579.
Odunukwe NN.
Tuberculosis masquerading as 'constant malaria'. West African Journal of
Medicine. 20(1):22-7, 2001 Jan-Mar.
Abstract
Four hundred adults aged 20-60 years, (200 females and 200 males) were studied. All the subjects were residing in the urban areas of Lagos, Nigeria. Thirteen percent claimed they were having "constant malaria" (> 8 times per year), 5% (20) claimed to have cough mostly during the cold period, 2.5% (10) produced mucoid sputum, 2.5% unproductive cough, 13% were AFB smear positive, 1.5% had positive chest X-ray for pulmonary Tuberculosis (PTB), 1.5% were HIV positive and 50% were mantoux positive (> 10 mm induration). All who complained of "constant malaria" were AFB positive. Malaria parasite density was lower in those who complained of "constant malaria" than those who did not complain (P = 0.003). The complaint of frequent malaria attack decreased after Antituberculosis therapy for 6 months. This study revealed that in a malaria and tuberculosis endemic region, early stage of tuberculosis can masquerade as "constant malaria". Therefore any such complaint should be fully investigated.
3580.
Oh EJ. Park YJ. Chang CL.
Kim BK. Kim SM. Improved
detection and differentiation of mycobacteria with combination of Mycobacterium
Growth Indicator Tube and Roche COBAS AMPLICOR System in conjunction with
Duplex PCR. Journal of Microbiological Methods. 46(1):29-36, 2001 Jul 30.
Abstract
In this study, a combination of liquid and solid media (current "gold standard" for culture) with combinations of liquid media (Mycobacteria Growth Indicator Tube (MGIT)) plus a commercial amplification system (Roche COBAS AMPLICOR System (CAS)), and solid media (Ogawa) plus CAS for detection of Mycobacterium tuberculosis were compared. In addition, the ability of the MGIT to recover mycobacteria from various clinical samples was compared with the abilities of egg-based Ogawa medium using equal volume of samples and a high concentration (6%) of NaOH for decontamination. A total of 705 specimens (395 respiratory and 310 extrapulmonary) that were collected from 554 patients were tested in parallel with three assays. The results of MGIT and Ogawa were evaluated with the "gold standard" (combination of culture and clinical data) and those of CAS were evaluated with extended gold standard including treated tuberculosis. A total of 130 mycobacterial infections (M. tuberculosis, n=122; mycobacterium other than tuberculosis (MOTT), n=8) were detected. The differentiation of M. tuberculosis and MOTT was successfully accomplished using duplex PCR. The overall sensitivity of the MGIT, Ogawa, and CAS for M. tuberculosis was 89.9%, 73.9%, and 79.9%, respectively. For the MOTT, the corresponding values for the MGIT and Ogawa medium were 100% and 12.5%, respectively. The mean detection time for M. tuberculosis was 22 days using MGIT and 32 days when using the Ogawa medium. The specificity of CAS was 98.4%, with an inhibition rate of 1.4%. A combination of MGIT plus CAS detected 97.5% of all M. tuberculosis infections (compared with MGIT plus Ogawa, 91.8%, P<0.05; compared with Ogawa plus CAS, 87.7%. P<0.01). Our results indicate that a combination of MGIT plus a Roche CAS in conjunction with duplex PCR, would be quite useful in clinical laboratories for both rapid detection and differentiation of M. tuberculosis and MOTT.
3581.
Orme IM. The search for new vaccines against
tuberculosis. [Review] [106 refs] Journal of Leukocyte Biology. 70(1):1-10, 2001 Jul.
Abstract
The failure of the BCG vaccine for tuberculosis in large, controlled clinical trials, coupled with the gradual consensus that it is mostly ineffective in preventing adult pulmonary disease in endemic areas, has led to a concerted effort to develop a new generation of vaccines. This work is ongoing in a variety of areas, including DNA vaccines, subunit vaccines, recombinant vaccines, and auxotrophic vaccines. Several such candidates are giving promising results in mouse and guinea pig, aerosol-challenge infection models and should move to clinical trials in the near future. [References: 106]
3582.
Packham S. Tuberculosis in the elderly. [Review]
[24 refs] Gerontology. 47(4):175-9,
2001 Jul-Aug.
Abstract
Tuberculosis is still a major cause of morbidity and mortality worldwide. Recent studies have suggested that even in the developed world its incidence in the elderly is increasing. Symptoms of active tuberculosis are non-specific and less pronounced in the elderly. Radiological features are more likely to be 'atypical' in the older subject and skin tests more frequently negative. This results in delay in diagnosis and higher mortality from tuberculosis in the aged population. A high degree of clinical suspicion is therefore required to ensure the diagnosis is not missed and appropriate treatment instigated. Copyright 2001 S. Karger AG, Basel [References: 24]
3583.
Prasad
A. Pandey KK. Tuberculous biliary
strictures: uncommon cause of obstructive jaundice. Australasian
Radiology. 45(3):365-8, 2001 Aug.
Abstract
Tuberculous biliary stricture is a very rare cause of obstructive jaundice. A case of a man who had had pulmonary tuberculosis 20 years ago is reported. He now presented with obstructive jaundice due to multiple strictures just below the confluence of the hepatic ducts and in the right hepatic duct. At surgery these turned out to be tuberculous in origin. There was also tuberculous involvement of the gall bladder and cystic duct. The commonest differential diagnosis in such cases is cholangiocarcinoma (as in the present case). Imaging helps in defining the extent of bile duct obstruction. Suspicion of the disease and establishing a tissue diagnosis is very important in treating this potentially curable condition, especially with the worldwide resurgence of tuberculosis.
3584.
Preston
I. O'Brien A. Clues to an elusive
effusion. Postpericardiotomy syndrome. Postgraduate Medicine. 109(5):131-2, 2001 May.
3585.
Rahmatulla RH. al-Mofleh
IA. al-Rashed RS. al-Hedaithy MA. Mayet IY. Tuberculous
liver abscess: a case report and review of literature. [Review] [11 refs]
European Journal of Gastroenterology & Hepatology. 13(4):437-40, 2001 Apr.
Abstract
Tuberculous liver abscess is rare worldwide. We report a 45-year-old man who presented with abdominal pain, fever and weight loss. Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver. Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli. The abscess was drained under ultrasound guidance. Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management. A greater awareness of this clinical entity is required for successful treatment. [References: 11]
3586.
Rastogi N. Legrand E.
Sola C. The mycobacteria: an introduction to nomenclature and
pathogenesis. [Review] [192 refs] Revue Scientifique et Technique. 20(1):21-54, 2001 Apr.
Abstract
Tuberculosis, caused by Mycobacterium tuberculosis, and leprosy, caused by M. leprae, are diseases known since antiquity. In developing countries, tuberculosis is still the leading cause of mortality due to an infectious disease. Taxonomically, mycobacteria belong to the genus Mycobacterium, which is the single genus within the family of Mycobacteriaceae, in the order Actinomycetales. Actinomycetales include diverse micro-organisms, but mycobacteria and allied taxa are easily distinguished on the basis of the ability to synthesise mycolic acids. Mycobacterial species are traditionally differentiated on the basis of phenotypic characteristics, and the authors provide an updated list of the biochemical tests currently employed and the culture properties that help to discriminate among various species of mycobacteria. However, as the phenotypic characteristics do not allow precise identification of all species, recent molecular taxonomical approaches for mycobacterial classification and phylogeny are also described. Mycobacteria are also a leading cause of infection in various domesticated animals and wildlife. The authors briefly describe the mycobacteria involved in animal infections, the wildlife reservoirs and strategies to control bovine tuberculosis, and the use of molecular tools for diagnostics and epidemiology of mycobacterial infections in animals. The characteristic of intracellular parasitism is discussed, in addition to the fate of pathogenic mycobacteria that have the ability to grow inside phagosomes and phagolysosomes of infected host macrophages. The mycobacterial cell envelope, which is a complex tripartite structure containing a high proportion of lipids (approximately 30% to 40% of the total weight) could play a crucial role in the adaptation of mycobacteria to intracellular growth and survival, immune modulation and drug resistance. [References: 192]
3587.
Ray
G. Banerjee PK. Ghoshal UC.
Dhar K. Pal BB. Biswas AD.
Das U. Saha ML. Acharya AN.
Majumdar S. Etiology and management of obscure gastrointestinal
bleed--an appraisal from eastern India. Indian Journal of
Gastroenterology. 20(3):90-3, 2001
May-Jun.
Abstract
OBJECTIVES AND METHOD: Forty patients (mean age 45 years; 24 men) attending a tertiary care hospital in eastern India during the period 1996-2000 were investigated to evaluate the etiology and clinical spectrum of obscure gastrointestinal bleed. RESULTS: The patients presented to hospital after mean symptom duration of 2.5 years. They had received an average of 15 units of blood transfusion. Most patients presented with recurrent melena (85%); all had iron-deficiency anemia. A total of 230 investigations (89 gastroscopies, 54 colonoscopies, 25 double-contrast meal and follow-through studies, 14 small bowel enemas, 24 radionuclide scans, 16 mesenteric angiographies and 8 intraoperative endoscopies) yielded positive diagnosis in 87.5% of cases. The diseases encountered were small bowel and colonic angiodysplasias (32.5%), ileal Crohn's disease (20%), intestinal tuberculosis (10%), intestinal tumors (10%), nonspecific small bowel ulcers and strictures (7.5%), Meckel's diverticulum (5%) and hemobilia (2.5%). The etiology remained obscure in 5 (12.5%) cases. Overall success of surgery was 63%; in-hospital mortality was 7.5%. CONCLUSION: Though obscure gastrointestinal bleed is commonly caused by angiodysplasias, it can be an atypical presentation of Crohn's disease.
3588.
Redha
S. Suresh RL. Subramaniam J. Merican I.
Pancreatic tuberculosis presenting with recurrent acute pancreatitis. Medical
Journal of Malaysia. 56(1):95-7, 2001
Mar.
Abstract
Tuberculosis, in its extrapulmonary form, though emerging as a common clinical problem, rarely affects the pancreas. Its indolent course, vague symptomatology along with its non-specific laboratory and radiographic findings call for greater vigilance. We report a case of pancreatic tuberculosis, previously managed as recurrent alcohol related pancreatitis which showed symptomatic improvement following commencement of antituberculosis drugs. The diagnosis of pancreatic tuberculosis in this case was based on the abdominal CT scan findings, response to anti-tubeculous chemotherapy and overall laboratory and radiological work-up.
3589.
Robinson
AJ. Horne CA. Weaver A. Coexistence of axillary tuberculous lymphadenitis with
lymph node metastases from a breast carcinoma. Clinical Oncology (Royal College
of Radiologists). 13(2):144, 2001.
3590.
Rook
GA. Zumla A. Advances in the
immunopathogenesis of pulmonary tuberculosis. [Review] [68 refs] Current Opinion in Pulmonary Medicine. 7(3):116-23, 2001 May.
Abstract
Tuberculosis remains a global emergency because of our lack of understanding of the details of its pathogenesis. In the last 12 months there have been striking advances in the molecular genetics of the organism. Mutated strains of Mycobacterium tuberculosis have been used to study the genetic requirements for virulence and establishment of latency, and the biology of the interaction with host cells. Genes involved in lipid metabolism seem particularly important. The probable sites of latency within the host lungs have been identified by in situ polymerase chain reaction. The complex control by M. tuberculosis of apoptosis of T cells and macrophages has been somewhat clarified, and the data may suggest that M. tuberculosis causes death of a subset of T cells, while preserving some macrophages as hiding places with reduced microbicidal and antigen-presenting function. Similarly the demonstration of a very large relative increase in interleukin (IL)-4 and IL-13 expression, (together with IL-4delta2, the IL-4 splice variant), that correlates with lung damage, has been supported by data from flow cytometry and in situ hybridization, and indicates that a subversive T helper-2 (Th2) component in the response to M. tuberculosis may undermine the efficacy of immunity and contribute to immunopathology. Recently defined changes in metabolism of cortisol within the lesions may contribute to the development of the Th2 component. These findings underline the need to start testing vaccine candidates in models that mimic the situations in which bacille Calmette-Guerin fails, such as in the presence of latent infection, pre-existing Th2 responses to cross-reactive organisms, and stress. [References: 68]
3591.
Russell
DG. Mycobacterium tuberculosis: here
today, and here tomorrow. [Review] [70 refs] Nature Reviews Molecular Cell
Biology. 2(8):569-77, 2001 Aug.
Abstract
Mycobacterium tuberculosis is a highly successful pathogen that parasitizes the macrophages of its host. Its success can be attributed directly to its ability to manipulate the phagosome that it resides in and to prevent the normal maturation of this organelle into an acidic, hydrolytic compartment. As the macrophage is key to clearing the infection, the interplay between the pathogen and its host cell reflects a constant battle for control. [References: 70]
3592.
Saczek
KB. Schaaf HS. Voss M.
Cotton MF. Moore SW. Diagnostic
dilemmas in abdominal tuberculosis in children. Pediatric Surgery
International. 17(2-3):111-5, 2001 Mar.
Abstract
The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/l in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients. 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture.
3593.
Samanich
K. Belisle JT. Laal S. Homogeneity of antibody responses in
tuberculosis patients. Infection &
Immunity. 69(7):4600-9, 2001 Jul.
Abstract
The goals of the present study were twofold: (i) to compare the repertoires of antigens in culture filtrates of in vitro-grown Mycobacterium tuberculosis that are recognized by antibodies from noncavitary and cavitary tuberculosis (TB) patients and (ii) to determine the extent of variation that exists between the antigen profiles recognized by individual TB patients. Lipoarabinomannan-free culture filtrate proteins of M. tuberculosis were fractionated by one-dimensional (1-D) and 2-D polyacrylamide gel electrophoresis, and the Western blots were probed with sera from non-human immunodeficiency virus (non-HIV)-infected cavitary and noncavitary TB patients and from HIV-infected, noncavitary TB patients. In contrast to earlier studies based on recombinant antigens of M. tuberculosis which suggested that antibody responses in TB patients were heterogeneous (K. Lyashchenko et al., 1998, Infect. Immun. 66:3936-3940, 1998), our studies with native culture filtrate proteins show that the antibody responses in TB patients show significant homogeneity in being directed against a well-defined subset of antigens. Thus, there is a well-defined subset of culture filtrate antigens that elicits antibodies during noncavitary and cavitary disease. In addition, another set of antigens is recognized primarily by cavitary TB patients. The mapping with individual patient sera presented here suggests that serodiagnostic tests based on the subset of antigens recognized during both noncavitary and cavitary TB will enhance the sensitivity of antibody detection in TB patients, especially in difficult-to-diagnose, smear-negative, noncavitary TB patients.
3594.
Sanchez-Perez H.
Flores-Hernandez J. Jansa
J. Cayla J. Martin-Mateo M. Pulmonary tuberculosis and associated factors in
areas of high levels of poverty in Chiapas, Mexico. [see comments].
International Journal of Epidemiology.
30(2):386-93, 2001 Apr.
Abstract
OBJECTIVES: To estimate the prevalence of pulmonary tuberculosis (PTB) and factors associated with PTB in areas of high levels of poverty in Chiapas, Mexico. METHODS: In 1998 active case-finding was carried out among those aged over 14 years who had a cough of > or =15 days duration, in a convenience sample of 1894 households in 32 communities selected at random based on the level of poverty and on the level of access to health services, measured by travelling time (<1 hour, > or =1 hour) from the community to the nearest health care unit. Of the 277 identified with a productive cough, we obtained sputum samples from 228 for the purposes of detecting PTB through acid-fast smears and cultures. Mycobacteria characterization was carried out using the BACTEC method. The identification of factors associated with PTB was performed using bivariate analysis and via logistic regression models. RESULTS: A PTB rate of 276.9 per 100 000 persons aged > or =15 years was found (95% CI : 161-443). Blood in sputum was the only factor associated with PTB (none of the demographic or socioeconomic characteristics were). Of 16 positive cultures, 14 became contaminated. The two cultures characterized were Mycobacterium tuberculosis (one being multiresistant). CONCLUSION: The high prevalence of PTB detected indicates the need, both in the area studied and in others with similar conditions, to develop PTB control programmes which give priority to early diagnosis and to the provision of adequate treatment.
3595.
No
Abstract.
3596.
No
Abstract.
3597.
No
Abstract.
3598.
No
Abstract.
3599.
Sharma SK. Suresh V. Mohan A.
Kaur P. Saha P. Kumar A.
Pande JN. A prospective study of sensitivity and specificity of
adenosine deaminase estimation in the diagnosis of tuberculosis pleural
effusion. Indian Journal of Chest Diseases & Allied Sciences. 43(3):149-55, 2001 Jul-Sep.
Abstract
We prospectively evaluated the usefulness of adenosine deaminase [ADA] estimation in the diagnosis of tuberculosis [TB] pleural effusion. Seventy five subjects with pleural effusion were studied. Forty eight of them had TB pleural effusion [M:F: 37:11; mean age 33 +/- 14.4 years range 17-76] and the remaining 27 had pleural effusion due to causes other than TB [non-TB group] [M:F: 19:8; mean age 47.3 +/- 16.5 years; range 17-75]. Pleural fluid [PF] ADA levels were significantly higher in TB (n=48; mean 95.8 +/- 57.5 IU/L) compared with non-TB group (n=27; mean 30.7 +/- 27.2 IU/L) [p<0.001]. Serum ADA [S-ADA] levels were also significantly higher in TB (n=45; mean 39.6 +/- 18.3 IU/L) compared with non-TB group (n=26; mean 18.0 +/- 13.7 IU/L) [p<0.001]. PF-ADA levels were higher compared to S-SDA in TB (p <0.001) and non-TB groups [p<0.01]. Using a cut off of 35 IU/L, the sensitivity and specificity of PF-ADA in the diagnosis of TB was computed to be 83.3% and 66.6% respectively. At a cut-off level of 100 IU/L, PF-ADA was found to have a sensitivity 40% and specificity 100%. From this study it is concluded that, using 100 IU/L as the cut-off, it is possible to avoid pleural biopsy to ascertain the diagnosis of TB in as much as 40% of the patients.
3600.
Sheu SJ.
Shyu JS. Chen LM. Chen YY.
Chirn SC. Wang JS. Ocular
manifestations of tuberculosis. Ophthalmology.
108(9):1580-5, 2001 Sep.
Abstract
OBJECTIVE: To present the clinical and histopathologic findings in five cases of tuberculosis (TB) with various ocular manifestations. DESIGN: Observational case series. METHODS: Retrospective review of clinical findings, course, and treatment of five patients. Diagnostic techniques, including biomicroscopic, histopathologic, and molecular biologic test results, are presented. MAIN OUTCOME MEASURES: Visual acuity, slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography results. RESULTS: The ocular manifestations of TB in our patients included panophthalmitis, endophthalmitis, posterior uveitis with choroidal tubercles, keratitis, and a lid mass. Mycobacterium tuberculosis was identified in four cases in ocular specimens using acid-fast bacilli microscopy and in three cases by culture. Rapid diagnosis using polymerase chain reaction was obtained in one case. Extraocular foci of TB were identified in three cases with an intraocular infection at presentation. No patients had the human immunodeficiency virus (HIV) and none were immunocompromised. Two eyes could not be saved using antituberculous treatment because of delayed diagnosis and treatment. CONCLUSIONS: In this age of the HIV pandemic, TB is becoming more common. Because it is curable, heightened awareness and better understanding of the disease's ocular manifestations should be of concern to all ophthalmologists.
3601.
Shimouchi A. Tuberculosis problems in the
Asia-Pacific region. Respirology.
6(1):75-8, 2001 Mar.
Abstract
Tuberculosis (TB) is the top killer of the productive age group in developing countries. More than half of cases in the world occur in Asia-Pacific region. The number of cases will increase in the next decades due to increase in urban poor population and HIV incidence, and poor access to health services and poor TB programme. The mainstay of effective strategy is to promote DOTS. DOTS population coverage is high, 58% in the Western Pacific Region but low; 29% in the southeast Asia region. Even among intermediate TB-burden countries in Asia, reduction of incidence has stagnated in recent years because of aging population, health problems in the urban poor population and influx of populations from high endemic areas. Indicators of successful TB programmes are high cure rate and low drug resistance rate. There is a strong correlation between the overall quality of TB control in the past and the current primary drug-resistant rate. To solve these problems, priority should be given to nationwide implementation of DOTS in high TB-burden countries with emphasis on ensuring availability of free anti-TB drugs and strengthening primary health care. General hospitals and private sector should be involved in control programmes to prevent drug resistant cases.
3602.
Singh KK.
Zhang X. Patibandla AS. Chien P Jr.
Laal S. Antigens of Mycobacterium tuberculosis expressed during
preclinical tuberculosis: serological immunodominance of proteins with
repetitive amino acid sequences. Infection & Immunity. 69(6):4185-91, 2001 Jun.
Abstract
Four antigens of Mycobacterium tuberculosis that are expressed in vivo after aerosol infection but prior to the development of clinical tuberculosis (TB) in rabbits were identified by immunoscreening of an expression library of M. tuberculosis genomic DNA with sera obtained 5 weeks postinfection. Three of the proteins identified, PirG (Rv3810), polymorphic GC-repetitive sequence (PE-PGRS; Rv3367), and proline-threonine repetitive protein (PTRP) (Rv0538), have multiple tandem repeats of unique amino acid sequences and have characteristics of surface or secreted proteins. The fourth protein, MtrA (Rv3246c), is a response regulator of a putative two-component signal transduction system, mtrA-mtrB, of M. tuberculosis. All four antigens were recognized by pooled sera from TB patients and not from healthy controls, confirming their in vivo expression during active infection in humans. Three of the antigens (PE-PGRS, PTRP, and MtrA) were also recognized by retrospective preclinical TB sera obtained, prior to the clinical manifestation of TB, from human immunodeficiency virus-TB patients, suggesting that they are potential candidates for devising diagnostic tests for active, preclinical TB.
3603.
No
Abstract.
3604.
Stanford
JL. Stanford CA. Grange JM.
Lan NN. Etemadi A. Does
immunotherapy with heat-killed Mycobacterium vaccae offer hope for the
treatment of multi-drug-resistant pulmonary tuberculosis? [see comments].
Respiratory Medicine. 95(6):444-7, 2001
Jun.
Abstract
A patient is described with the tubulointerstitial nephritis with uveitis syndrome. The diagnosis can be difficult since it has to be differentiated from sarcoidosis, or infections like tuberculosis and toxoplasmosis. Our patient showed prompt recovery of fever, ocular symptoms and renal function after starting corticosteroids.
3605.
Su WJ.
Huang CY. Huang CY. Perng RP. Utility of PCR assays for rapid
diagnosis of BCG infection in children. International Journal of Tuberculosis
& Lung Disease. 5(4):380-4, 2001
Apr.
Abstract
We report Mycobacterium bovis BCG infection in two children vaccinated with BCG (Tokyo strain) on the first day of life. Their diagnoses were made by biopsy of skin lesions and pus from an anterior chest wall abscess, respectively, yielding a positive culture of mycobacteria fully susceptible to rifampicin, isoniazid and ethambutol, but resistant to pyrazinamide. M. bovis BCG was identified by a negative niacin test, absence of nitrate reductase and resistance to pyrazinamide and cycloserine. The diagnoses were further confirmed by a combination of an allele-specific polymerase chain reaction ated strain of Mycobacterium bovis, is the only available vaccine for the prevention of tuberculosis. Although complications are rare after BCG vaccination and the outcome is usually favourable, serious BCG infections can occur. We report two cases of M. bovis BCG infection in children, a 4-year-old immunocompetent girl and an 8-month-old immunodeficient boy. To our knowledge, this is the first report of BCG complications in children in which two recently developed polymerase chain reaction (PCR) based methods were used for rapid identification of M. bovis BCG infection. (PCR) and a multiplex PCR method. Based on the drug susceptibility results, treatment with rifampicin, isoniazid and ethambutol was instituted. One patient (Case 1) improved clinically and is well after treatment. However, the other patient with severe combined immunodeficiency died of disseminated BCG infection in spite of intensive anti-tuberculosis therapy. Although BCG is considered to be a safe vaccine, it should be kept in mind that complications related to BCG do occur.
3606.
Swati Banerjee, E Raji Nair,
Satish Kumar, MVR Reddy & BC Harinath. Assay of tubercular antibody,
circulating free and immune complexed antigen in the diagnosis of pulmonary
tuberculosis. Indian J Clin Biochem
2001;16(2):203-206.
3607.
Tahaoglu
K. Atac G. Sevim T. Tarun T. Yazicioglu O. Horzum G. Gemci I. Ongel A.
Kapakli N. Aksoy E. The
management of anti-tuberculosis drug-induced hepatotoxicity. International
Journal of Tuberculosis & Lung Disease.
5(1):65-9, 2001 Jan.
Abstract
SETTING: A tuberculosis ward in a chest disease teaching hospital. OBJECTIVE: To compare the efficacy of two different retreatment protocols on hepatotoxicity recurrence in tuberculosis treatment. DESIGN: In a prospective, randomised study, 45 patients with new tuberculosis developed hepatotoxicity after anti-tuberculosis treatment. Patients in Group I (n = 20) were retreated with a drug regimen consisting of isoniazid, rifampicin, ethambutol and streptomycin administered by gradually increasing the number and dosage of the drugs. Patients in Group II (n = 25) were retreated with the same regimen (isoniazid, rifampicin, pyrazinamide and ethambutol) in the same dosages throughout. RESULTS: Hepatotoxicity recurred in respectively zero and six (24%) patients in Groups I and II (P = 0.021). Of the six patients with recurrence of hepatitis, one could not be followed up. The other five received the same retreatment protocol as Group I. By the end of retreatment, all patients were cured. CONCLUSION: The recurrence rate of hepatotoxicity in the retreatment of tuberculosis is higher in the reintroduction of a full-dose regimen including pyrazinamide, which causes more hepatotoxicity than gradual reintroduction of a regimen without pyrazinamide.
3608.
Tang
XN. Chu KA. Lu JY. Ting YM. Lin CH. Multiple pleural nodules without
effusion--a rare presentation of tuberculous pleurisy. Chung Hua i Hsueh Tsa
Chih - Chinese Medical Journal.
64(3):187-90, 2001 Mar.
Abstract
We report a rare case of tuberculous pleurisy presenting with multiple pleural nodules without associated effusion or parenchymal lung lesions. A 62-year-old man had multiple discrete pleural nodules in the right hemithorax on chest radiography without any clinical symptoms. Thoracoscopic biopsy of the pleural nodules revealed a caseous granuloma with acid-fast bacilli. The patient received antituberculous therapy, with resolution of tuberculomas on chest film within 2 months. To our knowledge, only two similar cases have been previously reported in the English literature, and our observation should lead to broadening of the spectrum of the differential diagnosis of multiple pleural nodules.
3609.
van Gorkom J.
van Cleeff M. Becx-Bleumink
M. Veen J. Short-course instead of long-course chemotherapy for
smear-negative patients in sub-Saharan Africa. International Journal of Tuberculosis
& Lung Disease. 5(1):4-11, 2001
Jan.
Abstract
The use of short-course chemotherapy (SCC) in directly-observed treatment, short-course (DOTS) programmes in sub-Saharan Africa was often restricted to patients with infectious and serious forms of tuberculosis, because of high costs of such regimens. With reduced drug prices and wide-scale substitution of thiacetazone by ethambutol in the continuation phase of treatment, various short-course regimens are now available at the same or even lower costs than long-course regimens. Several DOTS programmes are considering extending access to short-course chemotherapy to non-infectious patients, or have done so already. The authors provide an overview of the issues regarding the debate on the introduction of universal SCC in national tuberculosis control programmes in low-income countries in sub-Saharan Africa. They advise on a low-risk strategy to avoid the emergence of rifampicin resistance as a consequence of the wide availability of rifampicin associated with universal short-course, and strengthening of the health system to maintain high performance levels in diagnosis and treatment.
3610.
Verver
S. Bwire R. Borgdorff MW. Screening for pulmonary tuberculosis among
immigrants: estimated effect on severity of disease and duration of
infectiousness. International Journal of Tuberculosis & Lung Disease. 5(5):419-25, 2001 May.
Abstract
OBJECTIVE: To estimate the effect of tuberculosis screening among recent immigrants on the severity of disease at diagnosis and on the duration of the infectious period. DESIGN: Comparison of pulmonary tuberculosis cases among immigrants detected through screening with those detected passively, using information from the Netherlands Tuberculosis Register. PARTICIPANTS: Immigrants from highly endemic countries diagnosed with culture-positive pulmonary tuberculosis within 30 months after arrival in The Netherlands, 1993 through 1998. OUTCOME MEASURES: Severity of disease (smear-positive disease, hospitalisation, case fatality) and duration of symptomatic period. RESULTS: A total of 882 bacteriologically confirmed tuberculosis patients from highly endemic countries had been in The Netherlands less than 30 months, and were detected through screening (454), or passively (368). Compared with patients detected passively, patients found through screening were less often sputum smear-positive (OR 0.5, 95%CI 0.3-0.8) and less often hospitalised (OR 0.2, 95%CI 0.1-0.2). Those detected through screening had a shorter symptomatic period. Screening is estimated to have reduced the infectious period by approximately 33%. CONCLUSION: The screening programme detected cases earlier, resulting in fewer hospital admissions, shorter duration of symptoms and therefore probably reduced tuberculosis transmission.
3611.
Von Arx DP.
Husain A. Oral tuberculosis. British Dental Journal. 190(8):420-2, 2001 Apr 28.
Abstract
Although rare, doctors and dentists should be aware of the possible occurrence of oral lesions of tuberculosis and consider them in the differential diagnosis of suspicious oral ulcers.
3612.
Wallis RS.
Johnson JL. Adult tuberculosis in the 21st century: pathogenesis,
clinical features, and management. [Review] [89 refs] Current Opinion in Pulmonary
Medicine. 7(3):124-32, 2001 May.
Abstract
This article reviews the significant advances in the past year in the basic and clinical aspects of adult tuberculosis (TB). Further research has deepened our understanding of host susceptibility and resistance mechanisms, including cytotoxicity, apoptosis, and antimicrobial polypeptides such as granulysin. Studies have confirmed the effects of HIV infection on risk of disease and disease manifestations, and have defined the effects of HIV on TB transmission. Recent studies also indicate a possible role for extended treatment of active disease and latent infection in HIV-1 infected individuals. Multidrug-resistant disease has been reported on every continent; rapid molecular approaches to the simultaneous diagnosis of TB and detection of rifampin resistance may facilitate prompt initiation of treatment. TB remains one of the major problems in global health. [References: 89]
3613.
Wang CH.
Lin HC. Liu CY. Huang KH.
Huang TT. Yu CT. Kuo HP. Upregulation of inducible nitric
oxide synthase and cytokine secretion in peripheral blood monocytes from
pulmonary tuberculosis patients. International Journal of Tuberculosis &
Lung Disease. 5(3):283-91, 2001 Mar.
Abstract
SETTING: Peripheral blood monocytes (PBM) are the main source of alveolar macrophages, which have an upregulation of inducible nitric oxide synthase (iNOS) in pulmonary tuberculosis (TB). TNF-alpha and IL-1 beta are thought to be involved in the immune response to mycobacterial infection. OBJECTIVE: To identify whether iNOS expression and cytokine release of PBM are upregulated and have a connection in TB infection. DESIGN: The expression of iNOS immunoreactivity on PBM from TB patients and normal subjects was measured by loading with anti-macrophage iNOS polyclonal primary antibody analyzed by flow cytometry. Expression of iNOS mRNA in PBM was detected by RT-PCR. The spontaneous generation of nitrite and cytokines (IL-1 beta and TNF-alpha) by cultured monocytes was also determined. RESULTS: Compared to normal subjects, iNOS immuno-reactivity, the capacity for spontaneous nitrite generation and the level of TNF-alpha or IL-1 beta secretion of PBM were significantly higher in TB patients. The amount of nitrite, TNF-alpha and IL-1 beta released from PBM of TB patients was inhibited by NG-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of NOS. The level of iNOS immunoreactivity on PBM was highly correlated with nitrite generation both in all the subjects studied and in TB patients alone. Spontaneous TNF-alpha production showed a stronger correlation with nitrite production than with IL-1 beta. CONCLUSION: The NO and cytokine synthase activities of monocytes appear to be concomitantly upregulated in response to mycobacterial infection. The enhanced NO generation by monocytes in TB patients may play an autoregulatory role in amplifying the synthesis of pro-inflammatory cytokines.
3614.
Wendel
KA. Alwood KS. Gachuhi R.
Chaisson RE. Bishai WR. Sterling TR. Paradoxical worsening of
tuberculosis in HIV-infected persons. Chest.
120(1):193-7, 2001 Jul.
Abstract
OBJECTIVE: To determine the incidence of paradoxical worsening of tuberculosis (TB) in HIV-infected persons. DESIGN: Observational cohort study. SETTING: Public, urban TB clinic. PATIENTS: HIV-infected persons treated for TB between January 1, 1996, and December 31, 1999, and followed through June 30, 2000. INTERVENTION: Patients received standard anti-TB therapy. Antiretroviral therapy was provided by primary medical providers. Patients receiving antiretroviral therapy were given nucleoside reverse transcriptase inhibitors alone or highly active antiretroviral therapy (HAART; nucleoside reverse transcriptase inhibitors in combination with a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor). Main outcome measure: Paradoxical worsening of TB. RESULTS: There were 82 TB cases in 76 patients. Paradoxical worsening was identified in 6 of 82 cases (7%; 95% confidence interval, 3 to 15%). Paradoxical worsening occurred in 3 of 28 cases (11%) in patients receiving HAART and in 3 of 44 cases (7%) in patients not receiving antiretroviral therapy (p = 0.67). Cases complicated by paradoxical worsening were more likely to have both pulmonary and extrapulmonary disease at initial diagnosis than cases without paradoxical worsening (83% vs 24%; p = 0.006). TB relapse occurred in 2 of 6 cases (33%) in patients with paradoxical worsening and in 4 of 76 cases (5%) in patients without paradoxical worsening (p = 0.06). CONCLUSIONS: Paradoxical worsening of TB occurred less frequently than in previous reports and was not associated with HAART. Paradoxical worsening also appeared to be associated with an increased risk of TB relapse. Further studies are warranted to better characterize the risk factors for paradoxical worsening and the appropriate duration of anti-TB therapy in patients in whom it occurs.
3615.
Wheeler
C. Berkley S. Initial lessons from
public-private partnerships in drug and vaccine development. Bulletin of the
World Health Organization.
79(8):728-34, 2001.
Abstract
In recent years, venture capital approaches have delivered impressive results in identifying and funding promising health discoveries and bringing them to market. This success has inspired public sector experiments with "social venture capital" approaches to address the dearth of affordable treatment and prevention for diseases of the developing world. Employing the same focus on well-defined and measurable objectives, and the same type of connections to pool and deploy resources as their for-profit counterparts, social venture capitalists seek to use the tools and incentives of capitalism to solve one of its biggest failures: the lack of drugs and vaccines for diseases endemic to low-income populations. As part of a larger trend of partnerships emerging in health product donation and distribution, public-private partnerships for pharmaceutical development have led research and development (R&D) efforts to generate more accessible and efficacious products for diseases such as malaria, tuberculosis, and AIDS. In this article, three R&D-focused partnerships are explored: the International AIDS Vaccine Initiative; the Medicines for Malaria Venture; and the newly formed Global Alliance for TB Drug Development. The article highlights key elements essential to the success of these ventures.
3616.
Wilkinson
RJ. DesJardin LE. Islam N.
Gibson BM. Kanost RA. Wilkinson KA. Poelman D. Eisenach
KD. Toossi Z. An increase in expression
of a Mycobacterium tuberculosis mycolyl transferase gene (fbpB) occurs early
after infection of human monocytes. Molecular Microbiology. 39(3):813-21, 2001 Feb.
Abstract
Changes in the mRNA levels of two Mycobacterium tuberculosis genes (fbpB known as antigen 85B, and hspX known as Acr) were studied in infected human monocytes. Antigen 85B is an enzyme involved in cell wall biosynthesis and is also a major target of the immune response. Acr is a stress protein believed to be involved in the bacillary response to adverse conditions and in non-replicating persistence. During the first 24 h of intracellular infection, the intramonocyte 85B mRNA level increased 54-fold (P = 0.00001) and 14.6 times in comparison with the 16S ribosomal rRNA. In contrast, the Acr mRNA fell 14.3 times. Although monocyte cytokine production was very variable, the 24 h secretion of tumour necrosis factor (TNF)-alpha correlated with the 85B-16S RNA ratio at 24 h (r = 0.77, Pcorr < 0.01). Furthermore, the addition of exogenous TNF-alpha to cultures was associated with a twofold increase in the 85B-16S ratio and, conversely, neutralization of endogenous TNF-alpha reduced the ratio. As antigen 85B also induces TNF-alpha, the positive feedback implied by our findings suggests a previously unsuspected role for this protein in the immunopathogenesis of tuberculosis.
3617.
Yamada
Y. Nakamura A. Hosoda M.
Kato T. Asano T. Tonegawa K.
Itoh M. Cytokines in pleural liquid for diagnosis of tuberculous
pleurisy. Respiratory Medicine. 95(7):577-81,
2001 Jul.
Abstract
An elevated level of adenosine deaminase (ADA) in pleural liquid has been considered as a supplemental diagnostic marker for tuberculous pleurisy. However, this is complicated by false-positives and -negatives. Recently, it has been revealed that various cytokines are intimately involved in the pathognomonic physiology of tuberculosis. In this study, interleukin-8 (IL-8), tumour necrosis factor alpha (TNFalpha) and interferon gamma (IFNgamma) were compared with ADA in pleural liquid of patients with inflammatory (21 cases), malignant (28 cases) and tuberculous (21 cases) disease. The pleural ADA, IL-8, TNFalpha and IFNgamma levels in the tuberculous group were higher than in the other three groups. Analysis of receiver operating characteristic (ROC) curves, to evaluate the utility of the various parameters, demonstrates values for the area under the curve (AUC) of 0.770, 0.875, 0.892 and 0.987, respectively for IL-8, TNFalpha, ADA and IFNgamma. No false-positives were encountered with IFNgamma and only one case with a small volume of pleural liquid was a false-negative. This indicates that IFNgamma is a very reliable marker of tuberculous pleurisy.
3618.
Yuen
MC. Tung WK. An uncommon cause of foot ulcer: tuberculosis osteomyelitis.
Emerg Med J. 18(2):140-1, 2001 Mar.
Abstract
Tuberculous osteomyelitis is an uncommon infection that usually involves the vertebrae. An otherwise healthy young man with a chronic discharging sinus on his right foot caused by tuberculous osteomyelitis is described. The risk factors, clinical features, radiological findings, and investigations of tuberculous osteomyelitis are briefly reviewed. Tuberculous osteomyelitis usually runs an insidious course; emergency physicians should be aware of the possibility of tuberculous osteomyelitis especially when patients present with chronic unexplained musculoskeletal symptoms.
3619.
Zissin R.
Gayer G. Chowers M. Shapiro-Feinberg M. Kots E.
Hertz M. Computerized tomography findings of abdominal tuberculosis:
report of 19 cases. Israel Medical Association Journal: Imaj. 3(6):414-8, 2001 Jun.
Abstract
BACKGROUND: Abdominal tuberculosis usually presents with general symptoms and obscure abdominal complaints for which computerized tomography is often the first imaging study. OBJECTIVE: To evaluate the CT findings of abdominal tuberculosis. METHODS: The CT scans of 19 patients (10 men and 9 women aged 20-85 years) with proven abdominal tuberculosis were retrospectively reviewed to define the location and extent of the disease. The patients were referred for the study mainly with general systemic symptoms. Additional abdominal complaints were present in four, including acute abdomen in one. Two had symptoms deriving from the urinary tract. Nine patients had recently arrived from high prevalence countries; five of them and two others were positive for human immunodeficiency virus. Three patients had a family history of tuberculosis; one had previously been treated for tuberculosis and four others had an underlying chronic disease. The diagnosis of tuberculosis was established by standard microbiological and histological techniques. RESULTS: We divided the disease manifestations into intraperitoneal (n = 13) and genitourinary involvement (n = 6). Peritoneal tuberculosis was fairly common, characterized by ascites, omental and mesenteric infiltration, and smooth thickening of the parietal peritoneum. One oncology patient had a false positive Tc-99m CEA isotope scanning, suggesting tumor recurrence. Genitourinary disease manifested mainly as hydronephrosis and calcifications. Three patients had pulmonary tuberculosis as well. CONCLUSION: The CT findings of abdominal tuberculosis may mimic various diseases, mainly diffuse peritoneal malignancy. We emphasize the need to consider tuberculosis in the differential diagnosis in patients with obscure abdominal symptoms, especially with multi-organ involvement. A high degree of clinical suspicion and familiarity with the abdominal CT manifestations allow early diagnosis of this treatable disease.
Apr 02
4281.
Aggarwal AN, Dhammi IK, Jain AK. Multifocal
skeletal tuberculosis. Trop Doct 2001 Oct;31(4):219-20
Multifocal
skeletal tuberculosis is an uncommonly reported entity. The article presents a
series of 18 cases encountered in our institution. There clinical
characteristics are analysed and compared with available international
literature.
4282.
Amaral L, Viveiros M, Kristiansen JE.
Phenothiazines: potential alternatives for the management of antibiotic
resistant infections of tuberculosis and malaria in developing countries. Trop
Med Int Health 2001 Dec;6(12):1016-22
The in vitro and in vivo activity of phenothiazines against antibiotic susceptible and antibiotic resistant Mycobacterium tuberculosis and malaria-causing Plasmodia is reviewed. Given the facts that pulmonary tuberculosis and malaria are the major causes of death in developing countries, that both of these infections continue to escalate in their resistance to antibiotics, that the cost for the management of these infections is beyond that afforded by most developing nations, and lastly, that new and effective agents are not forthcoming from the pharmaceutical industry, the scientific rationale for the potential use of select phenothiazines for the management of these infections is presented.
4283.
Andersen P, McAdam KP, Marchant A. Tuberculosis
contacts but not patients have higher gamma interferon responses to ESAT-6 than
do community controls in The Gambia. Infect Immun 2001 Oct;69(10):6554-7
The
Mycobacterium tuberculosis antigen ESAT-6 has been proposed for tuberculosis
immunodiagnosis. In The Gambia, 30% of community controls produced gamma
interferon (IFN-gamma) in response to ESAT-6. Increased proportions of
responders and intensities of responses were found in household contacts.
Responses that were initially low in tuberculosis patients increased after
treatment. An ESAT-6 IFN-gamma assay will be of limited use in the diagnosis of
tuberculosis in countries where tuberculosis is endemic. Its role in contact
tracing should be evaluated further.
4284.
Antoun MD, Ramos Z, Vazques J, Oquendo I, Proctor
GR, Gerena L, Franzblau SG. Evaluation of the flora of Puerto Rico for in vitro
antiplasmodial and antimycobacterial activities. Phytother Res 2001 Nov;15(7):638-42
The emergence of resistant strains of Plasmodium falciparum and Mycobacterium tuberculosis underscores the need for novel drugs that are effective against these microorganisms. As part of our screening programme of the flora of Puerto Rico, we tested a number of ethanol extracts of higher plants for antiplasmodial and antimycobacterial activities. A total of 40 extracts belonging to 23 plant families and 37 species were tested for antiplasmodial activity. Five extracts demonstrated activity against Plasmodium falciparum in vitro (50%-100% parasite suppression at 5 microg/mL). Another 63 extracts belonging to 30 plant families and 50 species were tested in vitro against Mycobacterium tuberculosis. Two extracts were found to be active, Ficus citrifolia and Pisonia borinquena (85% or more inhibition of microbial growth at 100 microg/mL of extract). Copyright 2001 John Wiley & Sons, Ltd.
4285.
Anupam Prakash, Hira H S: Tuberculous
osteomyelitis of sternum in adiabetic. Indian J Tuberc 2001, 48(1),
35-6.(014224). July 16, 2001.
Middle-aged diabetic woman who presented with a painless swelling of upper middle part of anterior chest was diagnosed to be suffering from the comparatively rare tuberculosis sternum. Pertinent literature is reviewed along with the case report.
4286.
Basta M, Lydakis C, Daskalogiannaki M, Schiza S,
Siafakas NM. Multi-focal tuberculosis with multiple intracranial tuberculomas
in a non-immunocompromised patient. Respir Med
2001 Oct;95(10):841-3 No
abstract.
4287.
Berker M, Atalay B, Soylemezoglu F, Ariogul S,
Palaoglu S. Cervical tuberculous spondylitis associated with systemic lupus
erythematosus. Spinal Cord 2001
Oct;39(10):549-53
STUDY DESIGN: A case report of cervical tuberculous spondylitis associated with systemic lupus erythematosus (SLE). Infection is a frequent problem in SLE, especially in patients hospitalised with the complications of the disease. Tuberculous spondylitis very rarely occurs in SLE patients, and cervical involvement has not been previously reported. CASE REPORT: A 54-year-old female patient was admitted to our hospital with a complaint of neck pain radiating to her shoulder of 2 months' duration. The neurological examination was completely normal and radiological investigations revealed narrowing, angulation and destruction of the end plates of the 5th and 6th cervical vertebrae. She has received corticosteroid and colchicine treatment for the diagnosis of SLE during the last 10 years. The anterior cervical approach was used and pyogenic material was debrided from the C5-6 intervertebral space, and an otogenous bone graft with a Smith Robinson type fusion was performed. CONCLUSION: High doses of corticosteroids are implicated as a risk factor for infection in SLE patients. Early diagnosis and appropriate medical and surgical treatment, as well as increased awareness of higher susceptibility to opportunistic infections, such as tuberculous spondylitis, are keystones for decreasing morbidity and mortality in patients with SLE.
4288.
Bewes P. Spinal
tuberculosis. Trop Doct 2001
Oct;31(4):237-40
Spinal tuberculosis
is an important and potentially crippling disease, but if recognized early and
treated energetically it can be brought under control, often with very
gratifying results. Knowledge of the exact bacteriology and sensitivity pattern
of the organisms involved can be very helpful indeed, and should be sought
where possible.
4289.
Boddinghaus B, Wichelhaus TA, Brade V, Bittner T.
Removal of PCR inhibitors by silica membranes: evaluating the Amplicor
Mycobacterium tuberculosis kit. J Clin Microbiol 2001 Oct;39(10):3750-2
The
effectiveness of PCR inhibitor removal by silica membranes in combination with
the Amplicor Mycobacterium tuberculosis kit was analyzed for 655 respiratory
and nonrespiratory specimens. The overall inhibition rate was reduced from
12.5%, when applying the Amplicor kit alone, to 1.1% with the addition of
silica membrane DNA purification.
4290.
Bretsche PA, Ismail N, Menon JN, Power CA, Uzonna
J, Wei G. Vaccination against and treatment of tuberculosis, the leishmaniases
and AIDS: perspectives from basic immunology and immunity to chronic
intracellular infections. Cell Mol Life Sci
2001 Nov;58(12-13):1879-96
The occurrence of infectious disease represents a failure of the immune system, a failure that must be prevented by effective vaccination or remedied by treatment. Vaccination against acute diseases such as smallpox and polio are very effective, due to the rapid and increased immune response of vaccinated individuals upon natural infection. In contrast, effective vaccination against intracellular pathogens that cause chronic diseases, such as the leishmaniases, tuberculosis and AIDS, has not been achieved. Clinical observations suggest cell-mediated, Th1 responses, exclusive of antibody production and the generation of Th2 cells, are optimally protective against these intracellular pathogens. Effective vaccination must ensure the generation of such a protective response. We explore here whether understanding very broad features of the regulation of the immune response can accommodate modern findings on the immunological features of these diseases, and provide a perspective within which strategies for effective vaccination and treatment can be developed.
4291.
Brown HM, Abbitt PL, Wilkinson EJ. Diagnosis of
clinically unsuspected extrapulmonary tuberculosis by fine needle aspiration: a
case report. Acta Cytol 2001
Nov-Dec;45(6):1032-6
BACKGROUND: Mycobacterium tuberculosis (MTb) infection remains the cause of higher morbidity and mortality than any other infectious disease in the world. Intact cellular immunity is necessary to resist the disease, and therefore the AIDS epidemic has greatly contributed to the resurgence of MTb. Depending on the degree of immunosuppression, the presentation of MTb in patients with AIDS can be atypical and difficult to diagnose as compared to the classical presentation of MTb in the nonimmunocompromised population. CASE: A patient who was not known to be HIV positive had a clinical picture of extensive abdominal and pelvic lymphadenopathy without chest radiographic abnormalities. The diagnosis of MTb was made by fine needle aspiration (FNA) of a pelvic lymph node. CONCLUSION: Miliary tuberculosis associated with AIDS may have an unusual clinical presentation and unusual cytologic features on ENA.
4292.
Carricajo A, Fonsale N, Vautrin AC, Aubert G.
Evaluation of BacT/Alert 3D liquid culture system for recovery of mycobacteria
from clinical specimens using sodium dodecyl (lauryl) sulfate-NaOH
decontamination. J Clin Microbiol 2001
Oct;39(10):3799-800
A total of 52 mycobacterial isolates were recovered from 1,197 clinical specimens decontaminated by a sodium dodecyl (lauryl) sulfate (SDS) NaOH protocol. Of these, 94% were recovered with the BacT/Alert 3D system (Organon Teknika, Durham, N.C.) and 79% were recovered on Lowenstein-Jensen (LJ) medium. Mean times to detection of organisms of the Mycobacterium tuberculosis complex (n = 47) were 22.8 days with LJ medium and 16.2 days with the system. The BacT/Alert 3D system is a rapid and efficient detection system which can be used with an SDS-NaOH decontamination procedure.
4293.
Caws M, Drobniewski FA. Molecular techniques in
the diagnosis of Mycobacterium tuberculosis and the detection of drug
resistance. Ann N Y Acad Sci 2001
Dec;953:138-45
Early diagnosis of Mycobacterium tuberculosis disease is crucial in initiating treatment and interrupting the train of transmission. The increasing incidence of MDR TB worldwide has also placed emphasis on the need for early detection of drug resistance, particularly to isoniazid and rifampicin. Molecular diagnostic techniques and automated culture systems have reduced turnaround times in the modern mycobacteriology laboratory, and the continuing evaluation and development of such techniques is increasing the use of molecular technology in developed nations. Simple phenotypic methods for the detection of resistance to first-line drugs and genotypic kit-form assays for detection of rifampicin resistance have been developed that have become key tools in the containment of MDR TB.
4294.
Chan ED, Chan J, Schluger NW. What is the role of
nitric oxide in murine and human host defense against tuberculosis?Current
knowledge. Am J Respir Cell Mol Biol
2001 Nov;25(5):606-12
The production of reactive oxygen intermediates and reactive nitrogen intermediates by innate immune cells is considered to be an effective host-defense mechanism against microbial pathogens. In the murine model of tuberculosis (TB), nitric oxide (NO) plays an essential role in the killing of Mycobacterium tuberculosis by mononuclear phagocytes. For example, in the mouse strain with a genetic disruption for inducible NO synthase (iNOS-/-), infection with M. tuberculosis is associated with a significantly higher risk of dissemination and mortality. Although more controversial in humans, there is a growing body of evidence that NO produced by TB-infected macrophages and by epithelial cells also has antimycobacterial effects against M. tuberculosis. The precise mechanism(s) by which NO and other reactive nitrogen species antagonize M. tuberculosis is not known, but may involve disruption of bacterial DNA, proteins, signaling, and/or induction of apoptosis of macrophages that harbor mycobacteria. In addition to cytokines such as tumor necrosis factor-alpha and interleukin 1-beta, mycobacterial cell wall components such as lipoarabinomannan and 19 kD lipoprotein, along with the T-cell-derived interferon-gamma, may also induce NO expression. In a Darwinian fashion, it also appears that certain strains of M. tuberculosis have evolved strategies to combat the toxic effects of NO.
4295.
Chen YC, Hsu SW. Tuberculous arthritis mimic
arthritis of the Sjogren's syndrome: findings from sonography, computed
tomography and magnetic resonance images. Eur J Radiol 2001 Dec;40(3):232-5
A patient with a history of Sjogren's syndrome developed chronic arthritis of left ankle. It was diagnosed as arthritis of the Sjogren's syndrome initially. However, joint pain persisted despite corticosteroid therapy. Sonography disclosed a multiloculated cystic lesion with peripheral hyperechoic enhancement around left ankle and extended to Achilles tendon and subcutaneous region. Computed tomography (CT) confirmed the findings. Magnetic resonance imaging (MRI) revealed increased signal intensity of the lesion after gadonillium enhancement on T1-weighted images. These abnormalities showed inhomogenous high signal intensities on T2-weighted images. Tuberculous arthritis was diagnosed by positive synovial tuberculous culture. Sonography is a valuable tool that offers significant advantages for the initial evaluation of arthritis of the Sjogren's syndrome and help early suspicious of tuberculous arthritis, because of its cost-effectiveness, superior differentiation between the cyst and solid lesions, convenience for guiding biopsy and drainage.
4296.
Chierakul N, Damrongchokpipat P, Chaiprasert A,
Arjratanakul W. Antibody detection for the diagnosis of tuberculous pleuritis. Int J Tuberc Lung Dis 2001 Oct;5(10):968-72
SETTING: University Hospital, Bangkok, Thailand. OBJECTIVE: To evaluate the diagnostic value of antibody detection in serum and in pleural effusion as a marker of tuberculous pleuritis (TBP). DESIGN: Cross-sectional study. MATERIALS AND METHODS: One hundred and fifty-five patients with pleural effusion who underwent diagnostic evaluation at Siriraj Hospital between March 1999 and May 2000 were recruited. Samples of pleural fluid were examined biochemically, cytologically and microbiologically. Pathological examination of pleural tissue was also performed. The diagnosis of TBP or other diagnosis was made by either pathological finding or culture result. Immunochromatographic tuberculosis (ICT-TB) tests for antibody detection were then performed using the stored serum samples and effusions from those patients with a final definite diagnosis. This test detects antibodies to five secreted antigens of Mycobacterium tuberculosis, including the 38 kDa antigen. RESULTS: We investigated 67 patients with TBP, 44 with malignant pleural effusions, seven with transudates and one with cryptococcal pleuritis. The combined ICT-TB serum and effusion tests were positive in 34/67 TBP and 22/52 non-TBP patients. The sensitivity, specificity, positive predictive value and negative predictive value of the ICT-TB test were 50.7, 57.7, 60.7 and 47.6%, respectively. In 11 TBP patients with human immunodeficiency virus (HIV) co-infection, the sensitivity of the ICT-TB test was 45.6%. There was no correlation between the test positivity and culture result or duration of disease. CONCLUSIONS: The diagnostic value of antibody detection in TBP is modest in an area with intermediate prevalence of tuberculosis, independently of HIV serological status.
4297.
Choi H, Lee CJ, Lee KJ, Moon KD. Primary
tubercolous osteomyelitis of the
sternum. J Cardiovasc Surg (Torino)
2001 Dec;42(6):841-3
We present an 82-year-old woman with anterior sternal pain diagnosed as primary mycobacterial osteomyelitis of the sternum. She was treated with simultaneous wide resection and reconstruction of the chest wall. On admission, computed tomographic scan showed a sclerotic sternal mass with soft tissue reaction. Mycobacterium tuberculosis was grown in initial culture. First-line antituberculous medication and local debridement failed. The successful result was achieved by extensive sternal and chondral resection followed by simultaneous bilateral pectoralis major muscle flap positioning.
4298.
Collins J. CT signs and patterns of lung disease. Radiol Clin North Am 2001 Nov;39(6):1115-35
The ground-glass pattern is a common but nonspecific finding on CT. In certain clinical circumstances, it can suggest a specific diagnosis, indicate a potentially treatable disease, and guide a clinician to an appropriate area for biopsy. A pattern of centrilobular ground-glass nodules is fairly specific for the diagnosis of hypersensitivity pneumonitis with the appropriate clinical history. The tree-in-bud pattern indicates disease affecting the small airways. The differential diagnosis is lengthy; however, the most common process leading to this CT appearance is infection. Although commonly associated with M. tuberculosis, many infectious organisms can produce this pattern. When honeycombing is seen on HRCT, a confident diagnosis of lung fibrosis can be made. The most common causes of interlobular septal thickening on HRCT are pulmonary edema, pulmonary hemorrhage, and lymphangitic spread of cancer, and smooth thickening is characteristic of all three. Diffuse lung cysts in patients who are not immunocompromised generally signify Langerhans' cell histiocytosis, lymphangioleiomyomatosis, or centrilobular emphysema. Centrilobular emphysema can be diagnosed when the centrilobular artery is seen as a small nodular opacity in the center of the cyst. Langerhans' cell histiocytosis is often associated with parenchymal nodules, helping to distinguish it from lymphangioleiomyomatosis. When a nodular pattern is seen on HRCT, the differential diagnosis is very long, but can be narrowed by noting whether the nodules are random, centrilobular, or perilymphatic in distribution. A mosaic pattern of lung attenuation can represent an infiltrative, small airway, or vascular process. The distinction can often be made by noting the size of the pulmonary vessels in the abnormal areas of lung, and whether air trapping is present on expiratory scanning. Computed tomographic signs can be useful indicators of a specific disease process. For instance, the air bronchogram sign indicates that an opacity is intrapulmonary in location, and signals the possibility of two types of neoplasm: lymphoma and bronchioloalveolar cell carcinoma. An air crescent sign indicates recovery of the immune system in an immunocompromised patient with invasive pulmonary aspergillosis. The fallen lung sign is diagnostic of a bronchial transection in the correct clinical setting. The gloved finger sign is very suggestive of allergic bronchopulmonary aspergillosis. The halo sign is highly suggestive of early angioinvasive pulmonary aspergillosis in patients with acute leukemia. When a split pleura sign is seen, the diagnosis is often empyema, although other causes of pleuritis can lead to a similar CT appearance.
4299.
Cruciani M, Malena M, Bosco O, Gatti G,
Serpelloni G. The impact of human immunodeficiency virus type 1 on
infectiousness of tuberculosis: a meta-analysis. Clin Infect Dis 2001 Dec 1;33(11):1922-30
To assess if the
relative infectiousness of patients with tuberculosis is enhanced by
coinfection with human immunodeficiency virus type 1 (HIV-1), data from 6
studies of 1240 health care workers who had contact with tuberculosis patients
were analyzed. Overall rates of tuberculin skin test conversion were similar
regardless of HIV-1 positivity of tuberculosis patients (odds ratio [OR], 1.04;
95% confidence interval [CI], 0.23-1.84). However, when only 3 studies during
nosocomial outbreaks of multidrug-resistant Mycobacterium tuberculosis were
analyzed, rates of skin test conversion were higher among contacts of
HIV-1-positive index cases (OR, 2.85; 95% CI, 1.85-3.85; P=.0002). A second
meta-analysis included data from 11 studies of 10,714 household contacts of
tuberculosis patients. Prevalence of both skin test positivity (OR, 0.45; 95%
CI, 0.20-1.03) and active disease (OR, 1.17; 95% CI, 0.78-1.56) were similar
regardless of HIV-1 positivity of index cases. These data suggest that
tuberculosis patients with HIV-1 infection are not intrinsically more
infectious to their contacts than are HIV-1-negative tuberculosis patients.
4300.
Das S, Chattopadhyay U K: Role of silicon in
modulating the internal morphology and growth of Mycobacterium tuberculosis.
Indian J Tuberc 2000, 47(2), 87-91.(013142) July1, 2001.
Silicon is known to enhance the growth and pathogenicity of Mycobacterium tuberculosis. In this study the pattern of growth of different strains of M. tuberculosis was studied on a carbon free silicon culture medium and compared with that on conventional media. Thirty-two strains of M. tuberculosis from mostly clinical isolates were serially propagated on a carbon free silicate medium and on different conventional media using standard inocula. There was initial good growth on the silicon-based medium in comparison with the conventional media. However, the growth was considerably reduced after early serial transfers but improved again in late serial cultures. The initial good growth appears to be due to increased activity of silico induced fatty acid synthase and the late improvement due to slow adaptation of M. tuberculosis to the carbon free metabolism by the formation of silicon acid esterified cell wall and silicon induced genetic alteration . all these changes were probably responsible for the formation of fibrous, ropelike structures and dense granules seen under electron microscope. Since the silicon content of the lung tissue is comparatively higher than many other tissues of the human body, it could play a role in the pathogenicity of tuberculosis in the lungs. 26 ref.
4301.
Davies P, Grange J. The genetics of host resistance and susceptibility to
tuberculosis. Ann N Y Acad Sci 2001
Dec;953:151-6
The study of
human genomics has the potential to aid our understanding of the
interindividual and interpopulation differences in susceptibility to
tuberculosis. Resistance to infection is affected by the ability of macrophages
to phagocytose and destroy the bacilli. Several genes are involved in this
process, and two have been the focus of recent interest: the natural
resistance-associated protein (NRAMP1) gene and the genes coding for the
vitamin D receptor. Susceptibility genes have also been discovered--for
example, one on the X chromosome that may explain the increased susceptibility
of males to tuberculosis. Studies have also focused on the variations in
virulence of the bacillus in both its drug-susceptible and drug-resistant
forms. These mechanisms must be understood in order to prevent, or combat, the
emergence of a virulent, multidrug-resistant form of the bacillus that would be
uncontrollable by means of today's treatment strategies.
4302.
de Maria A, Berardi M, Dignetti P, Ferrera L,
Viassolo L, Canonica GW. Side effects of antituberculosis treatment.
Thorax 2001 Dec;56(12):983 No
abstract.
4303.
de Maria A, Berardi M, Dignetti P, Ferrera L,
Viassolo L, Canonica GW. Side effects of antituberculosis treatment.
Thorax 2001 Dec;56(12):983 No abstract.
4304.
de Pinho AM, Santoro-Lopes G, Harrison LH,
Schechter M. Chemoprophylaxis for tuberculosis and survival of HIV-infected
patients in Brazil.AIDS 2001 Nov
9;15(16):2129-35
OBJECTIVE: To study the impact of chemoprophylaxis for tuberculosis on the survival of HIV-infected patients with a positive tuberculin skin test. DESIGN: Prospective observational cohort study. SETTING: Outpatient clinic of a university hospital, in Rio de Janeiro, Brazil. PATIENTS: Two-hundred and ninety-seven patients with a positive tuberculin skin test (reaction > or = 5mm) who were admitted to the cohort between January 1991 and December 1994. Follow-up ended on September 30, 1998. INTERVENTION: The use of chemoprophylaxis for tuberculosis. MAIN OUTCOME MEASURES: Death was the primary outcome variable. The occurrence of tuberculosis was studied as a secondary outcome. Cox regression models were used in these analyses. RESULTS: The median follow-up time was 43.6 months. Chemoprophylaxis was used by 128 (43%) of the patients. The use of chemoprophylaxis was associated with a reduction in risk for tuberculosis (hazard ratio, 0.38; 95% confidence interval, 0.14-1.04; P = 0.05). In a regression model adjusted for baseline CD4 cell count, chemoprophylaxis was associated with longer survival (hazard ratio, 0.24; 95% confidence interval, 0.09-0.65; P = 0.002). CONCLUSIONS: Anti-tuberculosis chemoprophylaxis was associated with a substantially prolonged survival among purified protein derivative-positive HIV-infected patients in Brazil. These data have important implications for the clinical care of patients with HIV infection in areas of the world with a high prevalence of Mycobacterium tuberculosis infection.
4305.
Deshmukh H, Prasad SR, Patankar T, Zankar M.
Internal mammary artery pseudoaneurysms complicating chest wall infection in
children: diagnosis and endovascular therapy. Clin Imaging 2001 Nov-Dec;25(6):396-9
Mycotic internal mammary artery (IMA) pseudoaneurysms are sparsely reported in medical literature. We report imaging findings of IMA pseudoaneurysms secondary to chest wall abscesses (staphylococcal and tuberculous) in two children. Both children were successfully treated by endovascular method thus obviating the need for surgery.
4306.
Dhammi IK, Jain AK. Unusual tubercular abscesses
in two elderly women. Trop Doct 2001
Oct;31(4):249 No abstract.
4307.
Dhiman S R: some observations of ABO, Rh (D)
blood groups in relation to pulmonary tuberculosis. Bionature, Bhopal 2001,
21(1), 49-53.(018321) Aug 16, 2001.No
abstract.
4308.
Dobbs KG, Lok KH, Bruce F, Mulcahy D, Benjamin
WH, Dunlap NE. Value of Mycobacterium tuberculosis fingerprinting as a tool in
a rural state surveillance program. Chest
2001 Dec;120(6):1877-82
OBJECTIVE: This study demonstrates the value of Mycobacterium tuberculosis fingerprinting used in conjunction with traditional epidemiologic methods to identify smoldering outbreaks of tuberculosis in endemic areas where background rates of tuberculosis are high. METHODS: IS6110 DNA fingerprinting was performed on isolates of M tuberculosis from verified cases of tuberculosis in Alabama from 1994 to 1998. A statewide database groups isolates into "clusters" and tracks them cumulatively over time. A large cluster was identified and was secondarily investigated using traditional epidemiologic methods. RESULTS: Twenty-five isolates were found to be identical by fingerprinting analysis. Patients were living within 10 counties across the state, and 12 cases were localized to a single county. This represented an ongoing, statewide tuberculosis outbreak previously unrecognized by local and state health officials. Secondary investigation of the cases revealed the primary sites of transmission to be a correctional facility and two homeless shelters. CONCLUSIONS: Population surveillance using M tuberculosis fingerprinting was successfully utilized to detect a significant and smoldering tuberculosis outbreak. Measures are currently in place to identify and prevent further transmission in the involved locations.
4309.
Doyal L. Moral problems in the use of coercion in
dealing with nonadherence in the diagnosis and treatment of tuberculosis. Ann N
Y Acad Sci 2001 Dec;953:208-15
Coercion and detainment can be a morally acceptable strategy to fight the spread of tuberculosis, but these measures need to be placed into a much broader context than that of their short-term potential effectiveness. TB should be de-stigmatized by full acknowledgment that we all share the blame for its perpetuation. When coercion and detention are necessary, they should incorporate a strategy of optimum protection for minimum violation of autonomy. National and international health care programs should provide effective and nonthreatening treatments for TB and other related illnesses such as HIV and should develop policies to tackle the environmental causes of TB and provide support for vulnerable victims. Corporate pressures to continue world poverty must be undermined.
4310.
Driver CR, Munsiff SS, Li J, Kundamal N, Osahan
SS. Relapse in persons treated for drug-susceptible tuberculosis in a
population with high coinfection with human immunodeficiency virus in New York
City. Clin Infect Dis 2001 Nov
15;33(10):1762-9
The optimal duration of tuberculosis treatment for persons infected with human immunodeficiency virus (HIV) has been debated. A cohort of 4571 culture-positive drug-susceptible patients who received > or =24 weeks of standard 4-drug tuberculosis treatment were assessed to determine the incidence of tuberculosis relapse. Tuberculosis "recurrence" was defined as having a positive culture < 30 days after the last treatment date and "relapse" as having a positive culture > or =30 days after the last treatment. Patients infected with HIV were more likely than those who were uninfected to have recurrence or relapse (2.0 vs. 0.4 per 100 person-years, P< .001). Patients infected with HIV who received < or =36 weeks of treatment were more likely than those who received > 36 weeks to have a recurrence (7.9% vs. 1.4%, P< .001). Clinicians should be aware of the possibility of recurrence of tuberculosis 6-9 months after the start of treatment. Sputum evaluation to ensure cure or assessment 3 months after completion of treatment should be performed among persons infected with HIV who receive the shorter regimen.
4311.
Farmer P, Bayona J, Becerra M.
Multidrug-resistant tuberculosis and the need for biosocial perspectives. Int J Tuberc Lung Dis 2001 Oct;5(10):885-6 No abstract.
4312.
Franco J, Camarena JJ, Nogueira JM, Blanquer R,
Ruiz MJ, Marin J. Serological response (Western blot) to fractions of
Mycobacterium tuberculosis sonicate antigen in tuberculosis patients and
contacts. Int J Tuberc Lung Dis 2001
Oct;5(10):958-62
OBJECTIVE: To assess the serological response to fractions of Mycobacterium tuberculosis sonicate antigen by Western blot analysis in patients with tuberculosis and contacts. METHODS: We studied 71 individuals including 43 patients with active tuberculosis, 16 contacts and 12 healthy blood donors. For Western blot analysis, M. tuberculosis (H37Rv strain) sonicate antigen extract was fractionated by electrophoresis on polyacrylamide gel (SDS-PAGE). RESULTS: We obtained antibody responses directed against four antigenic fractions with molecular weights of 71, 65, 26-38 and 19 kDa. Sixty per cent of pleural tuberculosis and 52.4% of smear-positive pulmonary tuberculosis had whole responses against all four fractions; there were no partial responses in these groups. For patients with smear-negative pulmonary tuberculosis whole responses were 17.6% and partial responses 41.2%. All contacts whose tuberculin tests converted from negative to positive (three cases) reacted exclusively against the 19 kDa fraction. CONCLUSIONS: Western blot-positive results in patients with pleural and smear-positive pulmonary tuberculosis were characterised by a whole pattern against all four antigenic fractions, whereas patients with smear-negative pulmonary tuberculosis showed heterogeneous results. The exclusive response against the 19 kDa fraction observed in contacts with tuberculin conversion could help to identify candidates for preventive therapy.
4313.
Gillooly DJ, Simonsen A, Stenmark H.
Phosphoinositides and phagocytosis. J
Cell Biol 2001 Oct 1;155(1):15-7
Phosphoinositide 3 kinases (PI3Ks)*Abbreviation used in this paper: PI3K, phosphoinositide 3 kinase. are known as regulators of phagocytosis. Recent results demonstrate that class I and III PI3Ks act consecutively in phagosome formation and maturation, and that their respective products, phosphatidylinositol 3,4,5-trisphosphate (PI[3,4,5]P(3)) and phosphatidylinositol 3-phosphate (PI[3]P), accumulate transiently at different stages. Phagosomes containing Mycobacterium tuberculosis do not acquire the PI(3)P-binding protein EEA1, which is required for phagosome maturation. This suggests a possible mechanism of how this microorganism evades degradation in phagolysosomes.
4314.
Goh KS, Legrand E, Sola C, Rastogi N. Rapid
differentiation of "Mycobacterium canettii" from other Mycobacterium
tuberculosis complex organisms by PCR-restriction analysis of the hsp65 gene. J
Clin Microbiol 2001 Oct;39(10):3705-8
A total of 102 isolates of the Mycobacterium tuberculosis complex, including available "M. canettii" isolates, were studied by PCR-restriction analysis of a 441-bp fragment of the hsp65 gene. PRA upon HhaI enzyme digestion (GCGC) allowed easy differentiation of "M. canettii" from other members of the M. tuberculosis complex (three bands of 260, 105, and 60 bp for "M. canetti," compared to four bands of 185, 105, 75, and 60 bp for other members of the M. tuberculosis complex). Sequencing of the 441-bp hsp65 fragment of "M. canettii" isolates showed the disappearance of an HhaI site at position 235 due to a C-to-T transition that corresponded to position 631 of the homologous hsp65 gene of M. tuberculosis H37Rv. Considering that "M. canettii" may also exist as a stable rough morphotype, we suggest that the true number of "M. canettii" isolates may be underestimated in clinical microbiology laboratories.
4315.
Gupta SK. Pediatric sarcoidosis in India. Indian
J Pediatr 2001 Oct;68(10):931-5
OBJECTIVE: Since 1957, when the first pediatric case of sarcoidosis was reported, 11 more cases have been traced in the Indian literature. METHODS: Nine of them were reported from general wards of hospitals (while the remaining 3 were from pediatric unit of AIIMS, New Delhi). Failure of initial treatment with anti-tuberculosis drugs for some months, necessitated search for an alternative diagnosis. Considerable delay (several months to years) occurred due to several parent- or physician-dependant factors. RESULTS: Affection more in girls (9 to 12), universal fever and constitutional symptoms, loss of weight, scanty lung features, hepatomegaly, often with massive splenomegaly, frequent lymphadenopathy etc. caused initial confusion. CONCLUSION: Treatment with oral steroid or with chloquine and NSAIDS with or without steroid MDI gave equally good results. Long follow-up was done in a few cases only, showing relapses in nearly 66%. One case had a superinfection with acid-fast bacilli.
4316.
Haimi-Cohen Y, Zeharia A, Mimouni M, Soukhman M,
Amir J. Skin indurations in response to
tuberculin testing in patients with
nontuberculous mycobacterial lymphadenitis. Clin Infect Dis 2001 Nov 15;33(10):1786-8
Mantoux results were examined for 29 children with culture-proven nontuberculous mycobacterial lymphadenitis, and 4 species were isolated: Mycobacterium avium-intracellulare complex (from 14 patients [48%]), Mycobacterium haemophilum (from 12 [41%]), Mycobacterium simiae (from 2 [7%]), and Mycobacterium scrofulaceum (from 1 [3%]); the median indurations for each species were 15.5 mm, 14.5 mm, 20 mm, and 23 mm, respectively, and in 17 cases (59%), they were > or =15 mm. In regions with a low incidence of tuberculosis, lymphadenitis thought to be due to nontuberculous mycobacteria should be managed as such, regardless of Mantoux results, thereby avoiding antituberculosis treatment.
4317.
Jai Prakash, Kar C R, Srivastava P K:
Tuberculosis in renal transplant recipients: a single centre experience from
northern India. Indian J Nephrol 2000, 10(1), 9-12. (013178). July1, 2001.
Study included 79 (71 male and 8 female) renal allograft recipients bertween Jan. 1991 to June 1997. The age of patients ranged between 21-48 (mean 34.2) years. Seventy persons had received live related (88.6%) and remaining nine had been transplanted with live related donor kidneys. Conventional immunosuppression was used in 64 (81%) patients and 15 cases received cyclosporine in addition. 13 patients (16.4%) were identified to have tubercular infection in post transplant period. All patients had normal chest radiograph prior to transplantation. They developed tuberculosis for the first time during 6.65 months of successful post transplant period. Pulmonary tuberculosis was found in 6 patients, 7 cases had extra pulmonary tuberculosis which included: abdominal 3, disseminated 2, spinal and meningeal tuberculosis 1 each. The mortality was 23%. is an important cause of morbidity in renal transplant patients and lesions of pulmonary and extra pulmonary tuberculosis are nearly equal in our transplant patients.
4318.
JH, Mulcahy D, Benjamin WH, Bishai WR.
Epidemiologic usefulness of spoligotyping for secondary typing of Mycobacterium
tuberculosis isolates with low copy numbers of IS6110. J Clin Microbiol 2001 Oct;39(10):3709-11
Restriction fragment length polymorphism (RFLP) analysis of IS6110 is commonly used to DNA fingerprint Mycobacterium tuberculosis. However, low-copy (< or =5) IS6110 M. tuberculosis strains are poorly differentiated, requiring secondary typing. When spoligotyping was used as the secondary method, only 13% of Maryland culture-positive tuberculosis (TB) patients with low-copy IS6110-spoligotyped clustered strains had epidemiologic linkages to another patient, compared to 48% of those with high-copy strains clustered by IS6110 alone (P < 0.01). Spoligotyping did not improve a population-based molecular epidemiologic study of recent TB transmission.
4319.
Katti MK. Assessment of RD 1-encoded
mycobacterial antigens in the immunodiagnosis of pulmonary, extrapulmonary, and
latent tuberculosis infections. J Infect Dis
2001 Dec 1;184(11):1497-8 No
abstract.
4320.
Khanna M, Myneedu V P, Sharma S K, Srivastava L
M: Immunological abnormalities in pulmonary tuberculosis. Proc Indian Sci Congr
Ass-Pt IV, Sect-II 1997, 24-5.(015331) Aug 1,
2001.
Twenty patients with
pulmonary tuberculosis (PTB) and healthy volunteers were studied. Peripheral
blood examination and Branchoalveolar Lavage (BAL) were performed. Serum
immunoglobulins (n=20) IgG (P<0.01) and IgM (<) were significantly raised
as compared to normal controls. Serum complement components (C3 and C4) level
was also increased significantly as compared to normal controls. The CD3+
and CD4+ cells decreased in peripheral blood and increased in BAL
fluid as compared to normal controls. the decrease in IL-2 and IL-2 receptor
level was observed in culture supernatant of blood lymphocytes in patients with
tuberculosis as compared to normal controls. It is concluded that patients with
pulmonary tuberculosis have increased immunoglobulins due to
hypergammaglobulemia and increased CD3* and CD4* cells in
BAL fluid due to formation of granuloma inside the lungs. The decrease in IL-2
and IL-2 receptor due to improper priming of naïve T cell.
4321.
Kingston M, Childs K, Carlin E. Adverse reaction
to antimycobacterials administered as a combination tablet with no reaction to
the same drugs in isolation. Sex Transm Infect
2001 Oct;77(5):392-3 No abstract.
4322.
Kisembo HN, Kawooya MG, Zirembuzi G, Okwera A.
Serial chest radiographs in the management of children with a clinical
suspicion of pulmonary tuberculosis. J Trop Pediatr 2001 Oct;47(5):276-83
The aim of the study was to define the role of serial chest radiographs (SCR) in the management of children with a clinical suspicion of pulmonary tuberculosis (PTB) and to determine the interval at which they should be taken. Eighty children with a clinical suspicion of PTB were studied and followed-up for a duration of 18 months. SCR during the time of treatment were taken at monthly intervals for the first 3 months, then at 2-monthly intervals up to the end of therapy, and finally 2 months post-therapy. These were reviewed and the changes while on treatment noted and correlated with the clinical picture. Lung opacities were observed in 73 children (91 per cent) and were the most common radiological finding on the initial chest X-ray. These were followed by reduced chest wall muscle bulk present in 66 children (83 per cent). Mediastinal and/or hilar lymphadenopathy was noted in 47 children with a significant occurrence in the 0-4 age group (p = 0.004). Pleural effusions, cavities and calcification were rare. Human immunodeficiency virus (HIV) seropositive children with PTB accounted for 87 per cent and carried a poor prognosis (p = 0.0007). The common chest radiographic findings in children with PTB include lung opacities with hilar/mediastinal lymphadenopathy. Pleural effusions, cavitation, calcifications, miliary spread and normal chest X-rays were rare. SCR are useful in monitoring response to treatment, detection of onset of secondary infections and complications. HIV positive patients carry a poor prognosis. Based on the results of this study, pre-treatment, 2 months after onset of treatment, and end of therapy radiographs are recommended as routine in children with a clinical suspicion of PTB.
4323.
Klein JL, Brown TJ, French GL. Rifampin
resistance in Mycobacterium kansasii is associated with rpoB mutations. Antimicrob
Agents Chemother 2001 Nov;45(11):3056-8
Rifampin is the most potent drug used in the treatment of disease due to Mycobacterium kansasii. A 69-bp fragment of rpoB, the gene that encodes the beta subunit of the bacterial RNA polymerase, was sequenced and found to be identical in five rifampin-susceptible clinical isolates of M. kansasii. This sequence showed 87% homology with the Mycobacterium tuberculosis gene, with an identical deduced amino acid sequence. In contrast, missense mutations were detected in the same fragment amplified from five rifampin-resistant isolates. A rifampin resistant strain generated in vitro also harbored an rpoB gene missense mutation that was not present in the parent isolate. All mutations detected (in codons 513, 526, and 531) have previously been described in rifampin-resistant M. tuberculosis isolates. Rifampin MICs determined by E-test were <1 mg/liter for all rifampin-susceptible isolates and >256 mg/liter for all rifampin-resistant ones. In addition, four of the five rifampin-resistant isolates were also resistant to rifabutin. We have thus shown a strong association between rpoB gene missense mutations and rifampin resistance in M. kansasii. Although our results are derived from a small number of isolates and confirmation with larger numbers would be useful, they strongly suggest that mutations within rpoB form the molecular basis of rifampin resistance in this species.
4324.
Lalvani A. Direct ex vivo analysis of
antigen-specific IFN-gamma-secreting CD4 T cells in Mycobacterium
tuberculosis-infected individuals: associations with clinical disease state and
effect of treatment. J Immunol 2001 Nov
1;167(9):5217-25
The wide spectrum of clinical outcomes following infection with Mycobacterium tuberculosis is largely determined by the host immune response; therefore, we studied several clinically defined groups of individuals (n = 120) that differ in their ability to contain the bacillus. To quantitate M. tuberculosis-specific T cells directly ex vivo, we enumerated IFN-gamma-secreting CD4 T cells specific for ESAT-6, a secreted Ag that is highly specific for M. tuberculosis, and a target of protective immune responses in animal models. We found that frequencies of circulating ESAT-6 peptide-specific IFN-gamma-secreting CD4 T cells were higher in latently infected healthy contacts and subjects with minimal disease and low bacterial burdens than in patients with culture-positive active pulmonary tuberculosis (p = 0.009 and p = 0.002, respectively). Importantly, the frequency of these Ag-specific CD4 T cells fell progressively in all groups with treatment (p = 0.005), suggesting that the lower responses in patients with more extensive disease were not due to tuberculosis-induced immune suppression. This population of M. tuberculosis Ag-specific Th1-type CD4 T cells appears to correlate with clinical phenotype and declines during successful therapy; these features are consistent with a role for these T cells in the containment of M. tuberculosis in vivo. Such findings may assist in the design and evaluation of novel tuberculosis vaccine candidates.
4325.
Leiner S. Management of tuberculosis. N Engl J Med
2001 Nov 15;345(20):1501; discussion 1502 No abstract.
4326.
Locham K K, Garg R, Manjit Singh: Tuberculosis of
lower cervical spine. Indian Pediat 2001, 38(5), 546-9.(015335) No abstract.
4327.
M, Abe C, Toyoda T, Kishimoto T, Ogura T.
Clinical evaluation of anti tuberculous glycolipid immunoglobulin G antibody
assay for rapid serodiagnosis of pulmonary tuberculosis. J Clin Microbiol 2001 Oct;39(10):3603-8
Previously we reported the development of a highly sensitive enzyme-linked immunosorbent assay specific for anti-tuberculous glycolipid (anti-TBGL) for the rapid serodiagnosis of tuberculosis. In this study, the usefulness of an anti-TBGL antibody assay kit for rapid serodiagnosis was evaluated in a controlled multicenter study. Antibody titers in sera from 318 patients with active pulmonary tuberculosis (216 positive for Mycobacterium tuberculosis in smear and/or culture tests and 102 smear and culture negative and clinically diagnosed), 58 patients with old tuberculosis, 177 patients with other respiratory diseases, 156 patients with nonrespiratory diseases, and 454 healthy subjects were examined. Sera from 256 younger healthy subjects from among the 454 healthy subjects were examined as a control. When the cutoff point of anti-TBGL antibody titer was determined as 2.0 U/ml, the sensitivity for active tuberculosis patients was 81.1% and the specificity was 95.7%. Sensitivity in patients with smear-negative and culture-negative active pulmonary tuberculosis was 73.5%. Even in patients with noncavitary minimally advanced lesions, the positivity rate (60.0%) and the antibody titer (4.6 +/- 9.4 U/ml) were significantly higher than those in the healthy group. These results indicate that this assay using anti-TBGL antibody is useful for the rapid serodiagnosis of active pulmonary tuberculosis.
4328.
Machado N, Grant CS, Scrimgeour E. Abdominal
tuberculosis--experience of a University hospital in Oman. Acta Trop 2001
Oct 22;80(2):187-90
OBJECTIVE: To
determine the clinical presentation and assess the usefulness of various
diagnostic modalities and outcome of treatment of abdominal tuberculosis (TB).
Materials and methods: The files of patients admitted to Sultan Qaboos
University Hospital (SQUH) with a diagnosis of abdominal TB from January 91 to
December 99 were studied retrospectively and data abstracted. RESULTS: Eighteen
patients were diagnosed during this period, of which ten were males. The median
age was 27 years (range 5-65). The common symptoms were fever, weight loss,
anorexia, and abdominal pain. Abdominal signs were less frequent and included
hepatomegaly and ascites. Eight patients had co-existent immunocompromised
disorders; two of these had active pulmonary TB. Diagnostic investigations
included gastrointestinal contrast studies in two, ultrasound (US) guided fine
needle aspiration cytology (FNAC) in nine, and laparoscopy and/or laparotomy in
seven. All patients underwent antituberculous therapy for 9-12 months, in
addition to the treatment of associated disorders. The response to
antituberculous therapy was good except in one patient with HIV. Four patients
died from associated primary disorders. CONCLUSIONS: The clinical presentation
was non-specific and nearly half of the patients had associated
immunocompromised disorders; thus a high index of clinical suspicion is
required. US guided FNAC and selective laparoscopy were the most useful
diagnostic modalities. Antituberculous therapy was effective.
4329.
Marshall BG, Wangoo A, O'Gaora P, Cook HT, Shaw
RJ, Young DB. Enhanced antimycobacterial response to recombinant Mycobacterium
bovis BCG expressing latency-associated peptide. Infect Immun 2001 Nov;69(11):6676-82
With a view to
exploring the role of transforming growth factor beta (TGF-beta) during
mycobacterial infection, recombinant clones of bacillus Calmette-Guerin (BCG)
were engineered to express the natural antagonist of TGF-beta,
latency-activated peptide (LAP). Induction of TGF-beta activity was reduced
when macrophages were infected with BCG expressing the LAP construct (LAP-BCG).
There was a significant reduction in the growth of LAP-BCG in comparison to
that of control BCG following intravenous infection in a mouse model. The enhanced
control of mycobacterial replication was associated with an increase in the
production of gamma interferon by splenocytes challenged during the acute stage
of infection but with a diminished recall response assessed after 13 weeks.
Organ weight and hydroxyproline content, representing tissue pathology, were
also lower in mice infected with LAP-BCG. The results are consistent with the
hypothesis that TGF-beta has a detrimental effect on mycobacterial immunity.
While a reduction in TGF-beta activity augments the initial response to BCG
vaccination, early bacterial clearance may adversely affect the induction of a
long-term memory response by LAP-BCG.
4330.
McMurray DN, Gennaro ML. Immunological
characterization of antigens encoded by the RD1 region of the Mycobacterium
tuberculosis genome. Scand J Immunol
2001 Nov;54(5):448-52
Development of immunoassays specific for the diagnosis of tuberculosis requires antigens unique to Mycobacterium tuberculosis. In a search for such antigens we tested six proteins encoded by RD1, a region present in M. tuberculosis and virulent M. bovis genomes but missing from the DNA of all substrains of M. bovis Bacillus Calmette-Guerin (BCG). The six proteins (Rv3871, Rv3872, Rv3873, MTSA-10, ESAT-6 and Rv3878) were purified to near-homogeneity from recombinant Escherichia coli. When tested for the ability to elicit antibody responses and delayed type hypersensitivity in tuberculous guinea pigs, only two of six antigens, ESAT-6 and MTSA-10, elicited strong skin reactions, while vigorous antibody responses were observed to all six proteins. When antibody responses to RD1 antigens were evaluated in sera from patients having pulmonary tuberculosis and from control subjects (patients having mycobacterioses other than tuberculosis, and healthy persons), a sizeable proportion (25%) of tuberculosis patients but none of the control subjects, had antibodies against MTSA-10 and/or ESAT-6. We conclude that MTSA-10 and ESAT-6 are promising candidates for immunodiagnostic assays specific for tuberculosis.
4331.
MF, Rothel JS. Comparison of a whole-blood
interferon gamma assay with tuberculin skin testing for detecting latent
Mycobacterium tuberculosis infection. JAMA
2001 Oct 10;286(14):1740-7
CONTEXT: Identifying persons with latent tuberculosis infection (LTBI) is crucial to the goal of TB elimination. A whole-blood interferon gamma (IFN-gamma) assay, the QuantiFERON-TB test, is a promising in vitro diagnostic test for LTBI that has potential advantages over the tuberculin skin test (TST). OBJECTIVES: To compare the IFN-gamma assay with the TST and to identify factors associated with discordance between the tests. DESIGN AND SETTING: Prospective comparison study conducted at 5 university-affiliated sites in the United States between March 1, 1998 and June 30, 1999. PARTICIPANTS: A total of 1226 adults (mean age, 39 years) with varying risks of Mycobacterium tuberculosis infection or documented or suspected active TB, all of whom underwent both the IFN-gamma assay and the TST. MAIN OUTCOME MEASURE: Level of agreement between the IFN-gamma assay and the TST. RESULTS: Three hundred ninety participants (31.8%) had a positive TST result and 349 (28.5%) had a positive IFN-gamma assay result. Overall agreement between the IFN-gamma assay and the TST was 83.1% (kappa = 0.60). Multivariate analysis revealed that the odds of having a positive TST result but negative IFN-gamma assay result were 7 times higher for BCG-vaccinated persons compared with unvaccinated persons. The IFN-gamma assay provided evidence that among unvaccinated persons with a positive TST result but negative IFN-gamma assay result, 21.2% were responding to mycobacteria other than M tuberculosis. CONCLUSIONS: For all study participants, as well as for those being screened for LTBI, the IFN-gamma assay was comparable with the TST in its ability to detect LTBI, was less affected by BCG vaccination, discriminated responses due to nontuberculous mycobacteria, and avoided variability and subjectivity associated with placing and reading the TST.
4332.
Morye V K, Thatte U M, Dahanukar S A: Drug use in
tuberculosis. Indian J Pharmac 2001, 32(2), 138. (016406) Aug 16, 2001.
Reports the drug use
pattern in tuberculosis, and examines patient’s knowledge of drug therapy and
the reasons of any for defaulting treatment. This study identified that several
problems exist in the implementation of DOTS. These are mainly in the area of
patient’s education and intervention must be planned.
4333.
Namavar Jahromi B, Parsanezhad ME, Ghane-Shirazi
R. Female genital tuberculosis and infertility.
Int J Gynaecol Obstet 2001
Dec;75(3):269-72
OBJECTIVES: This study was performed to evaluate the rate of diagnosed female genital tuberculosis and its presentational symptoms and methods of diagnosis. METHODS: A total of 3088 cases of tuberculosis (TB) who had been registered and treated in the Health Center of Fars Province from 1989 to 1999 were retrospectively studied. From this group, 46 women were diagnosed as having genital TB. The diagnosis in 41 cases was based on the standard pathological criteria of tissue specimens. The other five cases were excluded from this study due to the lack of classical diagnostic criteria. Statistical analysis was performed using the Z-test. RESULTS: The mean age of the patients at the time of diagnosis was 30.4 years. Seven patients presented with abdominal or pelvic pain (17.07%). In this group three cases underwent laparatomy due to abdominal mass and four patients for tubo-ovarian abscess, which led to the diagnosis. Abnormal uterine bleeding was the cause of diagnostic dilatation and curettage in three other patients (7.31%). However, in 31 cases (75.6%) TB was diagnosed during studies performed to evaluate the cause of their infertility, and the most common diagnostic procedure was endometrial curettage (25 cases). Female genital TB accounted for 1.32% of all tuberculous patients in this study. Of these, 75.6% were infertile by definition (Z=12.13 P<0.0001). TB endometritis was detected in 72.03%, tubal involvement in 34.03%, ovarian TB in 12.9% and cervical TB in 2.4% of the patients. CONCLUSIONS: This study confirms the presence of a strong relationship between genital TB and infertility; therefore genital TB would be more frequently diagnosed if this possibility was considered in the evaluation of every infertile patient in areas where tuberculosis is endemic.
4334.
Passmore JS, Glashoff RH, Lukey PT, Ress SR.
Granule-dependent cytolysis of Mycobacterium tuberculosis-infected macrophages
by human gammadelta+ T cells has no effect on intracellular mycobacterial viability.
Clin Exp Immunol 2001 Oct;126(1):76-83
One of the most important effector functions of activated gammadelta+ T cells in tuberculosis is their strong cytolytic activity against a variety of target cells, including M. tuberculosis-infected macrophages. In the present study, we investigated the relationship between the mechanism of cytolysis utilized by gammadelta+ CTL and intracellular M. tuberculosis survival using a panel of cytolytic human M. tuberculosis-specific gammadelta+ CTL clones. Cytolysis mediated by the gammadelta+ T-cell clones was found to be Ca2+-dependent, sensitive to Cyclosporin A, and was completely abrogated following Sr2+-induced de-granulation of the gammadelta+ T cell effectors. These data demonstrate that gammadelta+ T-cell-mediated cytoxicity was mediated via the granule exocytosis/perforin pathway. Despite significant cytolytic activity against mycobacteria infected U937 cells, the gammadelta+ CTL clones had no impact on the survival of intracellular M. tuberculosis.
4335.
Patel R K, Trivedi R, Bhagat R, Kadri N, Thaker
P, Joshi A: Worsening of CNS-tuberculosis after initiation of anti-tuberculosis
therapy. Gujarat med J 2000, 57(1), 85-6. (016431) Aug 16, 2001.
With advent of CT scan
and MRI diagnosis of T.B. is possible early in the course of disease. Most
patients respond to sensitive and complaint Anti Koch’s Disease treatment
(AKT). Many cases of worsening of CNS tuberculosis and appearance of new ring
enhancing lesions after initiation of AKT are reported. Most of these worsened
cases respond to addition of steroids. Rest may need timely neurosurgical
intervention. Appearance of new lesions after initiation of AKT in C.N.S
tuberculosis do not suggest drug resistance, so addition of second generation
AKT is not necessary. With therapy complete recovery generally ensues within
6-8 weeks.
4336.
Peloquin CA. Pharmacological issues in the
treatment of tuberculosis. Ann N Y Acad Sci
2001 Dec;953:157-64
A thorough review of the clinical trial data combined with new in vitro experimental information may make the optimization of dosages of TB drugs possible. Several factors can affect the selection and dosage of TB drugs including hepatic and renal impairment, pregnancy, duration of disease before treatment, and extent of debilitation. Drug interactions and pharmacodynamics must be considered, and their roles are discussed.
4337.
Prasad K N: Tuberculosis-relevance of tuberculin
skin test in diagnosis. Indian med Gaz 2001, 135(4), 108-13. (018373) Sept 1,
2001.No abstract.
4338.
Prasad P L, Wilson C G, Harjai M M, Kailash
Chand: Multidrug resistant tuberculosis(MDRTB) in children. Med J Armed Forces India 2001,57(2),
151-3.(015358), Aug 1, 2001. No
abstract.
4339.
Raja A, Ranganathan UD, Bethunaickan R, Dharmalingam
V. Serologic response to a secreted and a cytosolic antigen of Mycobacterium
tuberculosis in childhood tuberculosis. Pediatr Infect Dis J 2001 Dec;20(12):1161-4
BACKGROUND AND
AIM: Bacteriologic diagnosis of childhood tuberculosis is difficult, and alternate
methods are needed. The utility of a serologic test for major secretory antigen
(30 kDa) and a cytosolic antigen (16 kDa) of Mycobacterium tuberculosis was
evaluated for the diagnosis of tuberculosis in children. METHODS: Enzyme-linked
immunosorbent assay was used. Specific IgG, IgA and IgM antibodies were
measured in the sera from 26 clinically and/or bacteriologically diagnosed
cases of childhood tuberculosis and 61 normal children. RESULTS: Anti-IgG
antibodies alone, against both 30- and 16-kDa antigens, were detected in 65.4%
of patients. However, by combination of all three isotypes, increased
sensitivities of 84.6 and 73%, with a specificity of 96.7% each, were obtained
for 30- and 16-kDa antigens, respectively. CONCLUSIONS: We found good specificity
and reasonably good sensitivity for detection of antibodies by enzyme-linked
immunosorbent assay to 30-kDa antigen alone. The 16-kDa antigen did not perform
as well.
4340.
Rajagopalan S. Tuberculosis and aging: a global
health problem. Clin Infect Dis 2001
Oct 1;33(7):1034-9
Despite the World Health Organization's declaration that the spread of tuberculosis is a global emergency and despite the implementation of strong tuberculosis-control initiatives, this highly infectious disease continues to affect all vulnerable populations, including the elderly population (age > or =65 years). Tuberculosis in aging adults remains a clinical and epidemiological challenge. Atypical clinical manifestations of tuberculosis in older persons can result in delay in diagnosis and initiation of treatment; thus, unfortunately, higher rates of morbidity and mortality from this treatable infection can occur. Underlying illnesses, age-related diminution in immune function, the increased frequency of adverse drug reactions, and institutionalization can complicate the overall clinical approach to tuberculosis in elderly patients; maintenance of a high index of suspicion for tuberculosis in this vulnerable population is, thus, undoubtedly justifiable.
4341.
Rajiv J, Dam T, Kumar S, Bose M, Aggarwal KK,
Babu CR. Inhibition of the in-vitro growth of Mycobacterium tuberculosis by a
phytosiderophore. J Med Microbiol 2001
Oct;50(10):916-8
Non-compliance
by patients and poor clinical management due to the use of incorrect regimens
are the main reasons for the development of drug resistance by mycobacterial
strains. New strategies for the control of multi-drug-resistant mycobacterial
strains have become a necessity for proper management of tuberculosis, which,
according to the WHO report (1997), is estimated to remain among the top 10
mortality-causing diseases of the twenty-first century. One of the strategies
is the use of iron-sequestering agents like siderophores as active therapeutic
agents in the treatment of tuberculosis. This report describes for the first
time the inhibition of the growth of Mycobacterium tuberculosis H37Ra in vitro
by a phytosiderophore isolated from the root washings of Tephrosia purpurea.
This finding may help in the establishment of a new drug regimen which will be more
effective in the treatment of tuberculosis.
4342.
Rattan A: PCR for diagnosis of tuberculosis :
where are we now. Indian J tuberc 2000, 47(2), 79-82. (013261) July 1, 2001.
No abstract.
4343.
Raviglione MC, Gupta R, Dye CM, Espinal MA. The
burden of drug-resistant tuberculosis and mechanisms for its control. Ann N Y
Acad Sci 2001 Dec;953:88-97
Drug resistance in tuberculosis is largely a man-made phenomenon caused by erroneous prescribing practices on the part of physicians and noncompliance on the part of patients. The global epidemiology of drug-resistant TB, the impact of standardized short-course chemotherapy (SSC), and the potential future evolution of MDR TB are discussed in this chapter.
4344.
Raviglione MC. Determinants of drug-resistant
tuberculosis: analysis of 11 countries. Int J Tuberc Lung Dis 2001 Oct;5(10):887-93
SETTING: Eleven countries/territories. OBJECTIVES: Global information on the determinants of drug-resistant tuberculosis (TB) based on representative data is not available. We therefore studied the relationship between demographic characteristics, prior TB treatment, and human immunodeficiency virus (HIV) infection with anti-tuberculosis drug resistance. METHODS: Population-based representative data on new and previously treated patients with TB collected within an international drug resistance surveillance network. RESULTS: Of 9,615 patients, 8,222 (85.5%) were new cases of TB and 1,393 (14.5%) were previously treated cases. Compared with new cases, previously treated cases were significantly more likely to have resistance to one (OR = 2.5,95% CI 2.1-3.0; P < 0.001), two (OR = 4.6, 95%CI 3.7-5.6; P < 0.001), three (OR = 11.5, 95%CI 8.6-15.3; P < 0.001), and four (OR = 18.5, 95% CI 12.0-28.5; P < 0.001) drugs. An approximately linear increase in the likelihood of having multidrug-resistant tuberculosis (MDR-TB) was observed as the total time (measured in months) of prior anti-tuberculosis treatment increased (P < 0.001, chi2 for trend). In multivariate analysis, prior TB treatment for 6-11 months (OR = 7.6, 95% CI 2.6, 22.4; P < 0.001) and > or = 12 months (OR 13.7, 95% CI 4.5-41.6; P < 0.001), but not HIV positivity, was associated with MDR-TB. CONCLUSION: This study shows that prior but ineffective treatment is a strong predictor of drug resistance, and that HIV is not an independent risk factor for MDR-TB. The association between length of treatment and drug resistance may reflect longer treatment as a result of treatment failure in patients with drug resistance; it may also reflect irregular prior treatment for TB, leading to drug resistance.
4345.
Scanga CA, Mohan VP, Tanaka K, Alland D, Flynn
JL, Chan J. The inducible nitric oxide synthase locus confers protection
against aerogenic challenge of both clinical and laboratory strains of Mycobacterium
tuberculosis in mice. Infect Immun 2001
Dec;69(12):7711-7
Murine macrophages effect potent antimycobacterial function via the production of nitric oxide by the inducible isoform of the enzyme nitric oxide synthase (NOS2). The protective role of reactive nitrogen intermediates (RNI) against Mycobacterium tuberculosis infection has been well established in various murine experimental tuberculosis models using laboratory strains of the tubercle bacillus to establish infection by the intravenous route. However, important questions remain about the in vivo importance of RNI in host defense against M. tuberculosis. There is some evidence that RNI play a lesser role following aerogenic, rather than intravenous, M. tuberculosis infection of mice. Furthermore, in vitro studies have demonstrated that different strains of M. tuberculosis, including clinical isolates, vary widely in their susceptibility to the antimycobacterial effects of RNI. Thus, we sought to test rigorously the protective role of RNI against infection with recent clinical isolates of M. tuberculosis following both aerogenic and intravenous challenges. Three recently isolated and unique M. tuberculosis strains were used to infect both wild-type (wt) C57BL/6 and NOS2 gene-disrupted mice. Regardless of the route of infection, NOS2(-/-) mice were much more susceptible than wt mice to any of the clinical isolates or to either the Erdman or H37Rv laboratory strain of M. tuberculosis. Mycobacteria replicated to much higher levels in the organs of NOS2(-/-) mice than in those of wt mice. Although the clinical isolates all exhibited enhanced virulence in NOS2(-/-) mice, they displayed distinct growth rates in vivo. The present study has provided results indicating that RNI are required for the control of murine tuberculous infection caused by both laboratory and clinical strains of M. tuberculosis. This protective role of RNI is essential for the control of infection established by either intravenous or aerogenic challenge.
4346.
Sonika Gupta. Niraj Shende. Swati Banrjee. Satish
Kumar. M.V.R. Reddy. Bhaskar C. Harinath. Analysis of Seva Tb ES-31 antigen
specific immunoglobulins IgM, IgA and IgG in sera of sputum and culture
positive pulmonary tuberculosis. 2002 Jan;17:5-8.
Tuberculosis remains major
health problem in India and developing countries. Immunodiagnosis has important
role in screening, diagnosis and management of tuberculosis. SEVA TB ES-31
antigen has shown potential in detecting tuberculous IgG antibody in earlier
studies from our laboratory. In the present study we have analysed SEVA Tb
ES-31 antigen specific immunoglobulins IgM, IgA and IgG in clinically and
bacteriologically confirmed pulmonary tuberculosis cases to determine the
usefulness of specific immunoglobulin class in the diagnosis of patients attending the hospital.
Of the 30 cases of pulmonary tuberculosis 25 (83.3%) were positive for IgG, 19 (63.3%) for IgM and 16 (53.3%) for IgA. On combining IgG and IgM positivity, sensitivity was increased to 93.3%. While combining IgG and IgA positivity sensitivity increased to 90%. However specificity was decreased to 66.6% and 70% for both of these combinations respectively. It could be envisaged from this study that IgG antibody detection against ES-31 antigen showed acceptable sensitivity (83.3%) and specificity (86.6%) compared to IgM or IgA alone or in combination. When immuneresponses were analysed according to degree of sputum positivity, IgG response was observed to be predominant in all grades, compared to IgM or IgA antibody. The addition of IgM or IgA as an adjunct test increases the sensitivity but at the cost of specificity. Hence the detection of IgG alone is more useful compared to IgM or IgA assay, in detecting tuberculosis disease cases coming to the hospital.
4347.
Sterling TR, Dorman SE, Chaisson RE, Ding L,
Hackman J, Moore K, Holland SM. Human immunodeficiency virus-seronegative
adults with extrapulmonary tuberculosis have abnormal innate immune responses.
Clin Infect Dis 2001 Oct 1;33(7):976-82
Extrapulmonary
tuberculosis is presumably a marker of underlying immunodeficiency, but
cytokine response pathways in these patients have not been well studied.
Cytokine responses of peripheral blood mononuclear cells from human
immunodeficiency virus-seronegative adults with prior culture-confirmed
extrapulmonary tuberculosis were compared with those of persons with latent
Mycobacterium tuberculosis infection. Mitogen-stimulated interferon (IFN)-gamma
production, interleukin (IL)-12 production, and IFN-gamma receptor- and IL-12
receptor-mediated cytokine production did not differ between case patients and
control patients. However, median resting IL-8 production was significantly
lower in case patients than control patients (8051 vs. 19,290 pg/mL; P=.009).
In addition, the median tumor necrosis factor (TNF)-alpha response was lower in
case patients than control patients after stimulation with lipopolysaccharide
(833 vs. 1149 pg/mL; P=.06) and lipopolysaccharide plus IFN-gamma (3301 vs.
4411 pg/mL; P=.04). These abnormalities in resting IL-8 and
lipopolysaccharide-induced TNF-alpha production were not associated with
IFN-gamma or IL-12 abnormalities and were detected up to several years after
cure of disease, suggesting an abnormality in innate immunity.
4348.
T, Kasvosve I, Gomo ZA, Rouault T, Boelaert JR,
Gordeuk VR. Association of pulmonary tuberculosis with increased dietary iron.
J Infect Dis 2001 Oct 1;184(7):936-9
To determine whether increased dietary iron could be a risk factor for active tuberculosis, dietary iron history and human immunodeficiency virus (HIV) status were studied in 98 patients with pulmonary tuberculosis and in 98 control subjects from rural Zimbabwe. Exposure to high levels of dietary iron in the form of traditional beer is associated with increased iron stores in rural Africans. HIV seropositivity was associated with a 17.3-fold increase in the estimated odds of developing active tuberculosis (95% confidence interval [95% CI], 7.4-40.6; P<.001), and increased dietary iron was associated with a 3.5-fold increase (95% CI, 1.4-8.9; P=.009). Among patients treated for tuberculosis, HIV seropositivity was associated with a 3.8-fold increase in the estimated hazard ratio of death (95% CI, 1.0-13.8; P=.046), and increased dietary iron was associated with a 1.3-fold increase (95% CI, 0.4-6.4; P=.2). These findings are consistent with the hypothesis that elevated dietary iron may increase the risk of active pulmonary tuberculosis. To determine whether increased dietary iron could be a risk factor for active tuberculosis, dietary iron history and human immunodeficiency virus (HIV) status were studied in 98 patients with pulmonary tuberculosis and in 98 control subjects from rural Zimbabwe. Exposure to high levels of dietary iron in the form of traditional beer is associated with increased iron stores in rural Africans. HIV seropositivity was associated with a 17.3-fold increase in the estimated odds of developing active tuberculosis (95% confidence interval [95% CI], 7.4-40.6; P<.001), and increased dietary iron was associated with a 3.5-fold increase (95% CI, 1.4-8.9; P=.009). Among patients treated for tuberculosis, HIV seropositivity was associated with a 3.8-fold increase in the estimated hazard ratio of death (95% CI, 1.0-13.8; P=.046), and increased dietary iron was associated with a 1.3-fold increase (95% CI, 0.4-6.4; P=.2). These findings are consistent with the hypothesis that elevated dietary iron may increase the risk of active pulmonary tuberculosis.
4349.
Trautner BW, Darouiche RO. Tuberculous
pericarditis: optimal diagnosis and management. Clin Infect Dis 2001 Oct 1;33(7):954-61
Pericarditis is a rare manifestation of tuberculous disease. The appropriate diagnostic workup and optimal therapeutic management are not well defined. We present 10 new cases of tuberculous pericarditis and review the relevant literature. The specific topics addressed are (1) the importance of tissue for diagnosis, (2) the optimal surgical management, (3) the role of corticosteroids, and (4) the impact of human immunodeficiency virus (HIV) on the management of this disease. The cases and the literature suggest that the optimal management includes an open pericardial window with biopsy, both for diagnosis and to prevent reaccumulation of fluid. Corticosteroids probably offer some benefit in preventing fluid reaccumulation as well. The data are inconclusive regarding whether open drainage or corticosteroid use prevents progression to constrictive pericarditis. No studies have addressed these issues specifically in HIV-positive patients, but the 3 HIV-positive patients in our series had an excellent response to drainage and antituberculous therapy.
4350.
Trollip A, Albert H, Maskell T.
Bacteriophage-based technologies for the rapid diagnosis and drug
susceptibility testing of tuberculosis. Am Clin Lab 2001 Oct-Nov;20(9):39-42 No
abstract.
4351.
Vijayan V K: Role of bal in the diagnosis and
immunological evaluation of patients with pulmonary tuberculosis. Indian J
Tuberc 2000, 47(2), 73-8. (013323) July 1 2001 No abstract.
4352.
Wong DA, Yip PC, Cheung DT, Kam KM. Simple and rational
approach to the identification of Mycobacterium tuberculosis, Mycobacterium
avium complex species, and other commonly isolated mycobacteria. J Clin
Microbiol 2001 Oct;39(10):3768-71 No abstract.
4353.
Yilmaz A, Boga S, Sulu E, Durucu M, Yilmaz D,
Baran A, Poluman A. Delays in the diagnosis and treatment of hospitalized
patients with smear-positive pulmonary tuberculosis. Respir Med 2001 Oct;95(10):802-5
The aim of
present study was to investigate whether there was any delay in the diagnosis
and treatment of inpatients with smear-positive pulmonary tuberculosis
followed-up in our centre. We reviewed clinical records in February 1999 and
identified 134 hospitalized patients with smear-positive pulmonary
tuberculosis. Clinical files of the patients were analysed and a questionnaire
was completed. Several intervals and delays were calculated. Median application
interval was 17.5 days [95% confidence interval (CI) 21.3-32.4 days], median
referral interval was 3.5 days (95% CI 6.8-11.4 days), median diagnosis
interval was 3 days (95% CI 3.3-4.5 days) and median initiation of treatment
interval was 1 day (95% CI 1.1-1.6 days). Patients delay was present in 28.4%
of cases. The referral interval was longer than 2 days in 82 patients
(institutional delay). Ninety-three patients (69.4%) had delays in the
diagnosis and 34 patients (25.4%) had delays in the treatment. There was a
doctor's delay in 119 of 134 patients (88.8%) and clinic's delay in 98 patients
(73.2%). Our results have suggested that hospitalized patients with
smear-positive pulmonary tuberculosis experience several delays. These delays
may result in increased risk for transmission of infection. Decrease in the
risk of infection for community and medical personal may only be obtained by
preventing these delays.
4354.
Young D. Letting the genome out of the bottle:
prospects for new drug development. Ann N Y Acad Sci 2001 Dec;953:146-50
Use of the information gained from sequencing the Mycobacterium tuberculosis genome will enable scientists to accelerate the development of reagents for improved tuberculosis control. Cloning and expressing genes encoding the enzymes involved in cell-wall biosynthesis will provide the tools for screening millions of novel compounds. Cell wall inhibitors will be mainly useful in treating resistant disease, but cost factors are likely to limit the application of novel compounds in the design of new treatment regimens. More effective might be an approach to target metabolic processes that are essential even in nondividing bacteria. A third target for drug action is elimination of latent disease through a drug that acts in synergy with the immune response.
4355.
Zahrt TC, Deretic V. Mycobacterium tuberculosis
signal transduction system required for persistent infections. Proc Natl Acad
Sci U S A 2001 Oct 23;98(22):12706-11
It is estimated that nearly 2 billion people currently suffer from latent Mycobacterium tuberculosis infection. Although the key front-line antituberculosis drugs are effective in treating individuals with acute tuberculosis, these drugs are ineffective in eliminating M. tuberculosis during the persistent stages of latent infection. Consequently, therapeutics that directly target persistent bacilli are urgently needed. We have conducted a global analysis on a group of regulatory determinants that may play a role in M. tuberculosis virulence, and identified a two-component response regulator whose expression is required for entrance into and maintenance of persistent infection. Inactivation of this response regulator, Rv0981 (termed here mprA for mycobacterial persistence regulator), affected M. tuberculosis H37Rv growth in vivo in an organ- and infection stage-specific fashion. These results indicate that two-component systems are important for adaptation of the tubercle bacillus during stages of persistent infection.
4356.
Zheng X, Pang M, Engler HD, Tanaka S, Reppun T.
Rapid detection of Mycobacterium tuberculosis in contaminated BACTEC 12B broth
cultures by testing with Amplified Mycobacterium Tuberculosis Direct Test. J
Clin Microbiol 2001 Oct;39(10):3718-20
Contamination of broth cultures of acid-fast bacilli (AFB) by bacterial species other than Mycobacterium species frequently occurs. Many of these contaminated cultures require redecontamination and reincubation before the appropriate tests can be performed for identification, significantly affecting the turnaround time for reporting culture results. In this study, the Amplified Mycobacterium Tuberculosis Direct Test (MTD; Gen-Probe) was performed to detect the Mycobacterium tuberculosis complex (MTBC) in 125 BACTEC 12B broth cultures with positive growth indices. Among these, 41 grew non-AFB bacteria only, and all 41 were negative by the MTD. The remaining 84 bottles contained contaminated cultures that grew both AFB and other bacteria or yeasts. Repeat decontamination and reincubation of these specimens required a mean time of 13 days (range, 3 to 40 days). The MTD results were positive for 10 samples, 9 of which were MTBC culture positive and 1 of which grew Myobacterium celatum, a species known to cross-react in the MTD. All cultures growing other mycobacterial species were negative by the MTD. The results of this study demonstrate that the MTD is both sensitive and specific in detecting MTBC in contaminated broth cultures and that, when used selectively, the MTD can potentially rule in or out a diagnosis of MTBC as much as 12 days earlier than using nonamplified DNA probe testing alone can.
July 02
4878.
Abrol R,
Nagarkar NM, Mohan H, Srivastava M.
Primary bilateral tuberculous dacryocystitis with preauricular
lymphadenopathy: a diagnostic difficulty of recent times. Otolaryngol Head Neck
Surg. 2002 Feb;126(2):201-3.
No
Abstract
4879.
Agarwal N, Sharma
SK. Concomitant endobronchial tuberculosis, myocarditis and congestive heart
failure. Indian J Tuberc 2000, 47(3), 169-70.
Rare case of endobronchial as well myocardial tuberculosis, which
presented as acute congestive heart failure, is being reported. The patient
gradually improved on anti-tuberculosis drug therapy, steroids, digoxin,
enalapril and diuretics. The presence of myocardial tuberculosis without
pericardial or endocardial involvement or miliary dissemination is considered
extraordinary.
4880.
Ajay Kumar R,
Paul KL, Indulakshmi R, Manju YK, Vinod Kumar K, Ayyappan P, Joshi M, Mundayoor
S. Analysis of drug susceptibility in Mycobacterium tuberculosis isolated from
Thiruvananthrapuram using Alamar blue assay. Curr Sci 2001, 80(1), 70-3.
Tuberculosis (TB) is caused by
Mycobacterium tuberculosis and the control of the disease is hampered by
widespread emergence of drug resistance in this pathogen. An early information
on drug susceptibility would greatly facilitate an effective treatment of TB. Seventy
eight isolates of M. tuberculosis were obtained from TB patients from
Thiruvananthapuram over a period of about 18 months. Resistance and
susceptibility of these isolates to four frontline drugs were assayed using
Alamar Boue, and oxidation-reduction dye. Thirty-six per cent of the isolates
were susceptible to all the four drugs used, 21.8% were resistant to isoniazid,
8.9% to ethambutol and 2.6% to rifampicin. none was found resistant to
streptomycin alone. Multidrug resistance (resistance to at least rifampicin and
isoniazid) was found in 7.7% of the isolates. The remaining ones were resistant
to combinations of two or more of the drugs. Alamar Blue-based assay promises
to be an economical and fast method to determine drug susceptibility and resistance
of M. tuberculosis to aid effective drug therapy. 26 ref.
4881.
Akhan O,
Pringot J. Imaging of abdominal
tuberculosis. Eur Radiol. 2002 Feb;12(2):312-23.
The
concept of "abdominal tuberculosis" in this review refers to peritoneum
and its reflections, gastrointestinal tract, abdominal lymphatic system, and
solid visceral organs, as they are subject to varying degrees of involvement
alone or in combination. Some features, including free or loculated ascites
with thin-mobile septa, smooth peritoneal thickening and enhancement, misty
mesentery with large lymph nodes, smudged omental involvement, and advanced
ileocecal changes demonstrated by US, CT, or gastrointestinal series are deemed
suggestive radiological findings. The diagnosis still requires a high index of
suspicion,
once
the suggestive features have been demonstrated by imaging modalities.
4882.
Al-Dossary
FS, Ong LT, Correa AG, Starke JR.
Treatment of childhood tuberculosis with a six month directly observed
regimen of only two weeks of daily therapy. Pediatr Infect Dis J. 2002
Feb;21(2):91-7.
BACKGROUND:
Recommended treatment of childhood tuberculosis is 6 months in duration with at
least 3 drugs. We studied a regimen requiring as few as 58 doses, given
entirely by directly observed therapy (DOT), under program conditions. METHODS:
An observational trial was conducted to determine the effectiveness of a
completely DOT 6-month regimen for pulmonary, pleural and lymph node
tuberculosis in children with the use of 2 weeks of daily isoniazid, rifampin
and pyrazinamide therapy; then 6 weeks of twice weekly isoniazid, rifampin and
pyrazinamide therapy; followed by 16 weeks of twice weekly isoniazid and
rifampin. All therapy was given by workers from the health department, and patients
were followed by the Children's Tuberculosis Clinic in Houston, TX. Patients
were evaluated for changes in symptoms, weight, clinical or radiographic
findings and adherence to therapy. RESULTS: Of the 175 evaluable children (159
pulmonary/thoracic node, 4 pleural, 12 cervical lymph node), 81% of children
completed treatment in 6 months. Of the 33 patients who received extended
treatment, 3 did so because of physician choice, 17 had an inadequate response
to initial therapy, 2 had significant adverse reactions to drugs and 16 had
poor adherence to the DOT. Only 37% of patients had complete resolution of
disease at the end of treatment, but all continued to improve after therapy was
stopped. There was only 1 patient who relapsed after 4 years. CONCLUSION: This
regimen had results comparable with those of 6-month regimens with longer
durations of daily therapy. Determining treatment response in pediatric
tuberculosis is difficult because of the slow resolution of chest radiograph
abnormalities. DOT is an important aspect of treatment but does not solve all
problems with treatment adherence.
4883.
Andronikou S,
Smith B. "Spina
ventosa"--tuberculous dactylitis. Arch Dis Child. 2002 Mar;86(3):206.
No
Abstract
4884.
Aribas OK,
Kanat F, Gormus N, Turk E. Cold abscess
of the chest wall as an unusual complication of BCG vaccination. Eur J
Cardiothorac Surg. 2002 Feb;21(2):352-4.
Bacillus-Calmette-Guerin
(BCG) vaccination often results in local adverse effects; however, serious or
long-term complications are rare. The involvement of sternum among skeletal BCG
osteomyelitis is a rarely seen complication of BCG vaccination. Such a
complication may confuse with a chest wall tumor and a surgical intervention
may be needed for the definite diagnosis. A 9-month-old infant who had a
parasternal cold abscess in the anterior chest wall and sternal osteomyelitis
of tuberculosis in the late period of BCG vaccination of whom the etiological
diagnosis was histopathologically confirmed after surgery is presented and the
preoperative diagnostic problems are discussed.
4885.
Ashitani J,
Mukae H, Hiratsuka T, Nakazato M, Kumamoto K, Matsukura S. Elevated levels of alpha-defensins in plasma
and BAL fluid of patients with active pulmonary tuberculosis. Chest. 2002
Feb;121(2):519-26.
STUDY
OBJECTIVES: To investigate the role of neutrophil peptides named
alpha-defensins in patients with pulmonary tuberculosis (TB). PATIENTS:
Thirty-seven patients with TB and 25 healthy subjects. MEASUREMENTS AND
RESULTS:
Concentrations
of alpha-defensins (human neutrophil peptide [HNP]-1, HNP-2, and HNP-3) were
measured by radioimmunoassay in plasma and BAL fluid (BALF). Concentrations of
alpha-defensins were significantly higher in plasma and BALF of patients with
TB than in healthy subjects. In BALF of patients with TB, the concentration of
alpha-defensins correlated positively with the levels of interleukin 8, and
higher concentrations of alpha-defensins in BALF were also detected in patients
with cavitary lesions. There was an inverse relationship between plasma alpha-defensins
and FEV(1)/FVC ratio before treatment, and between plasma concentrations of
alpha-defensins before treatment and the improvement in percentage of vital
capacity after treatment. Plasma alpha-defensin concentrations returned to the
normal range after treatment. CONCLUSION: Our data suggest that alpha-defensins
released from neutrophils may play an important role in the pathogenesis of TB,
and that plasma alpha-defensin concentration may be a useful marker of disease
severity and deterioration of pulmonary function.
4886.
Atasoy C,
Kaya A, Fitoz S, Yildirim Z. Discrete
pleural nodules associated with a parasternal mass: an unusual manifestation of
tuberculosis. J Thorac Imaging. 2002 Jan;17(1):74-7.
SUMMARY:
The case presented describes an unusual appearance of thoracic tuberculosis
with multiple pleural nodules associated with a parasternal mass as depicted on
computed tomography. The patient is a 22-year-old woman who
presented
with pleuritic chest pain, a left parasternal mass, and weight loss. The pleura
of the left hemithorax was studded with multiple low-attenuation, rim-enhancing
nodules, and a left parasternal mass with similar imaging features
was
seen anterior to an enlarged left internal mammary lymph node. There were no
pulmonary parenchymal changes nor any mediastinal or hilar lymphadenopathy.
Cytologic examination of the specimen obtained with fine needle aspiration of
the
pleural and parasternal masses yielded granulomatous inflammation. The symptoms
remitted with antituberculous chemotherapy and a follow-up CT obtained 6 months
later showed complete resolution of the pleural nodules and parasternal
mass
and considerable regression of the left internal mammary lymph node.
Involvement of the pleura with discrete nodules in the absence of parenchymal
changes or mediastinal lymphadenopathy is rare in tuberculosis. To the best
of the present authors' knowledge, the
combination of a tuberculous parasternal mass and multiple pleural nodules as
the sole manifestations of thoracic tuberculosis has not been reported
previously.
4887.
Atasoy C,
Oztekin PS, Ozdemir N, Sak SD, Erden I, Akyar S. CT and MRI in tuberculous sternal osteomyelitis: a case report.
Clin Imaging. 2002 Mar-Apr;26(2):112-5.
We
report a 58-year-old male patient presenting with a 1-year history of
presternal swelling and pain. Plain radiography revealed increased soft tissue
density anterior to the body of the sternum, which showed cortical sclerosis.
Computed tomography (CT) demonstrated ring-enhancing hypodense soft tissue
masses surrounding the sternum, whose anterior and posterior cortices were
markedly thickened. On three-phase technetium bone scintigraphy, the left side
of the sternum showed increased radiotracer uptake and the central part of the
bone was photopenic. The bone marrow of the sternum and peristernal soft tissue
lesions were hypo- and hyperintense on T1- and T2-weighted magnetic resonance
(MR) images, respectively, and showed marked enhancement postgadolinium.
Treatment included both surgical intervention and medical therapy.
4888.
Aung H,
Sherman J, Tary-Lehman M, Toossi Z.
Analysis of transforming growth factor-beta 1 (TGF-beta1) expression in
human monocytes infected with Mycobacterium avium at a single cell level by
ELISPOT assay. J Immunol Methods. 2002 Jan 1;259(1-2):25-32.
Transforming
growth factor beta 1 (TGF-beta1) has been implicated in the pathogenesis of a
number of diseases including infection with intracellular pathogens such as
Mycobacterium avium complex (MAC). In this study, we developed an ELISPOT assay
for measurement of active TGF-beta1 produced by peripheral blood mononuclear
cells (PBMC) from healthy individuals in response to LPS or MAC. The frequency
of TGF-beta1 producing cells was significantly (p<0.04) higher in response
to LPS (10 microg/ml) as compared to unstimulated cells (n=4). Moreover, the
frequency of TGF-beta1 producing cells was threefold higher in monocyte (MN)-enriched cell population
than those in PBMC indicating that the source of TGF-beta1 producing cells in
PBMC was MN. In addition, the frequency of TGF-beta1 producing cells in
response to MAC (10:1, cfu:MN) was significantly higher (p<0.03) than
unstimulated cells. However, the frequency of TGF-beta1 producing cells in
response to MAC (10:1) was eight to ninefold lower than that by LPS (10
microg/ml). Moreover, there was a correlation between the level of total
TGF-beta1 in 24-h culture supernatants and the number of TGF-beta1 producing
cells upon MAC stimulation. TGF-beta1 ELISPOT-assay may be a sensitive and a
powerful tool for detection of TGF-beta1 producing cells, and may be helpful in
elucidation of the nature of TGF-beta1 production at sites of diseases.
4889.
Bailey HL,
Gabriel SM, Hodgson AR, Shin JS.
Tuberculosis of the spine in children. 1972 [classical article] Clin
Orthop. 2002 Jan;(394):4-18.
4890. Bailey WC, Gerald LB, Kimerling ME, Redden D, Brook N, Bruce F, Tang S, Duncan S, Brook