Acid-fast Mycobacterium Research Articles

Pre-immigration Screening for Tuberculosis in South Korea: A Comparison of Smear- and Culture-Based Protocols.

BackgroundTuberculosis (TB) is the most important disease screened for upon patient history review during preimmigration medical examinations as performed in South Korea in prospective immigrants to certain Western countries. In 2007, the U.S. Centers for Disease Control and Prevention (CDC) changed the TB screening protocol from a smear-based test to the complete Culture and Directly Observed Therapy Tuberculosis Technical Instructions (CDOT TB TI) for reducing the incidence of TB in foreign-born immigrants.MethodsThis study evaluated the effect of the revised (as compared with the old) protocol in South Korea.ResultsOf the 40,558 visa applicants, 365 exhibited chest radiographic results suggestive of active or inactive TB, and 351 underwent sputum tests (acid-fast bacilli smear and Mycobacterium tuberculosis culture). To this end, using the CDOT TB TI, 36 subjects (88.8 per 105 of the population) were found to have TB, compared with only seven using the older U.S. CDC technical instruction (TI) (p<0.001). In addition, there were six drug-resistant cases which were identified (16.7 per 105 of the population), two of whom had multidrug-resistance (5.6 per 105 of the population).ConclusionThe culture-based 2007 TI identified a great deal of TB cases current to the individuals tested, as compared to older U.S. CDC TI.

Cultural and morphological properties of atypical mycobacteria isolated from pigs on the territory of the Novosibirsk region

When examining biomaterial from tuberculin-reacting&nbsp;pigs, we have isolated 58 cultures of acid-fast&nbsp;mycobacteria, or 7,5 percent of the number of samplesstudied. The rate of cultures isolation from hen biomaterialamounted to 12.5 percent, from synanthropic birds&nbsp;7.5 percent, from environmental samples 9.4 percent.&nbsp;Resulting from cultural, biochemical and morphological&nbsp;studies, 6 species of atypical mycobacteria were found&nbsp;to persist in the organism of pigs, reacting to avian and&nbsp;mammalian PPD complexes, and in the environment of&nbsp;tuberculosis-free pig-producing farms in Novosibirsk&nbsp;Region. These mycobacteria species belong to 2–4 groups&nbsp;according to the Runyon’s classification, and include&nbsp;M. xenopi, M. avium-intracellulare, M. fortuitum, M.&nbsp;smegmatis, M. phlei, and M. scrofulaceum. Major field&nbsp;isolates from both pig biomaterial and the environment&nbsp;are represented by M. avium-intracellulare complex&nbsp;that indicates their wide distribution. From the samples&nbsp;of various environmental objects, being main sources&nbsp;of mycobacterioses in pigs, were isolated and identified&nbsp;28 cultures of different species of atypical mycobacteria&nbsp;with M. avium-intracellulare complex prevailed.&nbsp

Mycobacterial spindle cell pseudotumour: epidemiology and clinical outcomes

IntroductionMycobacterial spindle cell pseudotumour (MSP) is a rare disease characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria. The aim of this literature review is to describe...

Onset of 26th day after birth, intermittent cough with pulmonary multifocal nodules

Objective To improve the understanding of neonatal-onset pulmonary tuberculosis. Methods The clinical features, laboratory examination and imaging were analyzed in 2 cases with neonatal-onset pulmonary tuberculosis in the Respiratory Department of Beijing Children′s Hospital, Capital Medical University. Results The 2 patients were premature twins, were born at 33+ 3 weeks of gestation, presented with intermittent cough and transient fever on 26 days after birth.Chest CT scan showed pulmonary multifocal nodules.One case was complicated with pleural effusion, atelectasis and no effectiveness with antibiotics.The untypical pathogen infection was considered.The result of PPD was negative, the result of interferon gamma release array, gastric acid fast staining and mycobacterium tuberculosis culture were positive, finally they were diagnosed with pulmonary tuberculosis. Conclusions The clinical features and imaging of neonatal tuberculosis are always untypical and PPD is negative, which brings difficulties to clinical diagnosis.We should take untypical pathogens into account, such as tuberculosis, when some diseases cannot be explained by common pathogens. Key words: Pulmonary multifocal nodules; Pulmonary tuberculosis; Interferon-γ release array

Detection of mycobacterial infection in non-human primates using the Xpert MTB/RIF molecular assay

Tuberculosis is a major public health concern, and diagnostic strategies applied to animal populations are scarce. As part of ongoing efforts to control tuberculosis dissemination at our animal facility, two non-human primates (NHP, Saimiri sciureus) presenting cutaneous lesions were examined for mycobacterial infection. Both animals tested positive for acid-fast bacilli and Mycobacterium tuberculosis using a molecular assay (IS6110 PCR). Animals were euthanized and several samples were tested for M. tuberculosis using the Xpert MTB/RIF assay. Many samples were positive for M. tuberculosis and rifampicin resistance, and some produced mycobacterial growth. Oral swabs from cage mates were then tested with Xpert MTB/RIF, and the majority tested positive for M. tuberculosis and rifampicin resistance, and produced growth in culture. To our knowledge, this is the first report of multidrug-resistant mycobacterial infection in NHP. Additionally, our data shows that the Xpert MTB/RIF assay can be useful as a screening tool for tuberculosis infection in NHP.

Peritoneal dialysis-associated catheter infection caused by Mycobacterium abscessus in an elderly patient who was successfully treated with catheter removal.

An 89-year-old Japanese man on peritoneal dialysis (PD) was suspected of having a PD-associated catheter infection. He visited the hospital because of the discharge of pus from the exit site of his catheter. Gram staining of the pus showed Gram-positive bacilli, but these were acid-fast bacilli. The rapidly growing nontuberculous mycobacteria, Mycobacterium abscessus, was isolated. PD catheter removal and debridement were immediately performed. The patient received combination antibiotic therapy. His clinical course was good, but he required hemodialysis due to the discontinuation of PD. However, the patient and his family chose not to continue hemodialysis even when the symptoms of uremia appeared. Best supportive care was arranged by his primary care physician. M. abscessus is a rare causative organism for PD-associated catheter infections and is difficult to treat. In our case, a rapid and precise diagnosis was made using acid-fast staining and Mycobacterium culture. The risk of nontuberculous mycobacterial infections should be considered in patients on PD.

Aberrant staining with Grocott's methenamine silver: utility beyond fungal organisms

Historically, Grocott's methenamine silver (GMS) stain has been used in cytopathology to highlight Pneumocystis jiroveci and other fungal organisms. Several nonfungal organisms, however, can show distinct GMS staining patterns that are important to recognize. We prospectively and retrospectively identified nonfungal pathogenic organisms on GMS-stained liquid-based and cytospin preparations of respiratory cytologic specimens. The organisms included parasitic worms, viruses, and assorted bacteria. Nine cases were identified, including two cases each of Strongyloides stercoralis, Cytomegalovirus, Mycobacterium tuberculosis, Nocardia species, as well as one case of anthrax-like Bacillus cereus. The nonfungal organisms had silver deposition in varying locations including the internal organs and/or cuticle of Strongyloides stercoralis larvae, the intranuclear inclusions of Cytomegalovirus infected cells, the surfaces of partially acid-fast Nocardia species and acid-fast Mycobacterium tuberculosis, and the cell walls and central endospores of Bacillus cereus. In 3 of the 9 cases, organisms were not clinically suspected. It was the aberrant GMS staining that pointed to the diagnosis and led to the performance of the definitive stain, culture, or other test. GMS is a chromic acid, sodium bisulfate stain that precipitates silver ions in fungal polysaccharide walls, producing the characteristic black stain on light microscopy. It is helpful to recognize aberrant GMS staining to avoid misdiagnosis of fungal elements. GMS stains several nonfungal human pathogens and may be a particularly useful diagnostic aid when the infectious condition is not clinically suspected or the number of organisms is sparse and otherwise difficult to visualize by routine staining methods.

Evaluation of the Mycobactericidal Effect of Thio-functionalized Carbohydrate Derivatives.

Sugars with heteroatoms other than oxygen have attained considerable importance in glycobiology and in drug design since they are often more stable in blood plasma due to their resistance to enzymes, such as glycosidases, phosphorylases and glycosyltransferases. The replacement of oxygen atoms in sugars with sulfur forms thio-sugars, which are potentially useful for the treatment of diabetes and some bacterial and viral infections. Here, we evaluated the antibacterial activity of thio-functionalized carbohydrate derivatives. A set of 21 compounds was screened against acid-fast Mycobacterium tuberculosis (Mtb), gram-negative Escherichia coli and gram-positive Staphylococcus aureus. The tested carbohydrate derivatives were most effective against tubercle bacilli, with as many as five compounds (thioglycoside 6, thiosemicarbazone 16A, thiosemicarbazone 20, aminothiadiazole 23, and thiazoline 26) inhibiting its growth with MIC50 ≤ 50 µM/CFU. Only two compounds (aminothiadiazole 23 and thiazoline 26) were able to inhibit the growth of E. coli at concentrations below 1 mM, and one of them, aminothiadiazole 23, inhibited the growth of S. aureus at a concentration ≤1 mM. The five compounds affecting the growth of mycobacteria were either thiodisaccharides (6, 16A, and 20) or thioglycosides (23 and 26). All of these compounds (6, 16A, 20, 23, and 26) were able to inhibit the growth of Mtb deposited within human macrophages. However, three of the five selected compounds (6, 23, and 26) exhibited relatively high cytotoxicity in mouse fibroblasts at micromolar concentrations. The selected thio-sugars are very promising compounds, thus making them candidates for further modifications that would decrease their cytotoxicity against eukaryotic cells without affecting their antimycobacterial potential.

Mycobacteriosis in cultured F 2 generation Chinese sturgeon ( Acipenser sinensis ) and relevant blood physiological and biochemical indices

PDF HTML阅读 XML下载 导出引用 引用提醒 子二代中华鲟分枝杆菌感染及血液生理生化指标的变化 DOI: 作者: 作者单位: 1. 农业部淡水生物多样性保护重点实验室, 中国水产科学研究院 长江水产研究所, 湖北 武汉430223;2. 淡水生态与生物技术国家重点实验室, 中国科学院 水生生物研究所, 湖北 武汉 430072;3. 香港海洋公园, 香港 999077 作者简介: 张书环(1981-),女,博士,研究方向为鱼类病害及分子遗传学.E-mail:zhangshuhuan@yfi.ac.cn 通讯作者: 中图分类号: S941 基金项目: 中国水产科学研究院淡水渔业研究中心中央级公益性科研院所基本科研业务费专项资金项目（2015JBFM27）；中国科学院水生生物研究所淡水生态与生物技术国家重点实验室开放课题（2016FB16）；国家973计划项目（2015CB-150700）. Mycobacteriosis in cultured F2 generation Chinese sturgeon (Acipenser sinensis) and relevant blood physiological and biochemical indices Author: Affiliation: 1. Key Laboratory of Freshwater Biodiversity Conservation, Ministry of Agriculture;Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan 430223, China;2. State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China;3. Ocean Park, Hong Kong 999077, China Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:鱼类分枝杆菌病是由分枝杆菌属的非结核分枝杆菌造成的长期性感染疾病。本研究发现，养殖中华鲟（）子二代可感染该病，典型病理特征是腹水、腹膜肉芽肿、肾脏水肿、肝脏呈灰白色等。采集腹水，通过细菌分离培养获得一株缓慢生长型的抗酸杆菌，进一步通过16S rDNA和IS2404重复序列进行分子生物学鉴定，发现该菌与相似性最高。将10尾健康子二代中华鲟3次体检的血液参数与4尾分枝杆菌感染子二代中华鲟12次检查的血液参数进行比较，发现在26项生理生化指标中，有9项指标差异显著（<0.05），即中性粒细胞、淋巴细胞、钠、氯、钙、总蛋白、球蛋白、外周血白细胞总数（TWBC）和谷丙转氨酶（ALT），其中TWBC、中性粒细胞和ALT这3项指标显著升高，其他指标显著下降，说明分枝杆菌感染对鱼体肝脏和肾脏的损伤较大。采用盐酸卡纳霉素、红霉素和利福平三种抗生素联合用药进行治疗，给药时间75 d，治疗后腹水明显减少，RBC、血红蛋白、PCV、MCV和球蛋白这5项血液理化指标均有显著性升高（<0.05），说明药物治疗初期具有一定的效果，但随着病程的加剧，该尾鱼最终未能治愈。以上结果表明，分枝杆菌在中华鲟广泛流行，对中华鲟的危害较大，目前尚未见有效的疫苗和药物，因此对该病的预防、早期诊断和治疗极其重要。 Abstract:Chinese sturgeon, , is an ancient and large anadromous fish in the family Acipenseridae (Acipenseriformes, Actinopterygii) and has been classified as Critically Endangered on the IUCN. Hydroelectric dam construction, including the Gezhouba Dam and the Three Gorges Dam on the upper Yangtze River has resulted in a sharp decline in the wild populations of , indicating that cultured stocks may serve as the only source for species conservation. Many rehabilitation efforts, as well as controlled reproduction, have been undertaken to prevent this endangered species from becoming extinct. However, Chinese sturgeons in captivity are exposed to a range of stressors, including variable temperatures and water quality and potential pathogens. Non-tuberculous mycobacteria (NTM) causes cutaneous lesions and spreads to internal organs via the circulatory or lymphatic systems. In this study, a cultured F2 generation of Chinese sturgeon was infected with NTM, and developed typical symptoms of ascites, peritoneal granulomas, kidney edema, and a grey white liver. An acid-fast Mycobacterium liflandii identified by 16S rDNA and IS2404 sequence analyses. Nine blood indices were significantly different between ten healthy and four NTM-infected F2 Chinese sturgeon (<0.05). Total white blood cell count, neutrophils, and alanine aminotransferase levels were significantly elevated but the other indices decreased significantly, including lymphocytes, sodium, chlorine, calcium, total protein, and globulin, suggesting that the liver and kidney were badly damaged by NTM. An infected F2 Chinese sturgeon with serious ascites was treated for 75 days with a combination of rifampicin, erythromycin, and amikacin. The ascites decreased significantly early in the treatment, and five blood indices increased significantly (<0.05), including red blood cell count, hemoglobin, packed cell volume, mean corpuscular volume, and globulin, indicating that the antibiotics were effective. However, fish con-dition deteriorated over time and they were eventually euthanized. These results show that mycobacteriosis is a widespread and extremely harmful zoonosis of Chinese sturgeon. It is essential to promote research on a vaccine, drug susceptibility of isolated strains, medication dosing, and side effects in Chinese sturgeon to reduce endangering the health of the population. Furthermore, early supervision and diagnosis of this disease is required. We detected mycobacteria in the skin mucus of all infected Chinese sturgeon and in apparently normal individuals, indicating that sampling skin mucus is a good indicator of the distribution of the pathogen. Additionally, the isolated strain was found in water where infected Chinese sturgeon were held; therefore, it is important to monitor mycobacteria in water and in the fish population. How and where the Chinese sturgeon became infected with mycobacteria remain unknown. Fur-ther monitoring studies are necessary to evaluate the pathogenic potential of this strain in China for susceptible and receptive fish hosts and for mammals. This information will be useful to predict future epidemics and to implement ad-equate preventive and control measures. 参考文献 相似文献 引证文献

Sarcoidosis Masquerading as Atypical Hepatic Fibrosis in Takotsubo Cardiomyopathy

Hepatic Sarcoidosis (HS) should be considered in patients presenting with atypical fibrosis. A 37-year old African American man with type-2 diabetes presented with sudden onset left flank pain and nausea. His vitals were within normal limits except sinus tachycardia of 102/minute and examination was benign. Laboratory data including transaminases were normal. CT abdomen revealed left ureteral calculus (UC) and unexplained massive hepatomegaly. He underwent lithotripsy for the UC and was scheduled for a liver biopsy (LB). During the LB, he developed ventricular tachycardia with a rate of 254/minute, which required immediate electro-cardioversion followed by placement of Automated Implantable Cardioverter-Defibrillator (AICD). A transthoracic echocardiogram showed ejection fraction of 25-30%, with apical akinesis suggestive of Takotsubo cardiomyopathy (TC). Meanwhile, the LB showed minimal necrotizing granulomatous inflammation with atypical fibrosis on trichome stain, negative for amyloid, acid fast and fungal organisms as well as IgG4. Sarcoidosis was suspected, however, workup including angiotensin converting enzyme (ACE) levels, calcium, liver enzymes, bilirubin was normal, with the lack of pulmonary involvement on Chest x-ray. Endomyocardial biopsy confirmed non-caseating granulomas typical for sarcoidosis. In retrospect, we made a diagnosis of hepatic sarcoidosis (HS) along with TC. HS is seen in 50-80% of systemic sarcoidosis with only 10-30% presenting with abnormal liver enzymes. African American ethnicity and splenomegaly are risk factors. Clinically, HS can manifest with nonspecific fatigue, fever, or specific symptoms like jaundice, pruritus, abdominal pain while long standing disease can result in portal hypertension and end-stage liver disease. Cholestasis and liver involvement manifests as an elevation of ALP and /or GGT. Normal ACE levels don't rule out sarcoidosis but may distinguish it from other granulomatous diseases. CT may show hepatomegaly to multiple hypodense liver nodules. Definitive diagnosis requires histopathological examination of liver biopsy showing noncaseating granulomas, which are negative for fungal stains and acid-fast mycobacteria. Medical management is indicated if symptomatic or having cholestasis or in those at high risk of hepatic complications. IV steroids (10-20 mg/day) and ursodeoxycholic acid (20-40 mg/day) are the first line, while second and third line drugs include immunosuppressants.

Disseminated MAC Presenting as jejunitis in a CD4 Lymphopenic Non HIV Patient

64 years old man with multiple skin mycosis on chronic antifungal medications, found with liver cirrhosis and ascites de novo after right inguinal hernia repair. Patient reported increase abdominal girth, bilateral leg edema and diarrhea for the past 3 months. Abdominal CT demonstrated cirrhotic liver, anasarca, bilateral lower lung nodules and diffuse wall thickening of duodenum and jejunum. Labs remarkable for WBC on 5.3, band of 15, Hg of 8 g/dL, platelets on 339, SGPT on 10 U/L, SGOT on 15 U/L, alkaline phosphatase on 161 U/L, albumin of 2.8 g/dL, total protein on 5.1 g/dL, Fe/TIBC 6.4%, folate on 4 ng/ml, Vitamin B-12 on 205.6 pg/ml. Diagnostic paracentesis with a SAAG > 1.1, total protein on 2.3. Viral or hereditary etiologies for cirrhosis were excluded. Immunoglobulin (Ig) analysis showed CD4 lymphopenia, absence of B cell and IgM with low IgG in a HIV negative patient; suggesting an acquired condition rather primary immunodeficiency. Bone marrow biopsy and PET CT were performed to exclude malignancy. Bone marrow remarkable for nomocellular trilineage hematopoiesis and normal cytogenetic/immunophenotypic studies. PET scan showed moderate to severe hypermetabolic diffuse wall thickening at distal duodenum and jejunum with mild hypermetabolic bilateral lung nodules and abdominal lymphadenopathy. Upper endoscopy revealed atrophic gastric body and diffuse concentric mucosal edema with engorged mucosal folds from duodenal sweep to distal duodenum. Biopsies from duodenum were found with histiocytic-like expansion of the lamina propria and submucosa with inflammatory infiltrate. Microbiology culture discovered acid fast mycobacteria later identified as Mycobacterium Avium Complex. Upon microbiologic evaluation of patient's other tissues, MAC was also isolated in peritoneal fluid, blood and left lower lung nodule biopsy. Elevated fecal alfa-1 antitrypsin (365 mg/dl) was found suggesting protein losing enteropathy secondary to duodenal MAC infiltration as main etiology of hypoproteinemia and iron and vitamin B12 deficiency anemia. Disseminated MAC causing protein losing enteropathy in non-HIV immunocompromised patient is rare and currently published case reports suggest poor prognosis. Our patient is currently on ethambutol, clarithromycin and rifabutin regimen in addition to monthly IV IG replacement with increasing levels of total protein, albumin and less diuretic requirements to control ascites; all in favor of clinical improvement.

Imaging and Laboratory Diagnostics for Tuberculosis

Diagnosis of tuberculosis (TB) is difficult, since symptoms are often very unspecific or lacking. However active, prompt and accurate diagnosis is the key element in the public health response to tuberculosis and the cornerstone of tuberculosis control. Different diagnostic methods for an assured diagnosis of TB are necessary. Chest radiography is a useful keystone to identify tuberculosis, but diagnosis of tuberculosis cannot be established by radiography alone. CT scanning is used in patients without pathological chest radiography but clinically suspected active TB and to differentiate TB from other diseases. Radiological appearance is primarily determined by the immune status of patients and caverns and disseminated disease foci are often observed. Laboratory diagnostic methods include microscopic identification of acid-fast mycobacteria from any body fluid (especially sputum), as well as isolation and characterisation of mycobacteria in culture. It is then possible to type the pathogens by the shape of their colony, their growth behavior and their biochemical characteristics. These methods are regarded as the gold standard in diagnosis of active TB. In patients who are highly suspected of having TB, but whose sputum specimens tested negative for mycobacteria, a nucleic acid amplification test is additionally performed. Moreover, sensitivity testing with first and second line antitubercular drugs is applied as standard. Laboratory diagnostic testing of cellular immunity against pathogenic mycobacteria employs the tuberculin skin test (TST, Mantoux tuberculin test) or the more specific interferon γ test to determine γ interferon released by T lymphocytes stimulated in vitro. The new ELISA and ELISPOT procedures exhibit higher test specificity and less cross reactivity to NTM (non-tuberculosis mycobacteria), are independent of BCG-vaccination status and correlate better with the degree of exposure than does the TST.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India

Background: There is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1- diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India.

BackgroundThere is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1-diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital.Methods151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist.Results5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up.ConclusionsPatients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

β-Lactam Resistance Mechanisms: Gram-Positive Bacteria and Mycobacterium tuberculosis.

The value of the β-lactam antibiotics for the control of bacterial infection has eroded with time. Three Gram-positive human pathogens that were once routinely susceptible to β-lactam chemotherapy-Streptococcus pneumoniae, Enterococcus faecium, and Staphylococcus aureus-now are not. Although a fourth bacterium, the acid-fast (but not Gram-positive-staining) Mycobacterium tuberculosis, has intrinsic resistance to earlier β-lactams, the emergence of strains of this bacterium resistant to virtually all other antibiotics has compelled the evaluation of newer β-lactam combinations as possible contributors to the multidrug chemotherapy required to control tubercular infection. The emerging molecular-level understanding of these resistance mechanisms used by these four bacteria provides the conceptual framework for bringing forward new β-lactams, and new β-lactam strategies, for the future control of their infections.

Tubercular pleuropericardial cyst presenting with symptomatic pulmonary stenosis

A 24-year-old male presented to us with complaints of dyspnea on exertion and cyanosis. On examination, he had systolic murmur over pulmonary area. X-ray and contrast-enhanced computed tomography chest confirmed a large cystic pleuropericardial mass compressing the pulmonary artery which was excised successfully by midline sternotomy. Microscopic examination of purulent content of cyst revealed acid-fast Mycobacterium bacilli . This report is unusual on account that symptomatic and clinically evident pulmonary stenosis from pleuropericardial cyst is rare. Second, it is one of the rare presentations of tuberculosis.

FREQUENCY OF DETECTION AND SPECIFIC MORPHOLOGY OF NON-TUBERCULOUS MYCOBACTERIOSIS IN THOSE AT THE ADVANCED STAGE OF HIV (AS PER DATA FROM ORENBURG REGION)

Goal: to define frequency of detection of non-tuberculous mycobacterioses in Orenburg Region and to study the morphology of the autopsy samples of the patients suffering from HIV infection and non-tuberculous mycobacteriosis. Materials and methods. 7488 mycobacterial cultures were analyzed in order to differentiate non-tuberculous mycobacteria and to identify their species by molecular genetic methods. Post mortem diagnostics was performed with morphological description of generalized forms of mycobacterioses caused by M. avium. Results. The analysis showed that species of Mycobacterium tuberculosis complex significantly prevailed (98.9%) in Orenburg Region. The following non-tuberculous mycobacteria were found in HIV negative patients: M. avium complex, M. xenopi, M. gordonae. M. avium was the most common in HIV positive patients (75%). Non-tuberculous mycobacteriosis possesses a specific diagnostic feature i.e. detection of non-caseous granulomas, consisting of histiocytes and "foamy" macrophages, containing large number of acid-fast mycobacteria in cytoplasm. Diffusive fibrosis of macrophage-histiocyte granulomas and sclerosis of tissue in perifocal area of inflammation are the typical features of it.

Diagnosis and Treatment of Tuberculous Meningitis

Tuberculous meningitis (TBM) is the most fatal form among various types of tuberculosis. It is also the most difficult form for diagnosis. The prevalence of TBM is still high in South Korea compared to that in Western countries. TBM should be differentiated from viral or bacterial meningitis. However, diagnosing TBM is challenging. Clinical samples obtained from cerebrospinal fluid (CSF) are paucibacillary that decreases the sensitivity of mycobacterial diagnostic tests such as acid-fast bacilli (AFB) and Mycobacterium tuberculosis culture. Adenosine deaminase (ADA) is widely used as an adjunct diagnosis of TBM. However, ADA is not a specific marker for TBM. Therefore, more specific test is urgently needed for the confirmation of TBM. Recently, IFN-gamma releasing assay using peripheral blood mononuclear cells and CSF-mononuclear cells as well as the newly-developed Xpert MTB/RFP showed promising results in the rapid diagnosis of TBM. In general, anti-tuberculous therapy for patients with TBM except adjuvant steroid use is similar to that for patients with pulmonary tuberculosis. However, treatment of TBM can be occasionally complicated due to paradoxical response during anti-tuberculous therapy. Key Words: Tuberculosis; Meningitis; Diagnosis; Treatment

Diagnosis and Treatment of Tuberculous Meningitis

Tuberculous meningitis (TBM) is the most fatal form among various types of tuberculosis. It is also the most difficult form for diagnosis. The prevalence of TBM is still high in South Korea compared to that in Western countries. TBM should be differentiated from viral or bac terial meningitis. However, diagnosing TBM is challenging. Clinical samples obtained from cerebrospinal fluid (CSF) are paucibacillary that decreases the sensitivity of mycobacterial diagnostic tests such as acid-fast bacilli (AFB) and Mycobacterium tuberculosis culture. Adenosine deaminase (ADA) is widely used as an adjunct diagnosis of TBM. However, ADA is not a specific marker for TBM. Therefore, more specific test is urgently needed for the confirmation of TBM. Recently, IFN-gamma releasing assay using peripheral blood mononuclear cells and CSF-mononuclear cells as well as the newly-developed Xpert MTB/RFP showed promising results in the rapid diagnosis of TBM. In general, anti-tuberculous therapy for patients with TBM except adjuvant steroid use is similar to that for patients with pulmonary tuberculosis. However, treatment of TBM can be occasionally complicated due to paradoxical response during anti-tuberculous therapy. J Neurocrit Care 2014;7(2):78-85

Tuberculosis diagnostics in Fiji: how reliable is culture?

Acid-fast bacilli (AFB) smear microscopy and Mycobacterium tuberculosis culture are the first-line diagnostic tests for tuberculosis (TB). The contamination of TB cultures significantly reduces the reliability of TB diagnosis. To investigate factors associated with TB culture contamination in Fiji, and the relative diagnostic performance of culture compared to microscopy. All tests performed at the Daulakao Mycobacterium Reference Laboratory (DMRL) in Fiji from 2010 to 2012 were reviewed. Study variables included AFB smear and TB culture results, age and type of specimen, referring TB testing centre and patient age. Of 5708 specimens reviewed, 70% had both AFB smear and culture results recorded; 421 specimens were contaminated; 2.7% of specimens were either degraded or had no result recorded. There was moderate agreement (κ = 0.577) between the two tests. Culture was more likely to be positive at higher AFB smear scores. Culture contamination was associated with distance from the DMRL, sample age and operator-associated factors. Increases in the speed of referral from TB testing centres or the addition of preservatives to sputum specimens may results in less culture contamination. The planned introduction of liquid culture techniques in combination with culture on Ogawa media is likely to increase the sensitivity of TB diagnosis in Fiji.