Nontuberculous Pulmonary Diseases Research Articles

Genome Subtraction and Comparison for the Identification of Novel Drug Targets against Mycobacterium avium subsp. hominissuis.

Mycobacterium avium complex (MAC) is a major cause of non-tuberculous pulmonary and disseminated diseases worldwide, inducing bronchiectasis, and affects HIV and immunocompromised patients. In MAC, Mycobacterium avium subsp. hominissuis is a pathogen that infects humans and mammals, and that is why it is a focus of this study. It is crucial to find essential drug targets to eradicate the infections caused by these virulent microorganisms. The application of bioinformatics and proteomics has made a significant impact on discovering unique drug targets against the deadly pathogens. One successful bioinformatics methodology is the use of in silico subtractive genomics. In this study, the aim was to identify the unique, non-host and essential protein-based drug targets of Mycobacterium avium subsp. hominissuis via in silico a subtractive genomics approach. Therefore, an in silico subtractive genomics approach was applied in which complete proteome is subtracted systematically to shortlist potential drug targets. For this, the complete dataset of proteins of Mycobacterium avium subsp. hominissuis was retrieved. The applied subtractive genomics method, which involves the homology search between the host and the pathogen to subtract the non-druggable proteins, resulted in the identification of a few prioritized potential drug targets against the three strains of M. avium subsp. Hominissuis, i.e., MAH-TH135, OCU466 and A5. In conclusion, the current study resulted in the prioritization of vital drug targets, which opens future avenues to perform structural as well as biochemical studies on predicted drug targets against M. avium subsp. hominissuis.

Mass Spectrometric Identification of Urinary Biomarkers of Pulmonary Tuberculosis

BackgroundTuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics. MethodsWe conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded “validation” cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry. ResultsWe discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60 days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease. ConclusionUrinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB. FundingThis study was funded by Weill Cornell Medicine, the National Institute of Allergy and Infectious Diseases, the Clinical and Translational Science Center at Weill Cornell, the NIH Fogarty International Center grants, and the NIH Tuberculosis Research Unit (Tri-I TBRU).

ДИАГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ТЕСТА GENE XPERT MTB-RIF ВО ФТИЗИАТРИЧЕСКОЙ ПРАКТИКЕ

The article presents the data on the use of Gene Хpert MBT-RIF testing in 122 patients. In 69 (56.6%) patients the diagnosis of tuberculosis was confirmed, and some other non-tuberculous pulmonary diseases were verified in 53 (43.4%) patients. Efficiency of tuberculous causative agent detection by Gene Xpert was compared to routine bacteriological methods. The sensitivity of this method made 63.8%, specificity made 98.1%, prognostic value of the positive result - 97.8%, prognostic value of negative result - 67.5%. Factors associated with positive results of this method are presented.

Diagnostic utility of serum adenosine deaminase level in the diagnosis of pulmonary tuberculosis

This study was conducted to evaluate the role of serum adenosine deaminase (ADA) level in the diagnosis of pulmonary tuberculosis (TB) and its relationship with clinical, radiological, and laboratory parameters. This study was performed on 70 individuals: 60 patients with tuberculous and nontuberculous pulmonary diseases and 10 apparently healthy individuals as a control group. The participants were divided into four groups: group I included 30 patients with active pulmonary TB who were subdivided into group IA, which included 20 patients with sputum smear-positive pulmonary TB, and group IB, which included 10 patients with sputum smear-negative pulmonary TB (culture positive); group II included 10 patients with tuberculous pleural effusion; group III included 20 patients with nontuberculous lung diseases (five cases with pneumonia, five cases with pyogenic lung abscess, five cases with bronchiectasis, three cases with lung cancer, and two cases with mesothelioma); and group IV included 10 apparently healthy individuals as a control group. Patients were subjected to history taking, clinical examination, plain chest radiography posterior–anterior view, three consecutive sputum smears for acid-fast bacilli (AFB), sputum culture for AFB using BACTEC TB-460 system in group IB, laboratory investigations, tuberculin skin test, serum ADA level evaluation in all participants, and pleural ADA level evaluation in cases of tuberculous pleural effusion. Serum ADA showed high percentage positivity (90%) in the diagnosis of pulmonary TB, followed by tuberculin skin test (83.3%), chest radiography (73.3%), erythrocyte sedimentation rate (70%), sputum for AFB (66.6%), toxic symptoms (53.3%), and hemoptysis (36.3%). Serum ADA sensitivity and specificity at cut-off point 30.15 μ/l were 95 and 86.7%, respectively, with a positive predictive value of 90.5%, negative predictive value of 92.2%, and accuracy of 91.4%. Serum ADA level shows higher percentage positivity compared with clinical, radiological, and laboratory parameters in the diagnosis of pulmonary TB.

Nontuberculous pulmonary cavitary diseases of childhood.

We describe the demographic, clinic and radiologic features of nontuberculous cavitary pulmonary diseases in 42 patients with a mean age of 91.1±6.8 months. Infectious etiology was the most common cause (64%), including necrotizing pneumonia (n=15), ruptured hydatid cyst (n=5), lung abscess (n=5) and fungal infection (n=2). Other causes were bronchiectasis, congenital anomalies, foreign body aspiration, sarcoidosis and tumor.

Psychiatric morbidity in patients of pulmonary tuberculosis-an observational study.

Background:A lot of stigma and misconceptions about pulmonary tuberculosis still persist, in spite of the advances in treatment. Thus, a mere diagnosis of pulmonary tuberculosis can be a psychological trauma to an individual. The situation has aggravated with the association of tuberculosis with HIV infection.Aim:To study the psychiatric morbidity due to the various psychological stresses faced by a patient of pulmonary tuberculosis.Materials and Methods:The study group consisted of 100 inpatients admitted to pulmonary ward with diagnosis of pulmonary tuberculosis. The control group consisted of 100 inpatients admitted to pulmonary ward with nontuberculous pulmonary diseases. Psychiatric history and mental status were recorded on a specially designed proforma and diagnosis of any psychiatric illness, if present, arrived at as per International Classification of Diseases (ICD-10). The psychiatric tests applied were beck's depression inventory (BDI) and Taylor's Manifest Anxiety Scale (TMAS).Results:Of the patients of pulmonary tuberculosis, 24% could be given a diagnostic category, as per ICD-10, as compared to only 8% of the controls (P < 0.005). On BDI, 44% of patients of pulmonary tuberculosis showed depression as compared to 27% of the controls (P < 0.02). On TMAS, 38% of patients of pulmonary tuberculosis showed anxiety as compared to 24% of controls (P < 0.05). A greater incidence of depression (on BDI) and anxiety (on TMAS) was seen in those with longer duration of illness (P < 0.02) and in those with greater severity of illness (P < 0.02).Conclusion:In view of the high psychiatric morbidity associated with pulmonary tuberculosis, there is enough scope for psychiatric services to be made available to these patients. In addition, personnel involved in the treatment of these patients should be trained for early detection of psychiatric symptoms.

The importance of definition of active pulmonary tuberculosis and non-tuberculous pulmonary diseases in studies of diagnostic accuracy in high incidence areas.

In a recent study evaluating diagnostic accuracy of the interferon gamma release assay (IGRA) T-SPOT.TB for the diagnosis of tuberculosis in Southern China the authors found a low specificity of this assay in a group of patients with active pulmonary tuberculosis and non-tuberculous pulmonary diseases (NTBPD) (1). The authors may not be right in attributing this entirely to the presence of latent mycobacterium tuberculosis infection in the group of patients with NTBPD.

Usefulness of cytobrush for microbiological and cytological evaluation of the mare's endometrium

A material of about 6,000 cases of pulmonary tuberculosis (including acute pleurisy) and 691 cases of non-tuberculous pulmonary diseases was investigated in respect to serum titres (the antistreptolysin titre regarding beta-haemolytic streptococci and the antistaphylolysin titre for yellow staphylococci). Elevation of these titres occurred to a great extent among the tuberculosis cases (least among those probably healed). In the group of non-tuberculous disease of the lung the asthma and carcinoma cases show comparatively low incidence of titre rises. The titre elevation should be regarded as indicating an active infection by the respective bacteria, but beyond this even other, non-specific pathogens are certainly active to the same or a still greater extent. Particularly as regards the tuberculosis cases such multiple or supervening infections on the whole should not be deemed “secondary infections.” As a rule the incidence of titre elevations is highest in recent cases without marked pulmonary processes, and on the whole titre rises are nearly equally common whether the pulmonary lesions be minimal or very marked.Cases with signs of bronchostenosis both in tuberculosis and in the groups of non-tuberculous pulmonary diseases exhibit roughly fifty per cent higher incidence rates or raised antistreptolysin titres, and a similar, though somewhat lower difference is noted also as regards the antistaphylolysin titre when the stenosis cases are compared to such instances where no symptom of bronchial obstruction had been recorded. The results of post-mortem bacteriological studies, inter alia, support the opinion that the non-specific infections are lodging specially in the lymph nodes of the respiratory system.The cause of perforation processes or other types of encroachment of the process from the lymph nodes on to the bronchi, which subsequently may give rise to stenosing processes, is above all a clash within the node between a tuberculous process and one or several non-specific infections. Non-specific infections may frequently, not least in cases of primary tuberculosis, concur with or be older than the tuberculosis process.Chronic and acute non-specific infections may exert influence also in other ways, and such infections should be regarded as chief pathogenetic factors altogether in tuberculosis cases, and hence also as of considerable prognostical importance.As examples of acute pulmonary conditions, similar in type, where active tuberculosis is certainly absent, are adduced six typical cases including one of the so-called middle-lobe syndrome.

Microbial substitution of Mycobacterium avium-intracellulare to Mycobacterium abscessus during clinical course

Mycobacterium avium-intracellulare (MAI) is, among acid-fast bacilli, the most common cause of nontuberculous pulmonary diseases, and MAI infections are often treated according to the guidelines of the American Thoracic Society. However, despite the use of multiple drugs, patients sometimes do not recover with the initial round of treatment. Other kinds of nontuberculous mycobacteria are sometimes found in patients' respiratory samples, even during such treatment for MAI pulmonary disease. We experienced three patients with pulmonary disease due to Mycobacterium abscessus (MA) in whom the disease was difficult to treat because of resistance to all the antituberculous agents used. MA infection had occurred in these patients after long-term treatment with multiple drugs for previous MAI pulmonary disease. We considered that the MA infection in these patients appeared to be the result of insufficient efficacy of the drugs used for MAI and insufficiently aggressive use of antituberculous agents. It thus appeared that MA infection was the result of microbial substitution, and that, if this is the case, the guidelines for the treatment of MAI may need to be modified to eliminate microbial substitution.

Study of adenosine deaminase activity in pulmonary tuberculosis and other common respiratory diseases

Tuberculosis has, in a short span of time, become a major health problem in the third world or developing countries like India. In view of this, a retrospective study was conducted to study Adenosine deaminase activity in serum and pleural fluid in patients affected with Pulmonary Tuberculosis and other common non-tubercular chronic respiratory diseases. The study was carried out on 100 patients suffering from various pulmonary disorders, between January 2002 and August 2002. Thirty-five normal healthy individuals were included as control subjects. ADA estimation was done by sensitive colorimetric method. The study revealed that the serum ADA activity was higher in patients of tuberculous pulmonary and pleural diseases and non-tuberculous pulmonary diseases than in control subjects. The mean serum ADA activity in the patients' group was 35.5±6.93 u/l as compared to 16.20±2.85 u/l in control group, showing a highly significant (P≪0.001) difference. ADA activity was highest in tuberculous pleuropulmonary diseases. The pleural fluid ADA activity was higher in pyogenic pleural effusion than in tuberculous pleural effusion.

Adenosine deaminase activity in bronchoalveolar lavage in Turkish patients with smear negative pulmonary tuberculosis

The sputum smear-negative patients have been a diagnostic challenge for health professionals. Adenosine deaminase (ADA) activity has been shown to rise in various body fluids of patients with tuberculosis (Tb). A prospective clinical trial was conducted to determine the diagnostic value of ADA activity in bronchoalveolar lavage (BAL) in sputum smear-negative subjects highly suggestive for pulmonary Tb. Nineteen (M/F: 15/4, mean age 46.8±16.5 years) sputum smear-negative patients highly suggestive for pulmonary Tb constituted Group I. Acid fast bacilli (AFB) grew on sputum and/or BAL culture of all subjects in this group. Twenty-nine patients (M/F: 19/10, mean age 55.7±8.0 years) with non-tuberculous pulmonary diseases constituted Group II. Ten of them had interstitial lung disease, nine lung cancer, five pneumonia and five COPD. Twelve subjects (M/F: 7/5, mean age 48.4±12.8 years) constituted the controls (Group III) undergoing fiberoptic bronchoscopy (FOB) for various indications and the lungs were found to be normal eventually. Albumin and ADA activity levels were measured in plasma and BAL in all the subjects. LocalADA was calculated. PlasmaADA and BALADA of Group I was significantly higher (P<0.001) than that of the other groups. LocalADA was also the highest in Group I when compared with the others (P<0.001) but that of Group II was also higher (P<0.01) when compared with controls. With a cut-off value derived from the control subjects, sensitivity of BALADA was 100% and specificity 85.3%. Sputum PCR results are available in a couple of days whereas that of BALADA are available in a couple of hours and BALADA costs cheaper than PCR in our country. Therefore, we conclude that BALADA may be a useful, cheaper and faster diagnostic test in sputum smear-negative patients highly suggestive for pulmonary Tb. LocalADA need not be calculated as it is also significantly higher in Group II subjects and thus not as reliable as BALADA.

Diagnostic Significance of the Serologic Test Using Antigen of Mycobacterium Tuberculosis for Antibody Detection by ELISA

연구배경: 결핵의 유병률은 감소하는 추세이나 노인, 항암약물요법, HIV 감염 풍에 의해 면역기능이 약화된 환자에 있어서 결핵의 발생이 문제가 되고 있으며, 특히 다제내성균주의 출현은 큰 문제이다. 결핵진단법 중 체액에서 도말검사나 배양검사를 통해서 Myco-bacterium tuberculosis를 검출하는 것이 표준진단법이나, 도말검사는 상대적으로 민감도가 낮고 배양검사는 오랜시간이 소요된다. 중함연쇄반응을 이용하여 결핵균의 DNA를 검출하는 방법은 매우 민감하나 비용이 많이 소요된다. ELISA(enzyme linked immunosorbent assay)를 이용하여 혈청에서 결핵균 특이항원에 대한 항체를 검출하는 방법이 객담도말음성인 활동성 폐결핵환자를 다른 비결핵성 폐질환으로부터 감별하는데 유용한지를 확인하고자 하였다. 방 법: 연세대학교 세브란스 병원에 입원한 183명의 객담도 말음성인 폐질환환자에서 항산균에 대한 객담도말 및 배양검사와 결핵균 특이 항원인 recombinant 38 kilo-dalton 항원과 culture filtrate항원을 이용한 ELISA 검사를 시행하였다. 결 과: 35명의 활동성 폐결핵환자 중 18명에서 배양검사상 Mycobacterium tuberculosis를 검출할 수 있었다. 38 kDa와 culture filtrate에 대한 흡광도는 활동성 폐결핵환자들에서 비결핵성 폐질환자들보다 유의하게 높았다 (p 0.05) 객담도말음성인 환자에 있어서 38 kDa과 culture filtrate의 민감도는 각각 20.0%와 31.4%였고 특이도는 각각 95.3%와 93.9%였다. 결 론: 객답도말검사 음성인 활동성 폐결핵환자에 있어서 ELISA를 이용한 38 kDa과 culture filtrate 항원에 대한 혈청항체검사법은 기존진단방법보다 낮은 민감도를 보여, 비결핵성 폐질환으로부터 활동성 폐결핵을 감별진단하는데 크게 도움이 되지 않을 것으로 여겨진다. 【Background: Diagnosis by direct microscopy and/or by culture of the Mycobacterium tuberculosis from body fluids or biopsy specimens is Gold standard. However, the sensitivity of direct microscopy after Ziehl-Neelsen staining is relatively low and culture of mycobacteria is time consuming. Detection of mycobacterial DNA in clinical samples by the polymerase chain reaction is highly sensitive but laborious and expensive. Therefore, rapid, sensitive and readily applicable new tests need to be developed. So we had evaluated the clinical significance of serologic detection of antibody to 38 kDa antigen, which is known as the most specific to the M. tuberculosis complex, and culture filtrate antigen by ELISA in sputum AFB smear negative patients. Method: In this study, culture tests for acid fast bacilli with sputa or bronchial washing fluids of 183 consecutive patients who were negative of sputum AFB smear were performed. Simultaneously serum antibodies to 38 kDa antigen and unheated culture filtrate of M. tuberculosis were detected by an ELISA method. Results: The optical densities of ELISA test with 38 kDa and culture filtrate antigen were significantly higher in active pulmonary tuberculosis cases than in non tuberculous pulmonary diseases (p 0.05). In the smear-negative active pulmonary tuberculosis patients, the sensitivity of the ELISA using 38 kDa antigen and culture filtrate was 20.0% and 31.4%. respectively. The specificity was 95.3% and 93.9%. respectively. Conclusion : In active pulmonary tuberculosis but smear negative, the serologic detection of antibody to 38 kDa antigen and culture filtrate by ELISA cannot substitute traditional diagnostic tests and does not have clinically significant role to differenciate the patient with active pulmonary tuberculosis from other with non-tuberculous pulmonary diseases.】

Diagnostic significance of circulating immune complexes in patients with pulmonary tuberculosis

A polyethylene glycol (PEG) precipitation method was used to examine sera of patients with active pulmonary tuberculosis (PT), leprosy and non-tuberculous pulmonary diseases and of healthy control subjects for immune complexes (ICs). Mycobacterium tuberculosis antigen 5 was detected in the ICs in 80% of patients with PT by the indirect (sandwich) enzyme-linked immunosorbent assay (ELISA). Detection of mycobacterial antigen in ICs has diagnostic potential as an adjunct in the laboratory diagnosis of PT, particularly when repeated bacteriological investigations for M. tuberculosis in clinical specimens are negative. Levels of ICs tend to decrease with the duration of anti-tuberculosis chemotherapy and their detection can also be used to assess the clinical response to therapy in patients with PT.

Souble interleukin-2 receptors in pulmonary tuberculosis.

Serum levels of soluble interleukin-2 receptor (IL-2R) were measured in patients with pulmonary tuberculosis, nontuberculous pulmonary diseases (bacterial pneumonia, lower respiratory tract infection, lung cancer), and in normal volunteers. Patients with tuberculosis had increased levels of soluble IL-2R compared to normal controls. Abnormally elevated levels were also shown in patients with nontuberculous pulmonary diseases, suggesting that elevations of soluble IL-2R are not specific for tuberculosis. In patients with tuberculosis, elevated levels of soluble IL-2R were steadily decreased to normal levels during successful treatment. Additionally, soluble IL-2R levels in tuberculosis were closely correlated with adenosine deaminase levels. Thus, it seems possible that measurements of soluble IL-2R may be beneficial in the diagnosis and the management of patients with tuberculosis. Furthermore, we demonstrated that elevated levels of soluble IL-2R in tuberculosis appear to be a consequence of cellular activation of mononuclear cells and not to be the result of cell death with subsequent IL-2R release.

Purified Protein Derivatives Lymphocyts Stimulation Test in Pulmonary Tuberculosis and non-tuberculous Pulmonary Diseases

Purified Protein Derivatives Lymphocyts Stimulation Test in Pulmonary Tuberculosis and non-tuberculous Pulmonary Diseases

Defective Leukotaxis in Monocytes from Patients with Pulmonary Tuberculosis

Because the accumulation of macrophages and their precursors, peripheral blood monocytes, in foci of infection is an important feature of the host reponse to mycobacterial challenge, the leukotactic responsiveness of monocytes from patients with active tuberculosis was evaluated. With a double-filter, in vitro technique, defective leukotaxis was demonstrated in monocytes from 19 of 20 untreated patients, whereas normal leukotactic responses were found in monocytes from 11 of 15 patients with chronic, nontuberculous pulmonary inflammatory diseases. This defect may be related to increased activity of a naturally occurring, heat-stable plasma substance with a molecular mass of approximately 2.3 x 10(5) daltons that inhibited leukotactic responsiveness. Monocyte leukotaxis improved and the leukotactic inhibitory activity of plasma disappeared in most patients while they were on therapy; these phenomena were unrelated to bacteriologic conversion or resolution of symptoms. In vitro studies with isoniazid, ethambutol, and rifampin excluded a direct effect of these drugs or their metabolites on monocytes or on the leukotactic inhibitor in plasma. Thus, defective leukotaxis of monocytes in patients with pulmonary tuberculosis may be an epiphenomenon of the local tissue reaction.

Pulmonary Function of Non-Tuberculous Pulmonary Diseases

Pulmonary Function of Non-Tuberculous Pulmonary Diseases

The effect of tuberculin on the oxygen utilization of circulating leucocytes in different pulmonary diseases

The oxygen utilization of circulating leucocytes with and without tuberculin was examined in 82 patients with pulmonary diseases. The oxygen consumption of leucocytes from 42 (80%) of 52 patients with active pulmonary tuberculosis was enhanced by more than 15% in presence of tuberculin. The oxygen utilization of cells from 10 patients with inactive tuberculosis was not enhanced. Enhancement occurred in only 15% of patients with non-tuberculous pulmonary diseases. La consommation d'oxygene des leucocytes circulant, en présence ou non de tuberculine, fut mesurée chez 82 malades presentant une maladie pulmenaire. La présence de tuberculine augmentait de plus de 15% la consommation d'oxygene des leucocytes pour 42 malades sur 52 (80%) qui etaient porteurs d'une tuberculose pulmonaire active. Il n'y eut pas d'augmentation de l'utilisation d'oxygene chez les cellules provenant de 10 malades ayant une tuberculose inactive. L'augmentation s'est produite chez 15 pour cent seulement des malades non tuberculeux. Se examinó la utilización de oxígeno por parte de los leucocitos circulantes, con y sin tuberculina, en 82 enfermos tuberculosos. El consuma de oxigeno de los leucocitos en 42 enfermos sobre 52 (80%) con tuberculosis activa, se acrecentó en màs del 15% en presencia de tuberculina. La utiliza ción de oxígeno de células de 10 enfermos con tuberculosis inactiva no fué acrecentada. El acrecentamiento ocurrió solamente en el 15% de enfermos con procesos pulmonares no tuberculosos.

Management of Common Pulmonary Diseases

Summary Report of the 21st Research Conference on Pulmonary Diseases of the Veterans Administration and the Armed Forces THE 21ST RESEARCH CONFEBENCE on Pulmonary Diseases of the Veterans Administration and the Armed Forces met in St. Louis, Jan. 22-25, 1962. The change in the name of the conference from Chemotherapy of Tuberculosis, last year, reflects the increasing interest in nontuberculous pulmonary diseases. Fifty-two papers were presented, and these will be summarized along with pertinent comments which occurred during the discussion periods; however, the names of the individual authors will not be mentioned. Contributors included representatives from the cooperating Veterans Administration and Armed Forces hospitals, consultants, and guests. This is the tenth in a series of such reports. Pulmonary Tuberculosis Steroid Therapy—The first study, in which 8 Veterans Administration hospitals cooperated, was designed to determine the effect of steroid therapy on the incidence of favorable roentgenographic change, the disappearance of tubercle bacilli

Management of Tuberculous Patients in a General Hospital

1. One hundred and eleven tuberculous patients were treated medically and surgically in a general hospital from 1953 to 1959. 2. Only 20 patients with active tuberculosis were transferred to tuberculosis hospitals or sanatoria. 3. Thirty-seven patients with active tuberculosis were discharged from the hospital for care by the family physician under the direction of the phthisiologist. 4. Fifty-four patients with inactive pulmonary tuberculosis, who were hospitalized for late nonspecific pulmonary or cardiac complications or for other diseases were screened from transfer to tuberculosis institutions. 5. Many patients were screened for the various forms of acid-fast pulmonary diseases, the diagnosis of nontuberculous pulmonary diseases and the exclusion of these from transfer to the sanatoria, where super-infection is a real possibility.