Positive Bacilli Research Articles

EFFECT OF TRADITIONAL MEDICINAL PLANTS ON TEETH MICROFLORA

The oral cavity provides an ideal environment for the growth of microbiota. Many of the bacterial species in the oral cavity are involved in dental caries. Acidogenic and aciduric Gram positive bacteria, metabolize sucrose to organic acid, which dissolves the calcium phosphate in the teeth resulting in decalcication and nally causing decay. Therapeutic drugs used to treat dental diseases may have many undesirable effects such as diarrhea, vomiting and tooth staining. Therefore, natural phytochemicals isolated from plants used in traditional medicines are considered as a good alternative to synthetic chemicals. Therapeutic and chemical methods are costly but there are many easily available plants which we can use for cleaning our teeth and maintaining our oral hygiene. A study was undertaken to investigate the antimicrobial effect of , , Psidium guajava Mangifera indica Anacardium occidentale Azadirachta indica and on oral normal microora. Ethanolic and aqueous extracts of the leaves were prepared and was tested against the three isolates from the oral cavity using Agar well diffusion method namely Gram positive αhaemolytic cocci in chain, Gram positive non-haemolytic cocci in chain and Gram positive bacilli. and Psidium guajava Anacardium occidentale was found to be effective against the isolates. From this study and have shown Psidium guajava Anacardium occidentale great potential to act as natural and cost effective alternative for maintaining oral hygiene.

Avian Mycobacteriosis and Molecular Identification of Mycobacterium avium Subsp. avium in Racing Pigeons (Columba livia domestica) in Greece.

Simple SummaryAvian mycobacteriosis a contagious, chronic and potential zoonotic List B disease of the World Organization for Animal Health, is described in two lofts of pigeons in this review. Molecular analysis identified the causative agent as Mycobacterium avium subsp. avium. This is the first case report of avian mycobacteriosis in Greece, which describes the presence of granulomatous conjunctivitis and the molecular identification of M. avium subsp. avium as the causative agent in racing pigeons. The identification of the strain will enrich the epidemiological data and will contribute to the control of avian mycobacteriosis in pigeons.In this report, cases of avian mycobacteriosis in two lofts of racing pigeons are described. Three racing pigeons of 2-year old from the first loft (A) and four racing pigeons of 4–5 years old from the second loft (B) were submitted to the Unit of Avian Medicine for clinical examination and necropsy. In the case history chronic and debilitating disease was reported. The clinical signs included emaciation, depression, lameness, periorbital swelling and diarrhea, although the appetite was normal. Post mortem lesions involved an enlarged spleen with multiple different sized yellow nodules. Similar lesions were also observed in the liver, conjunctiva of the inferior eyelids and in the femoral bone marrow. The suspicion of avian mycobacteriosis was based on history, clinical signs and typical lesions. In order to confirm the diagnosis, histopathology was performed on tissue sections and revealed the presence of multiple granulomas with central necrosis. In addition, Ziehl-Neelsen positive bacilli were observed in histological sections and smears from the granulomas of the affected tissues. Molecular analysis identified the causative agent as Mycobacterium avium subsp. avium. This is the first case report of avian mycobacteriosis in Greece, which describes the presence of granulomatous conjunctivitis and the molecular identification of M. avium subsp. avium as the causative agent in racing pigeons.

Comparing Treatment Outcomes between Confirmed and Non-Confirmed Childhood TB Cases: Study from a Major Tertiary Center in Thailand

Tuberculosis (TB) in children is challenging to diagnose due to its non-specific symptoms and difficulties in obtaining confirmatory laboratory results. This study aimed to compare the treatment outcomes of confirmed and non-confirmed TB in children. The medical records of children aged ≤ 15 years diagnosed with TB at Songklanagarind Hospital from January 2007 to December 2018 were examined. The TB cases were classified into three groups, confirmed cases (positive culture and/or polymerase chain reaction), probable cases (positive histopathological and/or acid-fast bacilli results) and presumptive cases (clinical manifestations and imaging findings compatible with TB and good response to anti-TB drugs but without microbiological confirmation). Of 177 children, 66 (37.3%) had a confirmed diagnosis, 57 (32.2%) a probable diagnosis, and 54 (30.5%) a presumptive diagnosis. The successful treatment rates of the confirmed, probable and presumptive TB groups were 80.3%, 87.7% and 92.6%, respectively (p = 0.21). Of the 54 presumptive cases, a history of household contact with TB led to a diagnosis of asymptomatic pulmonary TB in 10 (18.5%) cases. Patients with a presumptive diagnosis were less likely to have disseminated and/or miliary TB (1.9% vs. 7.0% of probable vs. 22.7% of confirmed, p < 0.01). Only one-third of the study patients had a confirmed TB diagnosis. The successful treatment and mortality rates did not significantly differ among the three groups. To increase the detection rate of early diagnosis of childhood TB, physicians should perform active TB contact investigations in household members of the index case.

Comparative study of conventional Ziehl−Neelsen and bleach concentration method in detecting acid-fast bacilli in fine-needle aspiration material of lymph nodes

Background: Tuberculosis (TB), specific infectious disease, affects most of the organs of the human body. Extrapulmonary TB manifests commonly as lymphadenopathy. Emergence of acquired immunodeficiency syndrome warrants the rapid diagnosis to limit its spread. Aim and Objectives: The application of bleach concentration method in detecting tubercle bacilli in the material obtained by fine-needle aspiration (FNA) of lymph nodes, evaluating sensitivity of bleach concentration method over conventional direct smear method in diagnosing tubercular lymphadenitis, detecting bacilli in the background of granuloma formation. Materials and Methods: The prospective, hospital-based, cross-sectional study was carried out in a study population of 78 patients where 15 cases got eliminated following the cytological diagnosis of malignancy and inadequacy of sample. Patients with lymphadenopathy underwent FNA after clinical examination, history taking, and informed consent. The aspirated material was stained with Leishman, H and E, conventional Ziehl−Neelsen (ZN), and bleach concentration method. Data were collected and statistical analysis done. Results: The predominant age group affected was (16–30) years with male preponderance. 44.44% cases were cytomorphologically diagnosed with tuberculous lymphadenitis. Acid-fast Bacilli (AFB) was found in 23 cases by conventional ZN method and 39 cases by bleach concentration method. Sensitivity of bleach method was 92.35% compared to 54.76% in conventional ZN method. Bacilli positivity was more in cases presenting with necrosis than with granuloma alone. Conclusion: Bleach method for detecting AFB is more sensitive than conventional ZN method. It is safe, inexpensive, easy to perform, requires no additional equipment, and safe to handle in laboratory.

Exacerbating factors in elderly patients with Mycobacterium avium complex pulmonary disease.

No previous studies have examined Mycobacterium avium complex pulmonary disease (MAC-PD) in only elderly patients ⩾75 years old. Here, we investigated the exacerbating factors of MAC-PD in elderly patients and clarified cases that can be followed up without MAC medication. From April 2011 to March 2019, 126 advanced aged patients at our institute were newly diagnosed with MAC-PD, and could be observed based on radiological findings for over a year. Their medical records were retrospectively examined for clinical and radiological findings at the time of diagnosis and 1 year later. To identify the predictors of exacerbation, clinical characteristics of 109 treatment-naïve patients were compared between exacerbated and unchanged groups. Additionally, the unchanged group was followed for one more year. In the current study, positive acid-fast bacilli smears from the sputum test, the presence of cavitary lesions and extensive radiological findings, particularly abnormal shadows in ⩾3 lobes, were predictive of exacerbation among treatment-naïve elderly MAC-PD patients. In the unchanged group, <10% showed exacerbation of radiological findings within the subsequent year. In conclusion, if the sputum smear is negative, no cavitary lesions are present, and abnormal shadows are restricted to ⩽2 lobes, elderly patients with MAC-PD may remain untreated for a few years.

Antimicrobial Properties of the Hydroethanolic Extract of &amp;lt;i&amp;gt;Bauhinia rufescens&amp;lt;/i&amp;gt; L. and &amp;lt;i&amp;gt;Euphorbia hirta&amp;lt;/i&amp;gt; L., Two Plants of the Traditional Chadian Pharmacopoeia

Objective: To evaluate the antimicrobial properties of hydroethanol extracts of Bauhinia rufescens L. and Euphorbia hirta L. Methodology and results: The hydroethanol extracts of Bauhinia rufescens L. and Euphorbia hirta L.; two plants of the Chadian traditional pharmacopoeia used in the treatment of infantile diarrhoea and gastroenteritis in adults were submitted to in vitro tests in order to highlight their antibacterial and antifungal properties. The method of microdilution in liquid medium coupled with spreading on agar medium was used for the tests. The microbial strains used consisted of 13 hospital bacterial strains and 6 reference strains including a yeast strain of the Candida albicans ATCC 90028 species. The results obtained confirm the antimicrobial properties of Bauhinia rufescens L. and Euphorbia hirta L. because at 50 mg/ml, they inhibit 100% the growth of gram positive and Gram-negative bacilli tested. On the other hand, for Candida albicans ATCC 90028, it is only the extract of Euphorbia hirta that was active at 50 mg/ml. Conclusion: In view of these results, we can say that these plants have an antibacterial activity and that their use in traditional phytotherapy is justified.

Laboratory findings and clinical characteristics of Pneumocystis pneumonia and tuberculosis infection among HIV-infected patients with pulmonary infiltrates in Jakarta, Indonesia.

Pneumocystis pneumonia (PCP) and pulmonary tuberculosis infection (PTB) are important opportunistic infections in HIV-infected patients. The diagnosis remains challenging since Pneumocystis jirovecii cannot be cultured, and expectorated-sputum is frequently difficult to obtain. The monoclonal-antibody detection for P. jirovecii from induced sputum is promising in diagnosing PCP. This study determined the percentage of PCP in HIV-infected patients with pulmonary infiltrates at three government hospitals in Jakarta. The concurrent infection of PTB was carefully documented as well. This cross-sectional study was carried out by documenting the clinical symptoms, laboratory findings, chest X-ray, while clinical outcomes were evaluated during hospitalization. The sputum induction was conducted for P. jirovecii with monoclonal antibody detection at the laboratory of Parasitology Department, Faculty of Medicine Universitas Indonesia, as well as Ziehl-Nielsen staining for PTB. The results indicated that of 55 HIV-infected patients with pulmonary infiltrates, the positive monoclonal antibody for P. jirovecii was detected in eight patients (14.6%). Weight loss, fever, shortness of breath, and crackles were found in all PCP patients; while dry cough in five patients. Moreover, PTB cases with positive acid-fast bacilli (AFB) was detected in five patients (9.1%), the PTB cases with negative AFB was 43.6% (24 out of 55 patients), and the rest 26 patients (47.3%) were not proven to have PTB. The concurrent infections of PCP and PTB were documented in three out of five positive AFB patients. The clinical outcome of eight PCP patients showed improvement in five patients, but the other three patients died. Laboratory findings play an important role in the diagnosis of PCP and PTB, along with clinical characteristics and radiological features. Low CD4+ cell count was considered a possible risk factor for PCP and poor clinical outcomes.

The association between osteopontin and tuberculosis: A systematic review and meta-analysis.

We examined the data reported in the studies for comparison of osteopontin (OPN) levels in tuberculosis and healthy participants, and to discuss whether OPN could be extended to disease diagnosis, severity assessment and therapeutic effect monitering. A systematic literature search was conducted in PubMed, EMBASE, Scopus, the Cochrane Library, Web of Science, the China National Knowledge Infrastructure (CNKI) and WanFang databases. The pooled risk estimates were shown in standardized mean difference (SMD) with 95% confidence interval (CI) for OPN levels. The random effect model was used according to the test of heterogeneity among studies. Subgroup analyses and meta-regression models were performed to identify the possible sources of heterogeneity. 17 retrospective studies with 933 tuberculosis participants and 786 healthy controls were finally included in this article. In the primary meta-analysis, higher serum/plasma OPN levels were found in tuberculosis patients (SMD = 2.58, 95%CI = 2.09~3.08, P<0.001). Besides, pooled results from positive acid-fast bacilli (AFB) staining and imaging-severe tuberculosis group demonstrated higher OPN concentrations (SMD = 0.90, 95%CI = 0.58~1.21, P<0.001; SMD = 1.11, 95%CI = 0.90~1.33, P<0.001; respectively), and OPN levels decreased after two months of standard anti-tuberculosis therapy (SMD = 2.10, 95%CI = 1.36~2.85, P<0.001). Elevated serum/plasma OPN levels may be associated with an increased risk of tuberculosis, while further well-designed studies are needed. Moreover, OPN could be considered as a potential biomarker for tuberculosis surveillance and severity assessment.

Assessment of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF- MS) for Accurate Bacterial Identification in Clinical Labs

Abstract Introduction/Objective On behalf of the diagnostic Medical Laboratory rapid, and accurate identification of bacteria with their one-to-one anti-microbial susceptibility outlines is of ultimate importance for the management of infected patients. Contemporary microbial identification methods employed in routine clinical diagnostic laboratories relies on the use of conventional phenotypic methods. Phenotypic methods are time consuming with minimum turn-around times of at least 24 hrs and in many occurrences of 48hrs. With the intention of accelerate laboratory processes the MALDI-TOF MS was familiarized. MALDI-TOF MS is established on proteomic profiling and permits for rapid identification of bacteria. This technology has not been widely used in Egypt, but has been regularly used in Europe for the past few years. Methods Two hundred forty three positive non duplicate blood cultures were accrued over a period of six months. Experimental aliquots were taken from excess sample material that was collected as part of routine clinical care. 105 were positive for Gram negative bacilli, 123 were positive for Gram positive cocci, 3 positive for Gram positive bacilli, and 7 were positive for yeast. MALDI-TOF identification was compared to conventional identification. Conventional identification consisted of a combination of MALDI-TOF identification of a subcultures colony by direct smear, biochemical reactions, Vitek 2, and molecular identification. Results Ninety seven of the one hundred and five blood cultures positive for Gram negative bacilli were monomicrobial. The majority of these were identified as Escherichia coli by conventional methods, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Eighty-four of these monomicrobial cultures were identified by MALDI-TOF to the species level. Eighty-one of the eighty-four were concordant with the conventional identification (96.4%). Conclusion The MALDI-TOF proved to be useful for the rapid and reliable identification of g-ve bacteria from the clinical specimens. The difference in turnaround time for bacterial identification was significant between MALDI-TOF MS and VITEK 2 with minimal preparation for the blood cultures.

Patterns of Mycobacterium avium-intracellulare complex infection in duodenal endoscopic biopsies in HIV/AIDS patients

Mycobacterium avium-intracellulare complex (MAIC) is a nontuberculous opportunistic infection in immunocompromised patients. Involvement of the gastrointestinal tract (GIT) is usually part of a disseminated disease in AIDS patients with a low CD4 count, however with standard antiretroviral therapy (ART), a localized presentation is more likely. It can affect any part of the GIT, mostly the duodenum and typically as patches. Incomplete or refractory ART for HIV-strains, therapy-related side effects, noncompliant or incomplete treatment to previous MAIC infections, superimposed complications and comorbid opportunistic infections may result in atypical clinical, endoscopic and histopathologic manifestations. We performed a retrospective review study retrieving cases of MAIC in duodenal endoscopic biopsy. We found five cases of MAIC in HIV/AIDS patients. They were males with an average age of 40-years. They showed different histopathologic features, variable patterns of MAIC-histiocytic infiltrates, and varying intensity of intracellular acid-fast positive bacilli. Enterocytes vacuolization and transepithelial elimination were also observed. Three cases were associated with cytomegalovirus and cryptococcal infections. A case was complicated by lymphangiectasia-associated protein-losing enteropathy. Initially, three cases were morphologically missed. Ziehl-Neelsen stain helped reach the correct diagnosis. Pathologists have an important role in patients' management by guiding clinicians to the correct diagnosis. Pathologists should be aware of these different histopathologic manifestations, their potential pitfalls, look for certain helpful clues complemented with multiple levels and special stains. In particular, AFB stains are mandatory in all mucosal biopsy specimens from HIV/AIDS patients regardless of their appearances.

RISK FACTORS OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS: A CASE-CONTROL STUDY IN DR. KARIADI GENERAL HOSPITAL, SEMARANG, INDONESIA

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). Prevalence of TB among DM patients ranged from 1.7 % to 36 %. Limited information has been reported regarding TB among DM patients in Indonesia. This case-control study aimed to investigate prevalence and related factors of pulmonary TB among DM patients in Dr. Kariadi General Hospital. Cases of pulmonary TB were defined by a positive acid-fast bacilli smear or molecular rapid test and thorax x-ray. Data were presented as frequency and percentage comparing the case and control group. Chi-square continued by Binary logistic regression analyses were done to determine the relationship between the parameters and TB status performed by the SPSS 16. Prevalence of 8.02% or 72 patients were diagnosed as having pulmonary TB from 898 registered patients with DM. Of the 72 TB patients, 30 completed the data as case group, and 45 DM patients without TB determined as a control group. Comparison between the case and control group study found differences in household contact (63.3 % and 4.4 %, respectively), random plasma glucose (76.7 % and 33.3 %), duration of DM (40 % and 71 %), and treatment compliance (30 % and 68.9 %). The final model in Binary logistic regression involved household contact, random plasma glucose level, and treatment compliance. The prevalence of pulmonary TB among DM patients in Dr. Kariadi General Hospital was 8.02%. Risk factors that were associated with this occurrence were: household contact, high random plasma glucose level, and poor treatment compliance.

Sensitivity optimisation of tuberculosis bioaerosol sampling.

Detection of Mycobacterium tuberculosis (Mtb) in patient-derived bioaerosol is a potential tool to measure source case infectiousness. However, current bioaerosol sampling approaches have reported low detection yields in sputum-positive TB cases. To increase the utility of bioaerosol sampling, we present advances in bioaerosol collection and Mtb identification that improve detection yields. A previously described Respiratory Aerosol Sampling Chamber (RASC) protocol, or "RASC-1", was modified to incorporate liquid collection of bioaerosol using a high-flow wet-walled cyclone (RASC-2). Individuals with GeneXpert-positive pulmonary TB were sampled pre-treatment over 60-minutes. Putative Mtb bacilli were detected in collected fluid by fluorescence microscopy utilising DMN-Trehalose. Exhaled air and bioaerosol volumes were estimated using continuous CO2 monitoring and airborne particle counting, respectively. Mtb capture was calculated per exhaled air volume sampled and bioaerosol volume for RASC-1 (n = 35) and for RASC-2 (n = 21). Empty chamber samples were collected between patients as controls. The optimised RASC-2 protocol sampled a median of 258.4L (IQR: 226.9-273.6) of exhaled air per patient compared with 27.5L (IQR: 23.6-30.3) for RASC-1 (p<0.0001). Bioaerosol volume collection was estimated at 2.3nL (IQR: 1.1-3.6) for RASC-2 compared with 0.08nL (IQR: 0.05-0.10) for RASC-1 (p<0.0001). The detection yield of viable Mtb improved from 43% (median 2 CFU, range: 1-14) to 95% (median 20.5 DMN-Trehalose positive bacilli, range: 2-155). These improvements represent a lowering of the limit of detection in the RASC-2 platform to 0.9 Mtb bacilli per 100L of exhaled air from 3.3 Mtb bacilli per 100L (RASC-1). This study demonstrates that technical improvements in particle collection together with sensitive detection enable rapid quantitation of viable Mtb in bioaerosols of sputum positive TB cases. Increased sampling sensitivity may allow future TB transmission studies to be extended to sputum-negative and subclinical individuals, and suggests the potential utility of bioaerosol measurement for rapid intervention in other airborne infectious diseases.

Prevalence of some food poisoning bacteria in semi cooked chicken meat products at Kaliobyia governorate with using of recent Vitek 2 compact and PCR techniques

Bacterial food borne pathogens are important food safety issue worldwide .Rapid and accurate identification of bacteriological pathogen isolated from food staff is important both for food quality assurance and for the tracing of outbreaks of bacterial pathogen.A grand total of ninety random samples of semi cooked chicken meat products represented by strips, pane and nuggets (30 of each)were collected from different supermarkets at Kaliobyia governorate for bacteriological examination using conventional culture method and rapid modern techniques as Vitek 2 compact system and molecular identification by PCR technique. The obtained results revealed that Staph aureus and E.coli incidence were 20% and 10% in strips, 26.6%and 13.3% in chicken pane and26.6% and 23.3%in nuggets for total examined samples.Also,the serologically identified E.coli were O127, O128, O153, O157 and O91 from examined samples. . Staphylococcus aureus and E. coli were identified in all examined samples by confirmatory identification using Vitek 2 compact system in examined 10 random samples of the chicken products. Result recorded accuracy 100% for examined samples and showed that the Vitek 2 system is a suitable tool for rapid and direct identification of gram positive cocci and gram negative bacilli from chicken products. Using of PCR technique revealed that there were one or more virulence genes in E.coli (stx1&stx2) strains isolated from the examined samples of chicken products.

Prediction of treatment failure and compliance in patients with tuberculosis

BackgroundTo improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data.MethodsA multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea.ResultsA total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76).ConclusionTo reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

Predictors of radiological aggravations of pulmonary MAC disease.

The number of patients with pulmonary Mycobacterium avium complex (MAC) disease is increasing worldwide, especially among middle-aged women and never-smokers. However, little is known about the factors causing exacerbations of pulmonary MAC disease in untreated patients. The aim of the present study was to identify the predictors of radiological aggravations of pulmonary MAC disease. From April 2011 to December 2018, 238 MAC patients at our institute were newly diagnosed with pulmonary MAC disease according to the 2007 American Thoracic Society/Infectious Disease Society guideline. Their medical records were examined retrospectively for their clinical findings. The radiological findings at the time of the diagnosis and 1 year later were evaluated. To identify the predictors of radiological aggravation, multivariable analysis was performed with the data of 167 treatment-naïve patients. Female, never-smoker, and nodular/bronchiectatic (NB) type were predominant in patients with pulmonary MAC disease. Univariate analysis of data from treatment-naïve subjects showed that no lung diseases other than MAC, extensive radiological findings, and a positive acid-fast bacilli (AFB) smear were significantly associated with radiological aggravations. On multivariate analysis, the radiological factor (larger affected area) and absence of other lung disease were significantly associated with radiological aggravations. In particular, the presence of abnormal shadows in more than 3 lobes was significantly associated with radiological aggravations. In this study, the presence of extensive radiological findings and the absence of lung diseases other than MAC were predictors of radiological aggravations of treatment-naïve pulmonary MAC disease. In particular, the presence of abnormal shadows in more than 3 lobes was significantly associated with radiological aggravations.

Distribution of RNA M. Leprae Household Contact in Endemic Area Indonesia

Background and Objective: Chronic leprosy disease is caused by the transmission of Mycobacterium &#x0D; leprae bacilli, and leprosy is still as an enigmatic disease which is not fully understood. In terms of the&#x0D; national level, leprosy disease in Indonesia remains a public health problem. 16S rRNA gene is a gene that&#x0D; encodes which codes the 16S part of the ribosome and it has specific nucleotides and can specifically be used&#x0D; to detect the cases of leprosy.&#x0D; Materials and Method: This study was classified as the observational study using a case-control research&#x0D; design. The total samples were 81 individuals that consisted of 27 leprosy patients (the case group) and 54&#x0D; non-leprosy patients (the control group). Analysis of 16S rRNA gene expression was conducted using the&#x0D; RFLP-PCR method to detect the risk of leprosy.&#x0D; Results: All samples of swabs of ear lobes for the case group (27 samples) were definitely positive infected&#x0D; by M. leprae and 2 dust samples (7%) collected from houses of the case group showed positive infected by&#x0D; &#x0D; leprae bacilli, i.e. S05 and S09 respectively. Of all samples of dust collected from houses of non-leprosy&#x0D; &#x0D; patients (the control group), 4 dust samples (14%) was positive infected by Mycobacterium leprae, i.e.&#x0D; C03, C05, C09, C11 respectively, and 2 non-leprosy patients were infected by M. leprae due to close social&#x0D; interactions with leprosy patients.&#x0D; Conclusion: Dust medium and close social interactions were the causal factors for the transmission of&#x0D; leprosy disease. Therefore, it is suggested to conduct strict control to prevent the widespread of leprosy&#x0D; disease by keeping the cleanliness of houses at the local areas and the surrounding environment as well as&#x0D; the caution to do social interactions with leprosy individuals.

Cytomorphological pattern analysis of tubercular lymphandenopathies

BackgroundThe spectrum of morphological pattern in tubercular lymphandenopathies was observed to study the various cytomorphological patterns and their correlation with acid fast bacilli. MethodsFNAC smears of 210 cases of granulomatous lymphadenitis stained with Giemsa, Pap and haematoxylin and eosin were used to analyze cytomorphological pattern and Zeihl Neelsen stained smears for acid fast bacilli (AFB) detection. Results193 cases with necrotising granulomatous inflammation or positive acid fast bacilli were included. Age group 21–30 years was most common (38.3%) followed by age group 11–20 years (30.05%). Females constituted 66.3% of patients and 33.7% were male. Overall the most common pattern in present study was pattern A (Epitheloid granuloma with caseous necrosis 33.7% followed by pattern B (caseous necrosis with few scattered epitheloid histiocytes and lymphocytes) 31.1% and pattern C (caseous necrosis with suppurative inflammation) 30.6%, followed by pattern D (Caseous necrosis only) (3.6%) and pattern E (non necrotising epitheloid granuloma with positive acid fast bacilli) (1.03%). Acid fast bacilli were demonstrable in 175 cases (90.7%). Amongst the acid fast bacilli positive cases highest bacillary load 3+ grade was seen in pattern C in 6/59 (10.16%) cases. ConclusionFNAC is a simple useful tool and should be attempted in all cases of lymphandenopathies. It helps in establishing a diagnosis of tubercular etiology based on its morphological patterns however demonstration of acid fast bacilli on aspirated material confirms the diagnosis.

Serum Krebs von den Lungen-6 level in the disease progression and treatment of Mycobacterium avium complex lung disease.

The lack of useful biomarkers reflecting the disease state limits the management of Mycobacterium avium complex lung disease (MAC-LD). We clarified the associations between serum KL-6 level, disease progression and treatment response. Resected lung tissues from MAC-LD patients were immunostained for KL-6. We compared serum KL-6 levels between MAC-LD and healthy control or bronchiectasis patients without nontuberculous mycobacterial lung disease (NTM-LD). Serum KL-6 level was assessed in a prospective observational study at Keio University Hospital between May 2012 and May 2016. We investigated associations between serum KL-6 level and disease progression and treatment response in patients untreated for MAC-LD on registration (n = 187). The KL-6+ alveolar type 2 cell population in the lung and serum KL-6 level were significantly higher in MAC-LD patients than in controls. Serum KL-6 level in bronchiectasis patients without NTM-LD showed no significant increase. Of the 187 patients who did not receive treatment on registration, 53 experienced disease progression requiring treatment. Multivariable Cox analysis revealed that the serum KL-6 level (aHR: 1.18, P = 0.005), positive acid-fast bacilli smear (aHR: 2.64, P = 0.001) and cavitary lesions (aHR: 3.01, P < 0.001) were significantly associated with disease progression. The change in serum KL-6 (ΔKL-6) was significantly higher in the disease progression group; it decreased post-treatment, reflecting the negative sputum culture conversion. Serum KL-6 level is associated with disease progression and treatment response. Longitudinal assessment combined with AFB smear status and presence of cavitary lesions may aid MAC-LD management.

TB myositis in a patient with dermatomyositis post immunosuppression

55-year-old African female with a history of initially refractory TIF1-y antibody positive dermatomyositis, with progressive proximal muscle weakness with difficulty swallowing, requiring regular inpatient admissions with the administration of IV steroids and IVIG. The patient was started on immunosuppression with mycophenolate as a steroid sparing agent. The patient slowly improved after initiation of immunosuppression, with a significant reduction in her rash, weakness, and dysphagia. After a few months of therapy, the patient noted pain in the right axilla and proximal right lower extremity with swelling and pain limiting her mobility. There was a concern for underlying malignancy for which PET scan was done, which showed hypermetabolic edema and swelling of musculature involving right thigh, right pectoral minor and left scapularis consistent with infectious or inflammatory myositis. Concern for focal dermatomyositis was raised and the patient received pulse IV steroids over 5 days with initial improvement. The patient later developed fevers, night sweats and chills, for which the patient was seen in ED. Initial vitals were concerning for sepsis, due to which patient was started on broad-spectrum antibiotics. CT scan of the chest and right lower extremity were done which showed, no pulmonary infiltrates, 5 cm right pectoralis minor and 9.4 cm right gluteus minimus fluid collection consistent with abscess.Interventional radiology was consulted, and abscesses were aspirated, aspirate from chest wall was positive acid-fast bacilli, concerning for mycobacterium. Cultures were sent to the health department and were noted to be positive for TB. At this time, it was noted that the patient had a prior diagnosis of latent TB when she moved to the United States. The patient was started on Myambutol, Nydrazid, Levaquin, Rifampin, and Bactrim.Tuberculous infections continue to be one of the deadliest infections around the world, with a significantly low incidence rate (2.8/100000) as compared to developing countries. Even with a low incidence rate, there is always a concern for reactivation of latent TB with the initiation of immunosuppression. Tb myositis is one of rare presentation and that can be difficult with diagnosis, especially in a patient who has an underlying autoimmune condition that could have a similar presentation. We recommend getting prior workup to rule out tuberculosis prior to the initiation of immunosuppression.

Avaliação microbiológica realizada em equipamentos de aerossolterapia hospitalar

A investigação da contaminação microbiológica em equipamentos de uso hospitalar permite avaliar se os processos de descontaminação adotados pelo serviço de saúde são adequados e contribui para minimizar os riscos de infecções relacionadas à assistência à saúde. Com base nisso, este estudo teve como objetivo avaliar a contaminação microbiológica de nebulizadores em três serviços de saúde e fazer uma breve associação entre métodos de contaminação e reprocessamento. Dez amostras de nebulizadores (máscara e copo reservatório) foram coletadas, com swabs umedecidos em solução salina e semeado em meio de cultura seletivo para bactérias e fungos. Após 24-48 horas de incubação a 37 °C, foi realizada a identificação por testes bioquímicos de culturas positivas. Também foi realizada uma análise dos protocolos de reprocessamento das unidades de saúde. 40% das amostras analisadas apresentaram contaminação por algum tipo de microrganismo. Enterobacter sp., bacilos Gram-positivos e Staphylococcus coagulase-negativos foram as amostras encontradas neste estudo. Apenas um hospital, que seguiu o recomendado para o produto de pré-lavagem e desinfecção, apresentou todas as suas amostras sem contaminação microbiológica. Assim, pode-se concluir que há fragilidade no reprocessamento desses equipamentos contaminados, cujas falhas na desinfecção impõem riscos à saúde do usuário.