Identification of Cytokines in Whole Blood for the Differential Diagnosis of Tuberculosis vs Pneumonia.

Clin Vaccine Immunol. 2010 Mar 17;

Authors: Su WL, Perng WC, Huang CH, Yang CY, Wu CP, Chang FY, Chen JH

Differentiating tuberculosis (TB) from pneumonia remains a challenge. We evaluated the cytokine profiles of whole blood cells from patients with TB (n=38), pneumonia (n=30), and healthy individuals (n=30) before and after stimulating cells with ESAT-6 or LPS. When the percent change in the levels of interferon (IFN)-gamma after stimulation with ESAT-6 was used in receiver operating characteristics (ROC) analysis (a graphic method to determine the diagnostic accuracy of a test) to identify a patient with TB, the area under the curve (AUC) was 90.4%; and a cut-off point of 3.59% change produced a corresponding sensitivity, specificity, and accuracy of over 80%. When the change in IFN-gamma after stimulation of blood cells with LPS was used to identify a patient with pneumonia, the AUC reached 89.1; and a cut-off point of 3.59% produced a sensitivity, specificity, and accuracy of approximately 80% each. When the change in interleukin (IL)-12 after stimulation of blood cells with LPS was selected to define a patient with pneumonia, the AUC was 85.2%; and a cut-off point of 2.08% gave a sensitivity, specificity, and accuracy of 80.0%, 78.9%, and 79.4%, respectively. We conclude that the percent change in IFN-gamma after stimulation of whole blood cells with ESAT-6 may differentiate patients with TB from patients with pneumonia. The percent change in IFN-gamma and IL-12 after LPS-stimulation of whole blood cells could differentiate patients with pneumonia from patients with TB.

PMID: 20237198 [PubMed - as supplied by publisher]

Craniovertebral junction tuberculosis: a case report and review of the literature.

J Infect Chemother. 2010 Mar 16;

Authors: Hoshino C, Narita M

Craniovertebral junction tuberculosis (CVJ TB) is a rare disease, potentially causing significant neurological deficits and even death. We report on a 80-year-old woman presenting with CVJ TB without pulmonary involvement. The diagnosis was made by biopsy of the cervical lymph node showing granulomatous caseation necrosis. Despite extensive erosion of the clivus, C1, and C2, and spinal cord compression, the patient was effectively managed with antituberculous drug therapy and conservative neck stabilization. Neck pain resulting from cervical spondylosis is common in elderly people. However, even if there is no obvious pulmonary involvement, CVJ TB should be considered in the differential diagnosis, especially in patients with painful neck stiffness. The most useful method available for evaluating this region is a combination of CT scan and MRI study. CVJ TB can be managed conservatively, except for a selected few cases, regardless of the extent of bony destruction.

PMID: 20232104 [PubMed - as supplied by publisher]

Increasing pathomorphism of pulmonary tuberculosis: an observational study of slow clinical, microbiological and imaging response of lung tuberculosis to specific treatment. Which role for linezolid?

Braz J Infect Dis. 2009 Aug;13(4):297-303

Authors: Manfredi R, Nanetti A, Monte PD, Calza L

During recent years, a progressive emerging of tuberculosis occurred, related to the overall increased age of general population, primary and secondary (iatrogenic) immunodeficiencies, the availability of invasive procedures, surgical interventions and intensive care supports, bone marrow and solid organ transplantation, and especially the recent immigration flows of people often coming from areas endemic for tuberculosis, and living with evident social-economical disadvantages, and with a reduced access to health care facilities. Since January 2006, at our reference centre we followed 81 consecutive cases of pulmonary tuberculosis, with 65 of them which remained evaluable for the absence of extrapulmonary complications, and a continuative and effective clinical and therapeutic follow-up. The majority of episodes of evaluable pulmonary tuberculosis (49 cases out of 65: 75,4%) occurred in patients who immigrated from developing countries. In two patients multiresistant (MDR) Mycobacterium tuberculosis strains were found, while two more subjects (both immigrated from Eastern Europe) suffered from a disease due to extremely resistant (XDR) M. tuberculosis strains. Although enforcing all possible measures to increase patients' adherence to treatment (empowerment, delivery of oral drugs under direct control, use of i.v. formulation whenever possible), over 72% of evaluable patients had a very slow clinical, microbiological, and imaging ameliorement (1-6 months), with persistance of sputum and/or bronchoalveolar lavage (BAL) fluid positive for M.tuberculosis microscopy and/or culture for over 1-4 months (mean 9.2+/-3.2 weeks), during an apparently adequate treatment. When excluding patients suffering from XDR and MDR tuberculosis, in four subjects we observed that off-label linezolid adjunct together with at least three drugs with residual activity against tuberculosis, led to a significantly more rapid clinical-radiological improvement and negative microbiological search, with consequent possibility to led to a protected discharge, supported by a sequential, oral therapy. Linezolid was also successfully employed in all the four patients with XDR or MDR pulmonary tuberculosis: among these patients, a definitive or temporarily negativization of respiratory secretions, and consequent discharge, was achieved only after linezolid adjunct. Notwithstanding the maintained microbiological susceptibility of M. tuberculosis strains responsible of the great majority of cases of pulmonary tuberculosis to first-line drugs, an unexpected tendency of patients to have a persistingly positive sputum and/or BAL, and to experience prolonged hospitalization for cure and isolation, has been recognized in the last years. No particularly suggestive radiological imaging seems predictive of a so prolonged course, so that we presently lack of clinical and imaging elements which may be predictive of this slow treatment response. The same is for demographic and epidemiological issues, eventual underlying diseases, and clinical presentation, so that a major problem for health care providers is to distinguish upon admission patients who will be prone to have slow therapeutic response and a related prolonged hospitalization. The novel oxazolidinone linezolid is characterized by an affordable in vitro activity against M. tuberculosis, and an extremely elevated intracellular concentration in respiratory tissues. Worldwide, increasing microbiological, pharmacological, and clinical evidences may recommend the use as linezolid adjunct as an off-label salvage treatment of pulmonary tuberculosis refractory to treatment, although not necessarily determined by resistant (MDR-XDR) M. tuberculosis strains. Randomized clinical trials including initially patients with ascertained chemioresistant tuberculosis, are strongly warranted.

PMID: 20231995 [PubMed - in process]

The NRAMPI, VDR and TNF-alpha gene polymorphisms in Iranian tuberculosis patients: the study on host susceptibility.

Braz J Infect Dis. 2009 Aug;13(4):252-6

Authors: Merza M, Farnia P, Anoosheh S, Varahram M, Kazampour M, Pajand O, Saeif S, Mirsaeidi M, Masjedi MR, Velayati AA, Hoffner S

The natural resistance-associated macrophage protein (NRAMP1), Vitamin-D receptor (VDR) and Tumor necrosis factor (TNF-alpha) have been associated in susceptibility to tuberculosis, but the results have been inconsistent. This study aimed to determine the association of NRAMP1, VDR, and TNF-á variant with development of pulmonary tuberculosis (PTB) among Iranian patients. The single nucleotide polymorphisms (SNPs) at INT4, D543, 3'UTR of NRAMP1 gene, SNPs in restriction sites of BsmI, and FokI of the VDR gene and SNPs of TNF-alpha at -238,-308, -244,857,-863 positions were analyzed by PCR-RFLP among two groups of individual; patients with PTB (n=117) and healthy controls (n=60). Thereafter, the frequencies of extended haplotypes and diplotypes were estimated. No statistically significant differences were observed in allele frequencies of INT4, D543, 3'UTR of NRAMPI, FokI of VDR and TNF-alpha at -238, -244,-863 and -857 position. Although, the frequency of b allele of BsmI [ORs: 0.24 CI95% (0.07-0.67 (p=0.001)] and -308 A variant in TNF-alpha promoter region [ORs:0.26 CI95%( 0.07-0.77) (p=0.006)] were significantly more in PTB patients than healthy controls. The frequency of extended diplotypes of NRAMP [GG TGTG++GA; 0.02(0.001-0.0035)], VDR [FFBB; 0.2(0.6-0.6] and TNF-alpha [CCCCGGGGGG; 0.49(0.25-0.97)] were statistically different in patients and control subjects (p<0.05). This study confirmed the association of SNPs in BsmI (B/b + b/b) of VDR and SNPs in -308A (G/A +G/G) of TNF-alpha genes with susceptibility to tuberculosis in Iranian PTB patients. Furthermore, the extended haplotypes and diplotypes analysis can be considered as an alternative way to determine the host susceptibility to TB.

PMID: 20231985 [PubMed - in process]

Tuberculosis in UK prisoners: a challenge for control.

J Epidemiol Community Health. 2010 Mar 15;

Authors: Anderson C, Story A, Brown T, Drobniewski F, Abubakar I

Aims Prisoners include a disproportionate number of those with social and clinical risk factors for tuberculosis and pose a challenge for control. The aim of this study was to investigate the characteristics of prisoners with tuberculosis in order to inform clinical management and control policy. Methods Between 2004 and 2007, 205 patients newly diagnosed as having tuberculosis in prison in the UK identified in national surveillance reports were studied. Isolates from prisoners were tested for susceptibility to first-line antituberculosis drugs and strain typed where possible. Results Prisoners were significantly more likely to be UK-born (47 vs 25%), to be white (33 vs 22%) and to have pulmonary disease (75 vs 56%) than other tuberculosis patients. Pulmonary cases were also more likely to be sputum-smear-positive (69 vs 57%). Over one-third of culture confirmed cases among prisoners were resistant to isoniazid. Less than half (48%) of patients diagnosed as having tuberculosis in prison completed treatment, with a fifth lost to follow-up. Discussion In the UK, imprisonment is an important risk factor for tuberculosis, especially drug-resistant and infectious forms of the disease. The management of tuberculosis among UK prisoners is further complicated by high rates of loss to follow-up care and poor treatment outcomes.

PMID: 20231737 [PubMed - as supplied by publisher]

Childhood Tuberculosis in the Kilimanjaro region: lessons from and for the TB Programme.

Trop Med Int Health. 2010 Mar 8;

Authors: Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS

Summary Objective To determine the magnitude of childhood TB and treatment outcome in Kilimanjaro region. Methods Retrospective review of registration-based data on TB notifications in Kilimanjaro region for the period 2002-2006. Results Between 2002 and 2006, there were 1615 patients of childhood TB in Kilimanjaro region constituting 13% of total TB burden and the average case detection rate was 147/100 000 for urban and 41.8/100 000 for rural populations. Of them, 54.2% were men and 75.2% had pulmonary TB (PTB); 24.9% were tested for acid-fast bacilli (AFB) by Ziehl-Neelsen staining showing that 5.8% of all patients with TB were AFB smear positive. The remaining 94.2% were presumptively treated for TB. Treatment success rate was 79.9%, mortality 10.9% and default rate was 7%. Unfavourable outcome was more common among unconfirmed TB patients. HIV testing was very rare but increased after 2004 (<2% before 2005, 11-16% afterwards.) Conclusion The rate of childhood TB in Kilimanjaro region is among the highest in the world. Microbiological diagnosis for TB and AFB smear positivity is very low. Treatment outcome in this region is poor. These findings argue for specific TB control strategies to be designed for children such as more AFB testing using new tools such as induced sputum and laryngeal swabs, active case finding, HIV testing of all suspected TB children, promoting and monitoring adherence. Regular epidemiological studies are also needed.

PMID: 20230572 [PubMed - as supplied by publisher]

[Tuberculosis annual report 2008--Series 5. Case finding]

Kekkaku. 2010 Feb;85(2):139-42

Authors:

Regarding current case findings, the mode of detection, delays in detection, the patient's occupation and so on were observed using the tuberculosis (TB) surveillance database. 81.3% of 24,760 TB patients newly notified in 2008 were detected at medical institutions. However, 10.8% of TB patients were detected during hospitalization with a disease other than TB and 8.5% of TB patients were detected under outpatients with a disease other than TB. The proportion of TB patients detected during inpatient or outpatient increased with age. On the other hand, significant proportion of adolescents and young adults were also detected by active case finding such as periodic school mass-screening and periodic health examination for employees. 22.5% of TB patients aged 15-19 years were detected by periodic school mass-screening, and 24.9% of TB patients aged 25-34 years were detected by periodic health examination for employees. Although active case finding generally detects bacillary negative cases, 14.1% of sputum smear positive pulmonary TB patients aged 20-49 years were detected by periodic health examination for employees. Although the proportion of TB patients detected by contact examination was only 3.0%, they were large among younger TB patients, e.g. 53.7% of those aged 0-14 years, 19.4% of those aged 15-19 years, 9.2% of those aged 20-24 years and 6.7% of those aged 25-29 years. According to the symptoms of 19,393 pulmonary TB patients, 28.7% had respiratory symptoms, 30.4% had both respiratory and other symptoms, and 15.1% had symptoms other than respiratory symptom. 24.8% of pulmonary TB patients had no symptoms and 0.9% had no data about symptoms. The proportion of TB patients only having other symptoms without respiratory symptoms increased among the elderly TB patients, e.g. 13.7% of those aged 65-69 years, 16.2% of those aged 70-74 years, 18.0% of those aged 75-79 years, 19.7% of those aged 80-84 years, 22.1% of those aged 85-89 years and 26.5% of those aged 90 years and over. Regarding the delay of case detection among 14,400 symptomatic pulmonary TB patients, patient's delay was longer in those aged 20-64 years and shorter in those aged 65 years and over. While, doctor's delay showed an inverse relationship with patient's delay. Total delay combining patient's delay and doctor's delay was strongly influenced by patient's delay. The sputum smear positive symptomatic pulmonary TB patients showed much longer total delay, and the proportion of total delay exceeding 3 months was 27.5% in those aged 20-64 years. Regarding occupation, the proportion of service workers and nurses/public health nurses were large among young TB patients. 8.4% of male TB patients aged 20-24 years and 10.8% of female TB patients aged 20-24 years were service workers. 10.7% of female TB patients aged 25-49 years were nurses/public health nurses. TB control for nosocomial infection is still important in Japan.

PMID: 20229822 [PubMed - in process]

[Japanese new guidelines for nontuberculous mycobacterial pulmonary disease]

Kekkaku. 2010 Feb;85(2):87-93

Authors: Kurashima A

Three important statements for Japanese pulmonary nontuberculous mycobacteriosis (NTM) were published in 2008. The first one is a new diagnostic criteria for pulmonary NTM, which was organized in association with the task force for nontuberculous mycobacteriois of the Japanese Society for Tuberculosis and the section for infectious disease and tuberculosis of the Japanese Respiratory Society. The second is a treatment guideline for pulmonary nontuberculous mycobacteriosis also which was made by the same joint working. The third is a sugical treatment guideline for pulmonary nontuberculous mycobacteriosis. The reason for the task of immediate importance is the number of pulmonary Mycobacterium avium complex (MAC) disease keeps increasing in our country and the disease cannot be disregarded widely in municipal hospitals or clinics. The morbidity rate of pulmonary MAC disease is assumed to be about 3.5 in the north American area. A lot of European nations are presumed that do not reach 1.0. Most of Asian researchers reply to our E-mail questions with the recent increasing of pulmonary MAC disease. Japanese estimated morbidity rate of this disease seems to be over 6.0 in 2007. It has been not clarified why a lot of this disease cases are in particular in Japan. In this situation, a concise diagnostic criteria is required from even a doctor who is not respiratory medicine specialists. The diagnosis can be confirmed by twice culture from sputa or one culture in case of bronchoscopic examination regardless of the bacterial strain. Moreover, it is possible to correspond to wider varieties of radiographic findings than 2007 diagnostic criteria of the United States. This disease became possible to diagnose before the consciousness syndrome appeared by the advancement of today's excellent imaging technology and nuclear acid amplification method. Therefore, the diagnosis confirmation and the beginning of chemotherapy time has become separated. In 2008, on Japanese medical insurance, the prescription of two drugs has become possible officially for pulmonary NTM due to the efforts of many stakeholders. However, pulmonary NTM is a disease to obtain a constant improvement at last continuing combination chemotherapy for a long term. Three drugs regiment of CAM as a main axis, adding EB, RFP or RBT is now a de facto international standard. New Japanese guideline for treatment describes the adverse events by a long-term administering more in detail than the previous one. However, it is difficult to control only by an internal therapy. In case of a localized lesion, we have recommended an appropriate surgical treatment. But a surgery treatment without combination of chemotherapy could not achieve an enough result. A multidisciplinary approach is important. The guideline of surgical treatment that reflected these content was also published in 2008.

PMID: 20229821 [PubMed - in process]

Natural-Killer Cell-Derived Cytolytic Molecules in HIV-Associated Pulmonary Tuberculosis-Role of Exogenous Interleukins.

J Clin Immunol. 2010 Mar 13;

Authors: Rao PV, Ramanavelan S, Rajasekaran S, Raja A

OBJECTIVE: The ability of NK cells to produce cytolytic molecules is impaired during HIV infection. The objective of the present study is to investigate whether impairment in production of innate cytokines in HIV-infected individuals is responsible for the defective NK cytolytic response. MATERIALS AND METHODS: The study included 30 subjects each of normal healthy subjects, pulmonary tuberculosis patients, HIV-infected individuals, and patients with HIV and TB co-infection. Intracellular staining method was adopted to enumerate the NK cells positive for cytolytic molecules. Highest stimulation of cytolytic molecules was seen with IL-15 + IL-12 combination. RESULTS: Stimulation with IL-15 + IL-12 showed an increased expression of perforin in NHS and HIV groups. Granzyme A was stimulated only in HIV, even with IL-15 + IL-12. Among the cytolytic molecules, maximal stimulation with IL-15 + IL-12 was seen for Granyme A and Granzyme B. Both the HIV and HIV-TB groups showed an increased response with IL-15 + IL-12 for granulysin. CONCLUSION: Supplementing IL-15 + IL-12 in vitro increased the number of NK cells that are expressing cytolytic molecules in HIV-infected individuals but in HIV-TB, the critical cytolytic molecule, perforin is not apparent perhaps due to the influence of TB on HIV.

PMID: 20229057 [PubMed - as supplied by publisher]

Ag85B-ESAT-6 adjuvanted with IC31((R)) promotes strong and long-lived Mycobacterium tuberculosis specific T cell responses in naïve human volunteers.

Vaccine. 2010 Mar 10;

Authors: van Dissel JT, Arend SM, Prins C, Bang P, Tingskov PN, Lingnau K, Nouta J, Klein MR, Rosenkrands I, Ottenhoff TH, Kromann I, Doherty TM, Andersen P

Though widely used, the BCG vaccine has had little apparent effect on rates of adult pulmonary tuberculosis. Moreover, the risk of disseminated BCG disease in immunocompromised individuals means that improved TB vaccines ideally need to be able to efficiently prime mycobacterially-naïve individuals as well as boost individuals previously vaccinated with BCG. Protective immunity against Mycobacterium tuberculosis is thought to depend on the generation of a Th1-type cellular immune response characterized by interferon-gamma (IFN-gamma) production. In the present study, we monitored safety and IFN-gamma responses in healthy TB-naïve humans receiving an entirely novel vaccine, composed of the fusion protein Ag85B-ESAT-6, administered at 0 and 2 months either as recombinant protein alone or combined with two concentrations of the novel adjuvant IC31((R)). Vaccination did not cause local or systemic adverse effects besides transient soreness at the injection site, but it elicited strong antigen-specific T cell responses against H1 and both the Ag85B and the ESAT-6 components. These strong responses persisted through 2.5 years of follow-up, indicating the induction of a substantial memory response in the vaccine recipients.

PMID: 20226890 [PubMed - as supplied by publisher]

Assessing the accessibility of HIV care packages among tuberculosis patients in the Northwest Region, Cameroon.

BMC Public Health. 2010 Mar 12;10(1):129

Authors: Njozing NB, Sebastian MS, Tih PM, Hurtig AK

ABSTRACT: BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a major source of morbidity and mortality globally. The World Health Organization (WHO) has recommended that HIV counselling and testing be offered routinely to TB patients in order to increase access to HIV care packages. We assessed the uptake of provider-initiated testing and counselling (PITC), antiretroviral (ART) and co-trimoxazole preventive therapies (CPT) among TB patients in the Northwest Region, Cameroon. METHODS: A retrospective cohort study using TB registers in 4 TB/HIV treatment centres (1 public and 3 faith-based) for patients diagnosed with TB between January 2006 and December 2007 to identify predictors of the outcomes; HIV testing/serostatus, ART and CPT enrolment and factors that influenced their enrolment between public and faith-based hospitals. RESULTS: A total of 2270 TB patients were registered and offered pre-HIV test counselling; 2150 (94.7%) accepted the offer of a test. The rate of acceptance was significantly higher among patients in the public hospital compared to those in the faith-based hospitals (crude OR 1.97; 95% CI 1.33 - 2.92) and (adjusted OR 1.92; 95% CI 1.24 - 2.97). HIV prevalence was 68.5% (1473/2150). Independent predictors of HIV-seropositivity emerged as: females, age groups 15-29, 30-44 and 45-59 years, rural residence, previously treated TB and smear-negative pulmonary TB. ART uptake was 50.3% (614/1220) with 17.2% (253/1473) of missing records. Independent predictors of ART uptake were: previously treated TB and extra pulmonary TB. Finally, CPT uptake was 47.0% (524/1114) with 24% (590/1114) of missing records. Independent predictors of CPT uptake were: faith-based hospitals and female sex. CONCLUSION: PITC services are apparently well integrated into the TB programme as demonstrated by the high testing rate. The main challenges include improving access to ART and CPT among TB patients and proper reporting and monitoring of programme activities.

PMID: 20226022 [PubMed - as supplied by publisher]

A modest proposal in response to Rhodes and Schiano.

Am J Bioeth. 2010 Feb;10(2):20-2

Authors: Devereaux M, Loring JF

PMID: 20131166 [PubMed - indexed for MEDLINE]

[Tuberculosis doesn't leave us]

Presse Med. 2010 Feb;39(2):159-60

Authors: Fichet D

PMID: 20080381 [PubMed - indexed for MEDLINE]

Tuberculosis vaccine.

Saudi Med J. 2010 Jan;31(1):9-13

Authors: Sarhan MA

Tuberculosis (TB) is still one of the leading causes of death from a single infectious agent, killing 1.6 million people each year, mostly in developing countries. The existing vaccines, Bacille Calmette and Guerin (BCG), are efficient in preventing the most severe disseminated forms of disease in children and newborns, but its efficacy against active TB in adults has been challenged by several clinical studies. It is a common opinion that only the development of a new and more effective vaccine against TB would significantly ease the deadly disease. In recent years, looking for a new vaccine or an improved TB vaccine is urgently needed. Such vaccines include new live and attenuated strains of Mycobacterium tuberculosis, improved recombinant BCG strains, subunit and DNA vaccines.

PMID: 20062891 [PubMed - indexed for MEDLINE]

The Circumpolar Inuit Health Summit: a summary.

Int J Circumpolar Health. 2009 Dec;68(5):509-18

Authors: Krümmel EM

PMID: 20044968 [PubMed - indexed for MEDLINE]

The treatment results of patients with multidrug resistant tuberculosis and factors affecting treatment outcome.

Tuberk Toraks. 2009;57(4):383-92

Authors: Karagöz T, Yazicio&#x11F;lu Moçin O, Pazarli P, Senol T, Yeti&#x15F; Duman D, Duman G, Saltürk C, Unal O, Halezero&#x11F;lu S

The treatment of multi-drug resistant tuberculosis (MDR-TB) is complicated and results are not always satisfactory. We aimed to investigate treatment results of our patients, relapse rates, factors affecting treatment outcome. We evaluated prospectively, 142 patients, who had been hospitalised with diagnosis of MDR-TB in our clinic between January 1995-December 2000 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital in Istanbul, Turkey. All patients were male and human immunodeficiency virus negative. The mean age was 39 + or - 11 (16-65) years. A mean number of 5.5 + or - 0.8 (4-8) second line drugs, including one parenteral drug, were administered. Of 142 patients, 102 (71.8%) were classified as cured, 16 (11.3%) patients were defaulters, failure was seen in 10 (7.0%) patients and 14 (9.9%) patients died during treatment. Surgical resection was applied in 35 patients and cure was achieved in 88.5% of them. Of 102 patients who were cured, 89 (87.2%) were available for follow up and mean duration of follow up was 19.2 + or - 10.3 (12-72) months. Relapse was not detected in any of them. Patients with unsuccessful outcomes had a higher incidence and higher mean number of second-line drugs usage in previous regimens, higher incidence of antecedent prothionamide and ofloxacin usage, higher incidence of extensive radiologic involvement and withdrawal of responsible drugs due to adverse effects. Limited radiologic involvement, non-usage of antecedent prothionamide and adjuvant surgery were found as significant independent factors effecting successful treatment outcome. MDR-TB is a complex but a treatable disease. To know much more about the factors effecting treatment results and to arrange the proper conditions, are expected to make increases in the success rates of MDR-TB treatment.

PMID: 20037853 [PubMed - indexed for MEDLINE]

Autofluorescence imaging is still valuable even in the presence of a peripheral lung lesion.

J Thorac Oncol. 2010 Jan;5(1):146

Authors: Han DH

PMID: 20035191 [PubMed - indexed for MEDLINE]

Initiation of acquired immunity in the lungs of mice lacking lymph nodes after infection with aerosolized Mycobacterium tuberculosis.

Am J Pathol. 2010 Jan;176(1):198-204

Authors: Kashino SS, Vallerskog T, Martens G, Troudt J, Keyser A, Taylor J, Izzo A, Kornfeld H, Campos-Neto A

Recent evidence points to lung draining lymph nodes as the site that initiates the immune response in mice infected with aerosolized Mycobacterium tuberculosis. Here we expanded these studies and showed that infection of mice that lack lymph nodes with aerosolized M. tuberculosis results in a massive mononuclear cell infiltrate in the lungs within 14 days postinfection. This infiltration clearly resembles an expansion of the bronchus-associated lymphoid tissue. As expected, no bronchus-associated lymphoid tissue was observed in M. tuberculosis-infected wild-type control mice. Importantly, acquired specific immune response to M. tuberculosis antigens could be detected in lung lymphocytes harvested from mice lacking lymph nodes as early as 14 days postinfection. In addition, the bacterial burden in these mice was indistinguishable from that observed in wild-type C57BL/6 control mice. These results indicate that in the absence of lymph nodes, priming of the immune response occurs in the lung tissues after infection of mice with aerosolized M. tuberculosis and clearly illustrate the enormous plasticity of the immune system to develop resistance to foreign pathogens.

PMID: 20008132 [PubMed - indexed for MEDLINE]

Acute pancreatitis: rare complication of retrograde single-balloon enteroscopy.

Endoscopy. 2009;41 Suppl 2:E324

Authors: Yip WM, Lok KH, Lai L, Li KF, Li KK, Szeto ML

PMID: 19921613 [PubMed - indexed for MEDLINE]

Utility of quantitative T-cell responses versus unstimulated interferon-{gamma} for the diagnosis of pleural tuberculosis.

Eur Respir J. 2009 Nov;34(5):1118-26

Authors: Dheda K, van Zyl-Smit RN, Sechi LA, Badri M, Meldau R, Meldau S, Symons G, Semple PL, Maredza A, Dawson R, Wainwright H, Whitelaw A, Vallie Y, Raubenheimer P, Bateman ED, Zumla A

The clinical utility of antigen-specific interferon (IFN)-gamma release assays (IGRAs) using pleural mononuclear cells, for the diagnosis of tuberculosis (TB), requires clarification. We compared the diagnostic utility of unstimulated pleural IFN-gamma levels with several pleural antigen-specific T-cell IGRAs (early secretory antigenic target-6 and culture filtrate protein-10 (T-SPOT.(R)TB, QuantiFERON(R)-TB Gold In-tube), purified protein derivative (PPD) and heparin-binding haemagglutinin (HBHA)) in 78 South African TB suspects. Test results were compared against a clinical score and a reference standard. Out of 74 evaluable subjects 48, seven and 19 had definite, probable and no TB, respectively. 11 (15%) out of 74 pleural samples (nine (19%) out of 48 of the definite TB cases) had total cell counts that were inadequate for T-cell processing. In the remaining 63 samples, the sensitivity, specificity, positive predictive value and negative predictive value of different diagnostic methods were as follows. Maximal bioclinical score: 54, 89, 92 and 43%, respectively; T-SPOT.(R)TB: 86, 60, 84 and 64%, respectively; QuantiFERON(R)-TB Gold In-tube: 57, 80, 87 and 44%, respectively; HBHA-specific IGRA: 59, 31, 64 and 27%, respectively; PPD-specific IGRA: 81, 40, 76 and 46%, respectively; and pleural fluid unstimulated IFN-gamma: 97, 100, 100 and 94%, respectively. Unstimulated IFN-gamma was the most accurate test for distinguishing TB from non-TB effusions in a high-burden setting. The antigen-specific T-cell IGRAs were limited by suboptimal accuracy and the inability to isolate sufficient mononuclear cells to perform the assay.

PMID: 19386693 [PubMed - indexed for MEDLINE]