Tuberculosis News and Journal Items - Week of May 22, 2000

>The CDC Center for HIV, STD, and TB Prevention provides the following
>information as a public service only. Providing synopses of key scientific
>articles and lay media reports on HIV/AIDS, other sexually transmitted
>diseases and tuberculosis does not constitute CDC endorsement. This update
>also includes information from CDC and other government agencies, such as
>background on Morbidity and Mortality Weekly Report (MMWR) articles, fact
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>Prevention News Update should be cited as the source of the information.
>**********************************************
>Cincinnati:"Three TB Cases Confirmed in Grant"; Cincinnati Enquirer Online
>(05/24/00).
>
> There have been three confirmed cases of active tuberculosis (TB)
>diagnosed in Grant County, Kentucky. The cases are not part of an outbreak,
>according to health officials, but physicians in four counties in the region
>have been alerted. Nine TB cases were diagnosed in the four counties last
>year, and already this year a total of four TB cases have been confirmed.
>One official noted that in the three Grant cases, the patients are not
>relatives, although two have come into contact with each other socially.
>********************************
>"What $8 a Year Could Do for Africa"; Washington Post (05/23/00) P. A29;
>Sachs, Jeffrey D.
>
> In a commentary, Jeffrey D. Sachs, the director of the Center for
>International Development at Harvard University, notes that spending $8 a
>year from every American could help fight HIV/AIDS, tuberculosis, and
>malaria in Africa. These diseases take the lives of millions of Africans
>every year, and a global effort led by America could stop the death toll.
>The United Nations recently estimated that $4 billion is needed each year to
>fight AIDS worldwide, and with several countries donating, the cost would be
>easily affordable. The creation of better vaccines could reduce these costs
>even further and prevent pain for both the people and the economy. Sachs
>also discusses the issue of debt cancellation, calling it a critical issue
>for Africa. In response to his question of whether Americans would be
>willing to provide $8 a year to help control and prevent several deadly
>diseases, Sachs writes, "In the America I know, the answer is surely
>yes--whether you are a liberal Democrat or a conservative Republican, a
>well--paid professional or a working-class family."
>**************************
>"World Bank Aims Funds at Russian TB Epidemic"; Reuters; (05/22/00);
>Henderson, Peter
>
> The number of tuberculosis (TB) cases in Russia is soaring, with
>experts estimating there were up to 200,000 TB cases in the country in 1998.
>A senior World Bank official said Monday that $2.5 million of an existing
>bank loan will be used as a stop-gap measure to help Russia fight the
>disease over the next six months. The World Bank board is expected to
>discuss in October a $170 million loan for Russia, including up to $120
>million for TB with the remainder going for AIDS care. According to the
>World Bank's Dr. Jean-Jacques de St. Antoine, many of the TB patients are
>prisoners or live in poverty; however, HIV-infected individuals are also at
>high risk of contracting the disease, and the number of HIV infections in
>Russia has increased significantly over the past three years.
>**********************************
>"USDA Donates 35,078 Tonnes of Food Aid for Russia"; Reuters (05/25/00).p
>
>The U.S. Agriculture Department will donate over 35,000 tonnes of vegetable
>oil and other products for sale in Russia. A single donation of 13,500
>tonnes will be given to the Vishnevskaya-Rostropovich Foundation, which will
>sell the oil to raise money for tuberculosis and hepatitis vaccines.
>*********************************************
>OTHER NEWS ITEMS:
>***********************************
>CANADA: Health unit issues tuberculosis alert for passengers on bus; May
>22 05:44 PM EDT
>
> NELSON, B.C. (CP) - The local health unit has issued a tuberculosis alert.
>The Kootenay-Boundary Community Health Services Society is asking people who
>were on one of two Greyhound bus trips in March to contact them for
>tuberculosis testing because a passenger had tuberculosis. "Often with TB
>there are no symptoms for a long time," said Marcella Mugford of the health
>services society. "They can be passing it on to other people and not even
>know it." The first bus trip was the March 6 eastbound bus, which left
>Vancouver at 6 p.m. It stopped in New Westminster, Abbotsford, Chilliwack,
>Hope, Westbank, Kelowna, Beaverdell, Rock Creek, Midway, Greenwood, Grand
>Forks, Christina Lake, Castlegar and the Playmor Junction before arriving
>in Nelson at 6:10 a.m. March 7. The bus continued on to Calgary, where it
>arrived at 8:05 p.m. The second was a westbound bus that left Calgary at
>6:30 a.m. March 15. The bus left Nelson at 5:20 p.m., making the same stops
>on the trip back to Vancouver, where it arrived at 5:15 a.m. the following
>day. Passengers who were only on the bus between Nelson and Calgary are not
>at risk, nor are those who traveled with the infectious person for only a
>short time. People who believe they were exposed to the tuberculosis on one
>of those bus trips should contact their local public health office to set up
>a test appointment. Doctors don't normally have the testing material for
>tuberculosis in their offices, Mugford said. Tuberculosis is spread when
>people cough bacteria into the air, infecting others. "Tuberculosis is not
>as contagious as measles or influenza, but it is contagious," Mugford said.
>About five to 10 per cent of people who are infected with the bacteria will
>eventually develop tuberculosis disease, which attacks the lungs and may
>involve other organs. "We want to identify people (who were exposed) early
>before there's any damage and when treatment is much simpler," Mugford said.
>"TB is a disease that, if it's caught early, can be treated very
>successfully."
>*****************************
>(African National Congress Daily News Briefing); NEW MEDICAL RESEARCH UNIT
>OPENED; JOHANNESBURG May 23 2000 Sapa.
>
>A new medical unit will research ways to curb the potentially-explosive
>ability of dormant tuberculosis bacteria to create a future health
>catastrophe in South Africa - where a third of the population are already
>inflicted with TB. Professor Valerie Mizrahi, who will head a
>mycobacteriology unit, said on Tuesday in Johannesburg that investigating
>the molecular basis of dormancy in Mycobacterium tuberculosis (M.
>tuberculosis) was the hottest area in TB research. South Africa has one of
>the highest infection rates in the world with around 180,000 new cases
>reported annually. Mizrahi was speaking at the opening of the
>mycobacteriology and cancer epidemiology unit - established under the
>auspices of the Medical Research Council, in conjunction with SA Institute
>for Medical Research, the University of the Witwatersrand and the Cancer
>Association of SA. Mizrahi said one of the most perplexing features of M.
>Tuberculosis was its ability to enter a dormant state during which it could
>lie low in an infected host for up to 30 years without causing obvious signs
>of disease. In most people the bacteria remain dormant and die with the
>host, but in HIV positive individuals - of which there are eight million in
>South Africa - there is a 10 percent risk of the bacteria reactivating from
>the dormant state. The research Mizrahi has been involved in surrounds
>altering the genetic make-up of M. tuberculosis. This means it is possible
>to look at any of its 4000 genes, and knock specific ones out. Mizrahi is
>the recipient of the UNESCO Women in Science Award for her ground breaking
>work on TB and HIV. She was also recently appointed a researcher at the
>renowned US-based Howard Hughes Medical Institute, who have provided a grant
>for her work. Dr Freddy Sitas will head cancer research under the new MRC
>unit. He said that while there were positive developments in researching and
>treating the disease in South Africa, the fact that some 34 percent of the
>population smoked and 20 percent were HIV positive, meant that the
>statistics would continue to climb. Research had also indicated that those
>who were HIV positive were more susceptible to developing cancer. More than
>50,000 South Africans were diagnosed with cancer for the first time last
>year, he said. Sitas' research will center around why certain people are
>more vulnerable to the disease and his team will use data from two large
>studies to examine the question. The first is a case study examining the
>importance of known risk factors like tobacco and alcohol use, HIV and other
>viruses. The second research program is a tobacco mortality study measuring
>the tobacco-attributable deaths in South Africa.
>**********************************
>Cooperation Sought at EU Summit; Paul Ames; Associated Press; Thursday, May
>25, 2000.
>
> BRUSSELS, Belgium -- The European Union wants next week's summit with
>President Clinton to give new impetus to trans-Atlantic cooperation on
>several issues, from building peace in the Balkans to developing Internet
>technology and tackling AIDS in Africa........ Clinton is scheduled to
>meet Wednesday with Antonio Guterres, the Portuguese prime minister who
>holds the EU's 15-nation rotating presidency, and European Commission
>President Romano Prodi, head of the EU's executive body..... EU officials
>said one development will be a leaders' debate on how to further harness the
>potential of the Internet and other technological advances to promote
>"innovation, information and growth." In another new initiative, the two
>sides are expected to stress the need to cooperate in the fight against
>AIDS, malaria and tuberculosis - the three biggest killers in Africa.
>Discussion is expected to focus on distributing medicines and public
>awareness campaigns.
>***********************************************
>OTHER JOURNAL ITEMS:
>************************************************
>Tubercle & Lung Disease; p 61-67, Volume 80, Number 2, April 2000;
>Expression of transforming growth factor-[beta] but not tumor necrosis
>factor-[alpha], interferon-[gamma], and interleukin-4 in granulomatous lung
>lesions in tuberculosis; H. Aung, Z. Toossi, S. M. McKenna, P. Gogate, J.
>Sierra, E. Sada, E. A. Rich.
>
>Report states the expression of transforming growth factor (TGF-[beta]1),
>tumor necrosis factor-[alpha] (TNF-[alpha]), interferon-[gamma]
>(IFN-[gamma]) and interleukin-4 (IL-4) were assessed in lung tissues from
>patients with tuberculosis. Authors report Vimentin, a constitutively
>expressed cellular protein, was present in 12 of 19 tissue sections
>indicating adequate preservation of tissue proteins in these cases. They
>did iImmunohistochemical studies for cytokines in the vimentin positive
>sections only. They report TGF-[beta]1 was localized to mononuclear
>phagocytes of tuberculous lung lesions in 4 of 12 tuberculosis patients;
>TNF-[alpha], IFN-[gamma], and IL-4 were absent in sections from all
>tuberculosis patients. Authors believe the failure to detect the latter
>cytokines may indicate that these molecules may not be expressed at the site
>of disease, or are not a feature of the late stages of tuberculous
>granulomas. TGF[beta] -1, although not universally expressed, may be
>involved in the development and/or consequences of tuberculous granuloma
>formation. Authors say these data substantiate further the role of
>TGF-[beta]1 in the immunopathology of tuberculosis.
>**************************
>Tubercle & Lung Disease; p 69-74, Volume 80, Number 2, April 2000;
>Identification of possible loci of variable number of tandem repeats in
>Mycobacterium tuberculosis; N. Smittipat, P. Palittapongarnpim.
>
>Authors note that three VNTR loci were previously cloned from Mycobacterium
>tuberculosis in their laboratory and the VNTR sequences were used as queries
>to search for similar sequences in the GenBank database by the BLAST
>program; direct and tandem repeats were identified visually. Their search
>revealed 45 more loci of direct and tandem repeats. They report comparison
>of the sequences to the ones in the genome sequence database of the M.
>tuberculosis CDC1551 strain revealed 22 different loci, and combining these
>results with previously reported experimental work, at least 24 loci should
>be polymorphic enough to be detected by simple PCR. They report the repeats
>are present both inside coding sequences and in intergenic regions on the
>5\' or 3\' ends of genes and note that M. tuberculosis contains several
>VNTR. They believe studies of their functions may be useful for
>understanding the differences of phenotypes between strains.
>************************
>Tubercle & Lung Disease; p 75-83, Volume 80, Number 2, April 2000; Molecular
>fingerprinting of Mycobacterium tuberculosis strains isolated in Vietnam
>using IS 6110 as probe; L. T. K. Tuyen, B. K. Hoa, H. M. Ly, L. N. Van, N.T.
>N. Lan, D. Chevrier, J.-L. Guesdon .
>
>This is a report of a study in Northern and Southern areas of Vietnam where
>researchers sought to look at the correlation between DNA fingerprinting of
>168 Mycobacterium tuberculosis strains isolated from patients with a
>particular historical past (political separation of Vietnam for 20 years)
>and data about geographical origin, drug susceptibility, HIV infection and
>BCG vaccination status. They compared restriction fragment length
>polymorphism (RFLP) patterns produced by Southern hybridization of
>PvuII-digested chromosomal DNA. They report finding the number of IS 6110
>copies for the 168 strains ranges from 0 to 23, and strains originating from
>the North or the South differ strongly with respect to the number of copies
>of IS 6110. They note strains originating from the north have predominantly
>from 3 to 14 IS 6110 copies while the southern strains have predominantly
>from 15 to 23 IS 6110 copies. They also report that strains isolated in the
>North are dispersed into 6 groups whereas 80% of the strains isolated in the
>South form a single group. Moreover, they observed that the prevalence of
>drug resistance is higher in strains isolated in the South than in the
>North. They observed no noticeable correlation between RFLP patterns, drug
>susceptibility, or HIV infection. They sum up that IS 6110 fingerprints of
>168 M. tuberculosis strains isolated in Vietnam showed a high range of
>polymorphism and note only a few
>strains have been found with no IS 6110 (1.8%). They comment that
>differences between the strains from the North and South, having more than
>six IS 6110, suggests that they derived from ancestral strains that would be
>distinguishable by the number of IS 6110 and their transposition sites
>throughout the genome. They point out the genomic structure of the
>population of strains from South Vietnam resembles that of the Beijing
>strain population and say this could account for a similar evolution of M.
>tuberculosis due to a selection by BCG-induced immunity in the two
>populations.
>**************************
>Tubercle & Lung Disease; Volume 80, Issue 2 - April 2000; Controlling
>tuberculosis - is it really feasible? (p 57-59); D. A. Enarson: US-Japan
>Cooperative Medical Science Program-Tuberculosis-Leprosy Panel\'s 34th
>Annual Research Conference, San Francisco, California: 27-30 June 1999 (p
>85-108); USJCMSP TB and Leprosy Panel - ABSTRACT NOT AVAILABLE.
>***********************
>Tubercle & Lung Disease; Volume 80, Issue 2 - April 2000; Tuberculosis
>Research at the Millennium: A report from the Fourth International
>Conference on the Pathogenesis of Mycobacterial Infection, Stockholm, Sweden
>(p 109-116); R. S. Wallis, R. Fleischmann, C. E. Barry, G. Kaplan. ABSTRACT
>NOT AVAILABLE.
> **********************************
>Infections in Medicine:17(4):284-288, 2000; Tuberculosis and Pregnancy:
>Update on an Old Nemesis; Fidelma B. Rigby, MD.
>
>Report notes that Mycobacterium tuberculosis infection occurs most
>frequently during the childbearing years, that altered immune response
>during pregnancy causes unusual manifestations of tuberculosis (TB), and
>therefore heightened awareness of the risk of TB in pregnant patients is
>important. The author addresses: the interaction between TB and pregnancy;
>TB screening during pregnancy; chemoprophylaxis during pregnancy; diagnosis
>of active TB; TB treatment during pregnancy; issues of compliance; and TB in
>neonates. The author says skin testing on all pregnant women and strategic
>efforts to identify active disease are key steps to successful treatment and
>notes chemoprophylaxis during pregnancy should be considered in patients
>with recent PPD conversion or known TB exposure. Rigby cautions that, in
>patients older than 35 years, the risk of isoniazid hepatitis usually rules
>out chemoprophylaxis. The author also says since active TB during pregnancy
>often presents with minimal symptoms, careful monitoring of all PPD-positive
>patients is required.
>***********************
>Archives of Internal Medicine; 2000;160:1513-152; Benefits of Screening for
>Latent Mycobacterium tuberculosis Infection; David N. Rose, MD.
>
>Article notes that the benefits of screening for latent Mycobacterium
>tuberculosis infection are unknown for most people, because screening has
>not been studied in clinical trials and preventive therapy has not been
>tested in all risk groups for whom it is recommended. Author conducted a
>MEDLINE search to determine tuberculosis risk. He reports a Markov model was
>used to analyze tuberculin skin test screening and preventive therapy for
>3-year-old and 30-year-old persons with positive test results; outcome
>measures were lifetime and 10-year tuberculosis risk, including spread to
>others, life expectancy extension, and number needed to screen and number
>needed to treat to prevent 1 case and 1 death during 10 years. He reports
>the benefits of screening and preventive therapy outweigh the risks for all
>groups tested, although the benefits range from large to small. He notes the
>number needed to screen to prevent 1 case is 10 to 6888, and the number
>needed to treat is 2 to 179. He cautions that persons with human
>immunodeficiency virus infection, intravenous drug abuse, or end-stage renal
>disease treated with transplantation and children exposed to high-risk
>adults have the highest tuberculosis rates and the lowest number needed to
>screen and number needed to treat to prevent cases and deaths. he observes
>the range of risks found in the literature for some risk groups, such as
>persons with silicosis, leukemia or lymphoma, end-stage renal disease
>treated with dialysis, or prolonged corticosteroid therapy, is wide and, as
>a result, the benefits of screening are uncertain. Rose concludes the
>benefits of screening and preventive therapy vary widely, although the
>benefits outweigh the risks for all risk groups, and he points out the
>benefits are large for some risk groups and uncertain for others.
>***************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>387-394; Redefining MDR-TB transmission `hot spots'; M. C. Becerra, J.
>Bayona, J. Freeman, P. E. Farmer, J. Y. Kim.
>
>Report notes that halting further spread of multidrug-resistant tuberculosis
>(MDR-TB) requires both new resources and a renewed discussion of priority
>setting informed by estimates of the existing burden of this disease; the
>1997 report of the first phase of the global survey by the the World Health
>Organization (WHO) and the International Union Against Tuberculosis and Lung
>Disease (IUATLD) uses the indicator of the proportion of TB cases that are
>MDR-TB to identify MDR-TB hot spots'. Authors sought to refine the
>definition of MDR-TB transmission `hot spots," and they obtained estimates
>of two additional indicators for regions where data are available: MDR-TB
>incidence per 100 000 population per year, and expected numbers of new
>patients with MDR-TB per year. They found there is generally much agreement
>in the three indicators considered, and some differences also appear. They
>conclude that it is useful, when defining indicators of MDR-TB transmission
>`hot spots', to include estimates of underlying TB incidence rates and of
>absolute numbers of MDR-TB cases. They say that estimating the force of
>morbidity of MDR-TB in a population is important for comparing this burden
>across settings with very different underlying TB incidence rates;
>estimating the absolute number of MDR-TB patients will be critical for
>planning the delivery of directly observed MDR-TB therapy and the rational
>procurement of second-line drugs. Through this exercise, they plan to
>initiate discussion about improved methods of quantifying and comparing
>current MDR-TB transmission `hot spots' that require intervention.
>***************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>395-400; The origins and precolonial epidemiology of tuberculosis in the
>Americas: can we figure them out?; T. M. Daniel Int J.
>
>Report reviews paleologic evidence of tuberculosis in the precolonial
>Americas looking for TB origins and subsequent epidemiology. Author
>speculates since the genus Mycobacterium is an ancient one, M. tuberculosis
>may have differentiated 20 400 to 15 300 years ago when the Americas were
>peopled by migrants from Asia in two major migrations, one occurring more
>than 20 000 years ago and the other 12 000 to 11 000 years ago. He notes
>that tuberculosis reached the Americas with these migrants, persisting at a
>low level of endemnicity in small, dispersed population groups. He believes
>about 1500 years ago, an epidemic of tuberculosis began, probably in the
>Andean region of South America and says it did not reach or subsided in time
>to leave highly susceptible indigenous American populations at the time of
>European colonization.
>**************************
>International Journal of Tuberculosis and Lung Disease:2000; 4 (5): 401-408;
>Community involvement in tuberculosis control: lessons from other health car
>programs; M. Hadley, D. Maher.
>
>Authors say that decentralizing tuberculosis control measures beyond health
>facilities, by harnessing the contribution of the community, could increase
>access to effective tuberculosis care. Their review of community-based
>health care initiatives in developing countries gives examples of the
>lessons for community contribution to tuberculosis control learned from
>health care programs. Their sources of information were Medline and Popline
>databases and discussions with community health experts. They say barriers
>to success in tuberculosis control stem from biomedical, social and
>political factors and lessons are relevant to the issues of limited
>awareness of tuberculosis and the benefits of treatment, stigma, restricted
>access to drugs, case-finding and motivation to continue treatment. Authors
>say the experience of other programs suggests potential for an expansion of
>both formal and informal community involvement in tuberculosis control. They
>point out informal community involvement includes delivery of messages to
>encourage tuberculosis suspects to come forward for treatment and
>established tuberculosis patients to continue treatment. They found a wide
>range of community members provide psychological and logistic support to
>patients to complete their treatment. They point out that lessons from
>formal community involvement indicate that programs should focus on ensuring
>that treatment is accessible. They says this activity could be combined with
>a variety of complementary activities: disseminating messages to increase
>awareness and promote adherence, tracing patients who interrupt treatment,
>recognizing adverse effects, and case detection. They recommend programs
>should generally take heed of existing political and cultural structures in
>planning community-based tuberculosis control programs. They also note that
>political support, the support of health professionals and the community are
>vital, and planning must involve or stem from the patients themselves.
>***********************
>International Journal of Tuberculosis and Lung Disease:2000; 4 (5): 409-413;
>DOT or not? Direct observation of anti-tuberculosis treatment and patient
>outcomes, Kerala State, India; V. N. Balasubramanian, K. Oommen, R. Samuel
>
>This report is from the Pathanamthittha District of Kerala State, India,
>where the directly observed treatment, short-course (DOTS) program was
>started in October 1994. Authors sought to determine the frequency with
>which direct observation actually occurred within a district-level DOTS
>program, and the association of treatment observation with treatment outcome
>under program conditions. They conducted a retrospective study which
>included 200 consecutive, newly-detected, smear-positive patients registered
>under the project between February 1995 and February 1996 at the District
>tuberculosis Center, as well as health workers responsible for providing
>directly observed treatment (DOT) who were separately and confidentially
>interviewed. The identified treatment outcomes from results of sputum smear
>examinations for acid-fast bacilli. They report all patients were recorded
>as having received DOT, but more than a quarter of patients (26.5%) did not
>actually receive it and the 53 patients who were not directly observed were
>much more likely to have treatment failure or relapse, as compared to those
>who had received DOT (45% vs. 3%, relative risk 16.6, 95% confidence
>intervals 6-46, P<0.001). They report women were somewhat less likely than
>men (61% vs. 76%, P=0.06) to receive DOT and non-receivers of DOT accounted
>for 86% (24/28) of treatment failures or relapses. They conclude that
>patients treated without direct observation have a substantially higher risk
>of adverse outcome than those treated under direct observation, but caution
>that, to be maximally effective, the DOTS program must be both confidential
>and convenient.
>***********************************
>International Journal of Tuberculosis and Lung Disease:2000; 4 (5): 414-419;
>Tuberculosis during infancy; H. C. Maltezou, P. Spyridis, D. A. Kafetzis.
>
>Report notes the worldwide re-emergence of tuberculosis during the last
>decade but few studies of infants with tuberculosis have appeared in the
>literature. Authors sought to describe tuberculosis during infancy and they
>reviewed the records of all infants diagnosed with tuberculosis at a
>tertiary care hospital from 1982 to 1998. They identified thirty-nine
>infants with a median age of 10 months, 59% of whom presented during the
>second half of the study period. They found diagnoses included endothoracic
>tuberculosis (33 patients), meningitis (3), miliary tuberculosis (2) and
>cervical lymphadenitis (1). They say reasons for medical evaluation were the
>onset of symptoms (25 patients), contact investigation (12) and tuberculin
>skin test screening (2). They report common signs and symptoms included
>fever (22 patients), cough (7), appetite loss (4) and wheezing/rales
>(4).They say chest X-ray revealed hilar adenopathy (22 patients),
>infiltrates (16), atelectases (3) and miliary pattern (2). They observed
>that cultures were attempted in nine patients and were positive in seven.
>They note all patients responded promptly to treatment and no complications
>or deaths occurred. They conclude that: tuberculosis in infants has been
>diagnosed increasingly during the last decade, endothoracic tuberculosis
>predominates, and one third of the patients were diagnosed due to contact
>investigation. They say pediatricians should be alert for tuberculosis in an
>infant with an atypical picture suggestive of infection because early TB
>diagnosis and treatment appears to prevent complications and reduce
>mortality,.
>*****************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>420-426; Medical students at risk of nosocomial transmission of
>Mycobacterium tuberculosis; V. M. C. Silva, A. J. L. A. Cunha, J. R.
>Oliveira, M. M. Figueira, Z. Brito Nunes, K. DeRiemer, A. L. Kritski.
>
>This report is from a university and teaching hospital in Rio de Janeiro,
>Brazil, a city with a high prevalence of tuberculosis. Authors sought to
>determine whether medical students are at increased risk of nosocomial
>transmission of Mycobacterium tuberculosis relative to other university
>students and they did a cross-sectional study of medical and chemical
>engineering students in different levels of their training programs.
>Authors obtained information about socio-demographic characteristics, BCG
>vaccination history, and potential exposures to TB using a standardized
>questionnaire. They used tuberculin skin testing (TST) to determine the
>prevalence of infection with TB. They report that medical students have an
>increasing prevalence of TST positivity as they advance in their training
>program to increasing levels of study (4.6%, 7.8%, 16.2%, respectively, P <
>0.001), but chemical engineering students do not (4.2%, 4.3%, 4.4%,
>respectively, P = 0.913). They say risks are greatest during the years of
>clinical training, when medical students have increased contact with
>patients. They conclude a program of routine tuberculin skin testing is
>needed, combined with interventions to reduce the risk of nosocomial
>transmission in the workplace.
>****************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>427-432; Acquired antituberculosis drug resistance in Yaounde, Cameroon; C.
>Kuaban, R. Bercion, G. Jifon, P. Cunin, K. Ngu Blackett.
>
>Authors sought to determine the prevalence of acquired resistance (ADR) to
>the main anti-tuberculosis drugs, and to identify risk factors associated
>with its occurrence in Yaounde. In this study, they included a total of 111
>previously treated adults admitted consecutively to the tuberculosis center
>with sputum smear-positive pulmonary tuberculosis between June 1996 and July
>1997. They obtained information on potential risk factors for ADR from each
>patient, and human immunodeficiency virus (HIV) serostatus was determined.
>They performed drug susceptibility testing to the main anti-tuberculosis
>drugs on cultures of Mycobacterium tuberculosis complex isolated from sputum
>samples of each patient by the indirect proportion method, and all patients
>whose isolates tested resistant to at least one anti-tuberculosis drug were
>defined as having ADR. They report growth of M. tuberculosis complex was
>obtained from sputum specimens of 98 (88.3%) of the 111 patients studied; 57
>(58.2%) of these were resistant to at least one anti-tuberculosis drug. They
>found resistance to isoniazid was the most common (54.1%), followed by
>resistance to rifampicin (27.6%), streptomycin (25.5%) and ethambutol
>(12.2%). They observed multidrug resistance in 27 (27.6%) of the cases. In a
>multivariate logistic regression analysis, they found ADR was significantly
>associated only with monotherapy use in previous tuberculosis treatment(s)
>(P = 0.03). They sum up saying the rate of ADR of M. tuberculosis is quite
>high in Yaounde; acquired resistance to rifampicin alone or in combination
>with isoniazid is also high; and monotherapy in previous anti-tuberculosis
>treatment(s) is a significant predictor of ADR in previously treated
>patients in Yaounde. They conclude their results underscore the urgent need
>for the re-establishment of a tuberculosis control program, using the DOTS
>strategy, in Cameroon.
>**************************
>International Journal of Tuberculosis and Lung Disease; 2000; 4 (5):
>433-440; Drug-resistant tuberculosis in South African gold miners: incidence
>and associated factors; G. J. Churchyard, E. L. Corbett, I. Kleinschmidt,
>D. Mulder, K. M. DeCock.
>
>Authors sought to document the incidence of and factors associated with
>drug-resistant tuberculosis (TB) in South African gold miners and they
>reviewed Mycobacterium tuberculosis drug susceptibility records for the
>period from 1 July 1993 to 30 June 1997. They report 2241 miners had
>culture-positive M. tuberculosis pulmonary disease where isolates were
>tested for drug susceptibility to the four primary anti-tuberculosis drugs.
>They observed the proportions of primary and acquired drug resistance were
>respectively 7.3% and 14.3% for isoniazid and 1.0% and 2.8% for resistance
>to at least isoniazid and rifampicin (multidrug resistance). They found
>resistance to streptomycin and ethambutol was uncommon, and rifampicin
>monoresistance was rare. They identified no significant factors for primary
>drug resistance and noted that patients with retreatment pulmonary TB who
>failed primary TB treatment (versus cure) were significantly more likely to
>have TB with resistance to any TB drug or MDR (odds ratios respectively
>9.82, 95%CI 2.97-33.5, and 18.74, 95%CI 1.76-475). They report human
>immunodeficiency virus (HIV) infection was not significantly associated with
>primary or acquired drug resistance, and there was no trend of increasing
>resistance over time. They conclude anti-tuberculosis drug resistance has
>remained stable despite the HIV epidemic and increasing TB rates. They
>believe directly observed therapy may have contributed to containing the
>level of drug resistance and say adherence to and completion of treatment
>are essential to prevent drug resistance and treatment failure, including in
>situations with high HIV prevalence.
>**************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>441-447; Exclusive mutations related to isoniazid and ethionamide resistance
>among Mycobacterium tuberculosis isolated from Korea; H. Lee, S. N. Cho, H.
>E. Bang, J. H. Lee, G. H. Bai, S. J. Kim, J. D. Kim.
>
>Report notes the single base change at the 94th codon of inhA has been
>referred to as the event that confers resistance on the drugs isoniazid
>(INH) and ethionamide (ETH) in Mycobacterium smegmatis and M. bovis. From
>this observation, authors point out that it has been anticipated that some
>of the INH-resistant clinical isolates of M. tuberculosis would carry
>missense mutations in the same region of the gene, but few polymorphisms
>have been identified in this region among INH-resistant isolates. Authors
>sought to understand the molecular basis for M. tuberculosis resistance to
>INH and ETH and they analyzed the sequence polymorphism at the 94th codon of
>inhA among M. tuberculosis isolates from Korea by polymerase chain reaction
>(PCR) cloning and sequence analysis. They found no nucleotide change at the
>94th codon of inhA was detected in any of the 24 INH-resistant isolates
>analyzed in this study. On the other hand, they found a point mutation
>exclusively at the regulatory region flanking a putative ribosome-binding
>site of the inhA locus in 14 isolates. They say all the mutations were of
>the same kind, which substitutes C to T and among 14 isolates, 12 were
>resistant to INH as well as to ETH, while two were resistant to INH only.
>They conclude that mutations previously found at the 94th codon of inhA have
>no particular relationship with the mechanism involved in the resistance of
>M. tuberculosis to INH and/or ETH. They speculate that the resistance
>mechanism of M. tuberculosis to INH/ETH may involve an altered level of
>InhA, an expression which may have been influenced by the sequence change in
>the regulatory region of the inhA locus.
>********************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>448-454; HIV-1 co-infection in children hospitalized with tuberculosis in
>South Africa; S.A. Madhi, R. E. Huebner, L. Doedens, T. Aduc, D. Wesley, P.
>A. Cooper.
>
>This study was done in hospitals associated with the Department of
>Pediatrics at the University of the Witwatersrand, Johannesburg, South
>Africa in order to define the prevalence of human immunodeficiency virus
>(HIV) co-infection and differences in clinical presentation between
>HIV-infected and non-infected hospitalized children with tuberculosis;
>children were prospectively enrolled between August 1996 and January 1997.
>Authors report, of 161 children enrolled, 42% were HIV-infected, including
>67/137 with pulmonary tuberculosis (PTB) and 1/24 with extra-pulmonary
>disease (EPTB). They observed that positive microscopy or bacteriology did
>not differ by HIV status for children with either PTB or EPTB. They noted
>that although age did not differ between HIV-infected and non-infected
>children with PTB, non-HIV-infected children with EPTB were significantly
>older than those with PTB only (median age 32 months vs. 14.5 months,
>P=0.004). They observed chronic weight loss, malnutrition and the absence of
>BCG scarring were more common in HIV-infected children with PTB and
>HIV-infected children were also more likely to show cavitation (P=0.001)
>and miliary TB (P=0.01) on chest X-ray. They found reactivity to tuberculin
>(>= 5 mm and >= 10 mm in HIV-infected and non-infected children,
>respectively) was significantly lower in HIV-infected children, as were CD4+
>lymphocyte levels. They report the mortality rate during the study was 13.4%
>in HIV-infected children compared with 1.5% in non-HIV-infected children
>(P=0.03). They conclude there is a high prevalence of HIV co-infection in
>children with TB and that progressive PTB and death are more common in
>HIV-infected children. They say tuberculin skin testing is of limited use in
>screening for TB in HIV-infected children even when using a cut-point of >=
>5 mm.
>*********************************
>International Journal of Tuberculosis and Lung Disease: 2000; 4 (5):
>455-462; The impact of HIV infection on recurrence of tuberculosis in South
>African gold miners; K. F. Mallory, G. J. Churchyard, I. Kleinshmidt, K. M.
>De Cock, E. L. Corbett.
>
>This is a report of the potential risk factors for recurrence of
>tuberculosis (TB) in a retrospective cohort study of 305 human
>immunodeficiency virus(HIV) positive and 984 HIV-negative South African gold
>miners treated for TB with directly-observed, rifampicin-based regimens.
>Authors say standard treatment changed from rifampicin, isoniazid and
>pyrazinamide (RHZ) to RHZ plus ethambutol (RHZE) during the study period.
>They report recurrence occurred in 37 HIV-positive and 46 HIV-negative men
>and HIV infection was associated with a significantly higher recurrence rate
>(8.2 vs. 2.2 per 100 person-years; multivariate-adjusted incidence rate
>ratio [IRR] 4.9, 95% confidence interval [CI] 3.0-8.1), as were
>post-tuberculous scarring (multivariate-adjusted IRR 1.6 for one or two
>scarred lung zones, 4.0 for three or more zones; test for trend P < 0.001)
>and drug resistance (multivariate-adjusted IRR 2.7, 95%CI 1.01-7.4). They
>report the recurrence rate was significantly higher following treatment with
>RHZ than RHZE (multivariate-adjusted IRR 2.1, 95%CI 1.1-4.0) although they
>say the difference between regimens needs to be interpreted with caution,
>however, as allocation was not randomized. They conclude the high
>recurrence rate among HIV-positive men requires further investigation to
>distinguish relapse from re-infection as the predominant cause, leading to
>consideration of further intensification of the initial regimen or use of
>secondary prophylaxis.
>*****************************************
>International Journal of Tuberculosis and Lung Disease; 2000; 4 (5):
>481-484: Detection of rifampicin resistance in Mycobacterium tuberculosis
>isolates from diverse countries by a commercial line probe assay as an
>initial indicator of multidrug resistance; H. Traore, K. Fissette, I.
>Bastian, M. Devleeschouwer, F. Portaels;
>
>Report notes that the line probe assay (LiPA), a rapid molecular method for
>detecting rifampicin resistance (RMPr) in Mycobacterium tuberculosis,
>correctly identified all 145 rifampicin-sensitive (RMPs) and 262 (98.5%) of
>266 RMPr strains among 411 isolates collected from diverse countries.
>Authors say, if used as a marker of multidrug-resistant tuberculosis
>(MDR-TB), detection of RMPr by LiPA would have detected 236 of the 240 MDR
>strains in this study but would have wrongly suggested the presence of MDR
>in 26 RMP-monoresistant isolates (sensitivity 98.3%, specificity 84.8%).
>Hence, they conclude the reliability of using LiPA (or any other rapid
>RMPr-detection method) as a surrogate marker of MDR-TB largely depends on
>the prevalence of RMP-monoresistance in the study population. The point out
>this approach must therefore be validated in each local situation.
>***********************
>Trends in Microbiology; 2000, 8:5:238-244; The eukaryotic-like Ser/Thr
>protein kinases of Mycobacterium Tuberculosis; Yossef Av-Gay and Martin
>Everett.
>
>Article notes that, in bacteria, extracellular signals are generally
>transduced into cellular responses via a two-component system, but genome
>sequence data have now revealed the presence of 'eukaryotic-like' protein
>kinases and phosphatases. Authors report Mycobacterium tuberculosis appears
>to be unique among bacteria in that its genome contains 11 members of a
>newly identified protein kinase family. They say these M. tuberculosis
>eukaryotic-like protein kinases could be key regulators of metabolic
>processes, including transcription, cell development and interactions with
>host cells.
>**************************
>Current Opinion in Microbiology; 2000, 3:35-42; Reactive nitrogen
>intermediates and the pathogenesis of Salmonella and mycobacteria; [Review
>article]; Michael U Shiloh, Carl F Nathan.
>
>Report notes that, over the past decade, reactive nitrogen intermediates
>joined reactive oxygen intermediates as a biochemically parallel and
>functionally non-redundant pathway for mammalian host resistance to many
>microbial pathogens. Authors note the past year has brought a new
>appreciation that these two pathways are partially redundant, such that each
>can compensate in part for the absence of the other, and in combination,
>their importance to defense of the murine host is greater than previously
>appreciated. In addition to direct microbicidal actions, they say reactive
>nitrogen intermediates have immunoregulatory effects relevant to the control
>of infection. Authors point out genes have been characterized in
>Mycobacterium tuberculosis and Salmonella typhimurium that may regulate the
>ability of pathogens to resist reactive nitrogen and oxygen intermediates
>produced by activated macrophages.
>**********************
>Chemotherapy 2000, 46:1:43-48; In vitro Investigation of the Antimicrobial
>Activities of Novel Tetramethylpiperidine- Substituted Phenazines against
>Mycobacterium tuberculosis; Constance E.J. van Rensburga, Gisela K. Joonéa,
>Frederick A. Sirgelb, Nthane M. Matlolaa, John F. O'Sullivan.
>
>Authors report the intra- and extracellular activities of 5 novel
>tetramethylpiperidine (TMP)-substituted phenazines against Mycobacterium
>tuberculosis H37Rv (ATCC 27294) were determined and compared with those of
>clofazimine and rifampicin. They also tested two of these agents, together
>with clofazimine, for their activities against drug-resistant strains of M.
>tuberculosis. They found three of the MP-substituted phenazine compounds
>were significantly more active than clofazimine against M. tuberculosis,
>including multidrug-resistant clinical strains of this microbial pathogen,
>demonstrating a lack of cross-resistance between the riminophenazines and
>standard anti-tuberculous drugs. Using M. tuberculosis-infected
>monocyte-derived macrophages, they found all of theTMP-substituted
>phenazines possessed intracellular activity which was superior to that of
>both clofazimine and rifampicin. In this model of intracellular bioactivity,
>they found the experimental compounds inhibited bacterial growth at
>concentrations which were approximately 10-fold lower than the corresponding
>minimal inhibitory concentration values obtained using conventional in vitro
>sensitivity testing procedures. They conclude their results show that the
>novel TMP phenazines are active against multidrug-resistant M. tuberculosis
>strains, and particularly effective intracellularly.
>****************
>Respiration 2000, 67:2:219-222; Miliary Sarcoidosis following Miliary
>Tuberculosis; K. Hatzakis, N.M. Siafakas, D. Bouros.
>
>This report describes a patient who presented with a miliary radiographic
>pattern due to tuberculosis and later with a similar miliary pattern due to
>sarcoidosis is described; the patient, a 47-year-old man, was admitted to
>the hospital due to coughing, weakness, weight loss and an abnormal chest
>radiograph with a miliary pattern; a gastric fluid culture was positive for
>Mycobacterium tuberculosis and he was treated appropriately; the patient
>showed complete clinical and radiological remission; one year later he
>presented with a dry cough and a similar miliary pattern on the chest
>roentgenogram; lung biopsy taken by thoracoscopy revealed sarcoidosis.
>Writers say the patient had a complete remission with corticosteroids, and
>to their knowledge, this is the first report describing a miliary pattern as
>presenting radiological sign in a patient with tuberculosis who subsequently
>developed a new miliary pattern due to sarcoidosis.
>*****************
>Journal of Thoracic and Cardiovascular Surgery; May 2000 * Volume 119 *
>Number 5 * p906 to p912; Surgical treatment of pulmonary aspergilloma:
>Gerard Babatasi, MD, PhD, Massimo Massetti, MD, Alain Chapelier, MD, PhD,
>Elie Fadel, MD, Paolo Macchiarini, MD, PhD, Andre Khayat, MD, Philippe
>Dartevelle, MD.
>
>This is a report of a retrospective study designed to confirm that
>aggressive pulmonary resection can provide effective long-term palliation of
>disease for patients with pulmonary aspergilloma. Writers found that, from
>1959 to 1998, 84 patients underwent a total of 90 operations for treatment
>of pulmonary aspergilloma in the Marie-Lannelongue Hospital; the mean
>follow-up period was 9 years, and 83% of the patients were followed up for 5
>years or until death, if the latter occurred earlier; the median age was 44
>years; the most common indications were hemoptysis (66%) and sputum
>production (15%); fifteen patients (18%) had no symptoms. They found
>tuberculosis and lung abscess were the most common underlying causes of lung
>disease (65%) and they say the procedures were 70 lobar or segmental
>resections, 8 cavernostomies, and 7 pneumonectomies. They report five
>thoracoplasties were required after lobectomy (3 patients) or pneumonectomy
>(2 patients). They found the operative mortality rate was 4% and major
>complications were bleeding (23 patients), prolonged air leak (31 patients),
>respiratory failure (10 patients), and empyema (5 patients). They report the
>actuarial survival curve showed 84% survival at 5 years and 74% survival at
>10 years, and during the first 2 years, death was related to the surgical
>procedure and the underlying disease. In contrast, they say 85% of the
>survivors had a good late result. They noted that lobar resection in both
>the symptomatic and the asymptomatic patients was conducted in low-risk
>settings and, for patients whose condition is unfit for pulmonary resection,
>cavernostomy may need to be undertaken despite the high operative risk. They
>believe better survival rate in this study may have been due to the
>selection of patients with better lung function and localized pulmonary
>disease.
>*******************
>Respiratory Medicine; pp 432-435, Volume 94, Number 5, May 2000 ; Use of
>pleural fluid C-reactive protein in diagnosis of pleural effusions; ü.
>YILMAZ TURAY, Z. YILDIRIM, Y. TüRKöZ, ç. BIBER, Y. ERDO[Gbreve]AN, A. I.
>KEYF, F. U[Gbreve]URMAN, A. AYAZ, P. ERGüN, Y. HARPUTLUO[Gbreve]LU.
>
>Authors say the aims of the study were to assess whether C-reactive protein
>(CRP) is a sensitive marker for discriminating between transudative and
>exudative and pleural effusions to evaluate whether it can be used to
>distinguish inflammatory pleural effusions from other types of effusion.
>They obtained pleural fluid and serum CRP levels in 97 patients with pleural
>effusion, using an immunoturbidimetric method (Olympus AU-600 autoanalyser).
>They compared CRP levels between transudates and exudates, inflammatory
>effusions and other types of effusion. They report that, according to the
>the criteria used, 16 patients were included in the transudate group and 81
>patients in the exudate group; pleural fluid CRP levels were significantly
>lower in the transudate group (P<0·04; 14·9±4·9 mg l-1and 35·5±4·9 mg
>l-1respectively). Also, they note the ratio of pleural fluid to serum was
>significantly lower in the transudate group (P<0·009; 0·8±0·5 mg l-1and
>2·8±0·7 mg l-1, respectively), while in the exudate group, 35 patients had
>neoplastic effusions, 10 chronic non-specific pleurisy, 19 tuberculous
>pleurisy, 16 parapneumonic effusion and one Dressler Syndrome. When they
>compared these sub-groups, the parapneumonic effusion subgroup CRP levels
>(mean 89±16·3 mg l-1) were significantly higher than those in the other
>subgroups, other exudate of neoplastic effusion, tuberculous pleurisy and
>chronic non-specific effusion and the transudate group
>(P<0·0001;P<0·0001;P<0·0004 and P<0·0001, respectively). They report the
>ratio between pleural fluid and serum CRP was significantly higher in the
>parapneumonic effusion subgroup than in the neoplastic subgroup (P<0·0002;
>6·6±2·7 mg l-1and 1±0·2 mg l-1, respectively); pleural fluid CRP levels >30
>mg l-1had a high sensitivity (93·7%) and specificity (76·5 %) and a positive
>predictive value of 98·4%. They say, in the differential diagnosis of
>pleural effusions, higher CRP levels may prove to be a rapid, practical and
>accurate method of differentiating parapneumonic effusions from other
>exudate types. They comment that, although the high level of CRP obtained in
>the exudate group may be due to the number of patients with parapneumonic
>effusion who were included, the pleural CRP level may also be helpful in
>discriminating between exudative and transudative pleural effusions.
>*********************
>Microbiology (2000), 146, 1157-1162; 2000 Society for General Microbiology;
>Genetics and Molecular Biology; Isolation of a novel insertion sequence from
>Mycobacterium fortuitum using a trap vector based on inactivation of a lacZ
>reporter gene; Morris Waskar1, Deepak Kumara,1, Ajai Kumar1 and Ranjana
>Srivastava.
>
>Article notes an insertion sequence of Mycobacterium fortuitum has been
>isolated using a trap vector following insertion in and inactivation of the
>lacZ reporter gene. Authors report the trap vector is a
>temperature-sensitive (ts) Escherichia coli-mycobacterium shuttle plasmid,
>pCD4, which contains ts oriM, the kanamycin-resistance gene as a selection
>marker and a lacZ expression cassette. They say the ts mutation present in
>pCD4 functions in mycobacteria and enables screening for transposable
>elements from the mycobacterial genome that disrupt the lacZ gene by
>screening for white colonies on X-Gal plates in both mycobacterial as well
>as E. coli hosts. They report the vector was used to isolate a novel 1·653
>kb insertion sequence from M. fortuitum named IS219; IS219 duplicated host
>DNA at the target site, had inverted repeats at its ends and contained two
>ORFs on one strand. They note one of the predicted proteins showed homology
>to a putative transposase from Acetobacter pasteurianus and IS219 was
>present in two copies in the genome of M. fortuitum. They conclude the trap
>vector appears to be useful in trapping insertion sequences from different
>mycobacteria by screening for the disrupted LacZ phenotype.
>************************
>Emerging Infectious Diseases; Mycobacterium tuberculosis Beijing Genotype
>Emerging in Vietnam; Dang Duc Anh, Martien W. Borgdorff, L.N. Van, N.T.N.
>Lan, Tamara van Gorkom, Kristin Kremer, and Dick van Soolingen.
>
>To assess whether the Mycobacterium tuberculosis Beijing genotype is
>emerging in Vietnam, authors analyzed 563 isolates from new cases by
>spoligotyping and examined the association between the genotype and age,
>resistance, and BCG vaccination status. They report three hundred one (54%)
>patients were infected with Beijing genotype strains, and the genotype was
>associated with younger age (and hence with active transmission) and with
>isoniazid and streptomycin resistance, but not with BCG vaccination.
>***************************
>The New England Journal of Medicine -- May 25, 2000 -- Vol. 342, No. 21;
>Weekly Clinicopathological Exercises: Case 16-2000: A 53-Year-Old Woman with
>Swelling of the Right Breast and Bilateral Lymphadenopathy; Eric A.
>Pillemer, Nancy L.
>
>Tuberculous mastitis is listed as one of the many diagnostic possibilities
>in this report, noting that it is rare in Western countries but is becoming
>more frequent in the United States, especially in immunocompromised hosts.
>Writers note that patients generally present with pain, redness, and
>swelling of the breast, often with a palpable mass and enlarged axillary
>lymph nodes. They report the diagnosis is based on microscopical
>identification of acid-fast bacilli or growth of Mycobacterium tuberculosis
>on culture and conclude that multiple negative cultures and the negative
>results of staining for acid-fast organisms in the report presented, rule
>out tuberculous mastitis.
>**************************
>British Medical Journal: 2000;320:1452 ( 27 May ); A memorable patient -
>Check, check, and check again; Geoff Scott.
>
>The writer, Scott, reports that a well known author came in at the end of
>his tuberculosis clinic with an chest x ray which suggested tuberculosis -
>the author was well but his contact was a man with AIDS and tuberculosis on
>the ward. The author had no symptoms and the physical examination was normal
>so, as is customary, Scott asked him to provide some sputum, which he
>managed with great perseverance, and blood, and arranged to see him a few
>days later. Scott says the author had a partner and child, and he called
>them to the contact clinic for Heaf tests and chest x ray examinations,
>which turned out to be negative. His blood tests were normal and the sputum
>was negative on direct examination, but Scott says he was so sure that his
>chest x ray film showed active tuberculosis that he was quite ready to
>embark on bronchoscopy and treatment. However, Scott said because all the
>normality made him suspicious, before committing the act of writing the
>prescription, he asked him to have another chest x ray examination, and
>surprisingly, this was completely normal - so at least he did not have
>tuberculosis and he could be sent on his way with sincere apologies for the
>inconvenience, unnecessary investigations, and anxiety caused by a
>monumental error. Then Scott noticed his chest x ray film had his name typed
>on a label stuck over the top right hand corner. Peeling it off Scott found
>another name
>which he later identified as belonging to a man who had attended the
>cardiology clinic on the same morning as the tuberculosis clinic. Scott rang
>him at home and got his mother who was sufficiently surprised that he
>decided to confide the reason for his call. The second patient turned out to
>be a postgraduate geology student living at university, who had done his
>MSc in Paris the previous year and been afflicted by a severe flu-like
>illness with anorexia, weight loss, cough, and haemoptysis which resolved
>after six weeks or so. His Parisian doctor had been so excited by a mitral
>murmur that he had quite forgotten to arrange a chest x ray examination. So,
>16 months later, he had eventually come to the cardiology clinic at Scott's
>hospital for follow up and had been sent for a routine examination. Scott
>reports his repeat x ray examination was abnormal and his sputum was full of
>acid-fast bacilli, so the diagnosis was not in doubt. Scott comments on one
>further complication: he was just about to embark on an expedition up to 19
>000 feet in the Himalayas and Scott's straw poll of expert tuberculologists
>was exactly divided as to whether he should be forbidden or allowed to go.
>Scott says the explanation for the extraordinary error: the radiographer
>could not believe that the abnormal x ray film could have been of the fit
>young man who bounced in from the cardiology clinic, but she felt that it
>must have come from the man who told her all about his contact with a
>tuberculous patient on the AIDS ward so she swapped the names. In
>conclusion, Scott cautions "Never believe what you see if it does not make
>sense. Check, check, and check again. "
>*********************************************************
>OTHER:
>**************************
>Journal of Emerging Infectious Diseases
>
>The entire issue of the above referenced May-June 2000 issue of CDC's
>journal, Emerging Infectious Diseases (EID), is now available on line at
><http://www.cdc.gov/ncidod/eid/upcoming.htm>
>
>
>
>
>