TUBERCULOSIS

Selected abstracts:

1.                  Burman WJ, Goldberg S, Johnson JL, Muzanye G, Engle M, Mosher AW, Choudhri S, Daley CL, Munsiff SS, Zhao Z, Vernon A, Chaisson RE. Moxifloxacin versus ethambutol in the first 2 months of treatment for pulmonary tuberculosis. Am J Respir Crit Care Med. 2006 Aug 1;174(3):331-8.

Denver Public Health and the Department of Medicine, University of Colorado Health Sciences; National Jewish Medical and Research Center, Denver, Colorado, USA. bburman@dhha.org
RATIONALE: Moxifloxacin has promising preclinical activity against Mycobacterium tuberculosis, but has not been evaluated in multidrug treatment of tuberculosis in humans. OBJECTIVE: To compare the impact of moxifloxacin versus ethambutol, both in combination with isoniazid, rifampin, and pyrazinamide, on sputum culture conversion at 2 mo as a measure of the potential sterilizing activity of alternate induction regimens. METHODS: Adults with smear-positive pulmonary tuberculosis were randomized in a factorial design to receive moxifloxacin (400 mg) versus ethambutol given 5 d/wk versus 3 d/wk (after 2 wk of daily therapy). All doses were directly observed. MEASUREMENTS: The primary endpoint was sputum culture status at 2 mo of treatment. RESULTS: Of 336 patients enrolled, 277 (82%) were eligible for the efficacy analysis, 186 (67%) were male, 175 (63%) were enrolled at African sites, 206 (74%) had cavitation on chest radiograph, and 60 (22%) had HIV infection. Two-month cultures were negative in 71% of patients (99 of 139) treated with moxifloxacin versus 71% (98 of 138) treated with ethambutol (p = 0.97). Patients receiving moxifloxacin, however, more often had negative cultures after 4 wk of treatment. Patients treated with moxifloxacin more often reported nausea (22 vs. 9%, p = 0.002), but similar proportions completed study treatment (88 vs. 89%). Dosing frequency had little effect on 2-mo culture status or tolerability of therapy. CONCLUSIONS: The addition of moxifloxacin to isoniazid, rifampin, and pyrazinamide did not affect 2-mo sputum culture status but did show increased activity at earlier time points.

2.                  Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F, Lazzeri E. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun. 2006 Aug;27(8):645-60.

Istituto di Malattie Infettive e Tropicali, Universita di Verona, Italy.
Bone infections represent a diagnostic or therapeutic challenge for the infectivologist, orthopaedic surgeon, radiologist and nuclear medicine physician. Staphylococcus aureus is the major bacterium responsible for bone infections although Mycobacterium tuberculosis is emerging as an infectious agent in Italy because of immigration from Africa and Asia. Osteomyelitis requires long and expensive antibiotic treatment, including rifampicin administered parenterally for several weeks and the use of antimicrobial-impregnated cement in prosthesis substitution. Sometimes it is necessary to carry out surgical debridement of a necrotic bone or the consolidation of compromised bones and joint prosthesis implants. Radiographs and bone cultures are mainstays for the diagnosis of bone infections but are often useless in the lengthy management of these patients. Diagnosis of skeletal infections still includes conventional radiography but magnetic resonance imaging is essential in haematogenous and spinal infections. Bone scans are still useful in acute osteomyelitis whereas scintigraphy using labelled white blood cells is preferred in infections of peripheral bone segments or joint prosthesis. In the axial skeleton a combination of an agent for detecting inflammation ((67)Ga citrate) and a metabolic agent ((99m)Tc-methylene diphosphonate) enables an infection and an area of increased metabolic activity to be distinguished. [(18)F]Fluorodeoxyglucose positron emission tomography, where available, has a significant impact in the study of infections using radionuclides: high-resolution tomographic images represent an effective alternative to gallium in the assessment of inflammation of spine lesions but a comparison with morphological examinations (computed tomography or magnetic resonance imaging) is essential.

3.                  How SH, Chin SP, Zal AR, Liam CK Pleural effusions: role of commonly available investigations. Pleural effusions: role of commonly available investigations. Singapore Med J. 2006 Jul;47(7):609-13.

Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, PO Box 141, Kuantan 27510, Malaysia. how_sh@yahoo.com

INTRODUCTION: Previous studies have reported high rates of undetermined causes of pleural effusions. We aimed to find out the proportion of pleural effusions in which the aetiology is uncertain despite commonly available investigations. METHODS: A prospective study was carried out at the University of Malaya Medical Centre from May 2001 to January 2002. All patients with pleural effusion admitted to the medical wards and non-medical wards during that period were included in the study. RESULTS: Of 111 patients with pleural effusion, malignancy was the commonest cause of pleural effusion (34.2 percent), followed by tuberculosis (22.5 percent) and parapneumonic effusions (18.9 percent). There were only two patients (1.8 percent) with undetermined cause despite extensive investigations. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy gave the highest yield of histological diagnosis (66 percent), followed by pleural fluid cytology (59 percent) and pleural biopsy (50 percent). The combination of these three procedures increased the diagnostic yield to 96 percent. In tuberculous pleural effusion, pleural fluid staining for acid-fast bacilli was negative in all cases but mycobacterial culture was positive in 24 percent of cases while pleural biopsy gave a better yield of 68.8 percent. Examination of sputum and bronchoalveolar lavage specimens confirmed the diagnosis of tuberculosis in 40 percent of cases. A combination of these investigations yielded the diagnosis in 92 percent of patients with tuberculous effusion. CONCLUSION: Malignancy is the commonest cause of pleural effusion, followed by tuberculosis and pneumonia, in patients treated in a teaching hospital in Malaysia. The number of undetermined causes could be minimised with a combination of readily-available and established investigations.

4.                  Pai M, Joshi R, Dogra S, Mendiratta DK, Narang P, Kalantri S, Reingold AL, Colford JM Jr, Riley LW, Menzies D. Serial testing of health care workers for tuberculosis using interferon-gamma assay. Am J Respir Crit Care Med. 2006 Aug 1;174(3):349-55.

Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA. madhukar.pai@mcgill.ca

RATIONALE: Although interferon-gamma (IFN-gamma) assays are promising alternatives to the tuberculin skin test (TST), their serial testing performance is unknown. OBJECTIVE: To compare TST and IFN-gamma conversions and reversions in healthcare workers. METHODS: We prospectively followed-up 216 medical and nursing students in India who underwent baseline and repeat testing (after 18 mo) with TST and QuantiFERON-TB Gold In-Tube (QFT). TST conversions were defined as reactions greater than or equal to 10 mm, with increments of 6 or 10 mm over baseline. QFT conversions were defined as baseline IFN-gamma less than 0.35 and follow-up IFN-gamma greater than or equal to 0.35 or 0.70 IU/ml. QFT reversions were defined as baseline IFN-gamma greater than or equal to 0.35 and follow-up IFN-gamma less than 0.35 IU/ml. RESULTS: Of the 216 participants, 48 (22%) were TST-positive, and 38 (18%) were QFT-positive at baseline. Among 147 participants with concordant baseline negative results, TST conversions occurred in 14 (9.5%; 95% confidence interval [CI] = 5.3-15.5) using the 6 mm increment definition, and 6 (4.1%; 95% CI = 1.5-8.7) using the 10 mm increment definition. QFT conversions occurred in 17/147 participants (11.6%; 95% CI = 6.9-17.9) using the definition of IFN-gamma greater than or equal to 0.35 IU/ml, and 11/147 participants (7.5%; 95% CI = 3.8-13.0) using IFN-gamma greater than or equal to 0.70 IU/ml. Agreement between TST (10 mm increment) and QFT conversions (>or= 0.70 IU/ml) was 96% (kappa = 0.70). QFT reversions occurred in 2/28 participants (7%) with baseline concordant positive results, as compared with 7/10 participants (70%) with baseline discordant results (p < 0.001). CONCLUSIONS: IFN-gamma assay shows promise for serial testing, but repeat results need to be interpreted carefully. To meaningfully interpret serial results, the optimal thresholds to distinguish new infections from nonspecific variations must be determined.

5.                  Wanchu A, Bhatnagar A, Kumar B, Bambery P, Singh S. Caspase 1 and caspase 8 in HIV infected patients with and without tuberculosis. J Postgrad Med 2004, 50(2), 98- 101.

Departments of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India. awanchu@yahoo.com

BACKGROUND: Caspase 8 is involved in apoptosis mediated by Fas and p55 tumor necrosis factor receptor ligation in HIV infection. Apoptosis is partially mediated by interleukin-1beta-converting enzyme (caspase-1). AIMS: We determined apoptosis, using caspase-1 and caspase-8, among patients with HIV infection, with and without tuberculosis (TB), those with TB alone and healthy individuals. SETTING AND DESIGN: Cross-sectional analysis of caspase-1 and caspase-8 among patients with HIV infection, with and without TB, those with TB alone and healthy individuals. MATERIALS AND METHODS: Nineteen HIV infected patients with TB (HIV+/TB+) and 20 with HIV infection without TB (HIV+/TB-) were studied. Fifteen individuals with TB alone were disease controls (HIV-/TB+) and 20 were healthy controls (HIV-/TB-). Caspases were measured by single-step ELISA using commercially available monoclonal antibodies. STATISTICAL ANALYSIS: Two-way ANOVA and Pearson's correlation coefficient. RESULTS: Mean CD4 counts of HIV+/TB+ were lower than HIV+/TB- (p<0.05). OD value of caspase 1 in HIV+/TB+ was 0.295+0.05, while that in HIV+/TB- it was 0.302+0.18. It was 0.293+0.07 in HIV-/TB+ and in HIV-/TB- the values were 0.287+0.06. OD value of caspase 8 in HIV+/TB+ was 0.307+ 0.07, lower than HIV+/TB- (0.927+0.25). It was 0.008+0.03 in HIV-/TB+ and in HIV-/TB-, 0.074+0.004. Values of caspase 8 in patients with HIV infection (with/without TB) were higher than those with TB alone or healthy individuals (p<0.01). Levels of caspase 8 in HIV+/TB- were higher than patients with HIV+/TB+ (p<0.01). CONCLUSION: Levels of caspase-1 are not different irrespective of presence or otherwise of TB and HIV infection. Fas-related apoptosis is higher in HIV infection. With concomitant TB, levels of caspase 8 were lower as compared with those without TB.

Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostic:

15215.  Abou-Raya S, Abou-Raya A. Spinal tuberculosis: overlooked? J Intern Med. 2006 Aug;260(2):160-3. 

15216.  Bansal RK, Malhotra C, Bhatia R, Chhabra S, Sood S. Tubercular dacryoadenitis--a case report and review of literature. Indian J Pathol Microbiol. 2006 Jul;49(3):385-7. 

15217.  Bera S, Shende N, Kumar S, Harinath BC.  Detection of antigen and antibody in childhood tuberculous meningitis. Indian J Pediatr. 2006 Aug;73(8):675-9. 

15218.  Cheng AC, Johnson DF. Multiloculated hepatosplenic abscesses. Clin Infect Dis. 2006 Jul 15;43(2):264-5.

15219.  Fellah L, Leconte I, Weynand B, Donnez J, Berliere M.  Breast tuberculosis imaging. Fertil Steril. 2006 Aug;86(2):460-1. 

15220.  Jain V, Sen B, Agarwal M, Maini L, Mehtani A. Tuberculosis of rib and lung presenting as subcutaneous emphysema. Pediatr Infect Dis J. 2006 Jul;25(7):662-3.

15221.  Kali PB, Gray GE, Violari A, Chaisson RE, McIntyre JA, Martinson NA. Combining PMTCT with active case finding for tuberculosis. J Acquir Immune Defic Syndr. 2006 Jul;42(3):379-81. 

15222.  Karthikeyan BV, Pradeep AR, Sharma CG. Primary tuberculous gingival enlargement: a rare entity. J Can Dent Assoc. 2006 Sep;72(7):645-8. 

15223.  Komurcu M, Botanlioglu H, Erdem H, Albay A.  Delayed and misdiagnosis of wrist tuberculosis. Int J Infect Dis. 2006 Jul;10(4):337.

15224.  Mandel L.  Tuberculous cervical node calcifications mimicking sialolithiasis: a case report. J Oral Maxillofac Surg. 2006 Sep;64(9):1439-42.

15225.  Maron R, Levine D, Dobbs TE, Geisler WM. Two cases of pott disease associated with bilateral psoas abscesses: case report. Spine. 2006 Jul 15;31(16):E561-4. Review. 

15226.  Mohan G, Kulshreshtha S, Sharma P. Zinc and copper in Indian patients of tuberculosis: impact on antitubercular therapy. Biol Trace Elem Res. 2006 Summer;111(1-3):63-9. 

15227.  Mohindra S, Gupta SK, Mohindra S, Gupta R. Unusual presentations of craniovertebral junction tuberculosis: a report of 2 cases and literature review. Surg Neurol. 2006 Jul;66(1):94-9; discussion 99.  

15228.  Narendran G, Swaminathan S, Sathish S, Rajasekaran S.  Immune reconstitution syndrome in a child with TB and HIV. Indian J Pediatr. 2006 Jul;73(7):627-9. 

15229.  Rotert R.  Case of the month. Mycobacterium tuberculosis. JAAPA. 2006 Jul;19(7):70.

15230.  Takasu N, Kinjou Y, Kouki T, Takara M, Ohshiro Y, Komiya I. Rifampin-induced hypothyroidism. J Endocrinol Invest. 2006 Jul-Aug;29(7):645-9. 

15231.  Wasay M, Arif H, Khealani B, Ahsan H. Neuroimaging of tuberculous myelitis: analysis of ten cases and review of literature. J Neuroimaging. 2006 Jul;16(3):197-205. Review. 

15232.  White MY, Gundry RL, Cordwell SJ. When does a fingerprint constitute a iagnostic? Lancet. 2006 Sep 16;368(9540):971-3.

Vaccine:

15233.  Muto J, Kuroda K, Tajima S.  Papular tuberculides post-BCG vaccination: case report and review of the literature in Japan. Clin Exp Dermatol. 2006 Jul;31(4):611-2. Review.

15234.  Saito M, Pan WK, Gilman RH, Bautista CT, Bamrah S, Martin CA, Tsiouris SJ, Arguello DF, Martinez-Carrasco G. Comparison of altitude effect on Mycobacterium tuberculosis infection between rural and urban communities in Peru. Am J Trop Med Hyg. 2006 Jul;75(1):49-54. 

15235.  Sterling TR, Haas DW. Transmission of Mycobacterium tuberculosis from health care workers. N Engl J Med. 2006 Jul 13;355(2):118-21.

15236.  Walker V, Selby G, Wacogne I.  Does neonatal BCG vaccination protect against tuberculous meningitis? Arch Dis Child. 2006 Sep;91(9):789-91. Review.

15237.  Watanabe Y, Watari E, Matsunaga I, Hiromatsu K, Dascher CC, Kawashima T, Norose Y, Shimizu K, Takahashi H, Yano I, Sugita M.  BCG vaccine elicits both T-cell mediated and humoral immune responses directed  against mycobacterial lipid components. Vaccine. 2006 Jul 17;24(29-30):5700-7.

15238.  Amaral L, Viveiros M, Kristiansen JE. "Non-Antibiotics": alternative therapy for the management of MDRTB and MRSA in economically disadvantaged countries. Curr Drug Targets. 2006 Jul;7(7):887-91. Review.  

15239.  Deogaonkar M, De R, Sil K, Das S.  Pituitary tuberculosis presenting as pituitary apoplexy. Int J Infect Dis. 2006 Jul;10(4):338-9.

15240.  Cohen J. HIV/AIDS: Latin America & Caribbean. Brazil: free drugs does not equal quality care. Science. 2006 Jul 28;313(5786):486.

15241.  Cook PP, Maldonado RA, Yarnell CT, Holbert D.  Safety and completion rate of short-course therapy for treatment of latent tuberculosis infection. Clin Infect Dis. 2006 Aug 1;43(3):271-5.

15242.  Deogaonkar M, De R, Sil K, Das S.  Pituitary tuberculosis presenting as pituitary apoplexy. Int J Infect Dis. 2006 Jul;10(4):338-9.

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