TUBERCULOSIS

Selected abstracts:

1.                  Adetifa IM, Brookes R, Lugos MD, de Jong BC, Antonio M, Adegbola RA, Hill PC.   Rising ELISPOT count prior to the onset of symptoms of full-blown tuberculosis disease. Int J Tuberc Lung Dis. 2007 Mar;11(3):350-2.  
Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia. iadetifa@mrc.gm
The relationship between the T-cell response to mycobacterial antigens and the likelihood of progression to disease has not been defined. We report a rapidly rising ELISPOT count in a 55-year-old man with evidence of Mycobacterium tuberculosis infection prior to the onset of symptoms of disease. This case illustrates the possible utility of quantitative changes in the ELISPOT count in predicting progression from M. tuberculosis infection to disease.

2.                 Gopi A, Madhavan SM, Sharma SK, Sahn SA.  Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007 Mar;131(3):880-9.
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Jonathan Lucas St, Suite 812-CSB, PO Box 250360, Charleston, SC 29426, USA.
Tuberculous (TB) pleural effusion occurs in approximately 5% of patients with Mycobacterium tuberculosis infection. The HIV pandemic has been associated with a doubling of the incidence of extrapulmonary TB, which has resulted in increased recognition of TB pleural effusions even in developed nations. Recent studies have provided insights into the immunopathogenesis of pleural TB, including memory T-cell homing and chemokine activation. The definitive diagnosis of TB pleural effusions depends on the demonstration of acid-fast bacilli in the sputum, pleural fluid, or pleural biopsy specimens. The diagnosis can be established in a majority of patients from the clinical features, pleural fluid examination, including cytology, biochemistry, and bacteriology, and pleural biopsy. Measurement of adenosine deaminase and interferon-gamma in the pleural fluid and polymerase chain reaction for M tuberculosis has gained wide acceptance in the diagnosis of TB pleural effusions. Although promising, these tests require further evaluation before their routine use can be recommended. The treatment of TB pleural effusions in patients with HIV/AIDS is essentially similar to that in HIV-negative patients. At present, evidence regarding the use of corticosteroids in the treatment of TB pleural effusion is not clear-cut.

3.                Huang Q, Tonge PJ, Slayden RA, Kirikae T, Ojima I.  FtsZ: a novel target for tuberculosis drug discovery. Curr Top Med Chem. 2007;7(5):527-43. Review. 
Department of Chemistry, State University of New York at Stony Brook, Stony Brook, New York, 11794-3400, USA.
The emergence of multi-drug resistant Mycobacterium tuberculosis (Mtb) strains has made many of the currently available anti-TB drugs ineffective. Accordingly there is a pressing need to identify new drug targets. FtsZ, a bacterial tubulin homologue, is an essential cell division protein that polymerizes in a GTP-dependent manner, forming a highly dynamic cytokinetic ring, designated as the Z ring, at the septum site. Following recruitment of other cell division proteins, the Z ring contracts, resulting in closure of the septum and then formation of two daughter cells. Since inactivation of FtsZ or alteration of FtsZ assembly results in the inhibition of Z ring and septum formation, FtsZ is a very promising target for new antimicrobial drug development. This review describes the function and dynamic behaviors of FtsZ, its homology to tubulin, and recent development of FtsZ inhibitors as potential anti-TB agents.

4.                  Kalita J, Misra UK, Ranjan P. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol. 2007 Jan;14(1):33-7.
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. jkalita@sgpgi.ac.in
There is paucity of studies on predictors of long-term sequelae of tuberculous meningitis (TBM). We report the neurological sequelae of TBM at 1 year and their predictors. Patients with TBM who were followed up for 1 year were included. The diagnosis of TBM was based on clinical, cerebrospinal fluid (CSF) and computed tomography (CT) scan findings. Detailed neurological examinations at admission and at 1 year were carried out. All the patients received four-drug antitubercular therapy. The frequency of sequelae at 1 year were noted and the role of various demographic (age, sex, duration of illness, BCG vaccination), clinical (weakness, seizure, extra central nervous system tuberculosis, Glasgow Coma Scale (GCS) score, cranial nerve palsy, stage, corticosteroid, drug-induced hepatitis, shunt surgery), and laboratory findings (erythrocyte sedimentation rate (ESR), CSF cell and protein, CT scan evidences of hydrocephalus, basal exudates, infarctions and tuberculoma) at presentation were evaluated employing logistic regression analysis. Sixty-five patients with TBM were included in this study whose age ranged between 13 and 80 years (mean 33.2), 27 of whom were females. Complete neurological recovery at 1 year occurred in 21.5% patients only although about 50% were independent for activities of daily living. Neurological sequelae were observed in 78.5% patients, which included cognitive impairment in 55%, motor deficit in 40%, optic atrophy in 37% and other cranial nerve palsy in 23%. On logistic regression analysis, focal motor deficit at admission was the most important predictor of neurologic deficits at 1 year. GCS score predicted the cognitive and motor sequelae. Neurological sequelae at year occurred in 78.5% patients with TBM in the form of cognitive impairment, motor deficit and optic atrophy. Sequelae were common in patients who had focal motor deficit and altered sensorium at admission.

5.                  Vashisht P, Sahoo B, Khurana N, Reddy BS. Cutaneous tuberculosis in children and adolescents: a clinicohistological study. J Eur Acad Dermatol Venereol. 2007 Jan;21(1):40-7.  
Department of Dermatology, Maulana Azad Medical College, New Delhi, India. drpriyankavashisht@yahoo.co.in
BACKGROUND AND OBJECTIVES: Resurgence of tuberculosis (TB) in the era of human immunodeficiency virus (HIV) has rejuvenated the interest in this global health problem. Cutaneous TB, an important extra-pulmonary form in children, is commonly seen in our dermatological practice. As detection of acid-fast bacillus (AFB) on smear or culture is not always positive, histopathology is necessary to help in diagnosing and classifying the variants of skin TB. The current study was conducted to analyse the clinicopathological characteristics of cutaneous TB in children and adolescents. MATERIALS AND METHODS: This prospective study included 103 patients (age<19 years). A detailed history and clinical examination was followed by complete investigative work up including fine needle aspiration cytology and culture. Histopathological evaluation was performed specifically noting the epidermal and dermal features. The patients were followed up regularly for one year after the start of treatment. RESULTS: The different patterns of cutaneous TB seen were, scrofuloderma 38 (36.9%), lichen scrofulosorum 34 (33%), lupus vulgaris 22 (21.3%), TB verrucosa cutis 4 (3.9%), papulonecrotic tuberculid 4 (3.9%) and erythema nodosum 3 (2.9%). Systemic associations were seen in 55 (53.4%) patients, namely TB lymphadenitis in 30 (29.2%), pulmonary TB in 13 (12.6%), abdominal TB in 6 (5.8%) and TB arthritis in 6 (5.8%). The histopathological corroboration of clinical diagnosis was seen in 65.7% of cases of scrofulodermas, 72.7% of cases of lupus vulgaris and 67.6% of cases of lichen scrofulosorum. CONCLUSIONS: A large spectrum of clinical patterns and histological characteristics of cutaneous TB exists in children. Lichen scrofulosorum is more commonly seen in comparison to adults. Systemic involvement was a feature in a major proportion of our patients.

6.                  Sander C, McShane H.  Translational mini-review series on vaccines: Development and evaluation of improved vaccines against tuberculosis. Clin Exp Immunol. 2007 Mar;147(3):401-11. Review. 
University of Oxford, CCVTM, Churchill Hospital, Oxford, UK.
clare.sander@ndm.ox.ac.uk
Tuberculosis (TB) continues to be a major global health disaster, despite the widespread use of BCG and effective drug therapies. The development of an efficacious new TB vaccine would be an important component of disease control in the future. Many approaches are being utilised to enhance understanding of the requirements of a successful vaccine. Numerous vaccines are being designed and assessed in a series of animal models, with a few progressing to clinical trials. Here, the steps involved in the development and evaluation of TB vaccines will be discussed, including description of the most frequently used animal models and the processes involved in advancing vaccines to phase III trials.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

16065.  Ahualli J. Regarding "case 90: disseminated tuberculosis". Radiology. 2007 Jan;242(1):318; author reply 319. 

16066.  Arora A : Basic science of host immunity in osteoarticular tuberculosis-A clinical study. Indian J Orthop 2006, 40(1), 1-15.

16067.  Chen SC, Chang WC, Lin YY, Wu CP, Tsai SH.  How deep a superficial gravity abscess? Intern Med J. 2007 Jan;37(1):64-5.

16068.  Chiu HH, Li JH, Lin JC, Liu YW, Jao YT. Coexistence of a tuberculous bronchoesophageal fistula and intracranial tuberculosis in an immunocompetent patient. South Med J. 2007 Feb;100(2):225-6.

16069.  Cruz AT, Starke JR.  Unsuspected central nervous system lesions in a small child. Pediatr Infect Dis J. 2007 Jan;26(1):91, 94-5.

16070.  Das AK, Banerjee S, Kumar S, Reddy MVR, Harinath BC.  Immunoscreening of clinically suspected pulmonary and extrapulmonary tuberculosis cases using ES-31 and ES-41 antigens – hospital case study.  The Indian Practitioner, December 2006; 59(12):801-804.

16071.  Demir MK.  Diagnosis please comment. Radiology. 2007 Jan;242(1):319; author reply 319.

16072.  Douthwaite S, Yassin MA, Squire SB, Arbide I, Cuevas LE.  Bleach-digested sputum smears for the diagnosis of TB in HIV-infected individuals. Trop Doct. 2007 Jan;37(1):35-6.  

16073.  Durrheim DN, Hensley MJ. Should medical students be routinely offered BCG vaccination? Med J Aust. 2007 Jan 15;186(2):98-9.

16074.  Edwards DJ, Kitetele F, Van Rie A.  Agreement between clinical scoring systems used for the diagnosis of pediatric tuberculosis in the HIV era. Int J Tuberc Lung Dis. 2007 Mar;11(3):263-9. 

16075.  Elgouhari HM, Kellie SM.  A cautionary tale. Am J Med. 2007 Mar;120(3):225-8.

16076.  Elston DM.  Advances in the diagnosis and therapy of mycobacterial disease. Cutis. 2007 Jan;79(1):17-9.

16077.  Fujita J, Higa F, Tateyama M.  Radiological findings of mycobacterial diseases. J Infect Chemother. 2007 Feb;13(1):8-17.

16078. Gupta S, Shende N, Bhatia AS, Kumar S and Harinath BC. IgG subclass antibody response to mycobacterial serine protease at different stages of pulmonary tuberculosis. Med Sci Monit, 2005;11(2): CR585-588.

16079.  Hesseling AC, Gie RP.  Scoring systems for the diagnosis of childhood tuberculosis: are we making progress?  Int J Tuberc Lung Dis. 2007 Mar;11(3):245.

16080. Higuchi K, Harada N, Mori T, Sekiya Y.  Use of QuantiFERON-TB Gold to investigate tuberculosis contacts in a high school. Respirology. 2007 Jan;12(1):88-92.

16081.  Lauten VA.  My TB story. S Afr Med J. 2007 Feb;97(2):103-4.

16082.  Lazarus AA, Thilagar B. Tuberculosis of pericardium, larynx, and other uncommon sites. Dis Mon. 2007 Jan;53(1):46-54.  Review.

16083.  Lazarus AA, Thilagar B.  Abdominal tuberculosis. Dis Mon. 2007 Jan;53(1):32-8. Review.

16084.  Lazarus AA, McKay S, Gilbert R.  Pleural tuberculosis. Dis Mon. 2007 Jan;53(1):16-21. Review.

16085.  Lazarus AA, Thilagar B.  Tuberculous lymphadenitis. Dis Mon. 2007 Jan;53(1):10-5. Review.

16086.  Mandal S, Jain S.  Purulent nipple discharge--a presenting manifestation in tuberculous  mastitis. Breast J. 2007 Mar-Apr;13(2):205.

16087.  Myers JN.  Miliary, central nervous system, and genitourinary tuberculosis. Dis Mon. 2007 Jan;53(1):22-31. Review.

16088.  Nelson KE, Hiransuthikul N, Hiransuthikul P. Diagnosis and treatment of latent tuberculosis. Int J Tuberc Lung Dis. 2007 Mar;11(3):353. 

16089.  Radhakrishnan V V: Diagnosis of tuberculous meningitis: newer approaches - suited to developing countries. Ann natn Acad med Sci India 2005, 41(1-2), 1-21.

16090.  Yew WW, Leung CC.  Update in tuberculosis 2006. Am J Respir Crit Care Med. 2007 Mar 15;175(6):541-6. Review.

Pathogenesis:

16091.  Sahiratmadja E, Alisjahbana B, de Boer T, Adnan I, Maya A, Danusantoso H, Nelwan RH, Marzuki S, van der Meer JW, van Crevel R, van de Vosse E, Ottenhoff TH.   Dynamic changes in pro- and anti-inflammatory cytokine profiles and gamma interferon receptor signaling integrity correlate with tuberculosis disease activity and response to curative treatment. Infect Immun. 2007 Feb;75(2):820-9.

16092.  Shende N, Upadhye V., Kumar S, Gangane N  and Harinath BC.  Study of M. tuberculosis ES - 31 and ES - 20 antigen levels in different pathogenic grades of lymph node tuberculosis.  The International Journal of Tuberculosis and Lung Disease, February 2007; 11(2): 222-226(5).

Vaccines:

16093.  Andersen P.  Vaccine strategies against latent tuberculosis infection. Trends Microbiol. 2007 Jan;15(1):7-13.

16094.  Brosch R, Gordon SV, Garnier T, Eiglmeier K, Frigui W, Valenti P, Dos Santos S, Duthoy S, Lacroix C, Garcia-Pelayo C, Inwald JK, Golby P, Garcia JN, Hewinson RG, Behr MA, Quail MA, Churcher C, Barrell BG, Parkhill J, Cole ST.  Genome plasticity of BCG and impact on vaccine efficacy. Proc Natl Acad Sci U S A. 2007 Mar 27;104(13):5596-601.

16095.  Cullen PA.  From Genomes to Protective Antigens--Designing Vaccines (GPADV 2006). Designing improved and novel vaccines in the future. 15-17 November 2006, Prague, Czech Republic. IDrugs. 2007 Feb;10(2):109-11.

16096.  Marris E.  A dozen vaccine candidates bring shot of hope to TB epidemic. Nat Med. 2007 Mar;13(3):274.

16097.  Mukherjee P, Dutta M, Datta P, Dasgupta A, Pradhan R, Pradhan M, Kundu M, Basu J, Chakrabarti P.  The RD1-encoded antigen Rv3872 of Mycobacterium tuberculosis as a potential candidate for serodiagnosis of tuberculosis. Clin Microbiol Infect. 2007 Feb;13(2):146-52. 

16098.  Sable SB, Kalra M, Verma I, Khuller GK.  Tuberculosis subunit vaccine design: the conflict of antigenicity and immunogenicity. Clin Immunol. 2007 Mar;122(3):239-51.

16099.  Sable SB, Plikaytis BB, Shinnick TM. Tuberculosis subunit vaccine development: impact of physicochemical properties  of mycobacterial test antigens. Vaccine. 2007 Feb 19;25(9):1553-66.

Chemotherapy, Immunotherapy, Management & Drugs: 

16100.  Cardona PJ.  New insights on the nature of latent tuberculosis infection and its treatment. Inflamm Allergy Drug Targets. 2007 Mar;6(1):27-39. Review. 

16101.  Coulter JB, Baretto RL, Mallucci CL, Romano MI, Abernethy LJ, Isherwood DM, Kumararatne DS, Lammas DA.  Tuberculous meningitis: protracted course and clinical response to interferon-gamma. Lancet Infect Dis. 2007 Mar;7(3):225-32. 

16102.  Greaves F, Ouyang H, Pefole M, MacCarthy S, Cash RA.  Compliance with DOTS diagnosis and treatment recommendations by private practitioners in Kerala, India. Int J Tuberc Lung Dis. 2007 Jan;11(1):110-2. 

16103.  Harrity S, Jackson M, Hoffman H, Catanzaro A.  The National Tuberculosis Curriculum Consortium: a model of multi-disciplinary educational collaboration. Int J Tuberc Lung Dis. 2007 Mar;11(3):270-4.

16104.  Laughon BE. New tuberculosis drugs in development. Curr Top Med Chem. 2007;7(5):463-73. Review.  

16105.  Martin A, Portaels F, Palomino JC.  Colorimetric redox-indicator methods for the rapid detection of multidrug resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis. J Antimicrob Chemother. 2007 Feb;59(2):175-83.

16106.  Matsumoto M, Hashizume H, Tsubouchi H, Sasaki H, Itotani M, Kuroda H, Tomishige T, Kawasaki M, Komatsu M.  Screening for novel antituberculosis agents that are effective against multidrug resistant tuberculosis. Curr Top Med Chem. 2007;7(5):499-507. Review. 

16107.  Mistry R, Cliff JM, Clayton CL, Beyers N, Mohamed YS, Wilson PA, Dockrell HM, Wallace DM, van Helden PD, Duncan K, Lukey PT.  Gene-expression patterns in whole blood identify subjects at risk for recurrent tuberculosis. J Infect Dis. 2007 Feb 1;195(3):357-65.

16108.  Parker WB, Long MC.  Purine metabolism in Mycobacterium tuberculosis as a target for drug development. Curr Pharm Des. 2007;13(6):599-608. Review. 

16109.  Rodrigues P, Gomes MG, Rebelo C.  Drug resistance in tuberculosis--a reinfection model. Theor Popul Biol. 2007 Mar;71(2):196-212.

16110.  Schwartz RA, Nervi SJ.  Erythema nodosum: a sign of systemic disease. Am Fam Physician. 2007 Mar 1;75(5):695-700. Review. 

16111.  Shingadia DV, Harry Baumer J.  Tuberculosis: diagnosis, management and prevention. Arch Dis Child Educ Pract Ed. 2007 Feb;92(1):ep27-9. Review.

16112.  Traore H, Ogwang S, Mallard K, Joloba ML, Mumbowa F, Narayan K, Kayes S, Jones-Lopez EC, Smith PG, Ellner JJ, Mugerwa RD, Eisenach KD, McNerney R.  Low-cost rapid detection of rifampicin resistant tuberculosis using bacteriophage in Kampala, Uganda. Ann Clin Microbiol Antimicrob. 2007 Jan 9;6:1. 

16113.  Wang Y, Collins C, Vergis M, Gerein N, Macq J.  HIV/AIDS and TB: contextual issues and policy choice in programme relationships. Trop Med Int Health. 2007 Feb;12(2):183-94. Review.