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Cluster of tuberculosis cases in North Carolina: Possible association with atomizer reuse

AMERICAN JOURNAL OF INFECTION CONTROL 2001年第1期29卷 1-6页

作者： Southwick, KL Hoffmann, K Ferree, K Matthews, J Salfinger, A N Carolina Dept Hlth & Human Serv Gen Commun Dis Control Sect Atlanta GA USA Ctr Dis Control & Prevent Epidemiol Program Off Atlanta GA USA Univ N Carolina Sch Med Chapel Hill NC USA Moore Reg Hosp Pinehurst NC USA New York State Dept Hlth Wadsworth Ctr Albany NY USA

Background: Three patients with identical strains of M tuberculosis (TB) underwent bronchoscopy on the same day at hospital A. Methods: We reviewed each patient's clinical history, hospital A's infection control practices for bronchoscopies, and specimen and isolate handling at each of 3 laboratories involved. We searched for possible community links between patients. Restriction fragment length polymorphism was performed on TB isolates. Results: The first patient who underwent bronchoscopy had biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the third patient 6 weeks after the bronchoscopy produced an isolate with an identical restriction fragment length polymorphism pattern to isolates collected during the bronchoscopies. No evidence existed for community transmission or laboratory contamination;the only common link was the bronchoscopy. Different bronchoscopes were used for each patient. Hospital ventilation and wall-suctioning were functioning well. Respiratory technicians reported sometimes reusing the nozzles of atomizers on more than one patient. A possible mechanism for transmission was contamination from the first patient of the atomizer ii it was used to apply lidocaine to the pharynx and nasal passages of other patients. Conclusions: A contaminated atomizer may have caused TB transmission during bronchoscopy. Hospital A changed to single-use atomizers after this investigation.

关键词：支气管镜/微生物学支气管镜检查交叉感染/流行病学交叉感染/微生物学交叉感染/传播疾病暴发流行设备污染设备重复使用感染控制分枝杆菌结核/遗传学分枝杆菌结核/分离和提纯雾化器和汽化器/微生物学北卡罗来纳/流行病学多态性限制性片段长度痰/微生物学结核/流行病学结核/微生物学结核/传播老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Contamination of bronchoscopes with Mycobacterium tuberculosis and successful sterilization by low-temperature hydrogen peroxide plasma sterilization

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第5期29卷 306-311页

作者： Bär, W de Bär, GM Naumann, A Rüsch-Gerdes, S Carl Thiem Clin Inst Med Microbiol D-03048 Cottbus Germany Forschungszentrum Borstel Natl Reference Ctr Mycobacteria Borstel Germany

Background. The transmission of mycobacteria by bronchoscopes has been reported several times in the last years. To explore methods to prevent transmission of tuberculosis in this way, we sterilized contaminated bronchoscopes with tow-temperature hydrogen peroxide gas plasma sterilization. Methods: Bronchoscopes were contaminated with Mycobacterium tuberculosis and decontaminated with a washer/disinfector ("normal washing"). Some were additionally disinfected with glutaraldehyde ("intensive washing"). Afterward the bronchoscopes were sterilized by low-temperature hydrogen peroxide plasma sterilization. Results: After normal washing, 8/17 samples had positive results by culture, and 7/17 had positive results by nucleic acid amplification technique. After intensive washing, all samples had negative results by culture, and 10/25 had positive results by nucleic acid amplification technique;after sterilization with low-temperature hydrogen peroxide plasma, sterilization, all samples had negative results by culture and nucleic acid amplification technique. Conclusion: Washing of bronchoscopes, as performed normally, is not sufficient for decontamination of bronchoscopes. Additional disinfection is recommended. If the nucleic acid amplification technique is used for diagnostic procedures, sterilization by low-temperature hydrogen peroxide plasma sterilization is recommended to avoid false-positive results.

关键词：抗感染药局部支气管镜/微生物学设备污染过氧化氢分枝杆菌结核/分离和提纯灭菌/方法人类

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Molecular fingerprinting of Mycobacterium tuberculosis strains isolated in Vietnam using IS6110 as probe

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TUBERCLE AND LUNG DISEASE 2000年第2期80卷 75-83页

作者： Tuyen, LTK Hoa, BK Ly, HM Van, L Lan, NTN Chevrier, D Guesdon, JL Inst Pasteur Lab Predev Sondes F-75724 Paris 15 France Natl Inst Hyg & Epidemiol Hanoi Vietnam Natl Inst TB & Pulm Dis Hanoi Vietnam Pham Ngoc Thach Hosp Ho Chi Minh City Vietnam Inst Pasteur Paris France

Setting: Northern and Southern areas of Vietnam. Objective: To study 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. Methods: Comparison of restriction fragment length polymorphism (RFLP) patterns produced by Southern hybridization of PvuII-digested chromosomal DNA. Results: The number of IS6110 copies for the 168 strains ranges from 0 to 23. Strains originating from the North or the South differ strongly with respect to the number of copies of IS6110. Indeed, the strains originating from the north have predominantly from 3 to 14 IS6110 copies while the southern strains have predominantly from 15 to 23 IS6110 copies. Furthermore, strains isolated in the North are dispersed into 6 groups whereas 80% of the strains isolated in the South form a single group. Moreover, the prevalence of drug resistance is higher in strains isolated in the South than in the North. No noticeable correlation is observed between RFLP patterns, drug susceptibility, or HIV infection. Conclusion: The IS6110 fingerprints of 168 M. tuberculosis strains isolated in Vietnam showed a high range of polymorphism. Only a few strains have been found with no IS6110 (1.8%). The differences between the strains from the North and South, having more than six IS6110, suggests that they derived from ancestral strains that would be distinguishable by the number of IS6110 and their transposition sites throughout the genome. The genomic structure of the population of strains from South Vietnam resembles that of the Beijing strain population. This could account for a similar evolution of M. tuberculosis due to a selection by BCG-induced immunity in the two populations. (C) 2000 Harcourt Publishers Ltd.

关键词：卡介苗印迹法 DNA 共病现象 DNA指纹法/方法基因组细菌 HIV感染/流行病学微生物敏感性试验分枝杆菌结核/遗传学分枝杆菌结核/分离和提纯多态性限制性片段长度结核/流行病学结核/预防和控制越南/流行病学人类

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Immunologic diagnosis of tuberculosis: a review

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TUBERCLE AND LUNG DISEASE 2000年第3期80卷 131-140页

作者： Chan, ED Heifets, L Iseman, RD Natl Jewish Med & Res Ctr Denver CO 80206 USA Univ Colorado Hlth Sci Ctr Div Pulm Sci & Crit Care Med Denver CO USA

The diagnosis of tuberculosis (TB) principally rests on the sputum examination and culture. However, the sensitivity of sputum smear for acid-fast bacteria is only similar to 50% and sputum culture has a relatively long turnaround time. As a result, a number of studies have been conducted in an attempt to find a rapid and accurate diagnostic test for TB. They include serological assays against various mycobacterial antigens. Here we review the merits and deficiencies of the serological tests for TB. In general, serological assays have a high negative predictive value, making them potentially useful as a screening test to rule out active TB although in HIV-positive individuals, low sensitivity and low negative predictive value compromises the accuracy of the seroassays in this group of individuals. In populations where the prevalence of latent TB infection is high, the relatively low positive predictive value of the tests reduces their specificity for active TB. Furthermore, the higher costs and greater training required in performing these tests makes it important that future studies also assess whether their use affects patient outcomes in management of TB. (C) 2000 Harcourt Publishers Ltd.

关键词：艾滋病相关机会致病菌感染/诊断艾滋病相关机会致病菌感染/免疫学分枝杆菌结核/免疫学分枝杆菌结核/分离和提纯试验预期值敏感性与特异性血清学试验痰/微生物学时间因素结核肺/诊断结核肺/免疫学人类

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TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test

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TUBERCLE AND LUNG DISEASE 2000年第4-5期80卷 191-196页

作者： Bonington, A Strang, JIG Klapper, PE Hood, SV Parish, A Swift, PJ Damba, J Stevens, H Sawyer, L Potgieter, G Bailey, A Wilkins, EGL N Manchester Gen Hosp Dept Infect Dis Monsall Unit N Manchester England Cecilia Makiwane Hosp Mdantsane Eastern Cape South Africa Manchester Royal Infirm Dept Clin Virol Manchester M13 9WL Lancs England

Setting: Cecilia Makiwane Hospital, Mdantsane, Eastern Cape, Republic of South Africa. Objective: To assess the role of the semi-automated Roche COBAS AMPLICOR(TM) Mycobacterium tuberculosis PCR test in the diagnosis of tuberculous meningitis (TBM). Design: Eighty-three specimens of cerebrospinal fluid (CSF) were collected prospectively from 69 patients with suspected TBM. The COBAS AMPLICOR TB PCR test was compared with the manual AMPLICOR(TM) TB PCR test, clinical and cerebrospinal fluid (CSF) findings, direct ZN smear and radiometric TB culture. Results: CSF from 7/40 (17.5%) patients treated for TBM were positive by TB COBAS AMPLICOR(TM). The sensitivity of the test was not significantly different (p = 0.375) from the manual TB AMPLICOR(TM) PCR test. The comparative sensitivities of the TB COBAS AMPLICOR(TM) PCR and the manual AMPLICOR PCR for detecting cases of definite and probable TBM from CSF collected within 9 days of commencing antituberculosis treatment were 40% and 60% respectively. All 29 patients not treated for TBM were negative by COBAS AMPLICOR(TM), giving a specificity of 100%. Conclusion: The COBAS AMPLICOR(TM) TB PCR test is a rapid and highly specific diagnostic test for TBM. However, there was a non-significant trend favouring slightly greater sensitivity using the manual AMPLICOR(TM) TB PCR test. (C) 2000 Harcourt Publishers Ltd.

关键词：评价研究 HIV血清阳性/并发症 HIV-1/分离和提纯分枝杆菌结核/分离和提纯聚合酶链反应/仪器和设备试验预期值前瞻性研究试剂盒诊断敏感性与特异性结核脑膜/脑脊髓液结核脑膜/并发症结核脑膜/诊断青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Comparative analysis of mycobacterial infections in susceptible I/St and resistant A/Sn inbred mice

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TUBERCLE AND LUNG DISEASE 2000年第1期80卷 15-25页

作者： Nikonenko, BV Averbakh, MM Lavebratt, C Schurr, E Apt, AS Cent Inst TB Dept Immunol Moscow 107564 Russia Montreal Gen Hosp McGill Ctr Study Host Resistance Montreal PQ H3G 1A4 Canada

Setting: The availability and appropriate use of animal models is of significant importance for a better and more detailed understanding of the genetic, immunological and pathological mechanisms underlying the development of mycobacterial disease in humans. Objective: To define a mouse model for tuberculosis severity that can be easily adapted to genetic and immunological analysis of host repsonse to Mycobacterium tuberculosis infection. Design: We describe here two inbred strains of mice, I/St and A/Sn (both Nramp1'), that differ vastly in commonly used parameters of susceptibility to infection with virulent and attenuated strains of M. tuberculosis. Results: Following infection with a high dose of virulent H37Rv. nn. tuberculosis and compared to their resistant A/Sn counterparts, I/St mice displayed more than a 2-fold shorter mean survival time and a more rapid onset and progression of severe body weight loss (cachexia). Moreover, I/St mice supported 20-100-fold higher multiplication of M. tuberculosis following challenge with H37Rv over a large range of infectious inocula. The high susceptibility of I/St mice was also reflected by more severe lung histopathology as evidenced by larger and more numerous lung granuloma and macrophage dominated cellular infiltrates. Finally, we determined that I/St are also unable to control infection with attenuated H37Ra M. tuberculosis and two strains of M. bovis (BCG and Ravenel) indicating hyper-susceptibility of the I/St mouse strain to mycobacterial infections. Conclusions: The results of our experiments suggest that comparative analysis of resistant A/Sn and susceptible I/St mice provides an ideal way to study host dependent aspects of tuberculosis susceptibility under the controlled conditions provided by an animal model. (C) 2000 Harcourt Publishers Ltd.

关键词：恶病质/遗传学恶病质/免疫学集落计数微生物疾病遗传易感性免疫天然/遗传学免疫天然/免疫学免疫天然/生理学肺/微生物学小鼠近交A/遗传学小鼠近交A/免疫学分枝杆菌结核/分离和提纯疾病严重程度指数性别因素脾/微生物学结核/遗传学结核/免疫学结核/微生物学动物女(雌)性男(雄)性小鼠

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Efficacy of amplicor PCR for the diagnosis of tuberculosis in respiratory specimens other than sputum

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TUBERCLE AND LUNG DISEASE 2000年第4-5期80卷 209-215页

作者： Shibuya, Y Shiozaki, T Hayashi, M Sugiyama, Y Jichi Med Sch Dept Pulm Med Minami Kawachi Tochigi 3290498 Japan Jichi Med Sch Dept Clin Pathol Minami Kawachi Tochigi 3290498 Japan

A total of 832 respiratory specimens not including the sputum (402 bronchial lavages, 241 bronchial brushing specimens, 136 pumping lavages, 41 pleural effusions, and 12 others) from 462 patients were assayed using the Roche Amplicor Mycobacterium tuberculosis test for amplification and identification of M. tuberculosis, M. avium and M. intracellulare (Amplicor PCR). The results were compared with those obtained using conventional microscopy and cultivation methods. Each patient had little or no sputum and showed an abnormal chest X-ray shadowing of unknown cause. No patients had previously undergone antituberculous therapy. Of the specimens obtained, 24 were both PCR and culture positive, 786 were both PCR and culture negative, 11 were PCR positive and culture negative, and 11 were PCR negative and culture positive. Based on these results, the sensitivity and specificity of Amplicor PCR were determined to be 68.67% and 98.6%, respectively, when compared with culture of respiratory specimens not including the sputum. After correcting for discrepancies due to differences in patient clinical data, the sensitivity of Amplicor PCR was found to be 68.6%, and the specificity to be 99.9%;the corresponding values for culture were 66.7% and 100%, and those for smear were 9.8% and 100%. Thus, Amplicor PCR was shown to possess a similar sensitivity to culture and to be a highly specific technique for the diagnosis of tuberculosis in the respiratory system using non-sputum specimens within hours in patients showing little or no sputum and abnormal chest X-ray shadowing of an indeterminant cause. (C) 2000 Harcourt Publishers Ltd.

关键词：支气管肺泡灌洗液/微生物学渗出液和滤出液/微生物学分枝杆菌鸟/分离和提纯分枝杆菌鸟复合/分离和提纯分枝杆菌结核/分离和提纯聚合酶链反应敏感性与特异性结核肺/诊断成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Immunization with f-Met peptides induces immune reactivity against Mycobacterium tuberculosis

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TUBERCLE AND LUNG DISEASE 2000年第1期80卷 5-13页

作者： Dow, SW Roberts, A Vyas, J Rodgers, J Rich, RR Orme, I Potter, TA Natl Jewish Ctr Immunol & Resp Med Dept Med Div Basic Immunol Denver CO 80206 USA Univ Colorado Hlth Sci Ctr Dept Immunol Denver CO USA Univ Colorado Hlth Sci Ctr Ctr Canc Denver CO USA

Objective: To determine whether synthetic peptides containing an amino terminal formyl-methionine residue and corresponding to the sequence of several proteins produced by Mycobacterium tuberculosis, would elicit an immune response in mice. Design: Peptides corresponding to the amino termini of 8 M. tuberculosis proteins and initiating with formyl methionine residues were synthesized. The ability of these peptides to bind to the mouse non-classical MHC class I molecule H-2M3(a) was determined by flow microfluorimetry. These peptides were used to pulse dendritic cells that were then injected into normal mice. These mice were subsequently challenged with aerosolized M. tuberculosis and, 30 days later, the number of viable bacteria in the lungs was determined. Results: Four of the 8 synthetic peptides bound to H-2M3a and stabilized its expression on the cell surface. Injection of mice with dendritic cells pulsed with H-2M3(a) binding peptides elicited non-MHC restricted cytotoxic T lymphocytes that killed peptide pulsed target cells and macrophages infected with M. tuberculosis. Immunization of mice with syngeneic dendritic cells pulsed in vitro with 2 of these peptides led to retardation of the growth of M, tuberculosis following aerosol challenge, Conclusion: Peptides that bind to non-polymorphic class I molecules can elicit immune reactivity directed towards M. tuberculosis, (C) 2000 Harcourt Publishers Ltd.

关键词：细菌菌苗/免疫学结合竞争性/免疫学集落计数微生物树突细胞/免疫学流式细胞术组织相容性抗原Ⅰ类/免疫学免疫细胞免疫法小鼠近交C57BL 分枝杆菌结核/免疫学分枝杆菌结核/分离和提纯 N-甲酰甲硫氨酸/免疫学 T淋巴细胞细胞毒性/免疫学疫苗合成/免疫学动物小鼠

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Taming tuberculosis - again

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NATURE STRUCTURAL BIOLOGY 2000年第2期7卷 87-88页

作者： [Anonymous]

Studies the x-ray crystal structure of the mycobacterium tuberculosis antigen 85c protein and its role in a late step of cell wall synthesis. History of tuberculosis; Details on tuberculosis infection; Resurgence of t... 详细信息

关键词：酰基转移酶类抗原细菌/化学抗原细菌/遗传学抗结核药/治疗应用细菌菌苗抗药性微生物分枝杆菌结核/分离和提纯结核/诊断结核/药物疗法结核/流行病学世界卫生人类

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First symptom of multifocal skeletal tuberculosis in children

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第5期38卷 572-573页

作者： Hata, T Hosoda, M Kawasaki Med Sch Dept Oral Surg Kurashiki Okayama 7010192 Japan

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