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Biomedical subjects

J M Grange

Publications and source records attributed to J M Grange.

At least 19 recordsLinked to original sources
PubMed1992

Specificity of antibodies and tuberculin response after occupational exposure to tuberculosis.

Specific antibody levels and delayed-type hypersensitivity skin responses to antigens of Mycobacterium tuberculosis in 39 hospital staff who were heavily exposed to tuberculosis (TB) were compared with those in 36 factory employees from Indonesia. Antibody levels to the TB68 epitope of the 14-kDa antigen were significantly greater, while titers to the TB23 (19-kDa) and TB72 (38-kDa) epitopes and lipoarabinomannan (LAM) were lower in exposed than in nonexposed subjects (all P less than .02). The intensity of tuberculin responses correlated positively with anti-LAM and negatively with anti-19-kDa antibody levels. Possible reasons for the selective humoral response of chronically exposed healthy subjects to the 14-kDa antigen, but not to other antigens immunogenic in patients with tuberculosis, are discussed.

Antibodies, Bacterial↗
PubMed1992

Use of gene probes based on the insertion sequence IS986 to differentiate between BCG vaccine strains.

Gene probes derived from the insertion sequence IS986, which have previously been shown to differentiate isolates of Mycobacterium tuberculosis for epidemiological analysis, are also capable of distinguishing two groups of BCG vaccine strains. Most BCG strains have a single copy of IS986, at the same chromosomal site, while the Brazilian, Japanese and USSR strains have an additional copy at a different, common location. These results correlate with the results of previous antigenic analysis and may reflect a different clonal origin of the two groups of BCG strains.

BCG Vaccine↗
PubMed1992

Survey of mycobacteria isolated from urine and the genitourinary tract in south-east England from 1980 to 1989.

Between 1980 and 1989, the Public Health Laboratory Service Regional Tuberculosis Centre, Dulwich, received cultures of mycobacteria isolated from urine and the genitourinary tract of 1392 new patients: 803 isolates were members of the tuberculosis complex (753 M. tuberculosis, 45 M. bovis, 4 M. africanum) and 589 were various species of environmental mycobacteria. The incidence of the latter isolations varied by region and by year and, with 17 exceptions (13 from endometrial curettings, 2 from hydrocele fluid, 1 from a scrotal abscess and 1 from a kidney), all isolations of environmental mycobacteria were from urine; very few of them appeared to be clinically significant. Those that could be significant included 1 isolate from a kidney, 1 from a post-renal transplant patient and 4 from patients with AIDS, 3 of whom had disseminated mycobacterial disease. Reports of clinically significant isolations of environmental mycobacteria from the genitourinary tract are reviewed.

England↗
PubMed1992

Bacteriological survey of tuberculous lymphadenitis in southeast England, 1981-1989.

STUDY OBJECTIVE: The aim was to detect any changing trends in the nature and incidence of tuberculous lymphadenitis in southeast England and to determine whether there is any evidence for an increase in this disease that could be related to HIV infection. DESIGN: Mycobacteria isolated from patients with lymphadenitis in the years 1981 to 1989 were identified. Information was available on the age, sex, and ethnic origin of the patients and the anatomical site from which the mycobacterium was isolated. SETTING: The Public Health Laboratory Service Regional Tuberculosis Centre at Dulwich, which receives over 95% of mycobacteria isolated in southeast England. MAIN RESULTS: From 1980 to 1989, cultures were received from 1817 patients with mycobacterial lymphadenitis: 1677 were M tuberculosis, 25 M bovis, 21 M africanum, and 94 were other (environmental) species. In comparison with a survey conducted in the same region in 1973-80, the number of ethnic Indian subcontinent patients with lymphadenitis due to M tuberculosis had dropped by 30% and the number of European patients had dropped by 43% and showed a continuing decline and a shift towards an older age group. By contrast, there was a 20% increase in the number of cases due to environmental mycobacteria. The number of species causing such infections had increased and a greater proportion of patients were adults. Three patients infected by environmental mycobacteria were known to be HIV positive. CONCLUSIONS: The incidence of lymphadentis due to M tuberculosis is declining but cases due to environmental mycobacteria are increasing, with a greater diversity of species and more adult patients. There is no conclusive evidence for an impact of HIV infection on the incidence and nature of mycobacterial lymphadenopathy in southeast England, but this cannot be ruled out.

Adolescent↗
PubMed1992

Cold fingers in leprosy.

Under conditions of maximal thermoregulatory peripheral dilatation, most healthy subjects (both Indian and European) showed raised blood flow in the fingertips (measured by laser Doppler flowmetry) where the skin temperature is only slightly lower than the core body temperature. Most borderline lepromatous (BL) leprosy patients had much colder fingers and the blood flow was slow: borderline tuberculoid (BT) patients had skin temperatures similar to those seen in healthy subjects, but their fingertip blood flow was reduced relative to that in control subjects. The occurrence of cold fingers and slow blood flow was clearly associated with evidence of sensory impairment to light touch, pressure and temperature. Slower fingertip blood flow was strongly associated with impairment of vasomotor control in this anatomical region, suggesting that both may be a consequence of leprosy peripheral neuropathy, at least in patients with early leprosy, but it is likely that leprosy arteriopathy may contribute to the lowered peripheral perfusion in advanced cases. It is suggested that the simple clinical sign of cold fingers may be of value in the preliminary assessment of patients presenting at any leprosy control clinic in the tropics.

Adult↗
PubMed1992

Mycobacterial infections following heart valve replacement.

Mycobacterial infection is an uncommon but very serious complication of heart valve replacement and other forms of cardiac surgery. Tuberculosis has been a rare complication of valve replacement in the industrially developed countries owing to the low incidence of that disease in such countries. Most reported cases are associated with the insertion of human allograft valves. Valvular tuberculosis could become a more serious problem if heart valve replacement surgery is used to any extent in countries where tuberculosis is common. The majority of other mycobacterial infections occurring after heart surgery have, for unknown reasons, been due to the rapid growers M. chelonae and M. fortuitum. Porcine xenograft valves have been contaminated by M. chelonae, possibly during manufacture as this is not a natural pathogen of pigs. A minority of patients receiving valves known to be contaminated by M. chelonae subsequently developed valve disease. Mycobacterial disease following insertion of mechanical valves is a very uncommon occurrence but the prognosis is poor. There have been several outbreaks of infection of the sternotomy wound by M. chelonae and M. fortuitum and, although the prognosis is better than for mycobacterial endocarditis, treatment, especially for infections due to M. chelonae, often involves extensive debridement including removal of the entire sternum. In view of the poor response to therapy, prevention by avoidance of contamination of all surgical materials, including implanted valves, by environmental mycobacteria is of paramount importance.

Heart Valve Prosthesis↗
PubMed1992

Measurements of blood flow and histometry of the cellular infiltrate in tuberculin skin test responses of the typical Koch type and the non-turgid variant form (Listeria-type) in pulmonary tuberculosis patients and apparently healthy controls.

The typical turgid Koch type and the non-turgid variant form (Listeria-type) of the tuberculin skin test responses were studied in 76 newly diagnosed pulmonary tuberculosis patients and 29 apparently healthy factory worker controls from Surabaya in Indonesia; in general, the patients had more intense responses than the controls. The blood flow velocity (RBCflux) at the centre of the reaction was similar in all groups, but central relative slowing (a presumed forme fruste of severe ischaemia) was much more common in the Koch-type reactions in tuberculosis patients. In both groups of subjects, the overall density of cellular infiltrate (and the major populations of inflammatory cells) was greater in the typical Koch-type reactions than in the non-turgid variant reactions. Thus the Koch-type reactions were indubitably more intense in inflammatory terms than the non-turgid variant form, but the results of this study do not exclude the possibility that there were underlying qualitative differences in pathogenesis between reactions of the two types as well as the obvious difference in severity.

Adult↗
PubMed1991

Is Africa lost?

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Early delayed hypersensitivity responses in tuberculin skin tests after heavy occupational exposure to tuberculosis.

The early (six hours) reaction to tuberculin skin testing was studied in 33 Indonesian hospital workers with frequent occupational exposure to M tuberculosis and compared with responses maximal at the usual time (48 hours) in factory workers, from the same locality but with only occasional occupational exposure, to determine the nature of the early reaction. The early reaction had the same general histopathological appearance as that seen in the conventional (48 hour) reaction, and both had an infiltrate consisting largely of T lymphocytes and macrophages. The cell densities were lower in the six hour reactions, but the relative concentration of macrophages was greater in the earlier response. These histometric measurements suggested that the six hour reaction was an accelerated delayed hypersensitivity reaction. Moreover, the absence of a specific IgE response or of particulate masses of Ig or complement, made it unlikely an anaphylactoid or Arthus-type reaction could have been responsible. It is concluded that those with frequent occupational exposure to M tuberculosis have larger numbers of circulating T cells reactive with mycobacterial antigens, so that the development of the skin test response to tuberculin is less dependent on "by-stander" cell infiltration to mediate the delayed hypersensitivity reaction than the reactions in those with less intense and less frequent natural exposure. The skin test response maximal at six hours is probably a hyperimmune reaction to an antigen recognised by T cells.

Adult↗
PubMed1991

Impairment of vasomotor reflexes in the fingertips of leprosy patients.

A method is described for eliciting fingertip vasomotor reflexes by inspiratory gasp and contralateral hand cold challenge. The results of the two tests are reproducible on replicate testing and, when taken together, have proved reliable for detection of impairment of autonomic reflexes in 10 newly registered leprosy patients who did not have any obvious deformity. Similar, but less severe, impairment of vasomotor reflexes was noted in a group of 10 fully treated, apparently cured ex-leprosy patients, none of whom showed clinically obvious neuropathy. Both the new patients and the ex-patients were significantly different from healthy contacts and from healthy Europeans, who were indistinguishable by this test. Evidence is presented suggesting that impairment of these vasomotor reflexes is mainly due to damage to the efferent pathway in the peripheral nerves. The method might prove valuable for investigation of early nerve damage in new patients or during reversal reactions in leprosy at a stage before irreversible damage is done.

Adult↗
PubMed1991

Impairment of fingertip vasomotor reflexes in leprosy patients and apparently healthy contacts.

Fingertip blood-flow velocity and its control by vasomotor reflexes were studied in leprosy patients and in healthy controls with a laser Doppler flowmeter. In newly registered patients, the flow was significantly lower than in the healthy controls, and even lower values were recorded in the long-standing patients with lower limb ulcers and/or deformity. The newly registered patients showed substantially impaired vasomotor reflex responses in the fingertips to cold challenge of the opposite hand or deep inspiratory gasp. Low blood flow and impairment of vasomotor reflexes were more prominent in those leprosy patients who showed clinical evidence of neuropathy and/or histological evidence of reaction in a punch biopsy of leprosy skin lesions. This aspect of dysautonomia to cold challenge was particularly prominent in apparently healthy, fully treated ex-patients. There was an unexpectedly high prevalence of impairment of vasomotor reflexes in newly registered and apparently healthy, adequately treated leprosy patients. The method is very sensitive, and it remains to be established whether the lesions it detects are nonprogressive residues, or previous nerve damage, or an indication of on-going nerve damage. A minority of leprosy contacts showed impairment of vasomotor reflexes. Those with two or more affected fingers were more likely to have had a higher level of exposure to Mycobacterium leprae than those with one or no affected fingers. The cause of this unexpected impairment of fingertip vasomotor reflexes in a minority of leprosy control workers has not yet been determined.

Adolescent↗