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Role of CD40 ligand in Mycobacterium avium infection.

Mycobacterium avium is a common opportunistic pathogen in immunocompromised patients such as those infected with human immunodeficiency virus. Although M. avium is an intracellular organism replicating predominantly in macrophages, disseminated M. avium infection is seen in AIDS patients with CD4(+) cell counts of <50 cells/microliters, suggesting a possible involvement of a T cell-macrophage interaction for the elimination of M. avium. To determine whether CD40-CD40 ligand (CD40L) interactions play a role in M. avium infection, we studied the ability of CD40L to restrict M. avium replication in human monocyte-derived macrophages (MDM) in vitro. MDM were infected with M. avium and cocultured with CD40L-transfected 293 cells for 7 days. Intracellular growth of M. avium in these MDM was assessed by colony counting. CD40L-expressing cells inhibited growth of M. avium in MDM by 86.5% +/- 4.2% compared to MDM cultured with control cells. These findings were verified by assays using purified, soluble recombinant human CD40L (CD40LT). CD40LT (5 micrograms/ml) inhibited intracellular growth of M. avium by 76.9% +/- 18.0% compared to cells treated with medium alone. Inhibition by CD40LT was reduced by monoclonal antibodies (MAbs) against CD40 and CD40L. The inhibitory effect of CD40LT was not accompanied by enhancement of interleukin-12 (IL-12) production by M. avium-infected MDM, while CD40L-expressing cells stimulated IL-12 production by these cells. Treatment of M. avium-infected mice with MAb against murine CD40L resulted in recovery of larger numbers of organisms (0.8 to 1.0 log) from the spleens, livers, and lungs of these animals compared to infected mice which received normal immunoglobulin G. These results indicate that CD40-CD40L signaling may be an important step in host immune response against M. avium infection.

Animals↗

Atypical mycobacterium infection with dermatological manifestation in a renal transplant recipient.

In April 1997, a 58-year-old renal transplant recipient presented with abscess-like nodules in his left calf and on his right foot. Furuncular disease was suspected and the patient was treated with flucloxacillin. However, the lesions increased in size and became ulcerative. In the following 3 months, cultures of punctuated material, blood, and urine remained negative and gram stains did not reveal micro-organisms. In June 1997, acid-fast stains were positive. A diagnosis of a nontuberculous mycobacterium (NTM) infection was made and empirical antimycobacterial therapy was started. The combination of relatively minor symptoms with enlarged purulent lesions, causing severe morbidity, raises the possibility of NTM infection in the immunocompromised patient.

Clarithromycin↗

Iatrogenic Mycobacterium infection after an epidural injection.

STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the mass and identification of the causative agent by histologic and microbiologic studies. SUMMARY OF BACKGROUND DATA: Spinal pain, caused by an infective mass, developed in a 39-year-old man 3 months after an epidural injection for low back pain. METHODS: Exploratory surgery was performed to remove the mass, and histologic and microbiologic studies were conducted. RESULTS: The inflammatory mass was excised successfully, and several specimens were examined for bacteriologic presence. Histologic examination of the excised specimen showed chronic granulomatous inflammation, and subsequent microbiologic studies cultured an acid- and alcohol-fast bacillus that was later identified as Mycobacterium fortuitum. CONCLUSION: A review of the literature shows that this is a particularly uncommon micro-organism.

Adult↗

The epidemiology of Mycobacterium bovis infections.

Mycobacterium bovis has an exceptionally wide host range, but until recent years there was little concern about infection in species other than cattle and man. Diversification of farming enterprises has led to cognizance of the need for control in other domestic animals, notably deer. There has also been recognition that self-maintaining infection is present in wildlife hosts in some countries--notably the European badger in the United Kingdom and Ireland, the Australian brush-tailed possum in New Zealand, and various species of ungulates in limited areas of a number of countries. Although transmission of M. bovis can occur by a number of different routes, control measures imposed on cattle and to a lesser extent on other species have reduced a number of the routes to insignificance. Hence the vast preponderance of transmission within host species is now by the airborne route, and predominantly between species as well. Transmission of infection from badgers to cattle may be an exception, with evidence remaining equivocal about the relative importance of pasture contamination by excretion in badger urine and airborne transmission. In general, contamination of feed and pasture appears to be unimportant in transmission of the disease, because survival times of infective doses of organisms on fomites are relatively short under realistic conditions and because animals are not commonly exposed to a dose high enough to be infective by the alimentary route. Infection through the oro-pharyngeal mucous membrane may be significant, although the infective dose for this route is not known. While many species of animals can become infected with M. bovis, only a few act as maintenance hosts and the rest are spillover hosts in which infection is not self-maintaining. With the exception of cattle and deer, other species have become maintenance hosts only within part of their ecological range. For both badgers and possums, maintenance of infection within a local population is due to pseudo-vertical transmission from mother to young, and horizontal transmission linked to breeding activity. Transmission from possums to domestic animals appears to occur mainly during atypical behavioural interactions between the species, and this may well be important for badgers as well. Difficulties in controlling the disease adequately in domestic animals generally result from administrative problems since the necessary technical procedures are available and have been shown to be effective. Where there is interplay between infection in wildlife and domestic animals, eradication of the disease becomes impractical.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Lessons from experimental Mycobacterium tuberculosis infections.

Mycobacterium tuberculosis is the cause of enormous human morbidity and mortality each year. Although this bacterium can infect and cause disease in many animals, humans are the natural host. For the purposes of studying the pathogenesis of M. tuberculosis, as well as the protective and immunopathologic host responses against this pathogen, suitable animal models must be used. However, modeling the human infection and disease in animals can be difficult, and interpreting the data from animal models must be done carefully. In this paper, the animal models of tuberculosis are discussed, as well as the limitations and advantages of various models. In particular, the lessons we have learned about tuberculosis from the mouse models are highlighted. The careful and thoughtful use of animal models is essential to furthering our understanding of M. tuberculosis, and this knowledge will enhance the discovery of improved treatment and prevention strategies.

Animals↗

Formulation and efficacy of liposome-encapsulated antibiotics for therapy of intracellular Mycobacterium avium infection.

Mycobacterium avium is an intracellular pathogen that can invade and multiply within macrophages of the reticuloendothelial system. Current therapy is not highly effective. Particulate drug carriers that are targeted to the reticuloendothelial system may provide a means to deliver antibiotics more efficiently to M. avium-infected cells. We investigated the formulation of the antibiotics ciprofloxacin and azithromycin in liposomes and tested their antibacterial activities in vitro against M. avium residing within J774, a murine macrophage-like cell line. A conventional passive-entrapment method yielded an encapsulation efficiency of 9% for ciprofloxacin and because of aggregation mediated by the cationic drug, was useful only with liposomes containing < or = 50 mol% negatively charged phospholipid. In contrast, ciprofloxacin was encapsulated with > 90% efficiency, regardless of the content of negatively charged lipids, by a remote-loading technique that utilized both pH and potential gradients to drive drug into preformed liposomes. Both the cellular accumulation and the antimycobacterial activity of ciprofloxacin increased in proportion to the liposome negative charge; the maximal enhancement of potency was 43-fold in liposomes of distearoylphosphatidylglycerol-cholesterol (DSPG-Chol) (10:5). Azithromycin liposomes were prepared as a freeze-dried preparation to avoid chemical instability during storage, and drug could be incorporated at 33 mol% (with respect to phospholipid). Azithromycin also showed enhanced antimycobacterial effect in liposomes, and the potency increased in parallel to the moles percent of negatively charged lipids; azithromycin in DSPG-Chol (10:5) liposomes inhibited intracellular M. avium growth 41-fold more effectively than did free azithromycin. Thus, ciprofloxacin or azithromycin encapsulated in stable liposomes having substantial negative surface charge is superior to nonencapsulated drug in inhibition of M.avium growth within cultured macrophages and may provide more effective therapy of M.avium infections.

Animals↗

Activation of ERK1/2 and TNF-alpha production are mediated by calcium/calmodulin, and PKA signaling pathways during Mycobacterium bovis infection.

Mycobacterium bovis bacillus Calmette-Guérin (BCG)-induced tumor necrosis factor (TNF)-alpha secretion via an extracellular signal-regulated kinase (ERK) mitogen-activated protein kinase-dependent mechanism is an important host defence mechanism against Mycobacterium tuberculosis in human monocytes. We now define distinct signaling pathways that regulate induction of TNF-alpha and activation of ERK1/2 by intracellular signaling mechanisms during M. bovis infection. We determined that M. bovis BCG-induced ERK 1/2 activation occurs through a mechanism that requires intracellular calcium and likely involves a calmodulin-sensitive step. In contrast, M. bovis BCG can induce p38 mapk activation by a calcium (Ca2+)/calmodulin-independent mechanism. Interestingly, we present evidence that M. bovis BCG activates protein kinase A (PKA), since pretreatment of monocytes with H-89, a inhibitor of PKA activity, blocked the ability of M. bovis BCG to induce ERK1/2 activation. These results were further supported by the fact that treatment of cells with KT5720, another well-described inhibitor of PKA activity, significantly diminished the effect of M. bovis BCG on ERK1/2 activation. Furthermore, secretion of TNF-alpha in M. bovis-infected human monocytes was also dependent on Ca2+/calmodulin, and PKA pathways. Finally, addition of H-89 significantly diminished TNF-alpha mRNA expression in M. bovis-infected human monocytes. These results indicate that the Ca2+/calmodulin, and PKA pathways play important regulatory roles in monocyte signaling upon M. bovis infection.

Blotting, Western↗

Endobronchial lesions involved in Mycobacterium avium infection.

Mycobacterium avium (M. avium) has been described traditionally as an opportunistic organism that causes disseminated disease in the human immunodeficiency virus (HIV)-positive population and that acts as a pulmonary pathogen in patients with underlying lung disease such as chronic obstructive pulmonary disease (COPD) or previously diagnosed tuberculosis. Pulmonary involvement of M. avium may range from asymptomatic colonization of the airway to invasive parenchymal or cavitary disease. However, endobronchial lesions involved in M. avium infection are rare in either immunocompetent or immunosuppressed hosts. We report here endobronchial mycobacterial infection in a HIV-negative patient.

Antitubercular Agents↗

[Atypical mycobacterium infections].

In response to an overview in Dermatosen 32, 195 (1984), here is given an update based on citations of newer works in this field. The growing importance of atypical mycobacteria is supported by the increasing cases of such infections in AIDS-patients.

Acquired Immunodeficiency Syndrome↗