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PubMed2006

Global incidence of multidrug-resistant tuberculosis.

BACKGROUND: The global number of incident cases of multidrug-resistant (MDR) tuberculosis (TB) in 2000 was estimated to be 272,906 (95% confidence interval [CI], 184,948-414,295). For accurate planning of TB control programs, this estimate and others have been revised using data from additional countries and by including in the model previously treated TB cases, which had not been accounted for in the previous analysis. METHODS: Multiple logistic regression was used to identify variables that were predictive of MDR-TB frequency among new and previously treated cases surveyed in 90 and 77 countries, respectively. These variables were then used to estimate MDR-TB frequencies in countries that had not been surveyed. RESULTS: The total number of MDR-TB cases estimated to have occurred worldwide in 2004 is 424,203 (95% CI, 376,019-620,061), or 4.3% (95% CI, 3.8%-6.1%) of all new and previously treated TB cases. In the same year, 181,408 (95% CI, 135,276-319,017) MDR-TB cases were estimated to have occurred among previously treated TB cases alone. Three countries--China, India, and the Russian Federation--accounted for 261,362 (95% CI, 180,779-414,749) MDR-TB cases, or 62% of the estimated global burden. CONCLUSIONS: These updated sets of estimates incorporating previously treated TB cases call for an urgent plan to expand appropriate diagnostic and treatment services for patients with MDR-TB in low-resource settings.

Global Health↗

PubMed2004

Presence and HRCT quantification of bronchiectasis in coal workers.

PURPOSE: The purpose of this study was to evaluate the presence of bronchiectasis in coal workers with or without coal worker pneumoconiosis (CWP) and to assess the extent of bronchiectasis, severity of bronchial wall dilatation and thickening by high resolution computed tomography (HRCT). MATERIALS AND METHODS: The retrospective study consisted of HRCT archieves of 93 coal workers. The coal workers with previous diagnosis of COPD (six), asthma (one) and tuberculosis (three) were excluded. Five coal workers with progressive massive fibrosis were not included into the study. The resulting patient group consisted of 78 patients (43 CWP; 35 non-CWP). Pneumoconiosis profusions of CWP workers were between p0/1 and p2/2 according to ILO 1980 chest X-ray classification. HRCT examinations of all subjects were evaluated for the presence, extent, dilatation and thickness of bronchiectasis. Analysis of extent, dilatation and thickness were performed according to established criteria. RESULTS: The diagnosis of bronchiectasis was put on 19 of 43 CWP (44.1%) and 7 of 35 non-CWP workers (20.0%). There were statistically significant differences between bronchiectasis positive and negative coal workers with CWP concerning age and exposure duration (P = 0.012 and 0.009, respectively). Then, multiple logistic regression analysis was performed to define exact risk factors. Exposure duration was only found to be related with presence of bronchiectasis [(odds ratio) OR = 1.494, 95% confidence interval 1.168-1.912]. CONCLUSIONS: The data from the present study shows that bronchiectasis is frequent and severe in CWP workers than without. Bronchiectasis is influenced by coal dust exposure. Thus, coal dust protection measures must be controlled efficiently to prevent bronchiectasis in coal workers.

Adult↗

PubMed1997

Comparison of sensitivities to two commercially available tuberculin skin test reagents in persons with recent tuberculosis.

Discrepancies have been reported between results obtained with tuberculin skin tests (TSTs) performed with use of different reagents. We compared TST results and determined the sensitivities of the two commercially available TSTs in 51 human immunodeficiency virus-negative persons with culture-confirmed active tuberculosis. Simultaneous TSTs were done with use of the Mantoux method and 5-tuberculin unit purified protein derivative (PPD) tuberculin preparations from single lots of Aplisol and Tubersol. Aplisol skin test reactions ranged from 5 mm to 26 mm (median, 16.0 mm), and Tubersol reactions ranged from 7 mm to 23 mm (median, 15.0 mm). The mean difference in paired reaction sizes for the two reagents was 0.58 mm and was not statistically different from zero (P value, 0.26). The difference in reaction sizes was < or =2 mm in 55% and > or =5 mm in 18% of patients. With a cutoff of either 5 mm or 10 mm to define a positive reaction, all results were concordant, with sensitivity of 100% and 96%, respectively. We found indistinguishable reaction size distributions and median TST results for the two commercially available PPD TST reagents, Aplisol and Tubersol, in a population with recent culture-proven tuberculosis.

Adult↗

PubMed2004

Hepatocyte growth factor (HGF) in patients with hepatitis B and meningitis.

OBJECTIVES: The present study investigates serum hepatocyte growth factor (HGF) levels in patients with acute and chronic hepatitis B and the relation between these levels and intrahepatic inflammatory markers of the liver and fibrosis, as well as the cerebrospinal fluid (CSF) HGF levels in patients with meningitis and the relation between these levels and CSF findings. To our knowledge this is the first study regarding CSF HGF levels in tuberculous meningitis. PATIENTS AND METHODS: The study consisted of 35 patients with chronic hepatitis B (HbeAg and HBV-DNA positive), 20 with acute hepatitis B, 20 with acute bacterial meningitis and 15 having tuberculous meningitis. HGF levels in the serum and CSF samples were measured by using the ELISA method. RESULTS: The mean serum HGF levels in acute hepatitis B group were found statistically significantly higher than those in the control group and chronic hepatitis B group (p<0.0001). It was established that serum HGF levels in patients with chronic hepatitis B were significantly correlated with serum alanine aminotransferase (ALT) and HBV-DNA levels (r: 0.816, 0.951; p<0.05, respectively). Similarly, serum HGF levels of patients with chronic hepatitis B were correlated with fibrosis score and hepatic activity index of the liver histopathology (r: 0.750, 0.459; p<0.05, respectively). The mean CSF HGF levels of patients with acute bacterial meningitis and tuberculous meningitis were higher than those in the control group (p<0.05). In addition, it was observed that mean CSF HGF levels in patients suffered from tuberculous meningitis were statistically significantly higher than those in acute bacterial meningitis (p<0.05). CONCLUSIONS: We suggest that serum HGF level in patients with chronic hepatitis B might reflect viral load, necro-inflammatory activity in the liver and the degree of structural progression. Our findings have demonstrated that tuberculous meningitis cause increased HGF concentrations in CSF. It is, therefore, suggested that examination of HGF levels in CSF may provide additional information in the differential diagnosis.

Acute Disease↗

PubMed2002

Comparative evaluation of efficacy and safety profile of three anti-tuberculous regimens in Mangalore.

The aim of our study was to evaluate and compare the therapeutic efficacy & safety profile of three different antituberculous regimens for pulmonary tuberculosis. The study sample size included 90 newly diagnosed, sputum positive patients of pulmonary. tuberculosis. 30 each from different groups. The parameters studied were, therapeutic efficacy included weight gain, cough, sputum examination and safety profile: nausea, vomiting, anorexia, gastritis, hepatitis, jaundice diarrhoea, rashes, dizziness, tingling & numbness, flu like symptoms & joint aches. Group-I showed statistically significant weight gain when compared to Group-II. Improvement in cough and conversion to smear negative were seen in 100% of patients in Group-I, 83.3% of patients in Group-II and 93.3% of patients in Group-III. Therapeutic efficacy was highest with Group I regimen, followed by Group III and Group II which was least efficacious. Group II also registered; the maximum cost and highest incidence of adverse effects.

Adult↗

PubMed2000

Comparison of the BACTEC MGIT 960 with Löwenstein-Jensen medium for recovery of mycobacteria from clinical specimens.

SETTING: Taiwan Provincial Chronic Disease Control Bureau. OBJECTIVE: To evaluate the rate of recovery and the mean time to detection (TTD) of mycobacteria in clinical specimens with two culture systems, the BACTEC MGIT 960 and Löwenstein-Jensen (LJ) medium. DESIGN: We studied 365 specimens, collected from 166 patients. Specimens were processed with standard N-acetyl-L-cysteine (NALC)-NaOH method, then inoculated onto BACTEC MGIT 960 and onto LJ slants. RESULTS: A total of 124 mycobacterial isolates (114 Mycobacterium tuberculosis and 10 non-tuberculous mycobacteria) were detected. The recovery rates were 94% (117/124) with BACTEC MGIT 960 and 75.8% (94/124) with LJ. The rates of contamination for each of the systems were 5.5% with BACTEC MGIT 960 and 4.1% with LJ. The TTDs for mycobacteria were 10.7 days with BACTEC MGIT 960 and 30.6 days with LJ. Excluding the non-tuberculous mycobacteria, the TTDs for M. tuberculosis were 11.1 days with BACTEC MGIT 960 and 30.7 days with LJ. The difference in TTD between smear-positive and smear-negative specimens for either mycobacteria (10.0 vs 12.6 days; P = 0.06) or M. tuberculosis (10.1 vs 12.7 days; P = 0.06) with BACTEC MGIT 960 was not statistically significant. CONCLUSION: The BACTEC MGIT 960 system can expedite the recovery of mycobacteria in culture. Combined with conventional solid medium, it also increases the overall recovery of mycobacteria in culture.

Acetylcysteine↗

PubMed2004

Tumor necrosis factor-alpha antibody for induction of remission in Crohn's disease.

BACKGROUND: Crohn's disease may be refractory to conventional treatments such as corticosteroids, enteral nutrition and immuno-suppressive agents. A number of patients with the disease may also become steroid-dependent leading to increased risk of developing steroid-related adverse effects. Recent studies suggest that TNF-a blocking agents may be effective in inducing remission in Crohn's disease. OBJECTIVES: To conduct a systematic review to evaluate the effectiveness of TNF-a blocking agents in inducing remission in patients with active Crohn's disease. SEARCH STRATEGY: We searched MEDLINE (1966-June 2003), EMBASE (1984-June 2003), the Cochrane Central Register of Controlled Trials from the Cochrane Library (Issue 2, 2003) and the IBD Review Group Specialized Trials Register. We hand-searched the articles cited in each publication obtained. SELECTION CRITERIA: We included only randomised controlled trials in which patients with active Crohn's disease (defined by a validated Crohn's disease activity index) were randomly allocated to receive a TNF-a blocking agent in the treatment arm, or to receive placebo or another treatment in the comparison arm. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of the methodological quality of each trial were independently performed by two reviewers. Any disagreement among reviewers was resolved by consensus. Outcome measures reported in the primary studies included clinical remission, clinical response and changes in disease activity index. MAIN RESULTS: Ten studies were identified of which 4 met the inclusion criteria. The included studies either differed in the type of TNF-a blocking agent used or in the way outcomes were assessed to such an extent that we considered it inappropriate to combine the data statistically. There is evidence from one randomised controlled trial that suggests that a single intravenous infusion of the monoclonal antibody cA2, infliximab, may be effective for induction of remission in Crohn's disease. There was no difference in response rates among infliximab doses of 5, 10 or 20 mg/kg. The results of two other trials suggested that CDP571, the genetically engineered human TNF monoclonal antibody, may also be effective in reducing disease activity index at 2 weeks after an infusion. We did not find any evidence to support the use of etanercept in Crohn's disease. REVIEWER'S CONCLUSIONS: Evidence from one randomized controlled trial suggests that a single infusion of infliximab may be effective for induction of remission in Crohn's disease. Based on this study, we can recommend a dose of 5 mg/kg. There is also some evidence that CDP571 may be effective in inducing remission in Crohn's disease. We did not find any evidence that supports the use of etanercept in Crohn's disease. The period of follow up for the patients in these studies was probably too short to allow adequate assessment of recently reported serious adverse effects such as tuberculosis and lymphoma.

Antibodies, Monoclonal↗

PubMed2001

Cytokine profile in human immunodeficiency virus positive patients with and without tuberculosis.

BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with a profound dysregulation of the immune system and alterations in the cytokine profile. Tuberculosis, a common opportunistic infection in HIV positive patients, leads to further immune suppression and a faster progression of the disease. This study was conducted to assess and compare the cytokine profiles in HIV positive subjects with and without pulmonary tuberculosis. METHODS: Twenty HIV positive patients and 20 controls were evaluated after being divided into four groups of 10 each--group 1--HIV positive patients without tuberculosis, group 2--HIV positive patients with pulmonary tuberculosis, group 3--healthy adults and group 4--HIV negative patients with pulmonary tuberculosis. After clinical evaluation, the CD4 cell counts and the cytokine profiles--interleukins (IL)-2, 4, 6, 10, 12, interferon gamma (IFN gamma) and tumour necrosis factor alpha (TNF alpha) were studied in all the subjects at the start and after three months of antituberculosis therapy. RESULTS: the CD4 cell counts were significantly lower in groups 1 and 2 compared to groups 3 (p < 0.01) and the counts in group 2 were significantly lower than in group 1 in both at baseline (p = 0.0076) and at three months (p = 0.089). The levels of the type 1 cytokines (IL-2, IL-12 and IFN gamma were significantly lower in patients in groups 1 and 2 compared to group 3 (p < 0.001 for both). The levels in group 2 were lower than in group 1 (p < 0.001). The type 2 cytokines (IL-4, IL-6, IL-10 and TNF alpha) were higher in group 1 and 2 compared to group 3, though statistically significant for IL-6 in group 1 (p < 0.05) and for IL-4, IL-6 and TNF alpha in group 2. A highly significant (p < 0.0001) positive correlation between CD4 cell counts and type 1 cytokines and a highly significant (p < 0.0001) negative correlation between CD4 cell counts and type 2 cytokines was observed. CONCLUSIONS: A decline in the type 1 and a rise in type 2 cytokines was observed in HIV infection. Patients in group 2 had the lowest CD4 cell counts, lowest levels of type 1 cytokines and highest levels of type 2 cytokines denoting maximum immunosuppression.

Adult↗

PubMed2003

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy.

BACKGROUND: Surgery performed to improve or replace the function of the diseased urinary bladder has been carried out for over a century. Main reasons for improving or replacing the function of the urinary bladder are bladder cancer, neurogenic bladder dysfunction, detrusor overactivity and chronic inflammatory diseases of the bladder (such as interstitial cystitis, tuberculosis and schistosomiasis). There is still much uncertainty about the best surgical approach. Options available at the present time include: (1) conduit diversion (the creation of various intestinal conduits to the skin) or continent diversion (which includes either a rectal reservoir or continent cutaneous diversion), (2) bladder reconstruction and (3) replacement of the bladder with various intestinal segments. OBJECTIVES: To determine the best way of improving or replacing the function of the lower urinary tract using intestinal segments when the bladder has to be removed or when it has been rendered useless or dangerous by disease. SEARCH STRATEGY: We searched the Cochrane Incontinence Group's specialised register (3 May 2001), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2001), MEDLINE (1966 to May 2001), PREMEDLINE (4 June 2001), Dissertation Abstracts (18.6.2001) and the reference lists of relevant articles. Date of most recent search: June 2001. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials of surgery involving transposition of an intestinal segment into the urinary tract. DATA COLLECTION AND ANALYSIS: Trials were evaluated for appropriateness for inclusion and for methodological quality by the reviewers. Three reviewers were involved in the data extraction. The data collected was then analysed for statistical significance. MAIN RESULTS: Two trials met the inclusion criteria with a total of 164 participants. These trials addressed only four of the 14 comparisons pre-specified in the protocol. There were no statistically significant differences found in the incidence of upper urinary tract infection, ureterointestinal stenosis and renal deterioration in the comparison of continent diversion with conduit diversion. There was no evidence of a difference in incidence of upper urinary tract infection and uretero-intestinal stenosis when conduit diversions were fashioned from either ileum or colon. No statistically significant difference was found in the incidence of renal scarring between anti-refluxing versus freely refluxing uretero-intestinal anastomotic techniques in conduit diversions. The confidence intervals were all wide, however, and did not rule out important differences. There was some limited evidence that use of the more complex nipple valve at the ureteroileal anastomosis was more likely to lead to upper tract deterioration than implantation into a non-detubularised, isoperistaltic ileal afferent limb. REVIEWER'S CONCLUSIONS: The evidence from the included trials was very limited. Only two studies met the inclusion criteria; these were small, of moderate or poor methodological quality, and reported few of the pre-selected outcome measures. This review did not find any evidence that bladder replacement (orthotopic or continent diversion) was better than conduit diversion following cystectomy for cancer. There was no evidence to suggest that bladder reconstruction was better than conduit diversion for benign disease. The small amount of usable evidence for this review suggests that collaborative multicentre studies should be organised, using random allocation where possible.

Cystectomy↗

PubMed1997

[Future prediction of tuberculosis incidence rates by prefecture].

We tried to predict the tuberculosis incidence rates by the year 2000 and 2005, based on the trends of incidence rates from the year 1981 to 1995 reported by the Ministry of Health and Welfare (MOHW). According to the studies conducted, the tuberculosis incidence rate in 2000 was predicted as 29.8 (95% CI: 28.7-30.8) per 100,000 population and that in 2005 was predicted as 25.2 (95% CI: 24.2-26.3 per 100,000 population in Japan. The incidence rates by prefecture in 2000 and 2005 were also predicted. The MOHW introduced some new tuberculosis control plans and has set on interim goal by the year 2000 to achieve a tuberculosis incidence at below 20 per 100,000 population. Whereas the possibility of achieving the stated incidence rate goal even by the year 2005 is very low in Japan, among prefectures, several prefectures were predicted to reach this level by the year 2000. Over several years the incidence rate in Japan has been high in the west and low in the east. However this is expected to greatly change in the future. The speed of decline in tuberculosis incidence rates has been stagnated since around 1980 with average annual declination rate from the year 1981 to 1995 was 3.3%. Among 17 prefectures, Tokyo Metropolitan had the lowest declination rate with an average annual declination rate of 1.1%. The prefecture surrounding Tokyo also showed low declination speed. This may indicate that in the future, the problems of tuberculosis will be concentrated in and around the big cities.

Forecasting↗

PubMed1997

Attendance versus compliance with tuberculosis treatment in an occupational setting--a pilot study.

AIM: To determine the prevalence of non-compliance with tuberculosis treatment at Freegold Mines. OBJECTIVES: 1. To establish the rates of attendance and collection of anti-tuberculosis drugs. 2. To determine prevalence of non-compliance by means of urine tests. DESIGN: A cross-sectional study conducted over 2 weeks at mine medical stations. METHOD: Urine samples were collected from tuberculosis patients 3 hours after drug ingestion. Non-compliance was established by testing these samples for rifampicin and/or isoniazid (INH) metabolites. Non-compliance was defined as a negative urine test result for these drugs in participants whose treatment regimens included one or both. Daily attendance and collection of drugs statistics are recorded in the medical station tuberculosis register. The patient rate of adherence was calculated as the observed number of days on which medication had been collected over the expected treatment days in a given period. RESULTS: Urine test results showed an overall prevalence of non-compliance of 14.6 +/- 3.3%. The study showed that non-compliance with tuberculosis treatment was underestimated by the surveillance data. The rate of non-adherence with treatment established from the formal surveillance procedure was 0.2%. The poor response rate of patients was found to be a major problem and fewer than 40% per day returned to bring urine specimens. The mean prevalences of non-compliance established by rifampicin and INH tests were 19.5 +/- 5.3% and 9.8 +/- 3.9%, respectively, and these were significantly different (Chi 2 = 7.44; P < 0.05). The proportion of false-positive results for INH and rifampicin urine tests were 21% (11/53) and 35% (17/48), respectively, showing that some patients were taking the wrong treatment. CONCLUSIONS: It is clear that attendance at the clinics does not accurately reflect compliance. Both programme compliance (dispensing of the correct treatment) and patient compliance need to be improved. This has important implications for the new national tuberculosis control policy adopted by the South African government that stresses the importance of directly observed therapy, short-course (DOTS) and a patient-centred approach.

Antibiotics, Antitubercular↗

PubMed2000

[Blood protein phenotypes and effectiveness of the treatment of patients with pulmonary tuberculosis].

Genetic polymorphism at 9 independent loci (HP, GC, TF, PI, PGM1, GLO1, C3, ACP1, and ESD) was studied in two groups of patients with pulmonary tuberculosis and healthy controls. The patients were subdivided into two subgroups depending on their response to chemotherapy: 1) responsive and 2) unresponsive to adequate chemotherapy. The control (Group 3) comprised 327-329 healthy persons; only 78 of them were phenotyped for ESD-locus. A pairwise comparison of arcsinus-transformed both phenotypic and allelic frequencies using t-test revealed significant differences between Groups 1 and 3 in phenotypes--GC 1F-1S, (P = 3.73 x 10(-4), C3 F-S (P = 4.10 x 10(-5), C3 S-S (P = 1.9 x 10(-6) and in alleles--C3*F (P = 4.2 x 10(-6), C3*S (P = 1.7 x 10(-6). These differences are reliable at the levels of significance, Pc corrected by all numbers of times, k, of independent pairwise comparisons (k = 126 for phenotypes, Pc = 0.00041; k = 60 for alleles, Pc = 0.000855). Differences between Groups 2 and 3 were significant as well: there were 8 P values both for phenotypes and alleles, which rejected the null-hypothesis at 5% significance while the expected numbers of times, kch, to reject the null-hypothesis by chance, were kch = 6.3 for phenotypes and kch = 3 for alleles. Differences between the two subgroups of patients were found to be insignificant because the P values were obtained, that rejected the null-hypothesis only 6 and 3 times for phenotypes and alleles, respectively. Principal component analysis showed that the GLO1 locus was not informative for the differences in the groups studied. The perspectives of further analysis of the data presented using the remaining 8 loci are discussed.

Adult↗

PubMed2000

Nutritional assessment of vitamin E in malnourished patients with AIDS.

Malnourished patients with acquired immunodeficiency syndrome (AIDS) may have low serum levels and reduced intake of alpha-tocopherol, mainly in the presence of acute-phase response. The aims of this study were to compare intake and serum levels of alpha-tocopherol between malnourished (MN) and non-malnourished (NMN) AIDS patients and to correlate alpha-tocopherol intake and serum levels. Undernutrition was defined as having a body mass index lower than 18. 5 kg/m(2) or a height-creatinine index lower than 70%. A semiquantitative food frequency questionnaire assessed alpha-tocopherol intake. High-performance liquid chromatography determined vitamin serum levels. The patients were divided into MN (n = 14) and NMN (n = 15) groups. There were no statistical differences in relation to clinical findings between MN and NMN, respectively, including moniliasis (7/14 versus 4/15), neurocryptoccocosis and neurotoxoplasmosis (6/14 versus 6/15), pulmonary tuberculosis (4/14 versus 2/15), and fever (1/14 versus 3/15). MN and NMN groups had similar peripheral blood CD(4) levels (111.4+/-87.1 versus 124.4+/-90.9 cells/mm(3)), and both groups had similar and adequate alpha-tocopherol intake (MN = 50.0+/-11.0 versus NMN = 47.2+/-16.5 mg) and serum levels (MN = 17.8+/-7.2 versus NMN = 19.8+/-6.3 micromol/L). Vitamin E intake and serum levels did not show a significant correlation (r = -0.22, P 0.05). Protein-energy nutrition status and acute-phase response were not factors determining vitamin status among AIDS patients.

Adult↗

PubMed1993

Antibodies to collagen in patients with idiopathic pulmonary fibrosis.

STUDY OBJECTIVE: The pathogenesis of idiopathic pulmonary fibrosis (IPF) is uncertain. This investigation was undertaken to determine if antibodies to human native collagens and their chains are present in the serum of the patients with IPF and to examine their relationship with clinical factors. MATERIALS: Serum specimens were obtained from 45 subjects. The subjects were separated into three distinct groups: group 1 consisted of 16 patients with IPF; group 2a, 9 patients with pulmonary fibrotic scars from previous tuberculosis were examined as a control group; group 2b, 20 normal individuals matched by age and sex. The collagen antigens used in this study consisted of four genetically distinct types, I, II, III, IV and their corresponding chains alpha 1(I) + alpha 2(I), alpha 1(II), and alpha 1(III). METHODS: a passive microhemagglutination assay was used to test the antibody activity in the sera of both patients and controls. Titration was performed in microtiter plastic plates, using 0.5 percent cell suspension. The specificity of anticollagen antibodies was then tested using an absorption serum technique with native collagens and their chains. Hemagglutination enhancement and inhibition tests, as well as chromatography, were used to determine the type of antibodies. RESULTS: Thirteen of 16 (81 percent) patients with IPF (group 1) had antibodies against at least one type of native collagen or one type of collagen chain in titers up to 1:512. Twelve patients exhibited anticollagen antibodies with titers above 1:16. By contrast, only 2 of 9 (22 percent) subjects with fibrotic scars (group 2a) and 3 of 20 (15 percent) normal subjects (group 2b) had antibody activity in titers up to 1:8. The differences between group 1 and group 2a and 2b were statistically significant, (p < 0.05 and p < 0.001, respectively). There was an inverse, statistically significant correlation between duration of the disease (IPF) and antibody activity. The correlation coefficient between duration of the disease and titers of antibodies to type III collagen (native and/or chain) was higher than the correlation coefficient between duration of the disease and titers to collagen I. The enhancement and inhibition of agglutination tests, as well as the chromatography, showed that the agglutination factors were antibodies of IgG and IgM classes. The antibody absorption test revealed that the anticollagen antibodies were specific for each collagen and its chain and there was no cross-reaction. CONCLUSION: This study suggests that the anticollagen antibodies could be a marker of IPF activity and may perpetuate the lung tissue inflammation. It is still unclear if the autoimmunity of the collagen participates in the pathogenesis of IPF or the presence of the anticollagen antibodies is simply an epiphenomenon.

Adult↗

PubMed1992

The prevalence of invasive amebiasis is not increased in patients with AIDS.

OBJECTIVE: To determine whether the frequency or severity of invasive amebiasis is increased in patients with AIDS. DESIGN: A case-control sampling approach, based on an autopsy registry. SETTING: General Hospital of Mexico City, Mexico, a large government-supported, tertiary care medical institution. PATIENTS, PARTICIPANTS: Ninety-four patients with AIDS and 335 historical and contemporary, age- and sex-matched controls who were defined as dying, but not because of AIDS. RESULTS: The odds ratio (OR) for mortality from invasive amebiasis was the same for cases and controls (0.7; 95% confidence interval, 0.07-7.2). By contrast, the OR for other diseases, such as miliary tuberculosis, cytomegalovirus infection, Pneumocystis carinii pneumonia and toxoplasmosis was greatly increased. Only one patient with AIDS had amebiasis of the common amebic ulcerative colitis type, without extraintestinal involvement. CONCLUSION: In conclusion, we show that the frequency and severity of invasive amebiasis is not increased in Mexican patients with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Randomized trial of three regimens to prevent tuberculosis in HIV-infected patients with anergy].

INTRODUCTION: To evaluate the efficacy of three regimens of prophylactic therapy for tuberculosis in HIV-infected patients with anergy. METHODS: Prospective, multi-center, randomized, comparative, and open clinical trial. Anergy was defined as absence of induration in response to three antigens (PPD, Candida albicans and parotiditis antigen) applied by the Mantoux method. Patients were randomized into one of the following prophylactic treatment groups: isoniazid for six months (6H), rifampin plus isoniazid for three months (3RH), rifampin plus pyrazinamide for two months (2RZ) or no treatment (NT). After completion of treatment, patients were followed up for two years. RESULT: A total of 319 patients were included in the study, 83 in the 6H regimen, 82 in 3RH, 77 in 2RZ and 77 in NT. The observation period following treatment was 88, 96, 81 and 126 person-years, respectively, for 6H, 3RH, 2RZ and NT. There were 11 cases of tuberculosis during the follow-up period. The tuberculosis rates (cases per 100 person-years) were 3.4, 3.1, 1.2 and 3.1 for 6H, 3RH, 2RZ and NT respectively, with relative risks in regimens 6H, 3RH and 2RZ with respect to NT of 1.07 (0.24-4.80), 0.98 (0.22-4.4) and 0.39 (0.04-3.48), all statistically non-significant. Twenty-nine patients died during the follow-up period, none due to tuberculosis, and no appreciable differences were found among the groups. CONCLUSIONS: The results showed no significant decrease in the risk of developing tuberculosis with any of the evaluated regimens and, therefore, do not support the use of antituberculosis chemoprophylaxis in anergic HIV-infected patients.

Adult↗

PubMed1993

Tuberculous meningitis in children: manifestation of an immune compromised state.

Thirty children in the age group 0-4 years with tuberculous meningitis (TBM) were investigated for their immune status (cell-mediated and humoral). Twenty age, sex and nutritional status matched children were investigated on the same lines, who served as controls. Absolute T cell counts were significantly increased (3126 +/- 1623) (p < 0.01) in TBM, though T cell percentages were comparable (59.8% in TBM versus 54.44% in controls). Leucocyte migration inhibition (LMI) test positivity was high (93%) in TBM patients. Mean LMI index showed a highly statistically significant difference (p < 0.001) between the 'Before-therapy' (0.62 +/- 0.16) and 'During-therapy' (0.77 +/- 0.23) groups in TBM patients. Mantoux test positivity with 1 TU of PPD was low (53.0%) in TBM in comparison to LMIT positivity. In humoral immune response, quantitative function measured by EAC rosettes was not altered. However, there was a significant decrease in the levels of IgA (79.48 +/- 33.78 IU) (p < 0.01), IgG (115.01 +/- 32.56 IU) (p < 0.01) and IgM (148.50 +/- 51.88 IU) (p < 0.05) in TBM patients. There was no significant difference in the complement levels in the TBM and control groups. The results show a well developed CMI response but a poor humoral response in TBM and represent an inverse relationship between the CMI and humoral responses.

Antibody Formation↗

PubMed2006

Exposure to silica and risk of ANCA-associated vasculitis.

BACKGROUND: Exposure to silica dust is considered to be one of etiological factors of antineutrophil cytoplasmic antibodies (ANCA) -associated vasculitis (AAV). METHODS: Subjects exposed to silica dust in Central Bohemia and followed in the Department of Occupational Medicine, Charles University, were selected for study. A group of 86 men exposed to SiO2 for at least 5 years were examined. The association between occupational exposure to silica dust and ANCA positivity is analyzed. RESULTS: The subjects had a mean age of 66.7 years, and mean exposure to silica of 22.3 years. ANCA were detected significantly more frequently in patients group (17.1%; P-ANCA 18x, C-ANCA 3x) than in controls (n = 28, mean age 64.2 years, P-ANCA 1x, i.e., 3.6%). ANCA positivity was found less frequently (7.1%) in the group with history of SiO2 exposure without signs of pronounced silicosis, than in the group with simple (30.3%) or complicated silicosis (36.0%). Odds ratio for ANCA positivity and relative risk estimate in patients with silicosis were highly significant. Among possible predictor factors for ANCA positivity, silicosis and tuberculosis were relevant. No typical AAV was present among the patients. CONCLUSION: Long-term silica exposure may be one of the exogenous factors contributing to ANCA production, however, silica exposure alone, without typical silicosis, was not associated with ANCA positivity.

Adult↗