Mycobacterium senegalense Infection in Kidney Transplant Patient with Diabetes, Memphis, Tennessee, USA.

Fewer than 30 cases of Mycobacterium senegalense infection have been reported. We report a complicated case of M. senegalense infection in Memphis, Tennessee, in the southeastern United States. The patient's comorbidities of past organ transplant and insulin-dependent diabetes required delicate consideration of those health conditions to guide treatment.

[A case of HIV combined with Mycobacterium celatum infection].

Here, we reported the diagnosis and treatment of a case of HIV infected person complicated by an extremely rare infection with Mycobacterium celatum. Due to the similarity of homologous sequence regions between Mycobacterium celatum and Mycobacterium tuberculosis complex, the identification of conventional Mycobacterium species was incorrect, which was corrected after first-generation 16S rRNA sequencing. This report aimed to improve the clinical understanding of Mycobacterium celatum infection and the level of differential diagnosis between non-tuberculous mycobacterial disease and tuberculosis.

Autosomal Recessive IL-12p40 Deficiency due to a Mutation in the IL12B Gene: Report of a Brazilian Patient with Lymph Node Mycobacterial Infection.

Background: Autosomal recessive interleukin (IL)-12p40 deficiency is a genetic etiology of Mendelian susceptibility to mycobacterial disease (MSMD). It has been described in ∼50 patients, usually with onset at childhood with Bacille Calmette-Guérin (BCG) and Salmonella infections. Case Presentation: A male patient born to consanguineous parents was diagnosed with presumed lymph node MSMD at the age of 13 years after ocular symptoms. A positive history of inborn error of immunity was present: BCG reaction, skin abscess, and recurrent oral candidiasis. Abnormal measurements of cytokine levels, IL-12p40 and interferon-gamma (IFN-γ), lead to the diagnosis of MSMD. Genetic analysis showed a mutation in exon 7 of the IL12B gene. Currently, the patient is alive under prophylactic antibiotics. Conclusion: We report a rare case of IL-12p40 deficiency in a Latin American patient. Medical history was crucial for immune defect suspicion, as confirmed by precision diagnostic medicine tools.

A Case of Disseminated Mycobacterium Haemophilum in a Kidney Transplant Recipient Presenting With Subcutaneous Nodules.

INTRODUCTION: Dermatologic manifestations of diseases in solid organ transplant recipients are common due to long-term immunosuppression. CASE PRESENTATION: We present the case of a 63-year-old man with a kidney transplant who exhibited subcutaneous nodules on lower extremities, cytopenia, and asymptomatic pulmonary infiltrate. Through a skin biopsy and 16S ribosomal RNA (rRNA) sequencing, Mycobacterium haemophilum was identified. His clinical course was complicated by empyema, septic arthritis, and recurrence of his skin manifestations, despite ongoing antimicrobial treatment. DISCUSSION: This case emphasizes the challenges and potential complications associated with M haemophilum infections in solid organ transplant recipients receiving long-term immunosuppressive therapy. It highlights the importance of employing advanced diagnostic techniques when evaluating dermatologic manifestations in these patients. The patient's complex clinical course also underscores the difficulties involved in effectively addressing and managing complications that may arise even after initiating therapy.

Mycobacterium genavense granulomatous typhlocolitis in a horse.

A 23-y-old gelding was presented to a veterinary teaching hospital with a history of chronic, refractory diarrhea. Clinically, the horse was in poor body condition, with a thickened and corrugated large intestine identified by transcutaneous abdominal ultrasonography. At postmortem examination following euthanasia, the large colon and cecum had segmental thickening of the intestinal wall with innumerable mucosal ulcers and prominent polypoid mucosal masses. Many mesenteric and hepatic lymph nodes were enlarged. Histology revealed granulomatous and ulcerative typhlocolitis and granulomatous lymphadenitis with myriad acid-fast, variably gram-positive, intrahistiocytic bacilli that stained by immunohistochemistry for mycobacteria. Molecular testing by PCR and sequencing identified the causative agent as Mycobacterium genavense, which is an unusual presentation of infection in a horse.

Anal mycobacterial infections / Infecções micobacterianas do ânus

Abstract Background Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn's disease. Objectives To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Resumo Introdução Infecções micobacterianas constituem um grave problema de saúde pública a nível mundial. As manifestações anoperineais são raras, mas constituem um importante diagnóstico diferencial com outras patologias igualmente graves que podem acometer a região, como as neoplasias malignas e a doença de Crohn. Objetivos Realizar um levantamento da literatura sobre infecções micobacterianas da região anoperineal, considerando as informações mais atuais para orientação diagnóstica e terapêutica dessa enfermidade. Métodos Foi realizada pesquisa nos bancos de dados PUBMED e LILACS com as expressões Mycobacterium, Anal, Infection e Tuberculosis. Foram revisados artigos referentes a séries de casos tratados, relatos clínicos e revisão da literatura publicada a partir de 2005. Resultados Foram compiladas informações sobre a epidemiologia das infecções micobacterianas; o comportamento clínico dos indivíduos afetados; opções diagnósticas e sua validade na prática clínica; e, por fim, opções terapêuticas. Conclusões Infecções micobacterianas da região anoperineal são raras. As apresentações clínicas mais comuns são a formação de ulceras e a fistulização. O diagnóstico envolve mais de um procedimento para identificação dos bacilos, e deve considerar a presença de manifestações em mais de um órgão. O tratamento é principalmente medicamentoso, sendo a cirurgia recomendada nas complicações agudas ou sequelas crônicas da doença.

Importancia diagnóstica de las infecciones extrapulmonares causadas por el género Mycobacterium / Diagnostic importance of extrapulmonary infections caused by the genus Mycobacterium

Introducción: el género Mycobacterium provoca infecciones pulmonares y extrapulmonares, dentro de estas últimas las localizaciones más frecuentes son; sistema nervioso linfático, central, circulatorio, genitourinario, gastrointestinal, tejido osteoarticular, y la piel. Objetivo: realizar las caracterizaciones etiológica de infecciones extra pulmonares producidas por el género Mycobacterium, destacar su importancia diagnóstica tanto en pacientes VIH- como VIH/sida. Métodos: se realiza un estudio descriptivo-prospectivo de corte transversal realizado de enero 2012 a mayo 2014. Durante este período se recibió un total de 825 muestras, 232 de pacientes VIH- y 593 de pacientes con VIH/sida. Las muestras que lo requerían se le aplicaron descontaminación cultivo, se utilizó el método de ácido sulfúrico al 4 por ciento, para el cultivo se usó el medio de Löwenstein-Jensen. Resultados: de las 825 muestras extra pulmonares en 29 (3,5 por ciento) se obtuvo cultivo positivo,14 (48,3 por ciento) con aislamiento de Mycobacterium tuberculosis (11 VIH+ y 3 VIH-), y 15 (51,7 por ciento) con aislamiento de otras especies micobacterianas (12 VIH+ y 3 VIH-), Mycobacterium avium-intracellulare, y Mycobacterium malmoense fueron las especies más aisladas. Conclusión: por todo lo anterior expuesto se recomienda mantener la vigilancia diagnóstica en este tipo de infección extra pulmonar, en especial en pacientes con sida, pues en muchos casos pueden tener fatales consecuencias por su diagnóstico tardío(AU)

Mycobacterium marinum infection: a case report

The infection by Mycobacterium marinum in humans is relatively uncommon. When it occurs, it mainly affects the skin, usually with a chronic, indolent and benign evolution. The diagnosis requires a high index of suspicion, and a significant delay may be observed between the first symptoms to the final diagnosis. This present case reports a M. marinum infection in an immunocompetent patient that had a chronic undiagnosed injury on the dominant hand for at least five years. The patient had several medical consultations, without proper suspicion, hampering adequate diagnostic investigation. Histopathology detected tuberculoid granulomas, but showed no acid-fast bacilli. The culture in appropriate medium and the polymerase chain reaction-restriction enzyme analysis (PRA)-hsp65 confirmed the diagnosis. Treatment with clarithromycin (1 g/day) for three months was effective. Although uncommon, this infection is a contact zoonosis. Therefore, it is important for clinicians to be aware of this diagnosis and properly guide preventable measures to professionals that are in risk group.

DIFFERENTIATION BETWEEN Nocardia spp. AND Mycobacterium spp.: CRITICAL ASPECTS FOR BACTERIOLOGICAL DIAGNOSIS / Diferenciação de Nocardia spp. e Mycobacterium spp.: aspectos críticos para o diagnóstico bacteriológico

New methodologies were developed for the identification of Nocardia but the initial diagnosis still requires a fast and accurate method, mainly due to the similarity to Mycobacterium, both clinical and bacteriologically. Growth on Löwenstein-Jensen (LJ) medium, presence of acid-fast bacilli through Ziehl-Neelsen staining, and colony morphology can be confusing aspects between Nocardia and Mycobacterium. This study describes the occurrence of Nocardia spp. in a mycobacterial-reference laboratory, observing the main difficulties in differentiating Nocardia spp. from Mycobacterium spp., and correlating isolates with nocardiosis cases. Laboratory records for the period between 2008 and 2012 were analyzed, and the isolates identified as Nocardia sp. or as non-acid-fast filamentous bacilli were selected. Epidemiological and bacteriological data were analyzed as well. Thirty-three isolates identified as Nocardia sp. and 22 as non-acid-fast bacilli were selected for this study, and represented 0.12% of isolates during the study period. The presumptive identification was based on macroscopic and microscopic morphology, resistance to lysozyme and restriction profiles using the PRA-hsp65 method. Nocardia spp. can grow on media for mycobacteria isolation (LJ and BBL MGIT™) and microscopy and colony morphology are very similar to some mycobacteria species. Seventeen patients (54.8%) were reported and treated for tuberculosis, but presented signs and symptoms of nocardiosis. It was concluded that the occurrence of Nocardia sp. during the study period was 0.12%. Isolates with characteristics of filamentous bacilli, forming aerial hyphae, with colonies that may be pigmented, rough and without the BstEII digestion pattern in PRA-hsp65 method are suggestive of Nocardia spp. For a mycobacterial routine laboratory, a flow for the presumptive identification of Nocardia is essential, allowing the use of more accurate techniques for the correct identification, proper treatment and better quality of life for patients.

Novas metodologias têm sido desenvolvidas para a identificação de Nocardia spp. mas o diagnóstico inicial ainda necessita de método rápido e preciso, principalmente devido à similaridade com o gênero Mycobacterium, clínica e bacteriologicamente. O crescimento em meio de Löwenstein Jensen (LJ), a presença de bacilos corados pela coloração de Ziehl Neelsen e colônias com características diferentes podem ser fatores de confusão entre nocardias e micobactérias. Este estudo descreve a ocorrência de Nocardia spp. em laboratório de referência em micobacteriologia, observando-se as principais dificuldades em diferenciar Nocardia spp. e Mycobacterium spp., correlacionando isolados com casos de nocardiose. Os registros laboratoriais dos anos 2008 a 2012 foram analisados e os isolados identificados como Nocardia sp. ou como bacilos não álcool - ácido resistentes (NBAAR) foram selecionados. Os dados epidemiológicos e bacteriológicos foram analisados. Trinta e três isolados identificados como Nocardia sp. e 22 como NBAAR foram selecionados para este estudo, perfazendo 0,12% do total de isolados identificados no período estudado. A identificação presuntiva foi baseada na morfologia macroscópica e microscópica, resistência à lisozima e perfis de restrição pelo método PRA-hsp65. Nocardia spp. pode crescer em meios de isolamento para micobactérias (LJ e BBL MGIT™) e microscopia de morfologia e as colônias são muito semelhantes a algumas espécies de micobactérias. Dezessete pacientes (54,8%) foram notificados e tratados para tuberculose, mas apresentaram sinais e sintomas para nocardiose. Concluimos que a ocorrência de Nocardia sp. no período estudado foi de 0,12%. Os isolados com características de bacilos filamentosos, formadores de hifas aéreas, com colônias que podem ter pigmento, rugosas e que não possuem padrão de digestão para BstEII no método PRA-hsp65 são sugestivos de Nocardia spp. Para um laboratório de rotina de Micobactérias, um fluxo de identificação presuntiva para Nocardia spp. é essencial para permitir que esses isolados sejam identificados com técnicas mais precisas, para que seja oferecido o tratamento adequado e qualidade de vida aos pacientes.

Mycobacterium neoaurum causing prosthetic valve endocarditis: a case report and review of the literature

Mycobacterium neoaurum is a rare cause of bacteremia, and infection usually occurs in an immunocompromised host in the setting of an indwelling catheter. Prosthetic valve endocarditis due to non-tuberculous mycobacteria typically carries a dismal prognosis; we report a case ofM. neoaurum prosthetic valve endocarditis with favorable response to antimicrobial therapy without surgical intervention.

Padronização do teste imunoalérgico aplicado ao diagnóstico da tuberculose e micobacterioses em suínos (Sus scrofa) experimentalmente sensibilizados com suspensões oleosas de Mycobacterium bovis ou M. avium inativados / Standardization of the immunoallergic skin test applied for the diagnosis of tuberculosis and mycobacterioses in swine (Sus scrofa) experimentally sensitized with oil suspensions of inactivated Mycobacterium bovis or M. avium

Foi investigado o valor diagnóstico da resposta alérgica cutânea em leitões experimentalmente sensibilizados, pela via intramuscular, com suspensões oleosas de Mycobacterium bovis ou M. avium inativados pelo calor.Foram utilizados 91 animais, divididos em quatro grupos: grupos A e B, cada um com 25 indivíduos, grupos C e D com 21 e 20 indivíduos respectivamente, balanceando-se as características de raça, linhagem, faixa etária e sexo. Aos 30 dias de idade, todos os animais foram submetidos a uma triagem com a aplicação de tuberculina PPD bovina, pela via intradérmica na base da orelha e não houve qualquer tipo de reação. Decorridos 60 dias do teste tuberculínico de triagem, o grupo A recebeu injeção intramuscular de 0,5 mL de uma suspensão oleosa de M. avium estirpe D4; o grupo B recebeu 0,5 mL de uma suspensão oleosa de M. bovis estirpe AN5; o grupo C (controle I), recebeu 0,5 mL do adjuvante oleoso; e o grupo D (controle II), recebeu 0,5 mL de solução fisiológica. Após 30 dias da sensibilização foi realizada a prova de tuberculinização comparativa com reação medida pela variação da espessura da pele com cutímetro de mola às 0h, 24h, 48h e 72h, após a aplicação das tuberculinas. No teste comparativo, lido às 48 ou 72 horas, a reação foi considerada negativa quando a diferença das reações entre o PPD bovino e o PPD aviário foi menor que 6,7 mm; suspeito ou inconclusivo quando a diferença se situou na faixa de 6,7 a 7,5 mm; e positiva de acordo com o tipo de PPD, considerando-se tuberculose para PPD M. bovis e micobacteriose para PPD M. avium, quando a diferença da reação foi superior a 7,5 mm.

The diagnostic value of the cutaneous allergic response to tuberculin in piglets experimentally sensitized intramuscularly with the oily suspensions of heat inactivated M. bovis or M. avium was investigated. Ninety-one animals were used and divided into four groups: groups A and B were formed each with 25 individuals, and groups C and D, with 21 and 20 individuals, respectively, balancing the characteristics of race, ancestry, age and sex. At the age of 30 days, all the animals were submitted to the screening test with the use of M. bovis PPD, by the intradermal route at the base of the ear and no reaction was detected. Sixty days after the screening tuberculin test, animals of the group A were injected intramuscularly with 0.5 mL of oily suspension of M. avium D4 strain; animals of the group B received 0.5 mL of an oily suspension of M. bovis, AN5 strain; group C (control I) received 0.5 mL of an oily adjuvant; and the individuals of the group D (control II) received 0.5 mL of saline solution. Following 30 days of sensitization, comparative skin reactions were measured by the variation in skin thickness with a caliper at 0h, 24h, 48h an 72h after applications of tuberculins. In the comparative test measured at 48 or 72h, the reaction was considered negative when the difference of the reactions between bovine PPD and avian PPD was less than 6.7 mm; suspected or inconclusive, when the difference stood in the range of 6.7 to 7.5 mm; and positive according to the type of PPD, considering tuberculosis the M. bovis PPD and mycobacteriosis the M. avium PPD, when the difference of the reaction was greater than 7.5 mm.

Adenitis tuberculosa por Mycobacterium bovis: reporte de caso / Tuberculous adenitis from Mycobacterium bovis: a case report

Introducción. La linfadenitis tuberculosa, que en la actualidad es producida con mayor frecuencia por Mycobacterium tuberculosis, alguna vez fue causada esencialmente por Mycobacterium bovis. Objetivo. Describir un caso clínico con adenitis tuberculosa por Mycobacterium bovis que resulta infrecuente. Caso Clínico. Mujer con antecedentes de salud y costumbre de ingerir leche cruda y derivados de la leche caseros no supervisados desde el punto de vista sanitario con adenitis cervical de más de 5 meses de evolución sin otro síntoma. El diagnóstico de adenitis tuberculosa por Mycobacterium bovis se realizó por biopsia, ELISA, RCP y cultivo. Discusión. Aproximadamente del 11 al 25 por ciento de todos los casos de TB son exclusivamente extrapulmonares. La linfadenitis cervical es la presentación periférica más frecuente de esta enfermedad. El tratamiento es aconsejable con 4 fármacos. La cirugía queda reservada para los procedimientos diagnósticos y las complicaciones. Conclusiones. La infección por Mycobacterium bovis es infrecuente en nuestro medio, no obstante debe tenerse en cuenta en la valoración diagnóstica de todo paciente con un síndrome adénico de localización cervical y elementos epidemiológicos.

Introduction. Tuberculous lymphadenitis, which currently is most often caused by Mycobacterium tuberculosis, was once mainly caused by Mycobacterium bovis. Objective. To describe an unusual case of tuberculous adenitis from Mycobacterium bovis. Case report. A woman with a history of consuming raw milk and unsupervised dairy home-made products presents with cervical adenitis of 5 month course unassociated to other symptoms. A diagnosis of Mycobacterium bovis tuberculous adenitis was made by biopsy, ELISA, PCR and culture. Discussion. Approximately 11 to 25 percent of all TB cases are extrapulmonary exclusively. Cervical lymphadenitis is the most common presentation of peripheral disease. Treatment usually is based on four drugs. Surgery is indicated for diagnostic procedures and complications. Conclusion. Mycobacterium bovis infection is uncommon in our environment, but must be considered in the diagnostic evaluation of all patients with cervical adenitis and epidemiological correlations.

A infecção por Mycobacterium tuberculosis e micobactérias nãotuberculosas na infância: um desafio diagnóst / Childhood Mycobacterium tuberculosis and nontuberculous mycobacter: a challenge on the diagnosis

Objetivos: Avaliar a tuberculose e micobaterioses na infância por meio de uma revisão bibliográfica criteriosae crítica, com ênfase na epidemiologia, aspectos clínicos e ferramentas diagnósticas. Métodos: A pesquisa foirealizada nas bases de dados Lilacs, SciELO, PubMed, durante o período de 2000 a 2009. Quarenta e seis artigos foram considerados e onze diretrizes e manuais nacionais e internacionais. Os descritores utilizados foram: criança, infância, tuberculose, micobactérias atípicas, biologia molecular e diagnóstico. Resultados: As crianças portadoras da infecção pelo Mycobacterium tuberculosis são consideradas por diversos autorescomo “órfãos da tuberculose”. Várias características dificultam o estabelecimento do diagnóstico definitivoda tuberculose e micobacterioses na infância, entre elas as clínicas com lesões não extensivas, o caráterpaucibacilar, as formas latentes, a dificuldade de coleta de espécimes clínicos, as falhas das técnicas dabaciloscopia e cultura e a prática rotineira dos países em desenvolvimento de investigar a etiologia tuberculosa após falência terapêutica para patógenos habituais. Conclusões: A detecção da micobactéria permanece como confirmação diagnóstica e a oportunidade de investigação do perfil de sensibilidade, favorecendo o tratamento efetivo para qualquer faixa etária independente de seu papel na transmissão da doença. Nesse cenário, assumem maior importância, novas estratégias diagnósticas, entre elas as técnicas de biologia molecular com a promessa de melhor sensibilidade, especificidade e pronta detecção.

Objectives: To evaluate the tuberculosis and mycobacteriosis in childhood by a careful and critical literature review, with emphasis on epidemiology, clinical features and diagnostic devices. Methods: The study wasmade based on the following databases: LILACS, SciELO and PubMed, between the period of 2000 to 2009. Forty-six papers and eleven national and international guidelines/manuals were considered. The keywords used were: child, childhood, tuberculosis, atypical mycobacteria, molecular biology and diagnosis. Results: Children infected by Mycobacterium tuberculosis were considered by several authors as “orphans of tuberculosis”. To define final diagnosis of tuberculosis and mycobacterial infections is difficult in childhood because of several characteristics such as: the clinical with nonextensive lesions, the paucibacillary nature, the latent forms, the difficulty of collecting clinical specimens, the failures of the smear and culture techniques and routine practice of developing countries to investigate the etiology of tuberculosis after therapeutical failures for usual pathogens. Conclusions: The detection of mycobacteria remains usual to confirm the diagnosis and the opportunity to investigate the sensitivity profile. This promotes effective treatment for all age groups independent of their role in the disease transmission. In this environment, new diagnostic strategies including the interferon-gamma dosage and the molecular biology techniques can provide better sensitivity, specificity and ready detection.

Infección diseminada por BCG en la Región de Los Lagos, Chile: reporte de cinco casos clínicos / Disseminated infection by BCG in Región de Los Lagos, Chile: five cases report

The bacillus Calmette-Guerin (BCG) is the attenuated strain of Mycobacterium bovis used in developing countries for preventing serious forms of tuberculosis. The neonatal BCG vaccine is applied in countries with high prevalence of tuberculosis. Most of the vaccinated individuals develop no adverse reactions; although, some subjects show side effects due to a host altered immunity. These reactions range from a simple adenomegaly in the same side of BCG vaccine inoculation, to a spread infection, often fatal. A regional or systemic spread has been described in patients with secondary or primary immunodeficiencies and partial or total genetic defects of interleukin IL-12/23 and IFN-gamma called as a whole "Mendelian susceptibility to mycobacterial infections" (MSMD). We describe five patients infected with M. bovis BCG-diagnosed between 1995-2008, at the base hospital in the city of Puerto Montt, Region de Los Lagos, Chile. These patients have the clinical course of MSMD.

El bacilo Calmette-Guérin (BCG), es la cepa atenuada de Mycobacterium bovis utilizada en países en vías de desarrollo para la prevención de formas graves de tuberculosis. La vacuna BCG neonatal se administra en países con alta prevalencia de la enfermedad. La mayoría de los vacunados no presenta reacciones adversas, algunos evidencian reacciones secundarias a una inmunidad alterada del huésped. Dichas reacciones varían desde una simple adenomegalia ipsilateral a la inoculación de BCG, hasta una infección diseminada, a menudo mortal. La infección diseminada se ha descrito en pacientes inmuno deficientes secundarios, primarios y en pacientes con defectos genéticos del eje interleuquina 12-23 (IL12/23)-interferón gama (IFN-gamma ) denominados "Síndrome de predisposición mendeliana a infecciones micobacterianas" (PMIM). Describimos cinco pacientes con infección por M. bovis-BCG diagnosticados entre 1995-2008, en el Hospital Base de Puerto Montt, Región de Los Lagos, Chile que cumplen con los criterios del PMIM.

Non tuberculous mycobacteria and toxoplasma co-infection of the central nervous system in a patient with AIDS

New-onset seizures are frequent manifestations in patients infected with Human Immunodeficiency Virus (HIV). We describe the clinical and radiological findings in an 25yr old AIDS patient presenting with new onset seizures as the primary manifestation of cerebral toxoplasmosis and Non Tuberculous Mycobacterial [NTM] co-infection. Cranial computed tomography showed a subtle ventricular dilatation whereas magnetic resonance imaging disclosed prominent temporal horn. Toxoplasma tachyzoites and rapidly growing mycobacteria were recovered from CSF. Seizures were complex partial in nature and refractory to antiepileptic therapy.

Do DNA extraction methods and Taq polimerase quality improve the double repetitive element (DRE) PCR typing method for Mycobacterium tuberculosis strains?

Double repetitive element (DRE) PCR amplification is a simple Mycobacterium tuberculosis typing method, however amplification failure or poor resolution of bands commit its efficacy. In order to verify if whether or not these features could be minimized by improving DNA extraction procedures or Taq polymerise quality, DRE-PCR was performed on 24 M. tuberculosis DNA samples extracted by heat-shock, mechanical and enzymatic methods applying conventional and hot start Taq pol. We demonstrated that when dealing with the Mycobacterium tuberculosis DRE-PCR typing method, Taq pol of better quality might be more important to improve amplification than the DNA extraction method.

Amplificação de duplo elemento repetido (DRE) por PCR é um método simples para tipagem de Mycobacterium tuberculosis, entretanto falha ou a baixa resolução das bandas na amplificação compromete a eficiência do método. Com o objetivo de verificar se estes problemas podem ou não ser minimizados pela utilização de diferentes procedimentos de extração de DNA ou de qualidades de Taq polimerase, DRE-PCR foi ensaiado em 24 amostras de DNA de M. tuberculosis extraídos pelos métodos de choque-térmico, - mecânico e enzimático utilizando Taq polimerase convencional e hot start Taq pol. Foi demonstrado que a qualidade da Taq pol utilizada talvez seja mais importante para uma melhor amplificação que o método de extração de DNA empregado.

Tratamiento antirretroviral en pacientes con sida y micobacteriosis / Anti-retroviral treatment in patients with AIDS and mycobacterial diseases

La tuberculosis y otras micobacteriosis constituyen asociaciones o coinfecciones frecuentes en pacientes con sida y se asocian con una elevada mortalidad. En esta revisión se actualizan los tratamientos de las principales enfermedades micobacterianas asociadas al sida (tuberculosis y micobacteriosis por Mycobacterium avium), con especial énfasis en las interacciones farmacológicas entre antimicobacterianos, principalmente rifampicina y claritromicina, y fármacos antirretrovirales. Se analizan los esquemas de tratamiento, su duración, la quimioprofilaxis primaria y secundaria y el momento óptimo de iniciación del tratamiento antirretroviral. Finalmente se describe el síndrome inflamatorio de reconstitución inmune y su tratamiento.