Transmission dynamics of tuberculosis in a high-incidence country: prospective analysis by PCR DNA fingerprinting.

We have prospectively analyzed the DNA fingerprints of Mycobacterium tuberculosis strains from a random sample of patients with newly diagnosed tuberculosis in Windhoek, Namibia. Strains from 263 smear-positive patients in whom tuberculosis was diagnosed during 1 year were evaluated, and the results were correlated with selected epidemiological and clinical data. A total of 163 different IS6110 fingerprint patterns were observed among the 263 isolates. Isolates from a high percentage of patients (47%) were found in 29 separate clusters, with a cluster defined as isolates with 100% matching patterns. The largest cluster included isolates from 39 patients. One predominant strain of M. tuberculosis caused 15% of cases of smear-positive pulmonary tuberculosis in Windhoek. That strain was also prevalent in the north of the country, suggesting that in contrast to other African countries with isolates with high levels of diversity in their DNA fingerprint patterns, only a restricted number of different strains significantly contribute to the tuberculosis problem in Namibia.

The diagnosis of pulmonary tuberculosis by gaschromatographic detection of tuberculostearic acid using flame ionisation detectors.

It has been shown that the detection of tuberculostearic acid (TBSA) with gas chromatography-mass-spectrometry provides a highly specific, sensitive and rapid method for the diagnosis of various forms of tuberculosis. However, the need for complex and expensive equipment prevented the more widespread use of this method. We report on the application of conventional gas chromatography with flame ionization detectors in the detection of TBSA in sputum samples. TBSA was detected in all patients with proven pulmonary tuberculosis before treatment or under treatment for less than 4 weeks (n = 18). Six of these patients (33%) had a negative microscopy result at the time of the study. Sputum samples from patients under therapy for longer than 4 weeks (n = 20) were TBSA-positive in 15 cases (75%). Only in two cases was the diagnosis by microscopy and/or culture not met by TBSA-detection. All sputa of 20 control patients with lung diseases other than tuberculosis were TBSA negative. Additional analysis of patients' data showed a significant relationship (P < 0.005) between the relative amounts of TBSA detectable in the sputum samples and the duration of therapy. It is concluded that conventional capillary gaschromatography may be sensitive and specific enough to be used for the detection of TBSA in sputum of patients with pulmonary tuberculosis.

Severe rhesus iso-immunization successfully treated with apheresis and azathioprine. Report of 2 cases.

Two patients are described in whom previous fetal loss had occurred due to rhesus (Rh) disease. In both patients apheresis was performed from a gestational age of 25 weeks in an attempt to remove excessive antibodies. In addition, production of new antibodies was suppressed by the administration of prednisone and azathioprine. A reduction in the antibody titres was accomplished although this was not reflected by a marked decrease in amniotic fluid bilirubin levels. The patients were delivered at gestational ages of 32 and 33 weeks since fetal lung maturity had then been demonstrated. Both babies were surprisingly little affected by the Rh disease and only one exchange transfusion was necessary for each. Neonatal follow-up for 2 years and 1 year respectively revealed no fetal abnormalities.

Biochemical vitamin B6 deficiency in adults with chronic glomerulonephritides with and without the nephrotic syndrome.

Thirty four patients suffering from chronic glomerulonephritides with and without the nephrotic syndrome and with an average age of 35 years were studied. Twenty eight of the patients underwent renal biopsy, as part of their management, and the histological classification was as follows: 7 membranous glomerulonephritis, 3 proliferative glomerulonephritis, 11 mesangiocapillary glomerulonephritis, 2 minimal change disease, 2 mesangial proliferative and 3 diffuse proliferative glomerulonephritis. Fourteen of the patients were on therapeutic diets mainly high protein - low salt and low cholesterol. Eighty three per cent of these patients were found to be biochemically deficient in vitamin B6 as judged by plasma pyridoxal-5-phosphate levels. No correlations were found between vitamin B6 and serum albumin, histological type of renal disease, duration of illness or serum cholesterol. By contrast, none of the patients with histologically similar disease that were daily receiving 25mg pyridoxine orally at the time of study were deficient. The importance of vitamin B6 deficiency in the nephrotic syndrome is discussed and it would appear that supplementary vitamin B6 should form part of the overall management of these patients.

South African multicentre study of metoprolol and propranolol in essential hypertension.

Ninety-three patients diagnosed as essential hypertensives, WHO stage I or II, entered this double-blind trial comparing 2 dose levels of CGP 2175-H 93/26 (metoprolol) with 2 doses of propranolol. Treatment on active medication was maintained for 6 weeks and was started after a 2-week washout and a 2-week placebo period. Twelve patients dropped out of the trial for reasons not related to the drugs and 1 patient was regarded as a therapeutic failure. Efficacy was assessed by measuring the diastolic and systolic blood pressure, pulse rate and by noting any significant ECG changes. All treatments reduced and maintained a lower blood pressure. However, a reduction with 360 mg propranolol per day was not statistically significant. Metoprolol 120 mg/d was significantly superior to propranolol 240 mg/d in holding the diastolic supine blood pressure at less than or equal to 90 mmHg. Metoprolol 120 mg/d and 210 mg/d pooled results were significantly superior to the propranolol 240 mg/d and 360 mg/d pooled data in maintaining a diastolic blood pressure of less than or equal to 90 mmHg. All treatments were well tolerated and in no case was it necessary to withdraw owing to adverse effects. No significant difference was detected between the treatments with respect to therapeutic emergent symptoms and signs. Laboratory results remained normal with all treatments.