Mycobacterium avium genotype is associated with the therapeutic response to lung infection.

Factors that can interfere with the successful treatment of Mycobacterium avium lung infection have been inadequately studied. To identify a potent predictor of therapeutic responses of M. avium lung infection, we analyzed variable number tandem repeats (VNTR) at 16 minisatellite loci of M. avium clinical isolates. Associations between the VNTR profiling data and a therapeutic response were evaluated in 59 subjects with M. avium lung infection. M. avium lung infection of 30 subjects in whom clarithromycin-containing regimens produced microbiological and radiographic improvement was defined as responsive disease, while that of the remaining 29 subjects was defined as refractory disease. In phylogenetic analysis using the genotypic distance aggregated from 16-dimensional VNTR data, 59 M. avium isolates were divided into three clusters, which showed a nearly significant association with therapeutic responses (p 0.06). We then subjected the raw 16-dimensional VNTR data directly to principal component analysis, and identified the genetic features that were significantly associated with the therapeutic response (p <0.05). By further analysis of logistic regression with a stepwise variable-selection, we constructed the highest likelihood multivariate model, adjusted for age, to predict a therapeutic response, using VNTR data from only four minisatellite loci. In conclusion, we identified four mycobacterial minisatellite loci that together were associated with the therapeutic response of M. avium lung infections.

[Clinical effect of the combined therapy of arbekacin and imipenem/cilastatin against methicillin-resistant Staphylococcus aureus].

We evaluated the efficacy of combined therapy of arbekacin (ABK) and imipenem/cilastatin (IPM/CS) against infections by methicillin-resistant Staphylococcus aureus (MRSA). The MICs of ampicillin, cefmetazole, cefotiam, cefuzonam, flomoxef, fosfomycin, ofloxacin, minocycline, ABK and IPM/CS against clinically isolated strains of MRSA were examined. Almost all strains of MRSA were resistant to these antibiotics except ABK. Furthermore, combination of ABK and IPM/CS showed smaller MICs than that of ABK or IPM/CS alone. All fractional inhibitory concentration indices (FIC indices) of ABK plus IPM/CS were lower than 0.75. The efficacy rate of combined therapy of ABK and IPM/CS in 22 patients with MRSA infections (15 patients with pneumonia, 3 patients with chronic bronchitis, 2 patients with sepsis, a patient with subcutaneous abscess and a patient with DPB) was 68%. And no patients had adverse reactions. Six (27%) of 22 strains of MRSA were eradicated. Significant correlations were found between bacteriological effect and severity of disease, and between serum albumin level and clinical effect.

[A case of endometrial tuberculosis diagnosed by polymerase chain reaction].

A 30-year-old female was admitted to our hospital for further investigation of infertility. The menstrual culture and polymerase chain reaction (PCR) of the endometrial tissue for detection of Mycobacterium tuberculosis were both positive. The pelvic CT scan and hysterosalpingography showed a slightly expanded uterus and irregularity of the endometrium. Barium enema and pyelography showed no abnormality. Since these data established a diagnosis of early primary endometrial tuberculosis, the combined therapy of three antituberculous agents was commenced. Menstrual smear, culture and PCR for M. tuberculosis were examined monthly throughout the therapy. The mycobacterial culture became negative soon after the start of therapy, followed by a negative PCR result 3 months later. We conclude that PCR is useful for the rapid detection of M. tuberculosis not only in pulmonary but also in endometrial tuberculosis.

Topical treatment of pulmonary aspergilloma by antifungals. Relationship between duration of the disease and efficacy of therapy.

Twelve patients with aspergilloma were treated with intracavitary or endobronchial administration of antifungals. Patients with successful therapy had significantly shorter mean duration of the disease course (3.6 months) than the less effective group (44.4 months, p < 0.01). Minimal inhibitory concentrations of antifungal agents against isolated strains of aspergilli were considerably lower than estimated intracavitary concentrations of the antifungals. A pathologic examination suggested that the old mycetoma was for the most part comprised of dead mycelial cells, against which antifungal agents were not effective. However, clinical improvement was obtained, regardless of the roentgenographic improvement. Our study suggested that early diagnosis and therapy are recommended to achieve better therapeutic effect.

Efficacy of erythromycin lactobionate for treating Pseudomonas aeruginosa bacteremia in mice.

We induced endogenous Pseudomonas aeruginosa bacteremia by administering cyclophosphamide and ampicillin to specific pathogen-free mice fed P. aeruginosa. Using this model, we evaluated the efficacy of erythromycin lactobionate (EML) in treating P. aeruginosa bacteremia. Treatment with EML at 50 and 100 mg/kg of body weight per day twice a day for 14 days significantly increased the survival rate. The most effective dose was 100 mg/kg/day, with a survival rate of 80% compared with a 20% survival rate in the control. However, the administration of EML at 500 mg/kg/day rather decreased the survival rate. In a model of intravenous infection, treatment with EML at 100 mg/kg/day twice a day for 7 days before the bacterial challenge also enhanced the survival rate. EML levels in serum, liver, and stool were apparently lower than the MIC (512 micrograms/ml). These observations suggest that EML is effective against P. aeruginosa bacteremia despite a lack of specific activity for this pathogen. Although the protective mechanism is still unclear, it is possible that a subinhibitory level of EML may affect the virulence of P. aeruginosa and enhance the host defense system.

[Giant abdominal myeloblastoma preceding overt acute myelogenous leukemia].

A 34-year-old man noted an abdominal mass in February 1986. Peripheral blood was normal, but barium enema disclosed a Borrmann 1 type tumor of the ascending colon. In April, his abdominal mass was increased up to 15 x 20 cm in size. He was admitted to our hospital. Peripheral blood and bone marrow showed overt leukemic picture (acute myelogenous leukemia). Colonic fiberscopy and biopsy as well as abdominal CT scan were done, and the abdominal mass proved to be a myeloblastoma. He received chemotherapy and 60Co irradiation. He was induced to complete remission, kept it for 11 months, and relapsed. After relapse, leukemic state became refractory. But leukemic cells did not form any mass. He died of pulmonary aspergillosis in November 1987. Autopsy showed hypocellular leukemic bone marrow, but we could detect no myeloblastoma.

[A clinico-physiological study on the generators of short latency somatosensory evoked potential].

The purpose of this paper is to locate the generators of each wave component in the short latency somatosensory evoked potential (SSEP), by means of cumulative analysis of the SSEP obtained from various localized lesions in the upper cervical cord through brain stem and cerebral subcortical structures. Since there are considerable inconsistency of naming each component in the literature, SSEP to median nerve stimulation of 10 normal subjects were examined by two different recordings, i.e. recording from an electrode at the parietal scalp with a reference electrode on Erb's point (Par.-Erb), and the other at the frontal scalp with a reference electrode on Cv 7 (Fro.-Cv 7), and the SSEP was carefully studied. In normal subjects, the SSEP by Par.-Erb lead yielded 5 negative components (N 7, N 11, N 16, N 18 & N 26) and 4 positive components (P 9, P 13, P 22 & P 42), while by Fro.-Cv 7 5 negative components (N 7, N 10, N 12, N 16 & N 28) and 5 positive components (P 9, P 11, P 13, P 20 & P 44). Thirty three patients were subjected to analyse the influence of localized lesions to each component of the SSEP and the recording was evaluated in regard to (a) identification of each component, (b) latency of each component and inter-peak latency difference exceeding 2 SD, and (c) over 50% asymmetry and laterality of the amplitude. Cervical spondylotic myelopathy, high cervical cord tumor, tonsillar herniation, pontine infarct and hemorrhage, circumscribed thalamic lesion, and vascular lesion of centrum semiovale were carefully examined with CT scan and the findings were compared with neurological findings periodically. SSEP was taken repeatedly, especially before and after operative intervention, and alteration of the component was referred to the clinical progress of the lesion. In conclusion, results obtained from our present observation indicated that P 9 was the extramedullary projection, P 11 was intramedullary origin of the lower cervical cord, P 13 was medulla oblongata origin and P 13-N 16 was projection from medulla oblongata to thalamus. N 16-N 18 and N 26 were considered projection from thalamus to hand area of the parietal lobe with some association area and N 28 had the generator widely based on frontal projection system. These findings appeared to be quite useful for topographic diagnosis and functional evaluation of the lesions in central nervous system.

Infants in Juba, Southern Sudan: the first six months of life.

A longitudinal survey of child health in Juba was done to secure data on which preventive schemes could be based. 223 pregnant women were identified in a systematic search of a district. 5 infants were stillborn and 10 were born prematurely. The mothers of 5 of the 10 premature infants had had acute malaria at or immediately preceding delivery. 2 of these premature babies later died from causes attributable to prematurity and therefore indirectly to the preventable maternal malaria. The causes of neonatal mortality included tetanus caused by cutting the cord with a blade of grass. Between the 1st and 6th month, 5 infants died of infective enteritis, 1 of bronchopneumonia, and 1 of pyrexia of undetermined origin associated with convulsions. Growth was much impaired by diarrhoea, which caused 85 attacks among 63 babies, and by lower respiratory infections, of which there were 119 among 74 of the babies. Skin and eye infections were also common. Removal of the unerupted canine teeth, believed to cure or prevent illness, caused much distress and some aspiration bronchopneumonia. Health education and improved hygiene and water supplies would greatly reduce the extent of morbidity and mortality.

PIP: A longitudinal survey of child health in Juba was done to secure data on which preventive schemes could be based. 223 pregnant women were identified in a systematic search of a district. 5 infants were stillborn and 10 were born prematurely. The mothers of 5 of 10 premature infants had had acute malaria at or immediately preceding delivery. 2 of these premature babies later died from causes attributable to prematurity and therefore indirectly to the preventable maternal malaria. The causes of neonatal mortality included tetanus caused by cutting the cord with a blade of grass. Between months 1-6, 5 infants died of infective enteritis, 1 of bronchopneumonia, and 1 of pyrexia of undetermined origin associated with convulsions. Growth was much impaired by diarrhea, which caused 85 attacks among 63 babies, and by lower respiratory infections, of which there were 119 among 74 of the babies. Skin and eye infections were also common. Removal of the unerupted canine teeth, believed to cure or prevent illness, caused much distress and some aspiration bronchopneumonia. Health education and improved hygiene and water supplies would greatly reduce the extent of morbidity and mortality.