Serum biomarkers of treatment response within a randomized clinical trial for pulmonary tuberculosis.

RATIONALE: Biomarkers for monitoring response to anti-tuberculosis treatment are needed. We explored immune markers previously published as having predictive capability for 8 week culture status in 39 adults enrolled in a clinical trial in Kampala, Uganda. METHODS: We consecutively selected 20 HIV-negative pulmonary TB subjects with positive cultures, and 19 subjects with negative cultures at the end of intensive phase therapy. At baseline and after 8 weeks, serum was assayed for nine cytokines and soluble cytokine receptors using multiplexed platforms or ELISA. We evaluated their association with week 8 culture status first using single-variable logistic models, then using cross-validated estimates of the C-statistic, a measure of discrimination, of candidate models including 2 or 3 analytes in addition to age. RESULTS: All but one analyte decreased from baseline to week 8 (all p < 0.01). Individual biomarkers were not associated with 8 week culture status. Logistic models including increasing age, higher baseline soluble tumor necrosis factor receptor alpha 1 (sTNF-R1), and higher week 8 C-reactive protein (CRP) concentration classified subjects by culture status with up to 85% accuracy and acceptable discrimination (cross-validated C-statistic 0.76) and calibration (Hosmer-Lemeshow P > 0.2). CONCLUSION: Exploratory post-hoc models including sTNF-R1, CRP, and age, classified 8 week culture status with promising accuracy.

Comparison of time to positive and colony counting in an early bactericidal activity study of anti-tuberculosis treatment.

SETTING: Patients with smear-positive, newly diagnosed pulmonary tuberculosis (TB) presenting to the out-patient TB clinic in Kampala, Uganda. OBJECTIVE: To compare colony-forming unit (cfu) counting and time to positive (TTP) in Mycobacteria Growth Indicator Tube (MGIT) culture as measures of early bactericidal activity (EBA). DESIGN: Patients were enrolled in an EBA feasibility study of standard TB chemotherapy. Sixteen-hour overnight sputum collections were obtained before and on days 2, 4, 7, 10, 12 and 14 of treatment for quantitative culture on selective Middlebrook 7H11 agar media and TTP in the MGIT liquid culture system. RESULTS: Log cfu and TTP were correlated over all time points (r(s) = -0.71, P < 0.001). Within-subject (day to day) variation as a percentage of total variation was very similar between the two measures: 25.7% for cfu and 25% for TTP. Mean EBA 0-14, 0-2 and 2-14 measured by TTP were similar to those previously reported. CONCLUSION: TTP measured by an automated, standardized, commercially available culture system correlates with cfu determinations. EBA measured by TTP provides similar information to cfu counting, and is reproducible across sites and in different patient populations. These findings support replacing cfu counting with TTP as the primary measurement in EBA studies.

Children as Partners in the Struggle Against AIDS and Care for PWAS

In the majority of PWAs families; children give care and nursing to PWAs yet they lack adequate information on AIDS for prevention. Project: Through counselling; focus group discussions and interviews; a need for education about basic nursing care and HIV/AIDS prevention ofr children was identified. an outreach programme was initiated for HIV/AIDS awareness involving civic and opinion leaders; children and their relatives. Children are educated on basic nursing care and acceptance of parents' death. Cousnelling for PWAs and education for children are given according to need and age group respectively. Results: there is now a remarkable sense of responsibility put in children staying with PWAs evidenced by their curiosity to learn about care; nursing; prevention and IGAs through asking questions or participation with the community health workers. Lessons Learned: If children are empowered they play a vital role in society in the fight against AIDS and care for PWAs particularly as aides to health care workers. Source: Int-Cof-AIDS. 1996. July 7-12; 11(2):392 (abstract no. Th.D. 4896

A Pseudomonas pyocin typing method applicable to the clinical laboratory.

A new pyocin typing method for the identification of specific strains of Pseudomonas aeruginosa is described. The method involves a bilayer agar technique in which the pyocin produced by the organism diffuses from the top agar layer number 2 through a filter paper into the bottom agar layer number 1. The filter paper permits the removal of agar layer number 2 and exposes layer number 1 which is then streaked with the indicator strains. Pyocin typing of fifty clinical isolates using both the bi-layer method and the scrap-chloroform reference method of Gillies and Govan produced identical typing results. A total of 375 clinical isolates has been typed by this inexpensive and time-saving bi-layer agar method.