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Biomedical subjects

H Mauch

Publications and source records attributed to H Mauch.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Incompatibility of tuberculosis therapy in a patient with AIDS].

A man with advanced HIV infection (CD4 lymphocytes 90/microliter, CD4/CD8 ratio 0.2) was admitted to hospital with fever, cough and weight loss. The radiological and bronchoscopic findings, together with the presence of acid-fast bacilli in the sputum, pointed to open pulmonary tuberculosis caused by Mycobacterium tuberculosis, a diagnosis confirmed by histological examination and culture. Quadruple antibiotic therapy with isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and amikacin was immediately begun and was at first clinically successful. Ten days later, however, a rash appeared; it was ascribed to RMP (anaphylactoid reaction after re-exposure). All the other first-line drugs tried during the ensuing eight months evoked severe adverse reactions (INH: rash and itching; amikacin: hearing impairment and tinnitus; EMB, pyrazinamide, prothionamide, p-aminosalicylic acid: rash and itching). Treatment was nevertheless clinically and microbiologically successful, and the patient insisted upon a 2 1/2 months' rest without therapy. This period was followed by extrapulmonary spread (severe arthritis of the elbow) and recurrence of pulmonary tuberculosis. The tubercle bacilli were sensitive to all the drugs so far employed. Renewed and lasting control of the infection was achieved only by continuous administration of steroids (prednisolone 10 mg twice daily) in conjunction with an unconventional antibiotic regimen consisting of amikacin, protionamide, terizidone, clarithromycin and sparfloxacin for some five months. Because of an episode of cerebral convulsions during treatment of cytomegalovirus retinitis with ganciclovir, the terizidone was discontinued (it was suspected of interacting with ganciclovir). The patient has had no more fits and sputum culture has remained negative for six months.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Nontuberculous mycobacteriosis as a complication of the Swyer-James syndrome].

The chest radiograph of a 35-year-old man with fatigue, exertional dyspnoea and haemoptyses revealed a cavity in the left upper lobe and a shrunken left lung with radiolucency greater than that on the right. Acid-fast rods in sputum were identified as Mycobacterium kansasii on culture. Scintigraphy showed a 9% residual perfusion on the left and abnormal ventilation, compatible with Swyer-James syndrome. This had favoured the development of a mycobacterial infection. There was also a decrease in ciliary function (rate of 4-7 Hz, normal: 10-11). Treatment, begun when tuberculosis had been suspected, was after sensitivity tests changed to a combination of rifampicin (600 mg), ethambutol (1600 mg) and protionamide (500 mg) daily. There was marked regression of the findings within 4 weeks, but treatment was prematurely stopped after 11 months. Two years later there was a recurrence which again responded well to the same drug regimen with additional sulphamethoxazole (1600 mg/d).

Adult↗
PubMed1993

["Single-shot" antibiotic prophylaxis in thoracic surgery; reduction of the postoperative infection rate].

A prospective, controlled and randomised trial was started to detect the effectivity of a "single-shot" antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecutively scheduled for major thoracic surgery except endoscopic procedures or mediastinoscopy were enrolled in this study and randomized into either the control group (no antibiotics perioperatively; n = 100) or the prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction of anaesthesia; n = 100). Clinical signs correlated with infection, radiological findings and the results of repeated microbiological examinations were recorded and a comparative statistical analysis was done. Compared to controls the prophylaxis group had fewer (not significant) infections of the wound, the pleural cavity and the urinary tract and fewer patients of this group showed "pronounced infiltration" in daily taken chest roentgenograms (significant), clinical signs for pneumonia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, isolated from tracheal aspirates, immediately taken after intubation disappeared more often. Specimens of pleural fluid taken postoperatively were less often positive for bacteria. Fewer patients were treated with antibiotics in the postoperative course and the courses were shorter in the prophylaxis group compared to controls. Considering the risk factor "positive microbiological culture" in preoperative tracheal aspirates, patients of the prophylaxis group showed much more seldom new radiological "infiltration" (statistically highly significant) and, in addition, had lower white blood cell counts (significant) and lower mean maximal body temperatures. The results of our trial confirm the preventive effect of "single-shot" antibiotic prophylaxis in thoracic surgery against infections.

Bacterial Infections↗
PubMed1993

Acute and long-term efficacy of antituberculous treatment in HIV-seropositive patients with tuberculosis: a study of 36 cases.

Thirty-six consecutively observed HIV-seropositive patients with tuberculosis, including 31 patients with AIDS, who received antituberculous treatment, were followed up to evaluate its efficacy. Treatment with standard antituberculous regimens was intended except when an individual's condition required a modified therapeutic approach. Therapeutic failure occurred in five patients (14%) while on treatment, one also had a post-treatment relapse. Treatment failure was associated with drug resistance and non-compliance in three patients and in another two, both of whom died early in the course of their disease, with HIV-related conditions other than tuberculosis. The median relapse-free post-treatment follow-up time in 24 patients in whom treatment did not fail was 13 months (range 4-67). Standard antituberculous treatment is highly effective in the immediate and long-term treatment of HIV-related tuberculosis provided that drug susceptibility and treatment compliance are confirmed.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Diagnostic problems in lower respiratory tract infections.

The main problems of diagnosis in lower respiratory tract infection are the differentiation of infection from colonization or contamination, and the isolation of a reliable and true pathogen. The clinical findings and differentiation of patients into those with pneumonia or infective exacerbations of chronic bronchitis should provide a definitive early diagnosis. Expectorated sputum may be unreliable in pneumonia, because of contamination by oropharyngeal flora. Although blood cultures may be negative, they provide a precise diagnosis and should be obtained in all pneumonias admitted to hospital. Other more invasive procedures are transtracheal needle aspiration, fibrebronchoscopic techniques including protected specimen brush and bronchoalveolar lavage with quantitative culturing and cytological analysis, transthoracic needle aspiration, thoracoscopy--guided biopsy and open lung biopsy. Any invasive procedure in a severely ill patient should be carefully directed weighing the risks as well as the benefits, whilst taking the underlying disease and expected survival into consideration.

Bacteria↗
PubMed1993

[Persistence of mycobacteria in the host: epidemiology, immunopathology and prophylaxis].

Tuberculosis continues to be one of the major causes of morbidity and mortality in the developed and developing countries. There are more than 5000 cases of active open tuberculous lung disease in Germany. Worldwide approximately 10 million persons get tuberculous infections each year. Other not yet infected people in the community are endangered by this disease, especially those with immunodeficiency e.g. AIDS-patients or tumor patients. M. tuberculosis with its unique glycolipid cell wall is fairly resistant against the immune system. Only specialized activated macrophages are able to inhibit its growth. The bacteria may persist for years in the living body, probably in granulomas. A positive tuberculin-reaction indicates an infection and persistance of mycobacteria but does not prove a disease. Approximately 1.5 billion people are tuberculin positive worldwide. Any weakening of the immune system can unleash M. tuberculosis to cause reactivation and active tuberculous disease. The main diagnostic tools since the time of Robert Koch are microscopy and culture. Neither immunoserology nor polymerase chain reaction are of significant diagnostic value until now. It is possible to cure each new tuberculosis case by adequate and continuous therapy. Resistance of M. tuberculosis against the "classical" antituberculotic agents mainly arises from non-compliance of treated patients. Multiresistant strains make tuberculosis incurable. In Germany, in contrast to some regions in Africa, Asia or in the United States of America, resistance against one of the antituberculotic drugs is still relatively low (5-10%). BCG-vaccination is recommended for high risk-groups only. Preventive chemotherapy is indicated for persons with conversion of tuberculin-reaction from negative to positive. The main infectious danger results from individuals with undiscovered active tuberculous lung disease via airborne droplet transmission. Therefore the most important task is to discover these persons in time by always considering the disease, when the corresponding symptoms are being observed. Because of the mentioned problems new efforts should be done to investigate the pathogenesis of the disease and its therapy with alternative drugs.

AIDS-Related Opportunistic Infections↗
PubMed1992

Production and analysis of specific monoclonal antibodies against the cell wall of Mycobacterium avium.

Monoclonal antibodies (mAbs) against Mycobacterium avium were produced which specifically reacted with cell walls of M. avium. The binding pattern was not limited to one subtype. The three most specific mAbs showed binding to the outer surface of M. avium but not to other mycobacterial or bacterial cell surfaces. The combined results of enzyme-linked immunosorbent assay, immunoblot and dot blot showed that mAb 4A006 bound to an epitope located in the cell wall and on the cell surface and mAb 4A010 to an epitope exposed on the cell surface and the cytoplasm. The mAb 4A009-binding epitope was only detectable on the cell surface but not in the cell wall or cytoplasmic fractions of M. avium. In the immunoblot technic a protein antigen with a molecular mass of 27-29 kDa was identified by the mAbs. The mAb 4A006 reacted with 142 out of 143 M. avium subtypes 1, 4 and 8 obtained from AIDS patients. These mAbs seem to be applicable for the identification of M. avium complex after culture.

Animals↗
PubMed1990

[Differentiation of M. tuberculosis and M. avium complex using various monoclonal antibodies].

M. avium-complex (MAC) is the cause of the most bacterial infections in AIDS patients. Because of the high resistance of MAC, a rapid differentiation between M. tuberculosis and MAC is of great interest. In an enzyme-linked immunosorbent assay (ELISA) we tested three monoclonal antibodies BS 103, BS 104, BS 113 and the combination of BS 103/BS 113, which bind selectively to the cell wall of M. tuberculosis. 98 MAC isolates from AIDS patients and 233 M. tuberculosis isolates from patients with lung disease were tested after primary culture of the bacteria on Lowenstein-Jensen media. ELISA could clearly discriminate MAC from M. tuberculosis with a specificity of 100% and a sensitivity of 98-100%. With these monoclonal antibodies the time for differentiation can be reduced by several weeks.

Antibodies, Monoclonal↗
PubMed1990

[Resistance testing of M. avium-intracellulare and M. tuberculosis of AIDS patients with new drugs and drug combinations].

The minimal inhibitory concentration (MIC) of rifabutin for M. tuberculosis was 0.006 to 0.06 micrograms/ml, and 0.12 to 0.25 micrograms/l for clofazimine. Accordingly, M. tuberculosis is inhibited by concentrations of these two medications that are far lower than the levels normally found in the serum. In the case of M. avium, the MIC of the new drugs such as rifabutin and clofazimine are, in contrast to the MICs for M. tuberculosis, merely of the order of the achievable serum concentrations. The minimum bactericidal concentrations of these two substances are much higher than the bacteriostatic concentrations, which probably explains the frequent therapeutic failures, while in the case of ciprofloxacin, the prevailing situation is much more favourable. The growth of all M. avium strains is inhibited (= sensitive) when elevated concentrations (double "breakpoint" concentrations) of a triple-drug combination comprising rifampicin, ethambutol and ciprofloxacin, or a combination of ethambutol, rifampicin, ciprofloxacin and prothionamid are tested at "normal breakpoint" concentrations.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Atypical mycobacterioses: diseases caused by Mycobacterium malmoense].

M. malmoense, once a rarity among the atypical mycobacterial infections, is presently being detected with ever greater frequency in human examination material. Strains of this organism apparently belong to the facultative pathogenic mycobacteria, as the cases described in this article show. Apart from other patients with mycobacterial infections of the lungs, the first case of infection of the lymph nodes in the neck is described.

Aged↗
PubMed1990

[Incidence of infections with mycobacteria in HIV infected patients].

In subjects with HIV infection, mycobacteria are frequently identified. The most commonly seen species are M. avium-M. intracellulare. On the other hand, there is considerable variation in the data regarding the incidence of infections with M. tuberculosis; in fact, these data correspond with the differences in prevalence of tuberculosis in the respective general population.

Cross-Sectional Studies↗
PubMed1989

Mycobacteremia in AIDS patients. Results of a prospective study.

The importance of blood cultures in diagnosing disseminated mycobacteriosis in AIDS patients was evaluated. Blood samples were screened for mycobacteria by culture and microscopic techniques. Mycobacteremia was proven in 20/136 (14.7%) AIDS patients, the agent being M. avium-M. intracellulare (MAI) in 16 cases and M. tuberculosis in four cases. The rate of cases with positive blood samples in disseminated MAI infection was 59.3% (16/27 cases) and in disseminated tuberculosis 57.1% (4/7 cases). To detect mycobacteria buffy-coat was slightly superior to lysated cell pellets, obtained by a lysis-centrifugation technique. In 4/16 cases with MAI bacteremia, the agent was proven by positive blood smears for acid-fast bacilli only; in these four patients MAI was demonstrated at other body sites. These results illustrate the diagnostic role of blood culture and its use in early diagnosis of disseminated mycobacteriosis, with microscopic examination of blood smears being an important adjunct.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The serodiagnosis of tuberculosis: a comparison of an enzyme-linked immunosorbent assay and a solid-phase radioimmunoassay.

Antibodies to a cytosolic fraction of Mycobacterium tuberculosis in sera from 104 patients with pulmonary tuberculosis and 141 age-matched healthy control subjects were quantitated by solid-phase radioimmunoassay (SPRIA) and an enzyme-linked immunosorbent assay (ELISA) technique. The SPRIA gave a greater discrimination than ELISA: in the former test 92% of patients had antibody levels in excess of those occurring in 97% of controls, while the corresponding figure with the latter was only 73%.

Adult↗
PubMed1988

Monoclonal antibodies selectively directed against the cell wall surface of Mycobacterium tuberculosis.

In the last few years several monoclonal antibodies against Mycobacterium tuberculosis have been described, but their use as diagnostic tools has been limited. In this study we describe eight monoclonal antibodies against M. tuberculosis for diagnostic purposes. The monoclonal antibodies were selected after enzyme-linked immunosorbent assay screening with whole bacterial suspensions of mycobacteria and other bacterial species. Four monoclonal antibodies (BS100, BS101, BS102, and BS104) reacted with a whole bacterial suspension of M. tuberculosis but not with the other mycobacteria. When tested with a cytoplasmic fraction of mycobacteria the same monoclonal antibodies showed a broad cross-reactivity. Therefore the monoclonal antibodies showed not specific but selective binding to M. tuberculosis. The molecular size of the recognized antigens ranged from 12 to 71 kilodaltons as determined by the immunoblotting technique. The ability to differentiate M. tuberculosis from mycobacteria other than tuberculosis was investigated by enzyme-linked immunosorbent assay with 131 freshly cultured strains of M. tuberculosis from patients and 36 strains of mycobacteria other than tuberculosis. The monoclonal antibody BS104 could clearly distinguish between M. tuberculosis and other mycobacterial species.

Antibodies, Bacterial↗