[Surveillance of drug resistance in tuberculosis].
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Humans↗
Biomedical subjects
M Kubín
Publications and source records attributed to M Kubín.
Adverse reactions to BCG.
In the post-war period the following BCG vaccines were successively in use for preventive vaccination in the Czech territory: (a) Copenhagen BCG, 1947-1950, (b) Prague BCG 725, 1951-1980, (c) Moscow BCG, 1981-1993, and (d) Behring BCG, from 1994 onwards. These BCG substrains can be now identified by modern methods of molecular genetics. Introducing the Moscow BCG brought about an elevated incidence of iatrogenic local and regional lymph node adverse reactions compared with the previous Prague BCG product and, as a new phenomenon, bone and joint involvements in children vaccinated at birth. The aim of this study was to analyze the incidence of postvaccination adverse reactions reported in the period from 1981 to 1993 as related to the Moscow BCG vaccine and, to demonstrate the effect of lower vaccination dosage on their frequency. The concentration of the Moscow BCG varied from 11 to 22.6 x 10(6) (average 16.2) CFU per 1 mg. In the period when full dose of BCG (0.05 mg per 0.1 ml) was applied to newborns 437 local and 195 regional lymph node complications were recorded, i.e. 0.08% of vaccinated were affected, demanding antituberculosis chemotherapy in 6.5% and surgical interventions in 24%. When the lowered vaccination dose (0.025 mg per 0.1 ml) was inoculated to newborns the local adverse reactions rose paradoxically affecting 0.1% of vaccinated but the regional lymph node reactions fell considerably to reach 0.01%; the demand for chemotherapy and surgery also fell down to 3.1 and 4.8% respectively. Bone and joint adverse involvements were recorded in 28 cases, i.e. in 3.7 per 10(5) of those vaccinated with the full dose.(ABSTRACT TRUNCATED AT 250 WORDS)
BCG Vaccine↗
Mycobacterial infections in patients with AIDS in a low HIV prevalence area.
The Czech Republic is characterized here as both a low HIV prevalence area (1.64 registered positivity per 10(5) population and 45 AIDS patients notified in the 1986-93 period) and a low tuberculosis prevalence area (mortality rate 0.8, incidence of bacillary pulmonary cases 11.3 per 10(5) population and risk of infection 0.04 in 1990). From 1986 to 1993 a total of 10 cases of mycobacterial infections complicating AIDS or ARC disease were registered in the Czech Republic in 9 male patients aged from 29 to 55, 8 homosexuals, and one woman aged 48. Classical pulmonary tuberculosis caused by M. tuberculosis was diagnosed in one male patient and was controlled by antituberculosis chemotherapy. The remaining mycobacterial infections were caused by the following opportunistic mycobacterial pathogens. (a) M. avium in five individuals, four of them died of a disseminated disease; (b) M. kansasii--in two patients, one died of a disseminated infection; (c) M. xenopi--involved in a fatal generalized CMV, and cryptococcal and mycobacterial infection; (d) M. fortuitum caused a generalized disease in a case of exhaustive multifocal encephalopathy. Authors conclude that under conditions of low prevalence of both HIV and tuberculosis infection the risk to AIDS patients of contracting classical tuberculosis is low. A relatively frequent occurrence of non-tuberculosis mycobacterial disease in AIDS patients afflicted with the impaired immunity is explained by transmission of opportunistic mycobacteria from the environment.
AIDS-Related Complex↗
Water as a possible factor of transmission in mycobacterial infections.
Mycobacterium kansasii and Mycobacterium xenopi are the most frequent species occurring in water in the Czech Republic. In the endemic area of M. kansasii in heavy industry and mining areas of North Moravia various mycobacterial species were detected in more than 20% of different water samples and M. kansasii was found in 1.5 to 1.9% of them, frequently in pit bathrooms and in the drinking water as well. Mycobacterium xenopi was detected in 35 and 50% of water samples collected in households of M. xenopi excretors in North Bohemia and in Prague. A nosocomial occurrence of M. xenopi was recorded in an hospital department in North Bohemia and in a rest home in Prague and all samples of water from the afflicted institutions were positive for M. xenopi. In a coal mine in Moravia a case of cutaneous involvement associated with the presence of M. marinum in mine water was also recorded. The incidence of various mycobacterial species (except of M. kansasii and M. xenopi) in spa and swimming pools in West Bohemia reached 35% positivity. Comprehensive reviews of bacteriological investigations for mycobacteria performed in the entire territory of the Czech Republic have been reported in annual reports since 1985. In the period from 1985 to 1991 a total of 5167 samples of various kinds of water samples were examined and mycobacteria were detected in 8.2 to 47.7% of them.
Czech Republic↗
Genetic DNA probes for Mycobacterium avium complex identification.
The acridinium ester labelled DNA probe specific for M. avium complex (MAC) was used for testing 30 strains of MAC previously identified by conventional procedures. The hybridization was positive in 26 strains, negative in 3 strains and one strain seemed to be contaminated when subcultured. The specific DNA probes allow to identify even the slow growing mycobacterial strains, in positive samples, within two hours while conventional methods usually take several weeks to show the result. A rapid confirmation of a mycobacterial species is invaluable for selecting an effective treatment as early as possible, which is extremely important e.g. in immunosuppressed patients, children with lymphadenitis, etc. Nevertheless, this method has the disadvantage of being too expensive for some laboratories, though questionable if repeated subcultures, technician's time and the delay in obtaining results are taken into account, and enabling to identify only a limited number of clinically significant mycobacterial species using commercially available probes.
Bacterial Typing Techniques↗
DNA fingerprint analysis of drug resistant Mycobacterium tuberculosis strains isolated in the Czech Republic.
DNA fingerprints were established in 12 drug resistant and 12 susceptible M. tuberculosis strains collected from patients residing in Prague, Czech Republic. The Restriction Fragment Length Polymorphism (RFLP) technique was based on the detection of the insertion sequence IS6110 in PvuII digested chromosomal DNA. All investigated strains possessed at least 5 copies of IS6110 ranging from 5 to 15 copies in the drug resistant isolates and 5 to 11 copies in susceptible isolates. Three multidrug resistant strains displayed identical fingerprints (5 bands), and two strains resistant to pyrazinamid had the same banding pattern (12 bands). The remaining isolates differed either in number or location of the IS6110 copies. Thorough epidemiological analysis did not furnish proof of direct contact among these patients.
Antitubercular Agents↗
Detection of serum antibodies in tuberculosis patients.
Sera of 14 bacteriological confirmed pulmonary tuberculosis and 16 non-tuberculotic or healthy controls were sampled in Ignace Deen University Hospital in Conakry, Quinea. Samples were examined for IgG and IgM antibodies by means of enzyme-linked immunosorbent assay (ELISA) using sonicated M. bovis BCG and M. avium antigens and were tested for antibodies to HIV-1/HIV-2 as well. Median of IgG antibody titres to M. bovis BCG antigen was 1:445 and differed significantly from that of the control group (1:149). The median of IgM antibody titres was 1:79.1 and did not differ statistically from that of control group (1:69.3) as well as the antibody titres against M. avium antigen in the IgG and IgM classes for both analyzed serum groups. Seven of tested TB patients sera were positive for antibodies against HIV-1. The median of IgG antibody titres against M. bovis BCG antigen was 1:442 not differing significantly from values of remaining TB patients as well as the IgM antibody titre (1:109).
Adult↗
[Drug resistance in M. tuberculosis in Prague 1987-1992].
In 1987-1992 in Prague drug resistance of M. tuberculosis to four standard antituberculotics (isoniazide, streptomycin, rifampicin, ethambutol) was recorded in 39 patients, i.e. in 1.5-5% of patients with bacillary tuberculosis. Initial resistance was found in 25, secondary resistance in 13 subjects, in one patient both types of resistance were observed. In both groups men and patients born before 1941 predominated. In patients with initial resistance findings rated as small or medium-sized predominated, while in secondary resistance half the findings were medium-sized or extensive; an extrapulmonary form was recorded in one female patient. In the group of patients with an initially resistant M. tuberculosis monoresistant strains predominated and the highest ratio was accounted for by strains resistant to isoniazide; in patients with secondary resistance strains with combined resistance to two or more drugs predominated, however in all instances a combination of isoniazide with other antituberculotics was involved. With regard to the changing epidemiological situation as regards tuberculosis (in particular the arrested decline of the incidence of bacillary tuberculosis and the increase of drug resistance of M. tuberculosis), the authors recommend further monitoring and epidemiological analysis of the incidence of strains with initial and secondary resistance, systematic external checks of laboratory technique used for testing the sensitivity to antituberculotics and its centralization as well as the introduction of analyses of restrictive fragments of the DNA genome (RFLP method) to monitor the spread of tuberculous mycobacteria in the population.
Adult↗
[Radiometric determination of Mycobacterium avium-intracellulare and Mycobacterium xenopi sensitivity to antitubercular agents].
Using the macrodilution radiometric technique in a BACTEC 460 apparatus, the authors assessed in 25 strains of the M. avium complex and 20 strains of M. xenopi the MIC of the following chemotherapeutic agents: Ciprofloxacine, clofazimine, rifampin, cycloserine, kanamycin, etionamide, ethambutol and amikacin. In all instances wild strains isolated in the Czech Republic in 1991-1992 were involved. In strains of the M. avium complex in the majority of drugs a major predominance of slightly or completely resistant strains was found. However, in addition to resistant strains there were also sensitive strains and strains with a reduced sensitivity in the group. The highest ratio of sensitive strains was recorded in clofazimine and amikacin. Strains of M. xenopi had, as compared with avian mycobacteria, lower MIC values with the exception of cycloserine and ethambutol in all the remaining chemotherapeutic agents. The applied radiometric technique was evaluated as a suitable method for assessment of the sensitivity of mycobacteria to chemotherapeutic agents, in particular because it provides results within a short time, i.e. within 8 days after inoculation and because of the quantitative evaluation of MIC values. It was therefore recommended for centralized assessment of sensitivity in the Czech Republic.
Antitubercular Agents↗
Water-borne household infections due to Mycobacterium xenopi.
Of 21 M. xenopi excretors recorded in Prague in 1990, 13 suffered from a serious pulmonary disease and the organisms were detected repeatedly in all of them. In 11 flats of these excretors water samples were collected from faucets and showers and M. xenopi was detected in five of them, as well as in five neighbouring flats. In flats of six remaining excretors and 12 adjoining flats, M. xenopi was not found. However, in 14 of 28 examined flats, the clinically insignificant M. gordonae was isolated. Water samples from three water-works, six regional water reservoirs and 10 street hydrants did not harbour mycobacteria. In the authors' view M. xenopi originating from infected drinking water outlets may cause infections in exposed household dwellers.
Chlorine↗
[Identification of mycobacteria species using genetic probes].
Using commercially available probes Gen-Probe (Accu-Probe, Epignost, Austria) labelled with acridinium ester, the authors identified 102 cultures of mycobacteria which are the causal agents of classical tuberculosis or cause mycobacterioses which are difficult to control by therapeutic measures. The cultures were isolated from sputum or lymph nodes and cultivated on Löwenstein-Jensen medium. The authors proved a 100% sensitivity of the probe for isolates of M. tuberculosis and M. kansasii. In a group of 36 strains sent as suspect M. avium 33 strains reacted with the probe for the M. avium complex, 28 strains with the M. avium probe and 4 strains with the M. intracellulare. One isolate hybridized only with the probe for the M. avium complex. In one isolate a positive hybridization value was recorded with the M. gordonae probe and in one pigmented strain with the M. kansasii probe. One isolate did not hybridize with any of the probes used. In one instance a mixed culture of M. tuberculosis and M. avium was involved. The results of hybridization were interpreted in RLU values (relative light unit). Isolates above 30,000 RLU were evaluated positively, as recommended by the manufacturer.
DNA Probes↗
Susceptibility of Mycobacterium kansasii to ethambutol and its combination with rifamycins, ciprofloxacin and isoniazid.
The susceptibility of Mycobacterium kansasii to antibacterial agents alone and in combination was studied. Widespread resistance to ethambutol, ciprofloxacin and isoniazid was found when these drugs were tested separately. However, pronounced antibacterial effects were seen when ethambutol was tested in combination with ciprofloxacin, rifampicin or rifabutin, which corresponded to significantly decreased resistance to these drugs in combination.
Ciprofloxacin↗
[A revolution in the therapy of leprosy].
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Humans↗
Level of serum antibodies to mycobacterial antigens in healthy Czechs.
Levels of IgG antibodies to Mycobacterium bovis BCG and M. avium antigens were examined by enzyme-linked immunosorbent assay (ELISA) in samples of sera from 898 healthy adults aged greater than 40 years and 1170 children aged 1-6 years, selected at random in 10 districts of Czechoslovakia. The median antibody titre to M. bovis BCG in adults ranged from 1:28 to 1:161.7 and that in children from 0 to 1:50. The mean titres of M. avium antigen ranged from 1:2 to 1:21 in adults and from 0 to 1:8 in children.
Adult↗
[Kaposi's sarcoma in a patient with developed AIDS].
The authors give an account on the first case of Kaposi sarcoma in a patient with developed AIDS in CSFR. They describe the case-history, clinical course and histopathological finding.
Acquired Immunodeficiency Syndrome↗
The antimicrobial activity of Fleroxacin RO 23-6240, a third generation fluoroquinolone derivative, tested in vitro.
The broad antimicrobial spectrum of Fleroxacin RO 23-6240 was tested on a panel of bacterial and several mycobacterial species. Staph. aureus strains, gramnegative bacteria E. coli, Kl. pneumoniae, Salmonella spp. were found to be rather susceptible to the tested preparation in vitro. The same was true of those species which are known to feature strong natural resistance, e.g. Ps. aeruginosa and Acinetobacter calcoaceticus. As regards mycobacteria, complete susceptibility was recorded for 10 M. tuberculosis strains, 17 M. kansasii strains and 4 strains of M. fortuitum. Only two of the eleven tested strains of the complex M. avium-intracellulare were found to be susceptible and one M. chelonae strain tested proved resistant. Due to their broad spectrum and strong bactericidal effects, chinolone preparations can be anticipated to assume an everincreasing significance in the future.
Bacteria↗
Establishment of 2-docosanol as a cellular marker compound in the identification of Mycobacterium xenopi.
Sixteen strains of Mycobacterium xenopi were studied by gas chromatography and thin-layer chromatography. Data on the cellular fatty acids, fatty alcohols, mycolic acids, and glycolipids indicated that this bacterium possesses a specific lipid composition. 2-Docosanol, detected in all studied strains, was found to constitute a useful chemical marker in the identification of M. xenopi.
Biomarkers↗
Screening of serum antibodies against Mycobacterium tuberculosis by enzyme-linked immunosorbent assay (ELISA) in healthy population.
Serum samples of venous blood of healthy individuals, chosen at random from two areas of the People's Democratic republic of Yemen, were examined for the presence of IgG antibodies against mycobacterial antigen by ELISA. From the district of Aden, the capital (A), there were 214 samples (72% vaccinated by BCG, 108 men and 106 women), other 235 ones originated from mountain area Laudar Muhairas (H) (66% vaccinated, 115 men and 120 women). The overall average of acquired titres was 1:81.4 in area A, and an average of 1:102.2 was recorded in area H. There was no substantial difference in the titres level in men of the two areas (1:86.9 and 1:90 resp.), however, a significant difference was observed in women: 1:75.7 in area A and 1:114.7 in area H. In area A the titres were ranging in all age groups from 1:61 to 1:83 and the differences between age groups and between vaccinated and unvaccinated individuals were not significant. In area H the titres were generally higher (1:72 to 1:164) in the unvaccinated and 1:79 to 1:204 in the vaccinated. The differences in the unvaccinated were not of a statistical importance: in the vaccinated, the titres of the 20-29 years old (1:204.5) substantially differed from the titres obtained in other groups. The differences in titres level between the two studied areas are explained by a different epidemiological situation, namely by a higher tuberculosis infestation of some age groups in area H.
Adolescent↗