Evaluation of strategies for molecular fingerprinting for use in the routine work of a Mycobacterium reference unit.

We have investigated the role of two rapid PCR-based typing methods, IS6110-based PCR and spacer-oligonucleotide typing, within a national tuberculosis reference service. The validity of clusters with IS6110 restriction fragment length polymorphism fingerprints with less than 6 bands was also investigated in the context of referred isolates.

Pathology attributed to Mycobacterium chelonae infection among farmed and laboratory-infected Atlantic salmon Salmo salar.

This study was promoted following concern over increasing mortality on 2 farms rearing Atlantic salmon Salmo salar in the Shetland Isles, Scotland. A Mycobacterium sp. was isolated from moribund, market-sized Atlantic salmon.

An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital.

We describe the epidemiology and control of a hospital outbreak of multi-drug-resistant tuberculosis (MDR-TB). A human immunodeficiency virus (HIV)-negative patient with drug-sensitive tuberculosis developed MDR-TB during a period of unsupervised therapy. She was admitted to an isolation room in a ward with HIV-positive patients, but the room, unbeknown to hospital staff, was at positive-pressure relative to the main ward.

Comparison of three molecular assays for rapid detection of rifampin resistance in Mycobacterium tuberculosis.

Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is an emerging problem of great importance to public health, with higher mortality rates than drug-sensitive TB, particularly in immunocompromised patients. MDR-TB patients require treatment with more-toxic second-line drugs and remain infectious for longer than patients infected with drug-sensitive strains, incurring higher costs due to prolonged hospitalization. It is estimated that 90% of United Kingdom rifampin-resistant isolates are also resistant to isoniazid, making rifampin resistance a useful surrogate marker for multidrug resistance and indicating that second- and third-line drugs to which these isolates are susceptible are urgently required.

Antituberculosis drug resistance surveillance in Kenya, 1995.

Setting: Twenty-two of the 42 administrative districts in Kenya.

Objective: To determine the prevalence of drug resistance in newly diagnosed patients with pulmonary tuberculosis, to determine possible risk factors associated with resistance, and to establish standard routine surveillance of drug resistance.

Design: Cross-sectional study.

Simultaneous genotyping and species identification using hybridization pattern recognition analysis of generic Mycobacterium DNA arrays.

High-density oligonucleotide arrays can be used to rapidly examine large amounts of DNA sequence in a high throughput manner. An array designed to determine the specific nucleotide sequence of 705 bp of the rpoB gene of Mycobacterium tuberculosis accurately detected rifampin resistance associated with mutations of 44 clinical isolates of M. tuberculosis.

The rapid diagnosis of isoniazid and rifampicin resistance in Mycobacterium tuberculosis--a molecular story.

Isoniazid and rifampicin resistance are assayed phenotypically by the resistance ratio, absolute concentration or proportion methods. Assay methods are often difficult to standardise and the World Health Organization (WHO) Global Programme on Drug Resistance is attempting to produce standardised drug resistance data worldwide. Broth-based methods are faster than solid media systems, and a commercial radiometric system, the Bactec 460, is arguably the fastest method and permits testing to be completed within 7-14 days; however, this method is expensive and requires disposal of radioactive material.

Enteropathy in Zambians with HIV related diarrhoea: regression modelling of potential determinants of mucosal damage.

Background: AIDS is characterised by small intestinal mucosal damage, but its aetiopathogenesis is poorly understood. Enteric infections in Africa differ from those in northern countries, where protozoan infections have been associated with severe enteropathy in AIDS patients.

Aims: To characterise enteropathy in Zambian AIDS patients compared with local controls, and to assess relative contributions of enteric infection, nutritional impairment, and immune dysfunction.

PHLS mycobacteriology reference services in England and Wales.

Tuberculosis (TB) is the most important cause of infectious disease in the world, with eight million new cases and three million deaths each year. The increasing incidence of TB in the developed and the developing world, increasing drug resistance, and the occurrence of nosocomial outbreaks of drug sensitive as well as drug resistant TB has led the PHLS to establish TB as a priority area. This article reviews the enhanced reference services for mycobacteriology provided by the PHLS in England and Wales.

Molecular diagnosis, detection of drug resistance and epidemiology of tuberculosis.

Tuberculosis remains one of the most common and important infectious diseases worldwide. Early diagnosis and detection of Mycobacterium tuberculosis drug resistance is vital for good clinical management and improving public health generally.

Tuberculosis in Siberia: 2. Diagnosis, chemoprophylaxis and treatment.

Objective: To assess tuberculosis diagnosis, chemoprophylaxis and therapy in Siberia as a paradigm for the Russian Federation.

Design: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994.

Results: Tuberculosis disease and cure is classified according to a Dispensary Group Register based principally on clinical and radiological criteria.

Tuberculosis in Siberia: 1. An epidemiological and microbiological assessment.

Setting: Siberia, Russian Federation.

Objective: To assess the situation regarding tuberculosis as a paradigm for the Russian Federation.

Design: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994.

Tuberculosis and AIDS.

Since the mid-1980s, the rate of decline in reported cases of tuberculosis (TB) has reached a plateau or reversed because of a combination of poverty and increased homelessness, immigration and displacement, poorly managed and supplied TB control programmes and, particularly in the developing world, the emergence of human immunodeficiency virus (HIV) infection. TB in HIV-positive patients may present atypically, both clinically and radiologically, with a lower probability of sputum positivity, greater difficulty in diagnosis, and a more rapid clinical deterioration than TB in HIV-seronegative patients. The emergence of multiple-drug-resistant strains of Mycobacterium tuberculosis, particularly in patients infected by HIV, carries a high mortality and has been associated with outbreaks in Europe and the USA.

Follow up of an immunocompromised contact group of a case of open pulmonary tuberculosis on a renal unit.

Background: The organisation, management, outcome and cost of follow up of a large group of mainly immunocompromised patients and healthcare workers who were exposed to a staff member of a London renal unit with smear positive pulmonary tuberculosis are described.

Methods: Following British Thoracic Society (BTS) guidelines, 576 close contacts were identified and divided into three groups: (1) 303 renal patients including 61 with renal transplants; (2) 90 surgical patients; and (3) 183 staff members. Screened contacts were interviewed, completed a symptoms questionnaire, and were offered a chest radiograph and Heaf or Mantoux test if appropriate with referral to a chest physician if required.