Paradoxical worsening of tuberculosis in a heart-lung transplant recipient.

We report on a heart-lung transplant recipient who presented with pulmonary tuberculosis (TB) 2.5 months after transplantation and then developed a paradoxical reaction after 4 months of adequate anti-TB treatment. She eventually recovered with anti-TB and high-dose steroid treatments. METHODS: Using sequential bronchoalveolar lavages, we assessed the inflammatory response in the lung and investigated the alveolar immune response against a Mycobacterium tuberculosis antigen. RESULTS: The paradoxical reaction was characterized by a massive infiltration of the alveolar space by M. tuberculosis antigen-specific CD4(+) T cells and by the presence of a CD4(-)CD8(-) T lymphocyte subpopulation bearing phenotypic markers (CD16(+)/56(+)) classically associated with NK cells. CONCLUSION: This case report illustrates that even solid organ transplant recipients receiving intense triple-drug immune suppression may be able to develop a paradoxical reaction during TB treatment. Transplant physicians should be aware of this phenomenon in order to differentiate it from treatment failure.

White-Light Supercontinuum Generation with 60-ps Pump Pulses in a Photonic Crystal Fiber

The generation of a spatially single-mode white-light supercontinuum has been observed in a photonic crystal fiber pumped with 60-ps pulses of subkilowatt peak power. The spectral broadening is identified as being due to the combined action of stimulated Raman scattering and parametric four-wave-mixing generation, with a negligible contribution from the self-phase modulation of the pump pulses. The experimental results are in good agreement with detailed numerical simulations. These findings demonstrate that ultrafast femtosecond pulses are not needed for efficient supercontinuum generation in photonic crystal fibers. © 2001 Optical Society of America.

Single-mode white-light supercontinuum with 60 ps pump pulses in a photonic crystal fiber

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