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.

How to beat the Rayleigh limit?

The problem of achieving super-resolution, i.e. resolution beyond the classical Rayleigh distance of half a wavelength, is a real challenge in several imaging problems. The development of computer-assisted instruments and the possibility of inverting the recorded data has clearly modified the traditional concept of resolving power of an instrument. We show that, in the framework of inverse problem theory, the achievable resolution limit arises no longer from a universal rule but instead from a practical limitation due to noise amplification in the data inversion process. We analyze under what circumstances super-resolution can be achieved and we show how to assess the actual resolution limits in a given experiment, as a function of the noise level and of the available a priori knowledge about the object function. We emphasize the importance of the a priori knowledge of its effective support and we show that significant super-resolution can be achieved for "subwavelength sources", i.e. objects which are smaller than the probing wavelength.