Pulmonary tuberculosis: relationship between sputum bacilloscopy and radiological lesions

OBJECTIVES: To determine the frequency of radiological manifestations of chest tuberculosis among the tuberculosis outpatients at the Santa Casa de Misericórdia de São Paulo Hospital, and to correlate these radiological findings with the sputum bacilloscopy. SAMPLE AND METHODS: A review was made of the medical record cards and chest X-rays of all patients attended between January 1996 and December 1998. Patients with a diagnosis of tuberculosis who presented intrathoracic manifestations of the disease and negative anti-HIV serology were selected. RESULTS: The selection included 153 patients, with an average age of 37.5 years, who were predominantly male (60.8%) and white (56.9%). Pulmonary lesions were present in 121 (79.9%) and extrapulmonary lesions in 32 (20.1%). Parenchymal-infiltrate lesions appeared in 56 patients (36.6%), cavity lesions in 55 (36.0%), pleural effusion in 28 (18.3%), isolated nodules in 6 (3.9%), mediastinal enlargement in 4 (2.6%) and miliary pattern in 4 (2.6%). Cavities were present in 45.5% of the patients with pulmonary lesions, generally in association with the parenchymal-infiltrate lesions. Parenchymal infiltrate was present in 86.8% of the patients with pulmonary lesions. There was significant presence of alcohol-acid resistant bacillus in the sputum of patients with cavities (76.4%), in comparison with those without cavities (50%) (p = 0.003). CONCLUSIONS: Parenchymal-infiltrate lesions are the most frequent radiological manifestation of pulmonary tuberculosis, and they are generally associated with cavities. There is a relationship between the presence of acid fast bacilli in sputum and pulmonary cavity lesions.

Burkholderia pseudomallei: a case report of a human infection in Ceará, Brazil

Burkholderia pseudomallei has rarely been isolated from environmental and clinical specimens in South America, particularly, in Brazil. This report describes a case of melioidosis with fulminant sepsis in a 10 year old boy, from rural area, in Tejuçuoca, State of Ceará, Brazil. Blood samples were positive and, through the analysis of results from biochemical tests and of drugs susceptibility profile, identified this gram-negative bacillus as B. pseudomallei. The contamination source remains obscure in this case, as soil and water tanks samples submitted to microbiological analyses did not indicate the presence of B. pseudomallei.

Cutaneous anthrax in Lima, Peru: retrospective analysis of 71 cases, including four with a meningoencephalic complication

Anthrax is a zoonosis produced by Bacillus anthracis, and as an human infection is endemic in several areas in the world, including Peru. More than 95% of the reported naturally acquired infections are cutaneous, and approximately 5% of them can progress to meningoencephalitis. In this study we review the clinical and epidemiological characteristics of the patients with diagnosis of cutaneous anthrax evaluated between 1969 and 2002 at the Hospital Nacional Cayetano Heredia (HNCH) and the Instituto de Medicina Tropical Alexander von Humboldt in Lima, Peru. Seventy one patients were included [49/71 (69%) of them men], with a mean age of 37 years. The diagnoses were classified as definitive (44%) or probable (56%). The most common occupation of the patients was agriculture (39%). The source of infection was found in 63 (88.7%) patients. All the patients had ulcerative lesions, with a central necrosis. Most of the patients (65%) had several lesions, mainly located in the upper limbs (80%). Four patients (5.6%) developed meningoencephalitis, and three of them eventually died. In conclusion, considering its clinical and epidemiological characteristics, cutaneous anthrax must be included in the differential diagnosis of skin ulcers. A patient with clinical suspicion of the disease should receive effective treatment soon, in order to avoid neurological complications which carry a high fatality rate.

EVALUATION OF ANTIMICROBIAL AND CYTOTOXIC ACTIVITIES OF PLANT EXTRACTS FROM SOUTHERN MINAS GERAIS CERRADO

The antimicrobial activity of plant hidroethanolic extracts on bacteria Gram positive, Gram negative, yeasts, Mycobacterium tuberculosis H37 and Mycobacterium bovis was evaluated by using the technique of Agar diffusion and microdilution in broth. Among the extracts evaluated by Agar diffusion, the extract of Bidens pilosa leaf presented the most expressive average of haloes of growth inhibition to the microorganisms, followed by the extract of B. pilosa flower, of Eugenia pyriformis' leaf and seed, of Plinia cauliflora leaf which statistically presented the same average of haloes inhibitory formation on bacteria Gram positive, Gram negative and yeasts. The extracts of Heliconia rostrata did not present activity. Mycobacterium tuberculosis H37 and Mycobacterium bovis(BCG) appeared resistant to all the extracts. The susceptibility profile of Candida albicans and Saccharomyces cerevisiae fungi were compared to one another and to the Gram positive Bacillus subtilis, Enterococcus faecalis and the Gram negative Salmonella typhimurium bacteria (p > 0.05). The evaluation of cytotoxicity was carried out on C6-36 larvae cells of the Aedes albopictus mosquito. The extracts of stem and flower of Heliconia rostrata, leaf and stem of Plinia cauliflora, seed of Anonna crassiflora and stem, flower and root of B. pilosa did not present toxicity in the analyzed concentrations. The highest rates of selectivity appeared in the extracts of stem of A. crassiflora and flower of B. pilosa to Staphylococcus aureus, presenting potential for future studies about a new drug development.

Simultaneous occurrence of pulmonary tuberculosis and carcinomatous lymphangitis

Tuberculosis is an important cause of mortality due to its high prevalence, considering that one third of the world’s population is infected with the tuberculosis bacillus. We report the first case of carcinomatous lymphangitis associated with active pulmonary tuberculosis. Carcinomatous lymphangitis is a rare event that may be confounded with tuberculosis because of its radiographic and clinical characteristics.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

The performance of an in-house nested-PCR technique for pleural tuberculosis diagnoses

Introduction This study evaluated the performance of an in-house nested-PCR system for the detection of the Mycobacterium tuberculosis complex in pleural fluid, blood and urine samples from pleural effusion tuberculosis patients by health services physicians in Pernambuco, Brazil. Methods A prospective double-blind study with 37 hospitalized patients of both sexes, aged over 15, was used to investigate the diagnosis of pleural effusion. The criteria used to define the cases included the demonstration of bacillus in biological samples by smear or culture or by a granulomatous finding in the histopathological examination, associated with an evident response to specific treatments to each clinical situation. Pleural fluid, blood and urine samples were collected and subjected to routine tests and the nested PCR technique to assess for M. tuberculosis amplification. Results In total, 37 pleural effusion patients took part in the study, of whom 19 (51.3%) had tubercular etiologies and 18 (48.7%) had etiologies from other causes. When the pleural fluid, blood and/or urine sample in-house nested-PCR sensitivities were evaluated simultaneously, the results were positive regardless of the biological specimen (the sensitivity was 84.2%); however, when the blood and/or urine samples were analyzed together, the sensitivity was 72.2%. When the pleural fluid samples were evaluated alone, the sensitivity was only 33.3%. Conclusions The performance of the diagnostic pleural tuberculosis nested-PCR was directly related to the diversity of the samples collected from the same patient. Additionally, this study may identify a need to prioritize non-invasive blood and urine collection for this diagnosis.

Deterioração bacteriológica do jaraqui Semaprochilodus spp. capturado no estado do Amazonas e conservado em gelo

Neste trabalho foram analisados 73 espécimes de jaraqui Semaprochilodus spp. conservados em caixas de poliestireno expandido entre camadas de gelo. Foram realizadas as seguintes análises: avaliação sensorial pela tabela de Torry modificada e pelo índice de qualidade por deméritos; determinação do pH e das bases voláteis totais (N-BVT); contagem total dos microrganismos aeróbios psicrófilos a 20 ºC por 4 dias, psicrotróficos a 7 ºC por 10 dias, dos mesófilos a 37 ºC por 2 dias; contagem, isolamento e identificação das bactérias Aeromonas sp. Bacillus sp. e Pseudomonas sp. a 20 ºC por 24 horas e de Plesiomonas sp. a 37 ºC por 2 dias. O jaraqui se manteve em condições de consumo, pela avaliação sensorial, por 18 e 21 dias. O pH e as bases voláteis totais não foram bons indicadores de qualidade; as contagens totais de psicrófilos, psicrotróficos e mesófilos não apresentaram diferença significativa e as bactérias não apresentaram comportamento deteriorador pela ausência da produção de H2S.

Diversity and capacity to promote maize growth of bacteria isolated from the Amazon region

ABSTRACT Maize plants can establish beneficial associations with plant growth-promoting bacteria. However, few studies have been conducted on the characterization and inoculation of these bacteria in the Amazon region. This study aimed to characterize endophytic bacteria isolated from maize in the Amazon region and to assess their capacity to promote plant growth. Fifty-five bacterial isolates were obtained from maize grown in two types of ecosystems, i.e., a cerrado (savanna) and a forest area. The isolates were characterized by the presence of the nifH gene, their ability to synthesize indole-3-acetic acid (IAA) and solubilize calcium phosphate (CaHPO4), and 16S rRNA partial gene sequencing. Twenty-four bacteria contained the nifH gene, of which seven were isolated from maize plants cultivated in a cerrado area and seventeen from a forest area. Fourteen samples showed the capacity to synthesize IAA and only four solubilized calcium phosphate. The following genera were found among these isolates: Pseudomonas; Acinetobacter; Enterobacter; Pantoea; Burkholderia and Bacillus. In addition, eight isolates with plant growth-promoting capacity were selected for a glasshouse experiment involving the inoculation of two maize genotypes (a hybrid and a variety) grown in pots containing soil. Inoculation promoted the development of the maize plants but no significant interaction between maize cultivar and bacterial inoculation was found. A high diversity of endophytic bacteria is present in the Amazon region and these bacteria have potential to promote the development of maize plants.

Nematódeos e bactérias em fôlhas de alcachôfra

Diseased plants of artichoke (Cynara scolimus L.) from the Instituto Agronômico, Campinas, Brazil, harboured nematodes in the leaves. The nematodes proved to belong to the species Protorhabditis oxyuris (Claus, 1862) Dougherty, 1955. As it could not be charged as the primary agent of the disease, a study of the bacteria found in the material was made. This disclosed that 4 different bacterial forms were present, namely Bacillus subtilis, Bacterium udum, Xanthomonas beticola var. cynarae n. var., and Cory neb acterium fascians var. cynarae n. var. The typical forms of X. beticola and of C. fascians are known as pathogenic to a number of plants: but, in the present case, unfortunately no inoculation trial could be made as an attempt to clear up the possible pathogenicity of any of them also to Cynara scolimus. The nematode P. oxyuris is the secondary agent, which however possibly play an important part in the distribution of the bacteria, as it has been repeatedly pointed out by previous writers with reference to closely related species. The symptoms of the disease are described. The main injuries found on leaves were necrotic areas progressing from the distal part of the limb, resulting in a great reduction of the leaf superficies.

Protozoários intestinais de vertebrados observados em Salobra

Protozoa were collected by means of dry smears and cultures in Cleveland's medium contained in 2cm3 ampules. The isolation and subsequent cultivation of trichomonad organisms in ampules were generally successfull; but the cultures went down, when transferred to test-tubes in the same medium, apparently because of the liberation of characteristic pigment by Bacillus pyocyaneus.

Poderá o carrapato transmitir a lepra?: isolamento e cultura dum bacilo acido-álcool resistente de sedimento de "Amblyomma cajennense" capturado em leproso: 2ª nota

In this 2nd note upon the possibility of transmission of human leprosy by ticks, the A. relates his stepps to obtain the collaboration of his colleagues working in leprosaria in various States of Brazil, Argentina and Paraguay in such studies. Firstly the A. describes the positive results of examination of sediment of ticks, the cattle tick Boophilus microplus (Canestrini, 1888), received from Paraná (Leprosário São Roque) , which were put on active lepers, two of them sucking during 9 days and one during 7 days. Two out of three were killed for examination and were very strongly positive for acid-fast bacilli. A series of tubes of Loewenstein medium was smeared with the sediment of such ticks. Secondly the A. relates his personnal experiment, carried out in Rio de Janeiro, trying to infect normal ticks in lepers. The experiment with Boophilus microplus was negative and was twicely positive the experiment with Amblyomma cajennense Fabricius, 1794. The experiment is being in progress and will be continued in other places of Brazil. Finally, after being given the general characteristics of Boophilus microplus, the A. describes the non-chromogenic culture of a acid-fast bacillus isolated by him from sediment of ticks (Amblyomma cajennense) captured in lepers from Colônia Santa Isabel (Minas gerais), which parasitism was spontaneous. The first isolation was obtained in Loewenstein medium after 62 days incubation at 37°C. The culture is pure and the bacillus is permanent acid-fast. The plate1, in full color, represents this culture in its four generations. The colonies are pearl-white in color, dry, elevated and rough, developing slowly and beginning as white pinhead points scattered upon the surface of the medium. The culture is not yet rich enough to be inoculated into laboratory animals, which will be done when possible.

Infecção experimental de carrapatos (Amblyomma cajennense) em ratos com lepra Stefansky

The A. succeeded, after various experiments, to infect ticks (Amblyoma cajennense) with STEFANSKY bacillus, upon feeding them in rats suffering from murine leprosy, in advanced stages. The A. thinks that will be ease to transfer the sickness from rat to rat by means of inoculation of triturate of infected ticks, as did MARCHOUX with Laelaps echdninus.

A lepra tuberculoide, ou melhor, a lesão tuberculoide na lepra, representa uma fase de transição desta dermatose e não uma forma clínica autônoma: novos achados bacterioscópicos na linfa subcutânea de leprosos

The A., after an intorductory history of his experience in leprosy, discusses the more convinient routine method of classification of leprosy cases, basing it in the facte that every case is mixt, i. e. when the skin shows any lesion the nerves of that region are also affected by the bacilli. Studying by a new thecnics, which he baptised before as "Lleras' method", the scarching of the agent of leprosy in tuberculoid cases, by examination of sub-corium lymph obtained from the lesion, he discovered new forms of the Hansen bacillus, which describes briefly, arriving at the following conclusions: 1. The A., after discussing about the evolution and clinical classification of leprosy, describes new forms of the HANSIN bacillus, discoverd in the lymph extracted from subcutis of leprosy lesion. 2. In 100 % of tuberculoid cases (total studied 29) the A. found, in the subcutis lymph, bacilli, granules, clubs or other forms of HANSEN bacillus. 3. Such bacteriological findigs and the proved mutation of tuberculoid leprosy into lepromatous type, demolished the basis of the so-called "polar" classification of leprosy. 4. Considering the proved facts already referred to, the A. arrived at the conclusion that 50 % of all papers published about tuberculoid leprosy, within the last ten years, are fanciful. 5. The presence, in the subcutis of lepers, of metamorphosic forms of HANSEN bacillus, is the cause of common relapses of negativated cases by treatment, which fact suggests a new therapeutics method to destroy such elements in loco, and exiges more strict examination before release of interned patients.

Verificação, em condiçoes naturais, da infecção de mais três hematófagos (Anophelineos, Flebótomos e Simulídeos) em leprosos

The A. went last August to the State of Minas Gerais to continue his studies on transmission of leprosy by insects. He selected ten lepers (all L3 cases) for his experiments. It happened in the middle of August, a few day after freezing temperature. Practically there were no day mosquitoes, even near a river where in March there were very many. Bringing the patients to a wood, near the Peixe River (Fish River), at the dawn they were attacked by very many Anopheles, some flebotomus, a few Simulium and very rare Culex scapularis. All these insects became infected, in different degrees, by biting such patients. CONCLUSIONS. 1. Two species of Anopheles (A. albitarsis and A. tarsimaculatus) became strongly infected by Hansen bacilli. 2. By dissection done by Dr. Oliveira Castro were found lepra bacilli in various points of the proboscis of two Flebotomus (F. intermedius) and in their stomachs. 3. By smearing were found lepra bacilli in two specimens of Simulium sp. (probably pertinax). 4. It was confirmed also the verification done last March, at the same Leper Colony, that Phthirius pubis can be also a carrier of lepra bacillus. 5. There was confirmed also natural infection of nymphs of Amblyomma cajennense in lepers. Dr. Oliveira Castro is dissecting the Anopheles to locate the bacilli in their organisms and he started, with the cooperation of the Director of Colonia Santa Fé, Dr. José Mariano, attenpts to re-infect a group of negative-nerve cases of leprosy with infected mosquitoes.