Association between the CD14 gene C-159T polymorphism and serum soluble CD14 with pulmonary tuberculosis.

BACKGROUND: Functional C-159T polymorphism in the promoter region of the CD14 lipopolysaccharide receptor has been reported to be associated with the development of tuberculosis (TB). OBJECTIVE: To assess the association of CD14 C-159T polymorphism and serum soluble CD14 (sCD14) levels with pulmonary tuberculosis (TB) in an Iranian population living in a TB-endemic area. DESIGN: A case-control study was performed prospectively on 120 newly diagnosed pulmonary TB patients and 131 healthy subjects. C-159T polymorphism was performed using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). Concentrations of sCD14 were measured in serum samples using enzyme-linked immunosorbent assay. RESULTS: The genotype frequencies of C-159T polymorphism differed significantly between TB patients and controls (P = 0.006). The risk of TB was 2.3-fold greater in individuals with the T-allele (CT + TT) in comparison to those without (OR 2.3, 95%CI 1.2-4.3, P = 0.006). Mean total sCD14 was significantly increased in the serum of patients with newly diagnosed pulmonary TB (mean ± SD = 3177 ± 751 ng/ml) compared to healthy controls (mean ± SD = 2955 ± 424 ng/ml, P < 0.004). CONCLUSION: These data indicate that the C-159T polymorphism of the CD14 gene is associated with TB; serum sCD14 levels were higher in TB patients in a sample of the Iranian population.

Topical treatment modalities for old world cutaneous leishmaniasis: a review.

Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens.

Glutaraldehyde test for rapid diagnosis of pulmonary tuberculosis.

OBJECTIVE: To determine the diagnostic value of blood glutaraldehyde gelification time in pulmonary tuberculosis (PTB). DESIGN: We analysed the blood gelification time using 2.5% glutaraldehyde in 83 PTB patients, 46 patients with non-tuberculosis pulmonary disease and 43 healthy subjects. RESULTS: The mean gelification time of PTB patients (556.9 +/- 122.4) is significantly less than non-tuberculosis pulmonary disease (708.0 +/- 100.5) and healthy subjects (821.2 +/- 138.3; P < 0.0001). The optimum cut-off point was 615 seconds by receiver operating characteristic curve analysis. The sensitivity, specificity, positive predictive value and negative predictive value were respectively 85.5%, 89.1%, 93.4% and 77.3% in distinguishing TB from non-PTB patients; and respectively 85.5%, 93.3%, 92.2% and 87.4% in distinguishing PTB patients from controls (non-PTB patients and healthy subjects). CONCLUSION: Because many centres lack sputum culture capacity and sophisticated radiology facilities, the glutaraldehyde test in conjunction with other conventional methods of diagnosis (sputum smear for acid-fast bacilli and frontal chest X-ray) could be a rapid, easy, cost-effective and reliable test for the diagnosis of PTB.

Tuberculous myelopathy: current aspects of neurologic sequels in the southeast of Iran.

OBJECTIVE: The spinal cord may be affected in different ways in the course of tuberculous infection. The objective of this study was to determine the epidemiologic features, clinical manifestations, pathophysiologic mechanisms, neurologic sequels, and treatment outcomes of tuberculous myelopathy in the southeast of Iran in which the disease is endemic. METHOD: A retrospective study was scheduled. All cases of tuberculous myelopathy treated in our hospital over the last 7 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous therapy were included. RESULTS: During a 7-year period, 43 cases of tuberculous myelopathy were found. The most frequent clinical manifestations were backache (86%) and fever (67%). Twenty patients were paraparetic or paraplegic and 40% had kyphosis. Imaging studies revealed thoracic and/or lumbar spine involvement in 92% of patients with tuberculous spondylitis. Fifteen, five and two patients had sensorimotor spinal cord syndrome, radiculomyelitis and intramedullary syringomyelic syndrome, respectively. Forty-seven percent required surgical intervention. There was improvement in 81% of the cases. CONCLUSION: Different pathophysiologic mechanisms acted on the clinical manifestations of spinal neurotuberculosis. A good outcome is expected if the diagnosis is made in the early stages before the appearance of spinal deformity and neurologic deficits.

Tuberculous radiculomyelitis: review and presentation of five patients.

BACKGROUND: The southeast region of Iran is an endemic area for tuberculosis. Tuberculous radiculomyelitis (TBRM) was considered a rare form of parenchymal neurotuberculosis. OBJECTIVE: To analyze the clinical, laboratory and electrophysiological data of patients with TBRM. We report five patients and review the literature. METHOD: We searched Medline since 1966 and reviewed all cases of TBRM, excluding those with Pott's disease. We then evaluated the clinical and electrophysiological data of our patients. RESULTS: Five patients (two men), with a mean age of 25 years, were assessed. The mean duration of symptoms before diagnosis was 4.5 weeks. Three patients had clinical manifestation of tuberculous meningitis (TBM). Diagnosis was based on sputum smear and culture, cerebrospinal fluid (CSF) culture and polymerase chain reaction (PCR) gene amplification of Mycobacterium tuberculosis. Paraparesis or paraplegia, sphincter incontinence and Babinski sign were the main clinical features. CSF analysis was compatible with chronic meningitis. Electromyography showed radiculopathy in all patients and peripheral nerve disease secondary to axonal damage in only three, while myelography showed adhesive arachnoiditis in three. CONCLUSION: Despite the rarity of TBRM, clinical features were well described. To prevent neurological sequelae, early diagnosis and treatment is mandatory. Electrophysiological study may predict the prognosis.