Resistance to anti-tuberculosis medications in the Horn of Africa.

We performed drug susceptibility testing among chronic patients hospitalised in the tuberculosis (TB) referral centre of the capital of Djibouti. Among 36 patients tested, 27 had multidrug-resistant TB and four had extensively drug-resistant TB. National guidelines must be revised urgently and the administration of second-line TB medications strictly controlled.

[Cystic fibrosis: a microbiological study over an 8-year period]. / Fibrosis quística: estudio microbiológico durante un período de 8 años.

OBJECTIVE: To study the microbiology of cystic fibrosis in our hospital for the period from 1985 to 1992. MATERIAL AND METHODS: The number of samples analyzed totalled 1,034, most of which were sputum and nasopharyngeal aspirates belonging to 113 patients (49 women and 64 men). The average age was 10 years (range: 15 days-33 years). RESULTS AND DISCUSSION: Only 1.7% of the samples were negative. Normal flora were found in 10.8% and one or more potentially pathogenic microorganisms were found in the remaining 87.4%. Colonies were over 10(6) UFC/ml in size in 77.8% of the quantified cultures. The most frequently identified microorganisms in the population overall were P. aeruginosa (53.9%), S. aureus (30.3%) and H. influenzae (22.0%). In patients less than 12 months old, however, the most common isolations were of S. pneumoniae and B. catarrhalis; cultures from patients older than 16 years old most often yielded filiform fungi, mainly Aspergillus spp. We found no strains of Legionella spp. and P. cepacia was found in only 3 cases, in which the clinical outcome was good. In addition to the 3 most common organisms, we recorded several consecutive isolations of Proteus mirabilis, Xanthomonas maltophilia and Serratia marcescens in patients older than 11 years old; this finding suggests that given the improved survival of cystic fibrosis patients over the coming years and the antibiotic pressure placed on them, there may be slight changes in the bacterial ecology typical of this disease. No strain of S. aureus proved resistant to methicillin, but P. aeruginosa was shown to be resistant to gentamycin (58.2%) among the aminoglycosides and also to some of the beta-lactams considered to be effective, as follows: 25.2% to piperacillin, 22.6% to ceftazidime and even 19.8% to aztreonam. There was slight resistance of ciprofloxacin (6.3%).

Time course of anti-SL-IV immunoglobulin G antibodies in patients with tuberculosis and tuberculosis-associated AIDS.

Immunoglobulin G (IgG) and IgM antibodies against the SL-IV antigen of Mycobacterium tuberculosis in the sera of patients with tuberculosis with negative serology for human immunodeficiency virus (HIV) infection (TB group; n = 97), patients with tuberculosis with positive serology for HIV infection (TB-HIV group; n = 59), and healthy controls (n = 289) were determined by enzyme-linked immunosorbent assay. All sera were obtained at the onset of tuberculosis, i.e., when clinical symptoms appeared. Clinical specimens were collected and cultured for the isolation of M. tuberculosis, and treatment with antituberculous drugs was started. Sera were also obtained from patients in the TB group at fixed intervals during treatment; sera were available from 13 patients in the TB-HIV group before the onset of tuberculosis. The best specificity and positive predictive values were obtained with the IgG assays. In the IgG assays at specificities above 96.0%, the sensitivities of the tests were 45.3 and 72.8% for the TB and TB-HIV groups, respectively, and the sensitivity was 51.9% when data from both groups were combined for analysis. For the TB group, results of this study indicated that the levels of IgG antibodies remain high during treatment. Thus, repetitive serological assays may not be useful for treatment follow-up. In the TB-HIV group, 12 of 13 patients had IgG-specific antibodies against the SL-IV antigen between 1 and 30 months before the onset of tuberculosis, so we suggest that the IgG antibody assay against SL-IV may be helpful for identifying tuberculosis in patients infected with HIV.

Diagnosis of mycobacterial infection in acquired immunodeficiency syndrome (AIDS) patients and HIV carriers.

Differences in tuberculosis diagnosis between infected and non-infected HIV patients were described. In Barcelona, tuberculosis is present in 41.6% of 851 patients in whom AIDS was detected between 1981 and the first quarter of 1990. We reviewed the results of the methods used for tuberculosis diagnosis in 270 AIDS patients controlled in our hospital, in whom tuberculosis was detected (33.3%), and we compared these data with the results obtained in HIV carriers with tuberculosis and with tuberculous patients without HIV infection. Statistically significant differences were found between the three groups with respect to sex, age, results of Ziehl-Neelsen stain in pulmonary specimens and skin test reaction; between AIDS patients and the non-HIV infected population differences were observed in tuberculosis site. Positive skin test reaction diminished from tuberculous individuals non-HIV infected (95%), to HIV carriers with tuberculosis (71.8%) and AIDS patients with tuberculosis (21.8%). Acid-fast smears from pulmonary specimens were positive in 35.7%, 23.5% and 43.7% respectively. Statistically significant differences were found in tuberculosis localization between tuberculous patients non-HIV infected and tuberculous patients with AIDS, in the last group tuberculosis lymphadenitis was the most frequent localization (33.3%) of extrapulmonary tuberculosis, followed by abdominal tuberculosis (15.5%). The incidence of HIV infection among tuberculous patients was 4.6 in our study, but could be higher if patients between 19 and 30 years old were always checked for anti-HIV antibodies.

[Evaluation of the serological follow-up of newborn infants, carriers of HIV-1 antibodies]. / Valoración del seguimiento serológico en recién nacidos portadores de anticuerpos anti VIH 1.

Serological follow-ups were performed in 19 newborns carrying HIV 1 antibodies over a period ranging between 9 and 62 months. Eight children developed AIDS ans 11 remained asymptomatic. Anti-HIV 1 antibodies were determined by ELISA and Western blot and p 24 antigen was detected by ELISA. Antibodies to HIV 1 disappeared in most children without AIDS symptoms between 10 and 12 months after birth, with antibodies against gp 41 being lost first. Children with AIDS remained positive during follow-up, although in 3 cases with positive was absent in all the asymptomatic children, while it was present in 75% of the patients with AIDS.