[Tuberculosis and mycobacteriosis important opportunistic disease in AIDS patients]. / Gruzlica i mykobakteriozy, wazne choroby oportunistyczne u chorych na AIDS.

OBJECTIVE: The aim of the search was investigation of tuberculosis in AIDS patients. Each year 8-9 mln people fall ill of tuberculosis and one third of them die. To the infection of tuberculosis and fast development into active state are especially exposed people with AIDS. MATERIAL AND METHODS: 696 people were examined on tuberculosis most of which were AIDS patients hospitalized and cured in Hospital of Infection Diseases and Prison Hospital. 159 patients were women and 537 were men. The average age was between 25 and 45 (70%). The investigated population was characterized according to age, social and living conditions, using drugs and former contact with tuberculosis. All patients suspected of tuberculosis had chest X-rayed, sputum, BAL and pleural liquor were taken to bacteriological examination when extrapulmonary tuberculosis was suspected. The material was taken adequately to the disease process: CSF, urine, lymph nodes, peritoneal fluids, blood, stool, swabs and other. Bacteriological investigations have been carried out by fast cultivating method since 1998 and rapid genetic method since 1999. Apart from modern, fast diagnostic methods, routine bacteriological procedures were applied in tuberculosis diagnosis. RESULTS: More than 30% of the examined population were from bad social-living conditions, 78% had risk factors, 65% were drug users. The analysis of the tuberculosis illness from 1997 to July 2001 shows growing tendency. Nowadays it is 20% cases proved by bacteriological diagnosis. The structure of falling ill with tuberculosis has changed. Considerable increase of extrapulmonary tuberculosis was observed, 20 patients died due to tuberculosis and 8 patients due to mycobacteriosis. Resistance of M.tub.complex occurred within the range of 10% cases.

DNA fingerprinting as an indicator of active transmission of multidrug-resistant tuberculosis in Poland.

OBJECTIVES: To use genetic fingerprinting to investigate the epidemiology of tuberculosis (TB) caused by Mycobacterium tuberculosis in Poland, a country with a relatively high incidence of tuberculosis, to improve TB control. DESIGN: One hundred M. tuberculosis isolates from 98 patients in the Institute of Tuberculosis and Lung Diseases in Warsaw from 1993 to 1995 and 85 isolates obtained from 50 patients in the Hospital of Lung Diseases in Lodz in 1996 were subjected to DNA restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 as a probe. RESULTS: IS6110-associated banding patterns of the M. tuberculosis isolates originating from different localities varied considerably, but isolates from Lodz had a higher degree of similarity. Strains with identical RFLP types were identified in patients of the same family or patients living in the same area, indicating active transmission. Of strains isolated in Warsaw, 45% were resistant to at least one drug, and 35% were resistant to two or more drugs and were classified as multidrug-resistant (MDR). Some drug-resistant isolates were found to have identical banding patterns and originated from epidemiologically linked cases. CONCLUSIONS: Active transmission of TB, including MDR TB, is occurring in Poland. Active measures must be taken to prevent the spread of drug-resistant TB in Poland and potentially, the rest of Europe.

[Initial evaluation of the diagnostic usefulness of tuberculin tests among the patients of the Center of Diagnosis and Treatment of AIDS]. / Wstepna ocena przydatnosci diagnostycznej próby tuberkulinowej w populacji pacjentów Centrum Diagnostyki i Terapii AIDS.

Tuberculin and Candida skin tests were done on 98 HIV(+) and 42 control HIV(-) patients of AIDS Diagnosis and Therapy Center in Warsaw. Prevalence of the positive Tuberculin tests in the control group was 29% and it was not significantly different from those groups of patients HIV(+) whose CD4 cell count was higher than 350. For those with CD4 cell count 350 or below, tests were positive only in two cases both of the patients with active tuberculosis. The prevalence of positive Candida tests was in the control group only 12% and such result did not differ significantly from any other group of HIV positive patients with different CD4 cell counts. It is concluded that routine Tuberculin skin tests might be of value due to low initial prevalence among patients of the AIDS Center and that those persons who undergo conversion into positive tests will be under high suspicion of TB asymptomatic infection. Low prevalence and rather random distribution of positive Candida skin tests shows their insufficiency as single reference tests in anergy panel.

[Initial assessment of the use of polymerase chain reaction (PCR) in diagnosis of tuberculosis among patients of the Center for Diagnosis and Treatment of AIDS]. / Wstepne badania zastosowania techniki reakcji lancuchowej polimerazy (PCR) w diagnostyce gruzlicy w populacji pacjentów Centrum Diagnostyki i Terapii AIDS.

This initial report on the use of PCR in diagnosis of TB was based on a group of 180 patients observed in the AIDS Diagnosis and Therapy Center in Warsaw. Out of 6 patients with positive results of PCR assay for MTB, five had positive AFB smears in induced sputum or BAL, two had positive MTB cultures. Five of them were treated with tuberculostatic drugs with clinical improvement and had negative sputum PCR MTB results after several weeks. Additional 11 patients with AFB positive sputum or BAL smears and negative PCR MTB were observed. None of them developed pulmonary tuberculosis, and none of them was confirmed by culture as MTB infection. The results presented in this paper confirm high specificity and sensitivity of polymerase chain reaction (PCR) as an fast diagnostic test very useful in the clinical settings of AIDS. With the increase of collected material further evaluation will be continued.

[The role of bronchoscopy and bronchoalveolar lavage in diagnosis of pulmonary tuberculosis in AIDS]. / Znaczenie bronchoskopii i plukania oskrzelowo-pecherzykowego w rozpoznawaniu gruzlicy pluc u chorych na AIDS.

Bronchoscopy was carried out in 32 HIV seropositive patients, most with AIDS during the period between January 1992 and August 1993. In 14 patients tuberculosis was diagnosed, in 13 it was bacteriologically confirmed. The mean age of the examined patients was 35.5 years (range 22-49 years). In 50% of the BAL samples bacterioscopy was positive. Bacteriological examination of the sputum and BAL fluid (bacterioscopy and culture) produced a confirmation of tuberculosis in 99.9% of the cases.

[Test of a quick differentiation of selected mycobacteria with pyrolytic gaseous chromatography]. / Próba szybkiego róznicowania wybranych gatunków mykobakterii metoda pirolitycznej chromatografii gazowej.

The five mycobacterium strains H37Rv series 363, M. bovis (An5) series 250, M. kansasii series 377, M. intracellulare series 364, M. xenopi series 302 and BCG series 180291 were tested using pyrolytic gas chromatography method. After regeneration of lyophylisate, the strains were incubated using L-J medium in 37 degrees C for 2 to 6 weeks--the period that was necessary to obtain profuse growth. The bacterial mass obtained from the culture was collected in test-tubes and pyrolized after autoclave incubation and dry procedure. The CHROM 5 gas chromatograph together with FID detector was used for detecting the products of pyrolysis. The signal was transmitted from the detector to analog-digital converter A/C and registered by IBM PC/XT computer. 12-15 analysis of each strain were performed. Chromatograms of strains pyrolysis products were recorded as files to the hard disc. This way the standard data base was built. The pyrolysis products of tested strains were compared with data base using BAZCHRO program. E. coli JC 7623 was employed as a standard for comparison of chromatograms. The similarity of chromatograms was presented as percentage. The 85-95% of similarity was obtained as a result of comparison of the same Mycobacteria strains.