Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD(®) Gen-probe testing.

INTRODUCTION: In our institution, patients with suspected pulmonary TB undergo multiple induced-sputum sampling for microscopy, culture and nucleic acid amplification (NAA) with the MTD(®) Gen-probe assay. Those with negative induced-sputum results still suspected with TB are then referred for bronchoscopy. We sought to determine the diagnostic yield of bronchoscopy in these patients with negative initial induced-sputum results both via smear and NAA testing. METHODS: We identified 30 consecutive cases of suspected pulmonary TB between 2001 and 2007, who had undergone a diagnostic bronchoscopy after negative results on induced-sputum smears and the MTD(®) Gen-probe on at least 2 samples. RESULTS: The cohort (M = 20 & F = 10) had a median age of 37 (range 16-85 yrs); were predominantly foreign born (27/30); HIV-negative (29/30) individuals with strongly positive TST's (mean 18 + 5 mm). Induced-sputum cultures were negative for M-TB in all patients after a full 60-day incubation period. BAL was culture positive for M-TB in 3/30 cases (10%) with 2 strains being pan-sensitive and the third being INH resistant. BAL microscopy with acid-fast smear (n = 30) and BAL Gen-probe (n = 23) were negative in all cases. A third of the patients (9/27, 33%) with negative bronchoscopy results were treated for culture negative TB. Treatment for latent TB was initiated in 5/27 (18%) individuals whereas 13/27 (48%) received no further treatment. CONCLUSION: Bronchoscopy provided diagnostic confirmation of pulmonary TB in 10% of subjects at least 2 negative induced-sputum samples by smear microscopy and NAA testing.

The treatment of serious anaerobic infections.

Thirty-one adult patients with infections due to anaerobic bacteria were treated with cefamandole. Bacteroides fragilis group (17) and Bacteroides melaninogenicus (13) were the most frequent anaerobes isolated. Duration of therapy varied from 2 to 49 days. Results were judged satisfactory in 26 cases, and unsatisfactory in 1 case. Four cases could not be evaluated. Adverse reactions occurred in 16 patients and included positive direct Coomb's test without hemolysis, transient liver function abnormalities, phlebitis, reversible neutropenia, fever, eosinophilia, and toxic epidermal necrolysis. The more significant reactions were associated with prolonged therapy. None was lethal. These data suggest that cefamandole is effective in treatment of most anaerobic infections.

Endocarditis from human-to-human transmission of Staphylococcus aureus.

Endocarditis due to Staphlyococcus aureus developed in two drug abusers who used the same paraphernalia for parenteral injections. The phage type of the organism isolated from the blood and nasal secretions of the first patient was identical to that of the organism isolated from the blood of the second patient. The epidemiologic and microbiologic data from our cases indicate human-to-human transmission of the responsible agent.

Intravenous metronidazole therapy for Bacteroides fragilis meningitis.

A 69-year-old man developed meningitis due to Bacteroides fragilis and Streptococcus MG-intermedius, which progressed during chloramphenicol and nafcillin therapy to the extent that he seemed near death, with frank pus covering the spinal cord at surgery. Treatment with intravenous metronidazole and penicillin G was curative. After multiple trauma, a 20-year-old man developed meningitis due to Escherichia coli and B fragilis. He failed to respond to chloramphenicol alone, but responded to combined treatment with chloramphenicol and metronidazole. The right frontal sinus and epidural space abscesses were drained and a right frontal lobe abscess was excised. Metronidazole may be a uniquely effective agent for treatment of meningitis due to susceptible strains of Bacteroides fragilis.

Cefamandole therapy in anaerobic infections.

Thirty-one adult patients with infections due to anaerobic bacteria were treated with cefamandole. Bacteroides fragilis group (17) and Bacteroides melaninogenicus (13) were the most frequent anaerobes isolated. Duration of therapy varied from 2 to 49 days. Results were judged satisfactory in 26 cases, and unsatisfactory in 1 case. Four cases could not be evaluated. Adverse reactions occurred in 16 patients and included positive direct Coombs' test without hemolysis, transient liver function abnormalities, phlebitis, reversible neutropenia, fever, eosinophilia, and toxic epidermal necrolysis. The more significant reactions were associated with prolonged therapy. None was lethal. These data suggest that cefamandole is effective in treatment of most anaerobic infections.