Clinical differences between pulmonary and extrapulmonary tuberculosis: a 5-year retrospective study.

This article describes the clinical, epidemiologic, laboratory, and treatment characteristics of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Eastern North Carolina, a primarily rural area. The database was obtained for 1988-1992 from the University Medical Center of Eastern North Carolina-Pitt County and East Carolina University School of Medicine (the tertiary care referral center for this region). One hundred thirty-eight culture-positive patients were enrolled in the study; 56% were PTB and 44% were EPTB. African-American males constituted 59% of the population. Sixty-nine percent of the patient base were uninsured. There was a bimodal age distribution of < 40 and > 60 years of age. Factors associated with PTB (reported as odds ratios) were white males (2.5), diabetes mellitus (5.4), and cancer (5.1). Factors associated with EPTB (reported as odds ratios) were African-American females, positive human immunodeficiency virus (HIV) serology (8.7), low hematocrit (32.6), and elevated alkaline phosphatase (199). This study emphasizes that in the latest resurgence of tuberculosis, impoverished rural areas, which have been ignored in earlier and present control efforts, are important reservoirs of disease.

AIDS in rural eastern North Carolina--patient migration: a rural AIDS burden.

A descriptive retrospective study on the AIDS and HIV patients of rural eastern North Carolina was performed. Our data show what appears to be a 'second wave' of HIV-related disease (HRD) in this area. Although most of our AIDS and HIV patients migrated from urban areas such as New York State, our patient population is now largely being replaced by locally infected or 'home-grown' patients. The epidemiological characteristics of rural HRD are significantly different to those of urban HRD: rural patients are more likely to be female, heterosexual, non-white, and younger. These epidemiological differences, along with limited medical and social services in a poor economic base, will make treating HRD a more difficult problem in rural areas than in traditional urban centers.

Heimlich valve treatment of Pneumocystis carinii-associated pneumothorax.

Two patients were treated for AIDS-associated bilateral pneumothoraces which persisted despite prolonged chest tube drainage. Heimlich flutter valves were used to facilitate the outpatient management of these patients.

False-positive results in serologic tests for Rocky Mountain spotted fever during pregnancy.

The data from this study demonstrate that false-positive results from tests for Rocky Mountain spotted fever increase with the duration of pregnancy. The sera of 4.0% (2/50) of women in their first trimester of pregnancy, 10.9% (5/46) in their second trimester, and 12.1% (12/99) in their third trimester yielded false-positive results from latex agglutination assays for Rickettsia rickettsii infections. The cause of these false-positive results was not determined by this study. These false-positive titers were not associated with clinical findings or other laboratory abnormalities. Even though these sera did not contain antibodies to R rickettsii detectable by indirect fluorescent antibody testing, such false-positive results from serologic tests for Rocky Mountain spotted fever can obscure the patient's correct diagnosis. This may lead to the unnecessary use of potentially toxic antibodies and prevent initiation of appropriate therapy.

Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma.

Rat-bite fever results from an infection with the organism Streptobacillus moniliformis. Symptomatic patients often present with fever, malaise, cough, maculopapular rash, and occasional arthritis, and usually have a history of rodent exposure. This report describes a patient with rat-bite fever resulting in suppurative arthritis. The patient's diagnosis was made by culture of S moniliformis from his left wrist. The diagnosis was delayed, however, owing to the lack of an exposure history, atypical clinical presentation, and the unusual microbiologic characteristics shown by this organism.

Brucella canis: an infectious cause of prolonged fever of undetermined origin.

We have reported a case documenting the difficulties encountered in diagnosing and treating patients with brucellosis caused by Brucella canis, including the nonspecific clinical presentation, low level of intermittent bacteremias, the slow-growing, fastidious nature of the organism, and the lack of antigenic cross-reactivity with the antigens usually used in routine Brucella serology. Further, the predominant southeastern United States epidemiology of this organism and the importance of exposure to dogs are also demonstrated by this report. It is important that physicians caring for patients in this region of the country be aware of the epidemiologic, serologic, and microbiologic pitfalls encountered in diagnosing B canis infections.

Effects of different protein supplements on mitogen responses of human peripheral blood lymphocytes.

We evaluated the effects of 6 supplements often used in human lymphocyte cultures, including fetal calf serum, autologous human serum, pooled human AB serum, hypogammaglobulinemic human serum, bovine serum albumin and human serum albumin. Lymphocyte proliferation of unstimulated and mitogen activated peripheral blood mononuclear cells was measured by [3H]thymidine incorporation. The response of cells stimulated with the T-cell mitogen phytohemagglutinin-P were significantly lower when cultured in bovine serum albumin supplemented media, but were otherwise not supplement dependent. In contrast, responses of cells stimulated with the B-cell mitogens Cowan I strain of S. aureus and antisera against the mu or delta chain of human immunoglobulin were significantly effected by supplement. Cultures containing fetal calf serum and bovine serum albumin had high background responses without a proportional rise in cellular proliferation when B-lymphocyte-specific mitogens were utilized. Autologous human serum and pooled human AB serum contained immunoglobulin which interacted with each of the B cell mitogens, thus limiting their usefulness as in vitro supplements. Cells grown in human serum albumin supplemented media had minimal background and high stimulated responses to B-cell mitogens. These results indicate that human serum albumin is an optimal supplement for in vitro human lymphocyte proliferative assays since it supports high stimulated cell responses with low background activity, is devoid of immunoglobulin and had minimal variability among lots.