A single dose of prophylactic antibiotic may be sufficient to prevent postprocedural infection in upper endosonography guided fiducial marker placement.

AIM: Prophylactic antibiotic after endosonographic ultrasound (EUS) guided fiducial marker placement is common practice to prevent infection. Duration of using prophylaxis antibiotic is unknown. The aim of this paper was to assess whether one time intraprocedural administration of a prophylactic antibiotic is sufficient to prevent infection after EUS guided fiducial marker placement. METHODS: Retrospective study was performed included all adult patients who underwent EUS guided fiducial markers over 18 month period. Procedure related infection was defined as any infection not directly attributable to any other cause within 30 days of the procedure. The patients followed up with the Gastroenterology clinic in one week and with Radiation Oncology clinic weekly after undergoing EUS guided fiducial marker placement. RESULTS: A total of 35 upper EUS-guided fiducial markers were placed during 20 procedures on 18 patients. The average age of patients was 59 years. There were 10 females and 8 males.. All patients received one dose of cephalosporin, amoxicillin, clindamycin or levoflocaxin. The fiducial markers were deployed in different organs. None of the patients developed any infections due to the procedure. CONCLUSION: This study suggests that one dose of intravenous antibiotic administered intraprocedurally is sufficient to prevent infection related to upper EUS guided fiducial marker placement.

The activity of rifabutin against Mycobacterium leprae.

Minimal effective doses of rifabutin and rifampicin were determined in Mycobacterium leprae isolated from skin biopsies of newly diagnosed, previously untreated lepromatous leprosy patients. Rifabutin was more potent than rifampicin. Our previous report that rifabutin was fully active against rifampicin-resistant M. leprae could not be confirmed. Examination of two strains of rifampicin-resistant M. leprae from elsewhere, and a repeat experiment on our original strain of rifampicin-resistant bacilli, showed full cross-resistance between rifampicin and rifabutin. A clinical trial in three newly diagnosed, previously untreated lepromatous patients showed that rifabutin has rapid bactericidal activity.

Comparison of a urine spot test and blood tests as indicators of patient compliance.

Irregular drug intake has been a concern of leprosy control programmes for many years and various methods have been used to monitor and encourage patient compliance. This study compares the results of a urine spot test for dapsone as proposed by Huikeshoven, with blood levels measured in the same patients by the modified Bratton Marshall method and by high performance liquid chromatography. Two hundred-sixty urine and blood specimens were obtained from subjects who were taking supervised and unsupervised medications as well as from controls who were taking no medications. The results indicate that the urine spot test is simple and easily performed, and for monitoring patient compliance under routine clinical conditions (hospital or field work) it compares favourably with blood levels of dapsone estimated by the Bratton Marshall method or by high performance liquid chromatography. The study also shows that dapsone level is not a good indicator of compliance in patients who are also taking daily rifampicin but the urine spot test remains useful in such patients.

A single skin lesion--an unusual presentation of lepromatous leprosy.

Lepromatous leprosy presenting as a solitary lesion with a high bacterial count is a rare occurrence. Such a case has been followed at the National Hansen's Disease Center, Carville, Louisiana, U.S.A., since 1977. The lesion was located on the left elbow and had been present for about nine months. The bacterial index in the lesion was 5+ and the morphological index was 0%, but slit-skin smears elsewhere were negative. The histopathology of the lesion was that of subpolar lepromatous leprosy, and the lepromin skin test was negative. Growth of the organism in the mouse foot pad was characteristic of Mycobacterium leprae, and the patient's response to dapsone monotherapy has been excellent. Therefore, this patient with a single skin lesion has lepromatous leprosy histologically, immunologically, and bacteriologically. This case illustrates the importance of slit-skin scrapings and biopsy in new cases with unusual lesions and, secondly, suggests that there are factors yet undetermined which play a significant role in determining host response to M. leprae.

Hansen's disease in native-born citizens of the United States.

This paper presents a statistical analysis of data on 1,309 Hansen's disease (HD) patients born in the continental United States during the 50 year period 1932-81. Fifty-six percent of them were born in Texas. The cases of 66 percent were classed as multibacillary, 31 percent were considered paucibacillary, and the type was unknown for 3 percent. Blacks and whites appeared to be equally susceptible to Hansen's disease. Thirty percent had a history of contact with Hansen's disease. The age at diagnosis has increased an average of 2.7 years per decade, and the increase has accelerated in the last two decades. If the present trend continues, Hansen's disease among native-born citizens of the United States will ultimately disappear.