[Interferon-Gamma Release Assays in the diagnosis of latent tuberculosis infection in clinical situations]. / Testy IGRA w diagnostyce zakazenia pratkami gruzlicy w wybranych sytuacjach klinicznych.

Until recently, the basic test to identify latent tuberculosis infection (LTBI) was the tuberculin skin test, despite its limitations in the form of low sensitivity and specificity. Currently, Interferon Gamma Release Assays from peripheral blood are used for a rapid diagnosis of LTBI and measurement of the interferon gamma (IFN-g) levels secreted by specific T cells stimulated with Mycobacterium tuberculosis antigens. Detection of LTBI is important in the control of people potentially at risk of TB disease, such as people remaining in close contact with BK (+) tb patient and for patients evaluated for biological treatment. The paper presents the value of IGRA in three selected clinical situations: in two cases of latent tuberculosis infection and in one case of active tuberculosis.

Lipoid pneumonia--a case of refractory pneumonia in a child treated with ketogenic diet.

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endogenous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicking serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.

[CXCL10/IP-10 as a new biomarker for Mycobacterium tuberculosis infection]. / Zastosowanie CXCL10/IP-10 jako nowego biomarkera zakazenia Mycobacterium tuberculosis.

In low prevalence countries, where identification and treatment of latent TB infection (LTBI) are basis of national programmes against tuberculosis, the diagnosis is focused mainly on tuberculin skin test (TST) and interferon gamma release assay (IGRA), both of which seem to be imperfect. This is why searches for a new, more specific biomarker for TB infection have been conducted. A promising candidate for the new marker is interferon gamma induced protein (IP-10). IP-10 is a chemokine, which can be detected in increased amounts in patients with active tuberculosis, latent TB infection and in individuals who had contact with an index case. It has been commonly suggested that a simultaneous analysis of IGRA and IP-10 level increases the effectiveness of IGRA, however it is still not certain whether measurement of IP-10 level might help distinguish between the above mentioned forms of tuberculous infection. Hopes are high as the protein is proved to be a good marker for treatment monitoring in adults, though there is no available data on its usefulness in monitoring therapy in paediatric population. More studies are still needed to fully assess the benefits of IP-10 level measurement as a biomarker for tuberculous infection, especially in children.

Ear tuberculosis: clinical and surgical treatment.

Two main points are discussed in this paper: First, the changing picture of the clinical process of tuberculosis, and second, various diagnostic problems caused by extra-pulmonary forms. We have analysed a case of ear tuberculosis in a child, and drawn the following conclusions: Directed chemotherapy is the primary method of treatment, and surgical methods should be used to provide tissue for bacteriological and histopathological analysis, to enable an early diagnosis during the first stage of the disease, and in other atypical cases.

[Antimycobacterial antibody level in pleural, pericardial and cerebrospinal fluid of patients with tuberculosis]. / Ocena poziomu przeciwcial przeciwpratkowych w plynie oplucnowym, osierdziowym i mózgowo-rdzeniowym u chorych na gruzlice.

The goal of the study was to evaluate IgG, IgA and IgM mediated humoral immune response against 38kDa and 16 kDa or 38kDa and LAM mycobacterial antigens in pleural, pericardial or cerebrospinal fluid from patients with tuberculosis (TB) and to compare to non-tuberculous controls (NTB). 30 cerebrospinal fluids (CSF) (16 TB pts and 14 NTB pts), 17 pericardial fluids (6 TB and 11 NTB) and 20 pleural fluids (7 TB and 13 NTB) were examined. Commercially available ELISA-based assays (Pathozyme Tb complex plus, Myco G, A and M--Omega Diagnostic) were used. Tests were performed and cut off established according to manufacturer instruction. Mean IgG level against 38 + 16kDa was significantly higher in neurotuberculosis group compared to control (p<0.05). Sensitivity of the test in detecting neurotuberculosis was of 42% and specificity of 96%. Mean IgG, IgA and IgM against 38kDa + LAM level was higher in TB group compared to NTB in CSF. No difference was observed between TB and NTB group in pleural effusion. Antimycobacterial antibody levels were non-significantly increased in pericardial fluid in TB. The findings of the study indicate that TB is associated with the presence of detectable levels of antibodies in the CSF and pericardial effusion. Anti 38kDa + 16kDa IgG test can be used in combination with other diagnostic methods to increase diagnostic accuracy of neurotuberculosis.

[Modern microbiological methods in diagnosis of adverse reactions after BCG vaccination. Case reports]. / Zastosowanie nowoczesnych metod mikrobiologicznych do diagno- zowania powiklan po szczepieniu BCG. Opis przypadków.

The attenuated bacilli Calmette-Guerin (BCG) vaccine is administered worldwide to prevent tuberculosis and is considered to have an excellent safety profile. In Poland, since 1955 BCG mass vaccinations have been compulsory. More than 95% newborns and 80% of older children of the population have been vaccinated. Complications of vaccination are uncommon. Although BCG has been used safely for many years, it can cause disease in humans, especially those with cellular immunodeficiencies. The risks associated with BCG vaccination include local complications, extraregional localized disease, and disseminated BCG disease. Identification of M. bovis BCG in laboratory is a very difficult process. Routine identification of mycobacterial isolates in clinical laboratories involves culture of Mycobacterium tuberculosis complex which includes M. tuberculosis, M. bovis, M. africanum and M. microti and the vaccine strain M.bovis BCG. Most laboratories cannot quickly differentiate between BCG and other members of M. tuberculosis complex and some cases of BCG complications in children may be considered and treated as tuberculosis. Because of difficulties in proper identification of BCG strains isolated from the patients, the prevalence of BCG infections is not know exactly. Knowledge of BCG infection would be of particular interest to the clinician responsible for the therapy. We describe the several methods using in mycobacterial laboratory for identification and suggest the modern algorithm of BCG strains identification including mycolic acids profile by HPLC and 14C PZA resistance methods. The methods allowed us fast and accurate identify M. bovis BCG infection in 5 children which have been described in our paper. Preliminary diagnosis for four children among five tested was tuberculosis. One immunocompromised HIV negative child died, one still excretes BCG bacilli. To our knowledge, this is the first report of BCG complication (AEFI) in Polish children in which HPLC and 14 C PZA methods have been used for rapid identification of M. bovis BCG infection and/or complication.