Nosocomial transmission of tuberculosis to a nurse demonstrated by means of spoligotyping of a formalin-fixed bronchial biopsy

BACKGROUND: Tuberculosis was diagnosed in a student nurse. The source of infection was unknown and no positive culture was available. METHODS: The diagnosis of tuberculous bronchitis was established on the grounds of a positive Mantoux test, the pathology of a bronchial biopsy and the results of a CT scan of the thorax. Spoligotyping of, for example, formalin-fixed tissue makes it possible to establish the diagnosis in a later phase after all. RESULTS: Cultures for Mycobacterium tuberculosis were not performed for the student nurse and Ziehl-Neelsen staining of the formalin-fixed bronchial biopsy was negative. The final tuberculosis diagnosis was confirmed by a PCR fingerprint technique, i.e., spoligotyping of a formalin-fixed biopsy specimen. By means of contact investigation and identification of the strain via spoligotyping, comparison of the spoligo patterns made it possible to treat both the patient and those infected by this person correctly. CONCLUSIONS: When there is a pronounced suspicion of tuberculosis and a microbiological culture is not available, it is recommended that supplementary spoligotyping of clinical specimens be carried out. The purpose is to confirm the diagnosis, trace the presumed source case and indirectly to provide information on the drug susceptibility of the relevant M. tuberculosis strain.     

Comparison of 14 Molecular Assays for Detection of Mycobacterium tuberculosis Complex in Bronchoalveolar Lavage Fluid

We compared 14 molecular assays for their ability to detect the Mycobacterium tuberculosis complex in bronchoalveolar lavage fluid samples. Three approaches were followed. First, by using DNA from Mycobacterium bovis BCG, we determined the detection limits of the assays using routine molecular methods. Second, in order to determine the analytical sensitivities of the assays, we added one of four M. tuberculosis isolates with various numbers of the insertion sequence IS6110 to N-acetyl-l-cysteine (NALC)-NaOH-treated bronchoalveolar lavage fluid samples in dilutions of 1:10 to 1:10,000,000. Third, intertest variabilities were measured and defined by the standard deviations for the quantitation cycle (Cq) values of three positive test results per dilution per assay. The 14 assays tested had similar analytical sensitivities, except for GeneXpert, which had an analytical sensitivity that was 10- to 100-fold lower than that of the other assays. The MP MTB/NTM test and the in-house TaqMan-10 revealed the best performances for the detection limit and had the highest analytical sensitivities. Most of the tests performed well regarding detection limit and analytical sensitivity for the detection of the M. tuberculosis complex in serial dilutions, and the differences were small. The MP MTB/NTM and the in-house TaqMan-10 assays revealed the best, and GeneXpert the worst, overall performances.     

Infection of great apes and a zoo keeper with the same Mycobacterium tuberculosis spoligotype

An animal keeper was diagnosed with pulmonary tuberculosis (TB) after bi-annual screening for latent TB infection in zoo employees. In the same period, several bonobos of the zoo were suffering from TB as well. The Mycobacterium tuberculosis strains from both the animal keeper and the bonobos appeared identical. We provide evidence that the animals infected their keeper.     

Experiences from longitudinal studies of aging: An international perspective

A review of current longitudinal studies of aging was undertaken to obtain background information for the initiation of new studies. Through interviews with investigators information was obtained on the aspects of population and sampling, topic selection, data collection, data quality, and collaboration. All investigators emphasized the importance of broad, multidisciplinary data collection to meet future research interests. Differences between studies are mainly related to organization, sampling design, and monitoring of data quality.Paper presented in part at the XIV International Congress of Gerontology, Acapulco, Mexico, June 18–23, 1989.This study was made possible by a grant from the Netherlands Ministry of Welfare, Health, and Cultural Affairs.     

Isolated torsion of the fallopian tube: a case report and review of the literature

Isolated torsion of the fallopian tube is a rare medical emergency, especially in premenarchal girls. We present a 9-year-old girl with right-sided lower abdominal pain. Isolated torsion of the fallopian tube was suspected preoperatively because of the clinical presentation combined with the results of ultrasound and magnetic resonance imaging (MRI). At emergency laparoscopy, the isolated torsion of the fallopian tube could be reduced, and the tube could be salvaged. This case report shows that the use of ultrasonography and MRI or CT is a helpful diagnostic tool to recognize this condition at an early stage. Especially in young girls presenting with abdominal pain, this should be kept in mind, as digital vaginal examination and vaginal ultrasound most often cannot be used in the diagnostic process. In conclusion, because prompt surgical intervention is required to preserve the tube and prevent progression to peritonitis and possible detrimental effects on future fertility, isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain in all female patients regardless of age.     

A woman with a special cervix

A 40-year-old woman (nulligravida) presented with abnormal cervical cytology. At colposcopy a double external uterine os was discovered with a levonorgestrel intra uterine contraceptive device placed in the opening on the left side. Ultrasound revealed an uterus bicornis bicollis. Despite frequent examinations, the abnormality had not been discovered earlier. Therefore, contraception and cervical cytology sampling had most likely been inadequate.