MICs and MBCs of clarithromycin against Mycobacterium avium within human macrophages

The inhibitory and bactericidal activities of clarithromycin were determined quantitatively against the intracellular populations of five Mycobacterium avium strains growing in monocyte-derived human macrophages. The MICs were 1.0 microgram/ml, and the MBCs ranged from 16.0 to 64.0 micrograms/ml; these values were similar to the MICs and MBCs found in broth cultures at pH 7.4 and were substantially lower than those found in broth cultures at pHs 6.8 and 5.0. Since the intracellular environment has a neutral or even an acidic pH, relatively low MICs and MBCs found in macrophage cultures can be associated with the fact that the drug concentrations in macrophages are substantially higher than those in the medium in which these cells are cultivated. Pretreatment of the macrophages 2 days prior to infection decreased the MICs twofold in comparison with results of experiments in which the drug was added to already infected macrophages.

Concurrent mammary gland hyperplasia and adrenocortical carcinoma in a domestic ferret

Mammary gland hyperplasia associated with adrenocortical carcinoma in a domestic ferret had a histologic appearance similar to that observed in cats. It is important to consider this hyperplastic condition in the differential diagnosis of mammary gland enlargement in the ferret.

Prevalence of minor congenital anomalies in newborns of diabetic mothers

Minor congenital anomalies (MCA) were assessed in the offspring of 802 gestational diabetic mothers, 117 pre-gestational diabetic mothers, and 380 offspring born to normal mothers. The prevalence of infants with MCA ranged between 19.4% and 20.5% in the three groups without any significant difference between them. There was no correlation between the prevalence and type of MCA and the severity of the diabetic state. Neither was there any correlation between the prevalence or type of MCA and the appearance or type of major congenital anomalies.

The disease of CBA and BALB/c mice that follows inoculation of a small number of Mycobacterium lepraemurium into the hind foot pad

To learn if the lack of an immune response in mice infected with Mycobacterium lepraemurium (MLM) was a consequence of the organisms, we studied the disease that followed inoculation of less than or equal to 5000 organisms into the hind foot pads of CBA and BALB/c mice. The mice of both strains demonstrated a rapid increase of bacterial numbers soon after inoculation, with a slowing of the rate of multiplication once the number of organisms per foot pad passed 3 x 10(7). By 1 year after inoculation, the numbers of organisms had reached levels greater than or equal to 10(11) in the spleen and liver, and greater than or equal to 10(8) in the femoral bone marrow. In mice that had been inoculated with as few as 5 MLM or 50 MLM, the organisms had multiplied to numbers greater than 10(8) in the foot pads and to greater than or equal to 10(9) in the spleens, suggesting that the ID50 of viable MLM may be less than or equal to 5 organisms per foot pad. No protection against superinfection could be demonstrated. On the other hand, initial multiplication of MLM in the foot pads was followed virtually immediately by the death of at least 97% of the organisms.

Blood-stained maternal milk: prevalence, characteristics and counselling

Blood-stained maternal milk at delivery and during lactation was prospectively studied in 7774 livebirths over a period of 2 years (1986-1988). Eight mothers had this atypical breast discharge, a prevalence rate of 1:971 livebirths (0.1%). The characteristics of this phenomenon were: early appearance (frequently a short time after delivery), with normal bacteriologic and cytologic investigations, disappearance in 2 to 5 days, without adverse effects on the mothers and their babies, no recurrence after cessation, and occurrence in the previous pregnancies (3 of the 5 multipara). As a result, the best policy is to reassure the parents about the benign and transient course of this condition and to recommend continuation of breast feeding.

Possible association between acetazolamide administration during pregnancy and metabolic disorders in the newborn

Development of metabolic acidosis, hypocalcemia and hypomagnesemia in a preterm infant whose mother was treated with acetazolamide throughout pregnancy is described. These neonatal metabolic alterations possibly related to acetazolamide administration in pregnancy have not been previously described in the literature. The metabolic acidosis was transient and resolved spontaneously despite breast feeding and continued administration of acetazolamide to the mother. Hypocalcemia and hypomagnesemia resolved quickly with appropriate treatment with calcium gluconate and magnesium sulphate, respectively. At follow-up at ages 1, 3 and 8 months, the baby showed mild hypertonicity of the lower limbs requiring physiotherapy.

Necrotizing enterocolitis after intravenous immunoglobulin treatment for neonatal isoimmune thrombocytopenia

A male neonate of 38 weeks' gestation with isoimmune neonatal thrombocytopenia treated with high dose intravenous immunoglobulin (IVIG) developed necrotizing enterocolitis (NEC) at 3 days of age. The known maternal and neonatal risk factors for the development of this disease were excluded. The association between high dose IVIG and the appearance of thrombotic events might be another aetiological factor for occurrence of NEC in a newborn infant.

Influence of phagosomal contents on the apparent inhibition of phagosome-lysosome fusion mediated by polyanionic substances in mouse peritoneal macrophages

The study of fusion of phagosomes with secondary lysosomes in macrophages is facilitated by assessing transfer of fluorescent or electron-opaque markers (or both) from the lysosomes to the phagosomes. When certain virulent viable pathogens are phagocytosed by mouse peritoneal macrophages, phagosome-lysosome fusion (P-LF) is inhibited. Nonviable counterparts ordinarily cannot impose this block. A similar, but spurious, block to P-LF seems to be mediated from the lysosomal domain following sequestration of certain polyanionic substances. This block has been judged to be relieved by, for example, heat-killed yeasts and various viable bacteria designated as fusion-inducing microorganisms, acting from the phagosome. In this study we tested this concept and believed it to be unfounded. Macrophages labeled with Thorotrast and incubated with dextran sulfate were offered a variety of viable and heat-killed microorganisms for phagocytosis: Saccharomyces cerevisiae, Mycobacterium lepraemurium, Streptococcus faecalis, and Escherichia coli. By electron microscopy, a transfer of Thorotrast to phagosomes up to 18 h was seen to be highly suppressed as compared with controls, but was not notably different for any of the targets, whether viable or not. Instead, inert 0.45-micron carboxylated polystyrene beads (the smallest target) showed the most delivery of marker. If polyanionic agents truly inhibited fusion, then "fusiogenic" microorganisms should free the marker for delivery. If polyanions do not inhibit P-LF and only trap the marker, the behavior of the various targets would correspond to what we found.

Enhancement of growth of Mycobacterium lepraemurium in macrophages by gamma interferon

Gamma interferon, an immune lymphokine that protects mouse macrophages against infection by several parasites, was ineffective against Mycobacterium lepraemurium. On the contrary, it significantly stimulated multiplication of M. lepraemurium in the macrophages. Simultaneous treatment of macrophages with gamma interferon and interleukin-4 or interleukin-2 or a combination of all three did not enhance the macrophage resistance to infection with M. lepraemurium, but instead stimulated growth of M. lepraemurium.

Haemophagocytosis and other haematological aspects of Mycobacterium lepraemurium disease of mice

CBA mice inoculated i.v. with 2 x 10(8) viable MLM were observed at intervals for 5 months. In the bone marrow, haematopoietic cells were progressively displaced by MLM-laden phagocytes; depletion of erythroid cells began earlier and was more pronounced than that of myeloid cells. Transiently, mild anaemia and profound leucopenia were noted. The spleen was enlarged and the site of increasing histiocytosis and extramedullary haematopoiesis which was accompanied by displacement of splenic parenchyma. The liver was enlarged and its parenchyma contained scattered islands of haematopoietic elements. Lymph node cells had been largely replaced by MLM-laden macrophages by the end of the process. Thus, MLM infection exerts important effects on haematopoiesis of susceptible mice and is accompanied by active extramedullary haematopoiesis. In addition, the haemophagocytosis, observed most commonly in immuno-compromised patients infected with certain viral or mycobacterial pathogens, was observed late in the course of MLM disease of mice.

Mycobacterium lepraemurium activates macrophages but fails to trigger release of superoxide anion

Mycobacterium lepraemurium failed to stimulate a normal respiratory burst when presented to mouse peritoneal or bone marrow macrophages. By comparison, Mycobacterium bovis (strain Bacillus Calmette-Guerin) or Saccharomyces cerevisiae, as expected, stimulated macrophages to release a large amount of superoxide anion (O2-). M. lepraemurium did not interfere with the response to yeast when both microbes were added together to macrophages. The low release of O2- induced by M. lepraemurium was not due to failure of M. lepraemurium to activate or prime macrophages, because exposure of macrophages to M. lepraemurium caused the expected enhancement of O2- release when the macrophages were stimulated by PMA. Similarly, macrophages taken from mice infected with M. lepraemurium were activated, as indicated by high PMA-stimulated O2- release. Macrophages primed in vitro by exposure to Escherichia coli LPS for 24 h did show a moderate O2- response when stimulated by M. lepraemurium, but macrophages primed by exposure to IFN-gamma muramyl dipeptide, or M. lepraemurium showed a weak response when subsequently challenged with M. lepraemurium. The priming effect of M. lepraemurium or LPS decreased substantially after macrophages were cultured in fresh medium for 24 h. Heat killing or opsonization of M. lepraemurium caused the M. lepraemurium to stimulate a high amount of O2- release from LPS-primed macrophages, but heat killing or opsonization of M. lepraemurium had no effect on release of O2- from unprimed macrophages. The results suggest that M. lepraemurium is taken into macrophages by a mechanism that bypasses the FcR and other receptors that are capable of triggering the production of O2-.

Mycobacterium lepraemurium activates macrophages but fails to trigger release of superoxide anion

Mycobacterium lepraemurium failed to stimulate a normal respiratory burst when presented to mouse peritoneal or bone marrow macrophages. By comparison, Mycobacterium bovis (strain Bacillus Calmette-Guerin) or Saccharomyces cerevisiae, as expected, stimulated macrophages to release a large amount of superoxide anion (O2-). M. lepraemurium did not interfere with the response to yeast when both microbes were added together to macrophages. The low release of O2- induced by M. lepraemurium was not due to failure of M. lepraemurium to activate or prime macrophages, because exposure of macrophages to M. lepraemurium caused the expected enhancement of O2- release when the macrophages were stimulated by PMA. Similarly, macrophages taken from mice infected with M. lepraemurium were activated, as indicated by high PMA-stimulated O2- release. Macrophages primed in vitro by exposure to Escherichia coli LPS for 24 h did show a moderate O2- response when stimulated by M. lepraemurium, but macrophages primed by exposure to IFN-gamma muramyl dipeptide, or M. lepraemurium showed a weak response when subsequently challenged with M. lepraemurium. The priming effect of M. lepraemurium or LPS decreased substantially after macrophages were cultured in fresh medium for 24 h. Heat killing or opsonization of M. lepraemurium caused the M. lepraemurium to stimulate a high amount of O2- release from LPS-primed macrophages, but heat killing or opsonization of M. lepraemurium had no effect on release of O2- from unprimed macrophages. The results suggest that M. lepraemurium is taken into macrophages by a mechanism that bypasses the FcR and other receptors that are capable of triggering the production of O2-.

Reduction of tellurite and deesterification of fluorescein diacetate are not well correlated with the viability of mycobacteria

Both Mycobacterium leprae and M. lepraemurium (MLM) were capable of reducing tellurium as tellurite ion (Te4+) to elemental tellurium (Te), seen by electron microscopy as fine crystals within the bacterial cells. There appeared to be close correspondence between the capacity to reduce tellurite, bright green fluorescence after staining with fluorescein diacetate (FDA) and the ability of M. smegmatis to multiply in culture. Likewise, there appeared to be correspondence between tellurite reduction and fluorescence after FDA staining for MLM subjected to prolonged storage in the cold or to heating at 70 degrees C. However, correspondence with tellurite-reduction or fluorescence after FDA staining was not observed when death of MLM occurred in vivo.

Discrepancy in assessment of phagosome-lysosome fusion with two lysosomal markers in murine macrophages infected with Candida albicans

Phagosome-lysosome fusion (P-LF) was studied in cultured mouse resident peritoneal macrophages after phagocytosis of Candida albicans. The macrophages were labeled with acridine orange (AO), the electronopaque colloidal Thorotrast, or both markers. After phagocytosis of heat-killed C. albicans, both markers were delivered to more than 95% of phagosomes. After ingestion of viable C. albicans by labeled cells, delivery of AO to phagosomes was highly suppressed (90%), and yet Thorotrast delivery was almost universal. After phagocytosis and 60 min of incubation, about 10 to 20% of the yeasts were killed, and a similar fraction of phagosomes was stained by the fluorescent marker. The evidence from Thorotrast transfer and assessment of yeast viability indicates that C. albicans largely resists intracellular killing by resident macrophages in the face of entirely uninhibited P-LF. We infer that AO must transfer to nearly all of the phagosomes but that it is evidently recognizable only in those in which the yeasts have been killed or possibly severely injured. This conclusion constitutes yet another limitation in the usefulness of AO for studying P-LF.

Death of Mycobacterium lepraemurium after multiplication in CBA, BALB/c and nude mice

The unexpected death of Mycobacterium lepraemurium in the course of systemic infection of mice, previously noted in the spleens of CBA mice, has been demonstrated in the spleens of BALB/c nu/+ and BALB/c nu/nu mice and also in the livers and other organs of mice of all three strains. That the same phenomenon was observed in nu/nu mice indicates that the mechanism of bacterial death does not involve a T-lymphocyte-mediated cellular immune response on the part of the mice.

Epispadias with complete prepuce and phimosis in a neonate

A rare type of epispadias in a neonate is described in which a complete phimotic prepuce was present. In this situation, the accurate diagnosis is very difficult and may be easily overlooked in the neonatal period. The broad, spadelike glans, the dorsally directed prepucial opening, and the urinary stream are signs previously described. The special shape of the raphe penis and the depression between the corpora cavernosa felt by palpation of the glans are useful new clinical signs to suspect this type of epispadias.

Autosomal dominant cerebro-costo-mandibular syndrome: ultrasonographic and clinical findings

We describe two patients, a father and his daughter, with the cerebro-costo-mandibular syndrome. New manifestations not previously described include microstomia, long philtrum, posterior cervical skin fold, short internipple distance, and depressed sacral region. The presence of hydrocephaly in the proposita and spina bifida in the father may be other manifestations of neuraxial involvement in this syndrome. The first intrauterine ultrasonographic documentation of this syndrome showed polyhydramnios and, especially, the very unusual shape of the ribs, which were short and defective. Most characteristics of the pedigree point to autosomal dominant inheritance. The great variability of inheritance and expressivity of the very few documented familial cases described in the literature, together with the great frequency of sporadic cases, indicates genetic heterogeneity of this syndrome.

Retrospective confirmation of Mycoplasma infection by the immunoperoxidase technique

Rat tissues embedded in paraffin blocks stored for 8-10 yr were sectioned for immunoperoxidase staining. Sections of lung, trachea and endometrium of 22 of 32 rats that had exhibited clinical symptoms of mycoplasmal pneumonia prior to euthanasia, and whose organs had shown gross lesions suggesting mycoplasmal infection on necropsy, demonstrated the presence of Mycoplasma pulmonis organisms by the immunoperoxidase technique in one or more of these tissues.

Spontaneous endometrial tumours of 'Sabra' rats

In a 2 year study of 171 female (101 virgin; 70 multiparous) 'Sabra' rats, spontaneous endometrial tumours were found in 69% of 2 year old animals. Tumour development appeared to be age related, and only virgin females showed tumours before 18 months of age. Polyps were the most prevalent tumour type, followed by adenocarcinomas. The Sabra rat can be included among those rat strains having a high incidence of spontaneous endometrial neoplasia.

Types of hymen in the newborn infant

The incidence of various types of hymenal shape, its orifice and their interference with spontaneous vaginal discharge were investigated during the routine physical examination of 333 female infants within the first 24 h of life. A smooth hymen with a central orifice was observed in 53.5% of the female neonates, a folded hymen with a central orifice in 27.3%; folded hymen with eccentric orifice in 4.5%; an anterior opening of the hymen in 10.8%; posterior opening in 0.6%; hymenal band in 3%; almost imperforate hymen in 0.3% of the newborns. The presence of anterior opening, posterior opening, hymenal band or almost imperforate hymen may interfere with free vaginal discharge. A ruffled, irregular hymen and a hymenal band require a careful investigation for other genital malformations.

Multiplication of Mycobacterium marinum within phagolysosomes of murine macrophages

Both in vivo and in vitro, Mycobacterium marinum organisms were found to multiply within phagolysosomes of murine macrophages. It thus appears that M. marinum are neither killed nor inhibited from multiplying by lysosomal enzymes.

Importance of the footpad lesion in the mouse response to local inoculation of Mycobacterium marinum

The importance of the footpad lesion was studied in CBA mice inoculated in the hind footpad with viable or heat-killed Mycobacterium marinum Popliteal or popliteal and inguinal lymphadenectomy was followed by modest enhancement of the process only when node excision was carried out 6 days after inoculation of a small number of viable organisms. Following inoculation in the footpad of a large number of heat-killed organisms, only 10% of the inoculum was recovered from the site of inoculation, only 0.1% from the popliteal node and even less from the inguinal node and spleen. Despite the small proportion of inoculated M. marinum remaining in the footpad, amputation of the inoculated foot as early as 4 days after inoculation abrogated the protective effects of the inoculation, whereas amputation performed 7 days after inoculation was without effect.