Pyomyositis

Poorly controlled diabetes is associated with an increased risk of infectious complications. With the increasing prevalence of diabetes, many more people are being looked after in primary care. We describe a case of pyomyositis, a potentially severe but uncommon complication of poorly controlled diabetes that was not recognised in the community. Clinicians looking after people with diabetes need to be aware that prolonged, unexplained symptoms need specialist assessment.

Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case–control study and recommendations

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Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case-control study and recommendations

We conducted a case–control study to examine risk factors for isoniazid-monoresistant Mycobacterium tuberculosis in an ongoing outbreak in London. Cases were defined as individuals with an isoniazid-monoresistant strain diagnosed from 1995 to the third quarter of 2006 with an indistinguishable restriction fragment length polymorphism (RFLP) or mycobacterial interspersed repetitive unit (MIRU)-variable number tandem repeats (VNTR) pattern who were resident in or had epidemiological links with London. Controls were all other individuals reported with tuberculosis to the Health Protection Agency London regional epidemiology unit or the HPA London TB Register during 2000 to 2005. Of 293 cases, 153 (52%) were sputum smear-positive compared with 3,266 (18%) of controls. Cases were more likely to be young adults (aged between 15 and 34 years), born in the United Kingdom (OR: 2.4; 95% CI: 1.7–3.4) and of white (OR: 2.9; 95% CI: 1.8–4.8) or black Caribbean (OR: 12.5; 95% CI: 7.7–20.4) ethnicity, a prisoner at the time of diagnosis (OR: 20.2; 95% CI: 6.7–60.6), unemployed (OR: 4.1; 95% CI: 3.0–5.6), or a drug dealer or sex worker (OR: 187.1; 95% CI: 28.4–1,232.3). A total of 113 (39%) of cases used drugs and 54 (18%) were homeless. Completion of treatment gradually improved in cases from 55% among those diagnosed up to the end of 2002 compared with 65% by the end of 2006. Treatment completion increased from 79% to 83% in controls from 2000 to 2005. There are complex social challenges facing many cases in this outbreak that need to be addressed if medical interventions are to be successful.

Seismic data from man-made impacts on the moon

Unusually long reverberations were recorded from two lunar impacts by a seismic station installed on the lunar surface by the Apollo 12 astronauts. Seismic data from these impacts suggest that the lunar mare in the region of the Apollo 12 landing site consists of material with very low seismic velocities near the surface, with velocity increasing with depth to 5 to 6 kilometers per second (for compressional waves) at a depth of 20 kilometers. Absorption of seismic waves in this structure is extremely low relative to typical continental crustal materials on earth. It is unlikely that a major boundary similar to the crustmantle interface on earth exists in the outer 20 kilometers of the moon. A combination of dispersion and scattering of surface waves probably explains the lunar seismic reverberation. Scattering of these waves implies the presence of heterogeneity within the outer zone of the mare on a scale of from several hundred meters (or less) to several kilometers. Seismic signals from 160 events of natural origin have been recorded during the first 7 months of operation of the Apollo 12 seismic station. At least 26 of the natural events are small moonquakes. Many of the natural events are thought to be meteoroid impacts.

Multidrug-resistant tuberculosis in Russia: clinical characteristics, analysis of second-line drug resistance and development of standardized therapy

The aim of the study presented here was to identify patients with multidrug resistant tuberculosis (MDRTB) in the Samara region of Russia and to analyze the susceptibility of their isolates to second-line drugs in order to develop an empirical, standard, second-line treatment regimen. Treatment of MDRTB can be individualized based on in vitro laboratory analysis or standardized. In the latter case there is still a need to ascertain local second-line drug-resistance patterns. Described here are the clinical characteristics of 251 MDRTB patients identified in the study and the second-line drug susceptibility of 69 MDRTB isolates obtained from them. Antimicrobial resistance to the following agents was detected in the isolates: rifabutin (88.2%), streptomycin (42.8%), amikacin (7.2%), doxycycline (7.4%), ciprofloxacin (4.3%), clofazimine (2.9%), cycloserine (7.4%), and prothionamide (1.5%). The results of the study indicate it is possible to develop a standard, effective, clinical treatment regimen using ethambutol, pyrazinamide, prothionamide, a fluoroquinolone and amikacin.

[Molecular genotyping of Mycobacterium tuberculosis strains isolated from patients in the Samara region by the restriction DNA fragment length polymorphism]

The typing of 106 M. tuberculosis (MBT) strains isolated from patients in the Samara region by the restriction DNA fragment length polymorphism (RFLP) IS6110 revealed that most of the strains (71.7%) belonged to the W family, 5 MBT strains (4.7%) belonged to the AI family, one culture was the mixture of two strains, AI and W. In addition, 24 MBT strains (22.6%) classified with other genotypes were detected. The analysis of the sensitivity of the MBT strains to rifampicin and isoniazid, with the method of absolute concentrations and by point mutations, demonstrated that 29 MBT strains (27.3%) were sensitive to rifampicin and isoniazid and 56 MBT strains (52.9%) were resistant to rifampicin and isoniazid simultaneously. Among the MBT strains of different RFLP families, strains both sensitive and resistant to these two preparations could be detected, but strains with multiple drug resistance prevailed in the W family (61.8%).

Molecular epidemiology of Mycobacterium tuberculosis in patients of Somalian and white ethnic origin attending an inner London clinic

BACKGROUND

In 2002, 6891 and 2850 tuberculosis (TB) notifications were received respectively for England and Wales and London. TB is an important public health problem in the Somalian population of inner London.

SETTING

An inner London TB clinic.

OBJECTIVE

To study the epidemiology, genetic diversity and clustering of tuberculosis in Somalian and white patients.

MAIN OUTCOME METHODS

In a cross sectional study from June 1998 to June 2001, IS6110 restriction fragment length polymorphism (RFLP) and secondary spoligotyping was performed on 57 M. tuberculosis isolates from 40 Somalian and 17 white patients. Contact tracing of patients provided epidemiological information.

RESULTS

In the Somalian group, using RFLP and spoligotyping, there were three clusters. Routine contact tracing confirmed one household cluster (two siblings). Spoligotyping yielded one cluster of two white patients who were patrons of a local pub. The rates of recent transmission were respectively 10.0% and 5.9% in the Somalian and white groups.

CONCLUSIONS

Heterogeneous RFLP patterns in both groups showed a predominance of reactivation disease. Clustering as evidence of recent transmission has public health implications for enhanced contact tracing and active intervention.

Optimizing an aerial spray for mosquito control

The role of proper flight line positioning was demonstrated to be critical for maximizing product efficacy when spraying in crosswinds by small-droplet spray strategies. Characterization studies indicated clearly that aircraft height, small drop emission distribution, and the ambient winds combine to dilute the spray cloud before impacting surface targets. A 5-fold increase in mortality was achieved when we used optimization techniques to position the aircraft during a crosswind treatment test.

Antibiotic resistant tuberculosis in the United Kingdom: 1993-1999

BACKGROUND

The re-emergence of tuberculosis as a global health problem over the past two decades, accompanied by an increase in tuberculosis drug resistance, prompted the development of a comprehensive national surveillance system for tuberculosis drug resistance in 1993.

METHODS

The UK Mycobacterial Resistance Network (Mycobnet), which includes all mycobacterial reference and regional laboratories in the UK, collects a minimum dataset on all individuals from whom an initial isolate of Mycobacterium tuberculosis complex has been isolated and submitted by source hospital laboratories. Data sought include susceptibility to first line antibiotics, demographic, geographical, and risk factor information.

RESULTS

There were 25 217 reports of initial isolates of M tuberculosis complex in the UK between 1993 and 1999. All were tested for sensitivity to isoniazid, rifampicin, and ethambutol and 12 692 of the isolates were also tested for sensitivity to pyrazinamide and streptomycin. A total of 1523 (6.1%) isolates were resistant to one or more drugs, 1397 isolates (5.6%) were resistant to isoniazid with or without resistance to other drugs, and 299 (1.2%) were multidrug resistant. Although the numbers of drug resistant isolates increased over the period, the proportions remained little changed. Certain groups of people were at a higher risk of acquiring drug resistant tuberculosis including younger men, residents of London, foreign born subjects, patients with a previous history of tuberculosis and those infected with HIV.

CONCLUSION

Although the proportion of drug resistant tuberculosis cases appears to be stable in the UK at present, more than one in 20 patients has drug resistant disease at diagnosis and more than one in 100 has multidrug resistant disease. Tuberculosis control measures should be strengthened to minimise the emergence of drug resistance through rapid diagnosis, rapid identification of drug resistance, supervised treatment, and maintenance of comprehensive surveillance.