The application of telemedicine technology to a directly observed therapy program for tuberculosis: a pilot project

We evaluated the use of videophone technology to provide directly observed therapy (DOT) to patients with active tuberculosis. During 304 treatment doses, adherence on videophone DOT was 95%, and patient acceptance of the technology was excellent. In selected cases, the use of videophone technology can maintain a high level of adherence to DOT in a cost-effective manner.

The use of adjuvant interferon-gamma therapy for hepatosplenic Blastoschizomyces capitatus infection in a patient with leukemia

Hepatosplenic fungal infections are a devastating complication of neutropenia. Despite aggressive antifungal therapy, clinical response may be poor. We describe a case of hepatosplenic Blastoschizomyces capitatus infection that responded to adjuvant interferon-gamma therapy.

Mycobacterium tuberculosis sigF is part of a gene cluster with similarities to the Bacillus subtilis sigF and sigB operons

The Mycobacterium tuberculosis (MTB) SigF alternate sigma factor has been shown to have significant homology to the Bacillus subtilis (BSU) stress-response sigma factor, SigB, as well as to the BSU developmental sigma factor, SigF. In this study we report that like both the BSU sigB and sigF genes, MTB sigF is preceded by an open reading frame (usfX) encoding a protein with significant homology to the previously described BSU anti-sigma factors, RsbW and SpollAB. Sequence analysis suggests that the usfX and sigF genes appear to be cotranscribed and translationally coupled. A second open reading frame called usfY precedes usfX, but has no significant homologues and may not be contranscribed with the usfX and sigF. The sigF gene has been overexpressed in Escherichia coli, purified, and used to raise polyclonal antibodies. Immunoblotting demonstrates that MTB SigF is antigenically closer to BSU SigB than to BSU SigF. Fusion of the MTB sigF gene to the MTB hsp60 promoter has demonstrated that inappropriate overexpression of sigF is lethal for the slow-grower Mycobacterium bovis bacille Calmette-Guérin (BCG), but not for the rapid-grower Mycobacterium smegmatis which lacks a sigF homologue. Hence, sigF, encoding an MTB stress response, stationary phase transcription factor, is preceded by an antisigma factor homologue and is incompatible with growth when constitutively overexpressed in BCG.

Immunogenicity of hepatitis B vaccine in preterm infants

OBJECTIVE

To determine the immunogenicity of hepatitis B vaccine in preterm infants when the first dose of vaccine is delayed until hospital discharge.

METHODS

One hundred two preterm infants (23 to 36 weeks gestational age) born to hepatitis B surface antigen-negative mothers were enrolled. Immunization was initiated just before hospital discharge with subsequent doses 1 and 6 months later. Serum specimens were obtained before the administration of each vaccine dose and 3 months after the last dose and were tested for antibody to hepatitis B surface antigen (antiHBs).

RESULTS

Eighty-seven infants (85%) completed the study. Ninety percent (n = 78) of infants who completed the study seroconverted (antiHBs > or = 10 mIU/mL); 10% (n = 9) remained seronegative at study completion. The geometric mean antibody titer to hepatitis B surface antigen for infants who seroconverted was 200 mIU/mL. Nonresponders (NR) differed from responders (R) in birth weight (NR = 2090 g, R = 1560 g) gestational age (NR = 33 weeks, R = 31 weeks), and weight gain before vaccine initiation (NR = 244 g, R = 633 g). There were no differences in weight or age at vaccine initiation, Apgar scores, interval between vaccine doses, or bacterial infections, steroid use, or transfusions before vaccine initiation.

CONCLUSIONS

Ninety percent of preterm infants responded to hepatitis B vaccine when the first dose of vaccine was delayed until hospital discharge. Nonresponders were more likely to be preterm infants of higher birth weight and higher gestational age, and to have gained less weight before vaccine initiation.

A stationary-phase stress-response sigma factor from Mycobacterium tuberculosis

Alternative RNA polymerase sigma factors are a common means of coordinating gene regulation in bacteria. Using PCR amplification with degenerate primers, we identified and cloned a sigma factor gene, sigF, from Mycobacterium tuberculosis. The deduced protein encoded by sigF shows significant similarity to SigF sporulation sigma factors from Streptomyces coelicolor and Bacillus subtilis and to SigB, a stress-response sigma factor, from B. subtilis. Southern blot surveys with a sigF-specific probe identified cross-hybridizing bands in other slow-growing mycobacteria, Mycobacterium bovis bacille Calmette-Guérin (BCG) and Mycobacterium avium, but not in the rapid-growers Mycobacterium smegmatis or Mycobacterium abscessus. RNase protection assays revealed that M. tuberculosis sigF mRNA is not present during exponential-phase growth in M. bovis BCG cultures but is strongly induced during stationary phase, nitrogen depletion, and cold shock. Weak expression of M. tuberculosis sigF was also detected during late-exponential phase, oxidative stress, anaerobiasis, and alcohol shock. The specific expression of M. tuberculosis sigF during stress or stationary phase suggests that it may play a role in the ability of tubercle bacilli to adapt to host defenses and persist during human infection.

A major outbreak of foodborne gastroenteritis among Air Force personnel during Operation Desert Storm

An outbreak of foodborne gastroenteritis affected 648 United States Air Force personnel stationed in Jeddah, Saudi Arabia during Operation Desert Storm. The implicated food source was a locally catered meal. Despite the presence of an aggressive Air Force public health program, foodborne illness had a major impact on manpower and medical resources during a critical phase of military operations. It is the recommendation of the authors that the Air Force not rely on local caterers during future deployments.

Use of Chlamydiazyme on urine sediment for diagnosis of Chlamydia trachomatis genital infections

The enzyme-linked immunosorbent assay testing of urine sediment in males has been FDA approved for the detection of Chlamydia trachomatis. We compared urine sediment testing to urethral or cervical swabs in 47 men and 219 women using a simpler technique than that recommended by the manufacturer. Sensitivity and specificity values of 88% and 97% for men and 29% and 98% for women, respectively, were found. Urine sediment testing is inadequate in women. However, urine sediment testing in men using our modified technique offers a rapid, accurate, and non-invasive approach which can effectively replace the use of urethral swabs throughout the military.