An autopsy case of cycloserine poisoning

Cycloserine was given to a 29-year-old girl with pulmonary tuberculosis for 500 days (total dose 250 g). Following this treatment, she began to show several psychiatric and neurologic symptoms and died. Histopathologically, deletion of the nerve cells in the cerebrum was diffusely observed, especially in the IIIrd layer of the frontal and temporal cortex and patchy demyelinations were found in the white matter of the parietal lobe. Characteristic findings were the change of small blood vessels and deletion of the nerve cell around the area of vessels in the hypothalamus, putamen and pallidum. The same changes of the blood vessels were found in the internal capsule. In the cerebellum, shrinkage of Purkinje cells and increase of Bergmann's glia were observed.

Management of tuberculosis: altered role of the primary care physician

Increasing incidence of tuberculosis is being reported in some areas, even though greater precision in diagnosis and greater reliability in treatment have been achieved within recent years than were previously possible. The Mantoux test is a convenient office procedure that should be done more often. Patients with active tuberculosis can now be treated on an outpatient basis with little morbidity or social or economic disruption.

Nocardia asteroides primary cerebral abscess and secondary meningitis

A rare case of primary cerebral abscess due to Nocardia asteroides, and its surgical removal, are described. Postoperative meningitis caused by the same fungi was succesfully cured with sulphadiazine and cycloserine. The nocardial disease, its neurological complications, and therapy are reviewed.

gamma-Aminobutyric acid (Gaba) and the dopamine hypothesis of schizophrenia

gamma-Aminobutyric acid (Gaba) has been shown to influence dopamine activity in the brain. The author suggests that Gaba could be involved in the hypothesized dopamine hyperactivity in schizophrenia. He discusses pharmacological interventions that may raise Gaba-mediated function in the brain and states that further development of Gaba analogues seems clearly indicated. It is conceivable, he concludes, that these compounds could enhance the antipsychotic activity of dopamine receptor blockers, which could lead to the use of lower doses and therefore fewer extrapyramidal side effects.

Ethambutol regimen in renal tuberculosis

A 10-year experience with an ethambutol regimen for renal tuberculosis is presented. Precaution must be taken with ethambutol since optic nerve atrophy can occur. This oral therapy is now given as a single, daily dose before breakfast and has proved successful in therapy and patient acceptance. No urine reversions have occurred in the 10 years. The regimen of ethambutol, isoniazid, cycloserine and pyridoxine may now be considered a first choice in therapy for renal tuberculosis.

An evaluation of the current therapeutic regimen for renal tuberculosis

Renal tuberculosis will continue to be a potentially lethal disease and must be considered a diagnostic possibility in all patients with infection in order to discover it in time. Multiple drug regimens have withstood the test of time and it appears that triple drug therapy is more efficacious than 2 drugs since triple drugs permit the skipping of 1 or another of the medications with less danger of relapse. Rifampin is a new drug that is well tolerated and efficacious, although expensive. We recommend continuous use of triple drugs for 2 years at least with the continuance of pyridoxine. We advise an excretory urogram, the collection of 3 urine specimens for culture and the passage of ureteral catheters every 6 months during treatment and every 12 months thereafter for 10 years. We do not consider relapse an indication for an operation but for further therapy, using medications to which the patient's organism is proved susceptible by bacteriologic means. Under modern conditions an operation is rarely necessary.

Clinical aspects of atypical mycobacterial infection

SUMMARY

Atypical mycobacterial infections may give rise to various clinical difficulties. Case reports of six patients--three adult patients with pulmonary lesions, two children with cervical lymphadentis and one patient in whom the atypical mycobacterium appeared to be present as a commensal--illustrate these difficulties. Determination of the significance of the organism and differentiation of condition from tuberculosis and others requires consideration of the clinical picture, the results of skin testing, histologic features and cultural characteristics. Three patients, including the two children, were treated with a combination of surgery and chemotherapy, with satisfactory results. An elderly patient with chronic bronchitis and a pulmonary infection due to M. kansasii was treated successfully with antiuberculosis agents alone. Chemotherapy is being tried on a fifth patient with cavitary disease due to M. intracellulare, but is seems likely that an operation will also be required.

Mycobacterial sporotrichoid

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