Performance of Interferon-Gamma and IP-10 Release Assays for Diagnosing Latent Tuberculosis Infections in Patients with Concurrent Malaria in Tanzania

Interferon-gamma (IFN-γ) release assays (IGRAs) are used to detect cellular immune recognition of Mycobacterium tuberculosis The chemokine IFN-γ-inducible protein 10 (IP-10) is an alternative diagnostic biomarker to IFN-γ. Several conditions interfere with IGRA test performance. We aimed to assess the possible influence of Plasmodium falciparum infection on the IGRA test QuantiFERON-TB GOLD® In-Tube (QFT) test and an in-house IP-10 release assay. In total, 241 Tanzanian adults were included; 184 patients with uncomplicated malaria (88 human immunodeficiency virus [HIV] coinfected) and 57 HIV-infected patients without malaria infection. Malaria was treated with artemether-lumefantrine (Coartem®). QFT testing was performed before initiation of malaria treatment and at days 7 and 42. In total, 172 patients completed follow-up. IFN-γ and IP-10 was measured in QFT supernatants. We found that during malaria infection IFN-γ and IP-10 levels in the unstimulated samples were elevated, mitogen responsiveness was impaired, and CD4 cell counts were decreased. These alterations reverted after malaria treatment. Concurrent malaria infection did not affect QFT test results, whereas there were more indeterminate IP-10 results during acute malaria infection. We suggest that IGRA and IP-10 release assay results of malaria patients should be interpreted with caution and that testing preferably should be postponed until after malaria treatment.

[Legionella pneumophila in the hot water system of Danish hospitals and institutions. A questionnaire study and a random sample test]

Hitherto, nosocomial epidemic outbreaks of legionnaire's disease have not been reported in Denmark. Only sporadic cases have been described. A survey of 75 Danish hospitals concerning the dimensions and operation of the hot-water systems revealed that only 13% had a hot water tank temperature above the recommended 60 degrees C. Temperatures of coldest tap water and of returning water were above 50 degrees C in only 31% and 24% respectively. Twelve representative hospitals with 35 independent water systems were investigated for the presence of Legionella pneumophila (Lp). Lp was demonstrated in all the hospitals and in 34 (97%) of the systems. The prevailing serogroups were (in order of frequency) 3, 1, 2, 5 and 6. We conclude that the operation of the hot tap water systems should be optimized. This report indicates that nosocomial epidemics are conceivable and attention should be paid to the disease as a diagnostic possibility in patients with primary atypical pneumonia.

[Epidemiology of Legionnaires' disease in Denmark. A comparative study]

An epidemiological study of Legionnaires' disease in Denmark is presented. A high incidence of apparently sporadic cases of Legionnaires' disease in Denmark was found. The source of infection remains obscure in most cases. No outbreaks have been registered in Denmark, in contrast to most European countries. It is concluded that intensified surveillance, including monitoring of water distribution systems in hospitals, combined with an earlier etiological diagnosis might disclose more nosocomial cases.

Mental function in elderly men after surgery during epidural analgesia

To evaluate whether there is a difference in mental function after general anaesthesia and epidural analgesia, a homogeneous group of 40 elderly men (age between 60 and 80) undergoing transurethral prostatectomy was studied. The study was prospective, randomised and double blind. Patients with all types of complications believed to impair mental function were excluded. Long-term, short-term, verbal and visual memory were tested preoperatively, and 4 days, and 3 weeks postoperatively. In conclusion, we found a significant and equal decline in test performance on the fourth postoperative day. Three weeks postoperatively, however, both groups had returned to or exceeded preoperative levels of performance.

Blood loss in transurethral prostatectomy: epidural versus general anaesthesia

The peroperative and postoperative blood loss was determined in 36 patients undergoing transurethral prostatectomy (TUR-P) using a photometric method. Seventeen patients were randomly allocated to epidural and 19 patients to general anaesthesia. No significant differences were found between the two groups in the total blood loss peroperatively, the corrected blood loss peroperatively (ml/g/min) or the blood loss postoperatively. The systolic blood pressures were equal in the two groups and no correlation between blood loss and blood pressure was demonstrated. The blood loss per g resected tissue was fairly constant and independent of prostatic weight, but bleeding per minute operating time increased significantly with prostatic size. As the total peroperative blood loss increases with operating time, rapid surgery is a possibility of reducing blood loss in TUR-P. Visual estimation of blood loss during TUR-P of larger glands was unreliable with underestimates of about 100 per cent in one third of the patients, when bleeding exceeded 400 ml. Therefore we recommend an accurate determination of blood loss during resection of larger glands.