Validation of bleach-treated smears for the diagnosis of pulmonary tuberculosis

SETTING

Health centres in Awassa, southern Ethiopia.

DESIGN

Consecutive patients visiting health centre laboratories for the evaluation of suspected pulmonary tuberculosis (TB) between June and September 2006 were investigated. On-the-spot, morning and second on-the-spot sputum samples were pooled for each patient. Direct smears were stained with hot Ziehl-Neelsen (ZN) technique and aliquots cultured for mycobacteria on Löwenstein-Jensen media. The remaining sputum was treated with household bleach, aliquoted and processed with short-term digestion, centrifugation and sedimentation techniques, and stained with ZN.

RESULTS

Acid-fast bacilli were detected in respectively 126 (25%), 141 (28%), 169 (34%) and 198 (40%) of the 497 pooled sputum samples processed by the direct, short-term, sedimentation and centrifugation techniques (P < 0.001). The sensitivity of the direct, short-term, sedimentation and centrifugation techniques was respectively 51.1%, 53.2%, 57.6% and 63.6%. The difference between the direct smear and centrifugation (P < 0.001) or sedimentation (P < 0.005) methods was significant. The specificity of the direct, short-term digestion, sedimentation and centrifugation techniques was respectively 97%, 93%, 86.5% and 80.8%.

CONCLUSIONS

Bleach treatment of sputum and centrifugation significantly improves the sensitivity of smear microscopy for the diagnosis of TB in a health centre in a high TB burden area. It is more sensitive, but possibly less specific, than other bleach methods.

Diagnosis of tuberculous lymphadenitis in Ethiopia: correlation with culture, histology and HIV status

SETTING

Butajira, Southern Ethiopia.

OBJECTIVE

To compare the diagnostic capacity of the clinical criteria for tuberculous lymphadenitis (TBLN) with histological and/or culture results and to assess the association of human immunodeficiency virus (HIV) with tuberculosis (TB) lymphadenitis.

DESIGN

Patients (n=171) were included in the study from October 2005 until July 2006 at Butajira Hospital. Laboratory tests were performed to confirm TBLN. HIV status was identified in TBLN patients and retrospectively in 1608 healthy individuals.

RESULT

A total of 136/161 (84.5%) patients were diagnosed with TBLN by histology. TBLN was culture-confirmed in 107/156 (68.6%) patients. The sensitivity, specificity, positive and negative predictive values of histology were respectively 92.5%, 49%, 79.8% and 75% when compared to culture as gold standard. Patients positive for TBLN by cytology and Ziehl-Neelsen (ZN) were also positive by histology and culture. Among the 143 confirmed TBLN patients, nine (6.3%) were HIV-positive. Of the 1608 healthy individuals, 77 (4.8%) were HIV-positive. Younger age (P=0.0001), female sex (P=0.016), not being married (P=0.0001) and illiteracy (P=0.016) showed a strong association with HIV in healthy individuals.

CONCLUSION

Clinical criteria alone over-diagnosed TBLN by 15.4% compared to histological and/or bacteriological results. The HIV prevalence in TBLN patients and healthy individuals was the same.

Very high DDT-resistant population ofAnopheles pharoensisTheobald (Diptera: Culicidae) from Gorgora, northern Ethiopia

Standard WHO insecticide bioassay tests were carried out in Gorgora, northern Ethiopia to evaluate the susceptibility status of Anopheles pharoensis Theobald for the insecticides DDT, malathion, permethrin and deltamethrin. The mortality and when appropriate knockdown effect of the insecticides were observed. The results indicated that this species was resistant to DDT. A high mortality was obtained after exposure to permethrin and deltamethrin but below 97 % which is the limit for susceptibility according to WHO. A prolonged knockdown time was noted for DDT and the two pyrethroids. An. phoaroensis was found to be susceptible to malathion.

Knowledge and practice of private practitioners in TB control in Addis Ababa

SETTING

Private clinics and hospitals in Addis Ababa, Ethiopia.

OBJECTIVES

To assess the knowledge of private practitioners (PPs) with regard to tuberculosis (TB) control and their practice of TB diagnosis, treatment and monitoring.

DESIGN

A descriptive survey was conducted among PPs. A total of 120 responded to a self-administered questionnaire.

RESULTS

According to 81.5% of the PPs, at least two to five TB cases were diagnosed in their clinic per week. The correct anti-tuberculosis treatment regimens recommended by the National Tuberculosis Programme (NTP) were mentioned by only 9.7% of the doctors, while 63% listed 68 regimens. The majority (41.0%) monitored treatment using chest X-ray (CXR) alone, while 21.0% use CXR in combination with another diagnostic tool. Eighty per cent of the PPs did not keep a TB register, and case holding was non-existent.

CONCLUSIONS

PPs in Addis Ababa diagnose a high number of TB cases. However, there is a huge lack of information on anti-tuberculosis treatment. This shows the likely irrational use of the few available anti-tuberculosis drugs, which may favour the emergence and spread of drug resistance.

Autoimmunity after induction of neonatal tolerance to alloantigens: role of B cell chimerism and F1 donor B cell activation

BALB/c mice rendered tolerant by the neonatal injection of semiallogeneic (C57BL/6 X BALB/c)F1 spleen cells develop features of autoimmune disease. The possible mechanisms involved in autoantibody production, particularly anti-DNA antibodies, were investigated. In the first 5 wk, there was polyclonal B cell activation, as indicated by marked hypergammaglobulinemia, with a predominance of IgG1 and an increased production of antihapten antibodies. IgG1 anti-SSDNA and anti-DSDNA antibodies were detected with similar kinetics, but at higher titers than the anti-hapten antibodies. Also, there was a correlation between the effective induction of tolerance, as evaluated by the measurement of alloantigen-specific cytolytic T lymphocyte precursors, the persistence of B cell chimerism, and the production of anti-DNA antibodies. Anti-DNA antibodies were observed only in mice exhibiting a persistence of immunoglobulins bearing the donor's allotype. To determine the origin of anti-DNA antibodies, experiments were conducted whereby newborn BALB/c (Igh-1a) mice were injected with F1 cells from mice resulting from a crossing between Igh congenic BALB/c mice bearing the IgCHb allotype and conventional C57BL/6 mice (Igh-1b). All anti-DNA and anti-hapten antibodies exhibited the Igb allotype and thus were produced by the F1 donor B cells. The initial phase of tolerance induction was apparently associated with an allogeneic helper effect, because DNP-KLH-primed F1 donor cells transferred to newborn BALB/c could be stimulated after challenge with DNP-BGG. The triggering of persisting auto-reactive F1 donor B cells may reflect an activation by "incompletely" tolerant semiallogeneic T cells.

Autoimmunity after induction of neonatal tolerance to alloantigens: role of B cell chimerism and F1 donor B cell activation

BALB/c mice rendered tolerant by the neonatal injection of semiallogeneic (C57BL/6 X BALB/c)F1 spleen cells develop features of autoimmune disease. The possible mechanisms involved in autoantibody production, particularly anti-DNA antibodies, were investigated. In the first 5 wk, there was polyclonal B cell activation, as indicated by marked hypergammaglobulinemia, with a predominance of IgG1 and an increased production of antihapten antibodies. IgG1 anti-SSDNA and anti-DSDNA antibodies were detected with similar kinetics, but at higher titers than the anti-hapten antibodies. Also, there was a correlation between the effective induction of tolerance, as evaluated by the measurement of alloantigen-specific cytolytic T lymphocyte precursors, the persistence of B cell chimerism, and the production of anti-DNA antibodies. Anti-DNA antibodies were observed only in mice exhibiting a persistence of immunoglobulins bearing the donor's allotype. To determine the origin of anti-DNA antibodies, experiments were conducted whereby newborn BALB/c (Igh-1a) mice were injected with F1 cells from mice resulting from a crossing between Igh congenic BALB/c mice bearing the IgCHb allotype and conventional C57BL/6 mice (Igh-1b). All anti-DNA and anti-hapten antibodies exhibited the Igb allotype and thus were produced by the F1 donor B cells. The initial phase of tolerance induction was apparently associated with an allogeneic helper effect, because DNP-KLH-primed F1 donor cells transferred to newborn BALB/c could be stimulated after challenge with DNP-BGG. The triggering of persisting auto-reactive F1 donor B cells may reflect an activation by "incompletely" tolerant semiallogeneic T cells.

Specific Schistosoma mansoni rat T cell clones. I. Generation and functional analysis in vitro and in vivo

In an attempt to determine the role of schistosome-specific T cells in the immune mechanisms developed during schistosomiasis, Schistosoma mansoni-specific T cells and clones were generated in vitro and some of their functions analyzed in vitro and in vivo in the fischer rat model. The data presented here can be summarized as follows: a) Lymph node cells (LNC) from rats primed with the excretory/secretory antigens-incubation products (IPSm) of adult worms proliferate in vitro only in response to the homologous schistosome antigens and not to unrelated antigens (Ag) such as ovalbumin (OVA) or Dipetalonema viteae and Fasciola hepatica parasite extracts. b) After in vitro restimulation of the primed LNC population with IPSm in the presence of antigen-presenting cells (APC) and maintenance in IL 2-containing medium, the frequency of IPSm-specific T cells is increased and the T cells can be restimulated only in the presence of APC possessing the same major histocompatibility complex (MHC) antigens. c) Following appropriate limiting dilution assays (LDA) (1 cell/well), 10 IPSm-specific T cell clones were obtained, and two of four maintained in culture were tested for their helper activity because they expressed only the W3/13+ W3/25+ surface phenotypes. d) The two highly proliferating IPSm-specific T cell clones (G5 and E23) exhibit an IPSm-dependent helper activity, as shown by the increase in IgG production by IPSm-primed B cells. e) IPSm-T cell clone (G5) as well as IPSm-T cell lines when injected in S. mansoni-infested rats can exert an in vivo helper activity, which is characterized by an accelerated production of IgG antibodies specific for the previously identified 30 to 40 kilodaltons (kd) schistosomula surface antigens (Ag). As recent studies have demonstrated that rat monoclonal antibodies recognize some incubation products of adult S. mansoni as well as one of the 30 to 40 kd schistosomula surface antigens, and taking into account the fact that the T cell clones here studied were restimulated either with IPSm or with schistosomulum Ag, it appears that such IPSm-specific T cell clones could be involved in the concomitant immunity mechanisms.

Specific Schistosoma mansoni rat T cell clones. I. Generation and functional analysis in vitro and in vivo

In an attempt to determine the role of schistosome-specific T cells in the immune mechanisms developed during schistosomiasis, Schistosoma mansoni-specific T cells and clones were generated in vitro and some of their functions analyzed in vitro and in vivo in the fischer rat model. The data presented here can be summarized as follows: a) Lymph node cells (LNC) from rats primed with the excretory/secretory antigens-incubation products (IPSm) of adult worms proliferate in vitro only in response to the homologous schistosome antigens and not to unrelated antigens (Ag) such as ovalbumin (OVA) or Dipetalonema viteae and Fasciola hepatica parasite extracts. b) After in vitro restimulation of the primed LNC population with IPSm in the presence of antigen-presenting cells (APC) and maintenance in IL 2-containing medium, the frequency of IPSm-specific T cells is increased and the T cells can be restimulated only in the presence of APC possessing the same major histocompatibility complex (MHC) antigens. c) Following appropriate limiting dilution assays (LDA) (1 cell/well), 10 IPSm-specific T cell clones were obtained, and two of four maintained in culture were tested for their helper activity because they expressed only the W3/13+ W3/25+ surface phenotypes. d) The two highly proliferating IPSm-specific T cell clones (G5 and E23) exhibit an IPSm-dependent helper activity, as shown by the increase in IgG production by IPSm-primed B cells. e) IPSm-T cell clone (G5) as well as IPSm-T cell lines when injected in S. mansoni-infested rats can exert an in vivo helper activity, which is characterized by an accelerated production of IgG antibodies specific for the previously identified 30 to 40 kilodaltons (kd) schistosomula surface antigens (Ag). As recent studies have demonstrated that rat monoclonal antibodies recognize some incubation products of adult S. mansoni as well as one of the 30 to 40 kd schistosomula surface antigens, and taking into account the fact that the T cell clones here studied were restimulated either with IPSm or with schistosomulum Ag, it appears that such IPSm-specific T cell clones could be involved in the concomitant immunity mechanisms.

Autoimmunity and immune complex disease after neonatal induction of transplantation tolerance in mice

Mice made neonatally tolerant to alloantigens were found to develop an immunologic disease resembling systemic lupus erythematosus. In BALB/c mice neonatally injected with C57BL/6 X BALB/c F1 hybrid spleen cells, features of autoimmunity were observed first. After 5-24 wk, antinuclear, anti-SS DNA, thymocytotoxic, and rheumatoid factor-like antibodies were detected in association with hypergammaglobulinemia and with the occurrence of circulating immune complexes and cryoglobulins. Some of the antinuclear antibodies were found to be produced by F1 donor B cells persisting in the host. Second, immunopathologic changes were detected in tolerant mice. In the kidneys, an immune complex glomerulonephritis of the membranous type was observed. Immunoglobulin deposits were also found in the choroid plexus and at the dermoepidermal junction. In addition, thrombocytopenia was a common finding, and a positive direct Coomb's test occasionally was detected. Features of autoimmune disease were closely associated with the effective induction of transplantation tolerance, as revealed by the inability of spleen cells to generate in vitro cytolytic responses against C57BL/6 alloantigens. It is suggested that, although transplantation tolerance is associated with a lack of cytolytic reaction of the host against F1 hybrid donor alloantigens, other types of allogeneic interactions could lead in this model to the development of autoimmunity and immunopathology.

Autoimmunity and immune complex disease after neonatal induction of transplantation tolerance in mice

Mice made neonatally tolerant to alloantigens were found to develop an immunologic disease resembling systemic lupus erythematosus. In BALB/c mice neonatally injected with C57BL/6 X BALB/c F1 hybrid spleen cells, features of autoimmunity were observed first. After 5-24 wk, antinuclear, anti-SS DNA, thymocytotoxic, and rheumatoid factor-like antibodies were detected in association with hypergammaglobulinemia and with the occurrence of circulating immune complexes and cryoglobulins. Some of the antinuclear antibodies were found to be produced by F1 donor B cells persisting in the host. Second, immunopathologic changes were detected in tolerant mice. In the kidneys, an immune complex glomerulonephritis of the membranous type was observed. Immunoglobulin deposits were also found in the choroid plexus and at the dermoepidermal junction. In addition, thrombocytopenia was a common finding, and a positive direct Coomb's test occasionally was detected. Features of autoimmune disease were closely associated with the effective induction of transplantation tolerance, as revealed by the inability of spleen cells to generate in vitro cytolytic responses against C57BL/6 alloantigens. It is suggested that, although transplantation tolerance is associated with a lack of cytolytic reaction of the host against F1 hybrid donor alloantigens, other types of allogeneic interactions could lead in this model to the development of autoimmunity and immunopathology.

Colony formation of cytolytic T cells in semisolid medium

Addition of supernatant from concanavalin A-stimulated spleen cells to in vitro primed cytolytic T lymphocytes in semisolid medium stimulated the growth of colonies of cytolytic lymphocytes. Optimal results were obtained using a peritoneal adherent cell underlayer where a 10% plating efficiency (greater than or equal to 4 cells per colony) was achieved when between 5000 and 100 000 cells were plated per dish. Individual colonies were harvested and tested in a short term (5h) 51Cr release microassay, employing 200 target cells. The frequency of lytic colonies varied from 46--67%. The observed lytic activities were specific for the relevant allogeneic target cells.