Few large prospective studies of adverse reactions after bacille Calmette-Guérin (BCG) vaccination are available. In a prospective national study of such adverse reactions among 918 subjects (aged 1 day to 54 years) over a 14-month period, 45 vaccinees (5%) reported 53 adverse reactions (23 injection-site abscesses, 14 severe local reactions, 10 cases of lymphadenitis, and 6 other reactions). Only 1% of vaccinees required medical attention. Reactions, particularly lymphadenitis, were significantly less common in infants <6 months old (but not in subjects aged > or =6 months) vaccinated by trained (vs. untrained) providers (relative risk [RR], 0.24; 95% confidence interval [CI], 0.09-0.68). Injection-site abscesses (RR, 2.96; 95% CI, 1.11-7.90) and severe local reactions (RR, 4.93; 95% CI, 1.11-21.90) were significantly more common in older vaccinees. Local reactions were more frequently reported by adult females than by adult males (RR, 7.18; 95% CI, 1.59-32.45). Adverse reactions were not significantly associated with any currently available vaccine batch, previous receipt of BCG vaccine, or concomitant administration of other vaccines.

Background: Tuberculosis of the breast is an uncommon disease with non-specific clinical, radiological and histological findings. Misdiagnosis is common as biopsy specimens are paucibacillary and investigations such as microscopy and culture are frequently negative.

In 2018, the National Notifiable Diseases Surveillance System received 1,438 tuberculosis (TB) notifications, representing a rate of 5.8 per 100,000 population, consistent with the preceding three years. Australia has achieved and maintained good tuberculosis (TB) control since the mid-1980s, sustaining a low annual TB incidence rate of approximately five to six cases per 100,000 population. The number of multi-drug-resistant TB (MDR-TB) cases diagnosed in Australia is low by international standards, with approximately 2% of TB notifications per year classified as MDR-TB. Australia’s overseas-born population continue to represent the majority of TB notifications (between 86% to 89% across the four reporting years) and the Aboriginal and Torres Strait Islander population continues to record TB rates around four to five times higher than the Australian-born Non-Indigenous population. Whilst Australia has achieved and maintained excellent control of TB in Australia, sustained effort is required to reduce local rates further, especially among Aboriginal and Torres Strait Islander populations, and to contribute to the achievement of the World Health Organization’s goal to end the global TB epidemic by 2035.

Three cases of Mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 ؋ 10 4 and 4.5 ؋ 10 3 CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of Mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 ؋ 10 6 CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers.Mycobacterium species are ubiquitous in the environment and are found worldwide (7,9,14,21,30). They have a predilection for a variety of natural waters, including lakes, rivers, and streams, and have also been detected in water supply systems (1,6,7,13,14,15,30). In a study of eight water supply distribution systems across the United States, the average number of M. avium in biofilms was 0.3 CFU per cm 2 and the number of M. intracellulare was 600 CFU per cm 2 for all surfaces (13). Mycobacteria not only survive but may persist and increase in number, and waters that have traversed such systems yield mycobacteria. Human beings are regularly exposed to these waters, which represent a potential source for infection.End uses of supplied water are myriad but include industry (machine coolant fluids), hospitals, commercial buildings, residential garden watering, residential drinking and cooking, hot water systems, baths and showers, swimming pools, spa pools or hot tubs, ice machines, aquariums, and miscellaneous purposes such as foot bath whirlpools (1,6,7,12,13,14,26,29,31). Recirculating hot water systems in buildings, spas, and hot tubs have yielded high numbers of M. avium. Indeed, hot water systems may have higher numbers of M. avium than the source water (10). Swimming pools have also yielded M. avium (12), and long-term exposure to aerosols has caused granulomatous pneumonitis in lifeguards (25).A number of reports have demonstrated an association of M. avium complex (MAC) in spa pools with lung disorders in humans (5,11,16,17,18,20). However, most did not study the relationship between clinical and environmental strains except for two studies that used restriction fragment length polymorphism and multilocus enzyme electrophoresis to demonstrate a genotypic link between MAC isolates from the patient and the spa pool (17,20). The present study attempted to define the source, burden, and persistence of MAC in spa pools associated with four cases of l...

Introduction of molecular biology-based technology into an Australian mycobacterial reference laboratory has resulted in the identification of three isolates of Mycobacterium interjectum in the past 12 months. Conventional phenotypic methods failed to identify the species of these isolates, and high-performance liquid chromatography found that only one of the three isolates had a mycolic acid pattern similar to that of the type strain. In contrast, all three isolates were rapidly identified as M. interjectum by 16S rRNA gene sequence analysis. Two isolates were recovered from the lymph nodes of children with cervical lymphadenitis, confirming the pathogenicity of this organism. However, the third isolate was obtained from the sputum of an elderly male with chronic lung disease without evidence of clinical or radiological progression, suggesting that isolation of M. interjectum should not imply disease. With the increasing use of molecular biology-based technology in mycobacterial laboratories, M. interjectum may be recognized more frequently as a pathogen or commensal organism.

High-income countries are moving toward tuberculosis (TB) elimination. Sophisticated diagnostic tests and effective treatment regimens are readily available. The range of available resources even makes effective treatment of multidrug-resistant tuberculosis (MDRTB) possible. The introduction of highly active antiretroviral therapy and specific TB control measures has reduced the incidence of HIV-associated TB disease. Unfortunately, the situation in low-income countries that carry 95% of the global TB burden is less positive. TB diagnosis still relies upon sputum smear microscopy. The management of MDRTB remains problematic though guidelines for DOTS-plus programs have been developed, and cheaper second-line drugs are becoming available. The HIV epidemic continues to confound TB control efforts, particularly in sub-Saharan Africa. The appropriate package of interventions for controlling HIV/TB disease remains undefined and unimplemented. The international community must provide the funding and technical support to address the alarming dichotomy in TB control that exists between rich and poor countries.

MDR-TB is uncommon in Australia. The large number of cases born in Papua New Guinea, and the poorer outcomes in this cohort, represent challenges with cross-border management of MDR-TB in the Torres Strait. Australia has an ongoing role in the prevention and management of MDR-TB locally and in the region.

We documented dramatic responses to infliximab in 4 tuberculous meningitis cases with severe paradoxical reactions after effective antibacterial treatment, despite high-dose steroids. In every instance, infliximab was used as a last resort after all other options were exhausted, resulting in delayed initiation that may have adversely affected patient outcomes.