Background/Aims: Species-level identification of nontuberculous mycobacteria (NTM) is important in making decisions about the necessity and choice of antimicrobial treatment. The reason is predictable clinical significance and the susceptibility profile of specific NTM species. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is recognized as a diagnostic tool for routine identification of bacteria and yeasts in the clinical laboratory based on protein fingerprint analysis. The aim of the study was to evaluate MALDI-TOF MS in the identification of NTM. Methods: A total of 25 NTM isolates from liquid cultures were identified with both polymerase chain reaction (PCR)-based hybridization assay and MALDI-TOF MS at the University Hospital Center Zagreb. Results: PCR-based hybridization assay identified 96% (24/25) and MALDI-TOF MS 80% (20/25) of tested NTM isolates. Five isolates with no reliable MALDI-TOF MS identification belonged to the Mycobacterium avium-intracellulare complex. Seventy percent (14/20) of NTM isolates successfully identified with MALDI-TOF MS had a score higher than 2.0, indicating reliable species identification. Conclusion: MALDI-TOF MS is a promising tool for the identification of NTM. With a further improvement of the protein extraction protocol, especially regarding the M. avium-intracellulare complex, MALDI-TOF MS could be an additional standard method for identification of NTM.
The possible immunological relationship between the pattern of Th1/Th2 cytokine production and tuberculin reactivity was assessed in patients with active Mycobacterium tuberculosis infection. The production of the intracellular cytokines interferon (IFN)‐γ and interleukin‐4 (IL‐4) was measured in CD4+ and CD8+ T cells obtained from peripheral blood and bronchoalveolar lavage fluid (BALF) of 20 tuberculin skin‐positive patients and compared with the findings recorded in nine tuberculin skin‐negative patients with active pulmonary tuberculosis. Upon stimulation with phorbol 12‐myristate acetate/ionomycin for 6 h, tuberculin‐negative patients had a significantly higher proportion of IFN‐γ‐producing CD4+ T lymphocytes in BALF than in peripheral blood, while both CD4+ and CD8+ T‐lymphocyte subsets in BALF of tuberculin‐positive patients secreted more IFN‐γ than their peripheral blood counterparts. Tuberculin‐negative patients had a significantly higher proportion of IFN‐γ‐producing CD4+ T lymphocytes in peripheral blood than tuberculin‐positive patients. There was no significant difference in the production of IFN‐γ by BALF CD4+ T lymphocytes, or by either peripheral blood or BALF CD8+ T lymphocytes. In two tuberculin‐negative patients, peripheral blood CD4+ T lymphocytes produced IL‐4. Study results suggested a higher immune activity in the blood of tuberculin‐negative patients, with an increased lymphocyte activity in BALF versus peripheral blood in both patient groups.
SUMMARY -Th e aim of this study was to investigate the role of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) in detecting latent tuberculosis in immunocompromised patients before introducing tumor necrosis factor (TNF-α) antagonists. Th e study included 300 subjects of similar age. Th e study group comprised of 150 QuantiFERON (QFT) positive subjects with rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis and psoriatic arthritis, while control group comprised of 150 QFT negative respondents with the same diseases. Exhaustive medical history was documented for all patients. Screening tests were performed including QFT-GIT, tuberculin skin test (TST), chest radiography and detection of Mycobacterium tuberculosis in sputum culture 2 times. A positive QFT-GIT test result, regardless of TST result, was considered as an indication for latent tuberculosis infection (LTBI) treatment. Results of this study showed good correlation between the conclusive results of QFT-GIT and TST. All study group patients had normal clinical fi ndings, normal radiologic fi ndings and negative results of sputum microbiological analysis during the course of prophylaxis and after its completion and during the course of biological therapy. Conversion of positive QFT-GIT test to negative was observed in 4% of study group patients, while QFT negative respondents remained negative. Th ere was a statistically signifi cant positive correlation between QFT-GIT, TST results and patient age, smoking habit and contact with tuberculosis. Study results showed that along with good clinical evaluation and detailed medical history, it is important to conduct testing in order to avoid disease progression or unnecessary isoniazid prophylaxis.
Little is known about the cause, nature, treatment and prognosis of pulmonary Langerhans' cell histiocytosis (LCH) in adults. We report the case of a 44-year-old female non-smoker suffering from pulmonary histiocytosis who after a 7-year remission period relapsed with both lung and bone disease. Using a combination of corticosteroids, methotrexate and bone irradiation treatment, the patient achieved total disease remission. The patient was a non-smoking female who has had long-term and swift remission of the disease on two occasions.
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