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Della bacillemia tubercolare e dei metodi per dimostrarla
F e b r u a r y , 1934]
C5INICAT, PATHOLOGY
Cases of lupus vulgaris and scrofuloderma. /~u~ from the lesions of 16 cases of cutaneous affections, usually considered to be tuberculous manifestations, none could be grown; these included erythema induratum Bazin, papulenecrotic tuberculide, Boeck's sarcoid, lupus pernio, erythema nodosum and lupus erythematodes. In 18 eases of lupus u guinea-pig was also inoculated. Tubercle bacilli were demonstrated in 16 of these by both methods ; in one case the culture gave a positive result and the guinea-pig a negative one, while in one ease the opposite result was obtained. The disease was often very ebronie in the guinea-pig, 10 of the above animals living for over a year, thus indicating diminished virulence of the bacillus. Culturally and with respec~ to their effect in rabbits, the isolated tubercle bacilli conformed to the human type. I t is pointed out that in recent years several investigators have obtained avian tubercle bacilli from tuberculous skin 19sions by the cultural method. As this type is practically non-pathogenic for the guinea-pig, only the cultural method will reveal its presence. SIGON, 5I. Delia baeillemia tubereolare e dei metodi per dimostrarla. S a n a t o r i u m , 1933, 4, 4. The writer found that a blood-culture carried out according to L6wenstein's method was positive in only three out of 58 cases of pulmonary tuberculosis. He maintains that this method is not a more delicate test than those already in use, and, like them, is unable to reveal tubercle bacilli when they are present in very small numbers in the blood. LSwenstein's method, therefore, does not possess any diagnostic value and cannot solve the problem of the relation between bacillmmia and the clinical course of tuberculosis. !
KALLOS, P. Beitr~4ge zur Frage der morphologischen Ver~4nderliehkeit des Koehsehen :Bacillus (Types humanus) in der Kultur. Gior. di .Battcriol. c Irarunnel., 1933, 10, 475. The writer has found that the additi(ln of serum from subjects of 5utaneous tuberculosis to K i r c h n e r ' s synthetic
227
medium had an un[avourable action on the development and morphological changes of the human type of tubercle bacillus. On the other hand, normal serum and the serum of subjects of pulmonary tuberculosis did not have this effect, nor did the serum of subjects of cutaneous tuberculosis have any effect on the tubercle bacilli from their own cutaneous feet. A marked chat,ge in the morphological character of the human type of tubercle bacillus was obtained by adding olive oil to the culture medium. FERRIS, I4. W. Generalized Tuberculosis Complicated by Presence of Yeast-like Organisms. Amer. Rev. Tub. 1933, 27, ;~48. Tile coincidental occurrence of both yeast-like forms and tubercle bacilli has not often been noted in the literature, although the similarity of the lesions caused by local and systemic blastomycotic and similar infections to those caused by the tubercle bacillus has frequently been pointed out. The problem of differential diagnosis is obviously much more difficult when both types of organism are found clinically in the body discharges or post-mortem in thetissues. In the ease now reported~ a woman, aged 47, gave a history beginning fifteen years ago, of nine years' r e c u r rent attacks of sore throats after which an ulcer developed on the pharynx, diagnosed bioscopically as tuberculous, the sputum at this time also being positive. Six years later extensive lesions were found in both lungs, with acidfast bacilli in the sputum, and ulceration of pharynx and tonsils, diagnosed as tuberculous. Tile Saranae laboratory found: (1) Acid-fast bacilli constantly in throa~-smears and in sputum; (2) guinea-pig inoculations from tbese were positive for tuberculosis; (3) budding yeast-like organisms in great numbers in fresh N a O H preparations and in cultures from the throat and from t:he washed sputum; (4) voided urine and purulent vaginal discharge gave pure culture of budding yeast-like organisms ; (5) blood culture and Wassermann negative. The patient died a fdw weeks after returning from Saranae Lake, autopsy showing, anatomically, granu-
C5INICAT, PATHOLOGY
Cases of lupus vulgaris and scrofuloderma. /~u~ from the lesions of 16 cases of cutaneous affections, usually considered to be tuberculous manifestations, none could be grown; these included erythema induratum Bazin, papulenecrotic tuberculide, Boeck's sarcoid, lupus pernio, erythema nodosum and lupus erythematodes. In 18 eases of lupus u guinea-pig was also inoculated. Tubercle bacilli were demonstrated in 16 of these by both methods ; in one case the culture gave a positive result and the guinea-pig a negative one, while in one ease the opposite result was obtained. The disease was often very ebronie in the guinea-pig, 10 of the above animals living for over a year, thus indicating diminished virulence of the bacillus. Culturally and with respec~ to their effect in rabbits, the isolated tubercle bacilli conformed to the human type. I t is pointed out that in recent years several investigators have obtained avian tubercle bacilli from tuberculous skin 19sions by the cultural method. As this type is practically non-pathogenic for the guinea-pig, only the cultural method will reveal its presence. SIGON, 5I. Delia baeillemia tubereolare e dei metodi per dimostrarla. S a n a t o r i u m , 1933, 4, 4. The writer found that a blood-culture carried out according to L6wenstein's method was positive in only three out of 58 cases of pulmonary tuberculosis. He maintains that this method is not a more delicate test than those already in use, and, like them, is unable to reveal tubercle bacilli when they are present in very small numbers in the blood. LSwenstein's method, therefore, does not possess any diagnostic value and cannot solve the problem of the relation between bacillmmia and the clinical course of tuberculosis. !
KALLOS, P. Beitr~4ge zur Frage der morphologischen Ver~4nderliehkeit des Koehsehen :Bacillus (Types humanus) in der Kultur. Gior. di .Battcriol. c Irarunnel., 1933, 10, 475. The writer has found that the additi(ln of serum from subjects of 5utaneous tuberculosis to K i r c h n e r ' s synthetic
227
medium had an un[avourable action on the development and morphological changes of the human type of tubercle bacillus. On the other hand, normal serum and the serum of subjects of pulmonary tuberculosis did not have this effect, nor did the serum of subjects of cutaneous tuberculosis have any effect on the tubercle bacilli from their own cutaneous feet. A marked chat,ge in the morphological character of the human type of tubercle bacillus was obtained by adding olive oil to the culture medium. FERRIS, I4. W. Generalized Tuberculosis Complicated by Presence of Yeast-like Organisms. Amer. Rev. Tub. 1933, 27, ;~48. Tile coincidental occurrence of both yeast-like forms and tubercle bacilli has not often been noted in the literature, although the similarity of the lesions caused by local and systemic blastomycotic and similar infections to those caused by the tubercle bacillus has frequently been pointed out. The problem of differential diagnosis is obviously much more difficult when both types of organism are found clinically in the body discharges or post-mortem in thetissues. In the ease now reported~ a woman, aged 47, gave a history beginning fifteen years ago, of nine years' r e c u r rent attacks of sore throats after which an ulcer developed on the pharynx, diagnosed bioscopically as tuberculous, the sputum at this time also being positive. Six years later extensive lesions were found in both lungs, with acidfast bacilli in the sputum, and ulceration of pharynx and tonsils, diagnosed as tuberculous. Tile Saranae laboratory found: (1) Acid-fast bacilli constantly in throa~-smears and in sputum; (2) guinea-pig inoculations from tbese were positive for tuberculosis; (3) budding yeast-like organisms in great numbers in fresh N a O H preparations and in cultures from the throat and from t:he washed sputum; (4) voided urine and purulent vaginal discharge gave pure culture of budding yeast-like organisms ; (5) blood culture and Wassermann negative. The patient died a fdw weeks after returning from Saranae Lake, autopsy showing, anatomically, granu-