THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
TUBERCULOSIS J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Tuberculosis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83311-7 1. Tuberculosis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of tuberculosis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to tuberculosis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to tuberculosis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Bacterial STDs
·
The Official Patient's Sourcebook on Bacterial Vaginosis
·
The Official Patient's Sourcebook on Chlamydia
·
The Official Patient's Sourcebook on Genital Herpes
·
The Official Patient's Sourcebook on Genital HPV Infection
·
The Official Patient's Sourcebook on Gonorrhea
·
The Official Patient's Sourcebook on Pelvic Inflammatory Disease
·
The Official Patient's Sourcebook on STDs and Pregnancy
·
The Official Patient's Sourcebook on Syphilis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON TUBERCULOSIS: GUIDELINES .......... 9
Overview............................................................................................................... 9 What Is Tuberculosis? ........................................................................................ 10 The Difference Between Latent TB Infection and TB Disease............................ 11 How Is TB Spread?............................................................................................. 11 What Is a Tuberculin Skin Test?........................................................................ 12 What Does a Positive Reaction Mean? .............................................................. 12 Skin Testing for Persons Who Have Been Vaccinated with BCG...................... 12 Treatment of Latent TB Infection ....................................................................... 12 Treatment for TB Disease ................................................................................... 13 For More Information......................................................................................... 13 More Guideline Sources ..................................................................................... 13 Vocabulary Builder............................................................................................. 23
CHAPTER 2. SEEKING GUIDANCE ....................................................... 25
Overview............................................................................................................. 25 Associations and Tuberculosis............................................................................ 25 Finding More Associations................................................................................. 30 Finding Doctors.................................................................................................. 31 Selecting Your Doctor ........................................................................................ 33 Working with Your Doctor ................................................................................ 34 Broader Health-Related Resources ..................................................................... 35 Vocabulary Builder............................................................................................. 35
CHAPTER 3. CLINICAL TRIALS AND TUBERCULOSIS........................... 37
Overview............................................................................................................. 37 Recent Trials on Tuberculosis ............................................................................ 40 Benefits and Risks............................................................................................... 56 Keeping Current on Clinical Trials.................................................................... 59 General References.............................................................................................. 60 Vocabulary Builder............................................................................................. 61
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 67 CHAPTER 4. STUDIES ON TUBERCULOSIS ............................................ 69
Overview............................................................................................................. 69
viii Contents
The Combined Health Information Database ..................................................... 69 Federally-Funded Research on Tuberculosis ...................................................... 77 E-Journals: PubMed Central .............................................................................. 91 The National Library of Medicine: PubMed .................................................... 125 Vocabulary Builder........................................................................................... 133
CHAPTER 5. PATENTS ON TUBERCULOSIS......................................... 141
Overview........................................................................................................... 141 Patents on Tuberculosis.................................................................................... 142 Patent Applications on Tuberculosis................................................................ 156 Keeping Current ............................................................................................... 173 Vocabulary Builder........................................................................................... 173
CHAPTER 6. BOOKS ON TUBERCULOSIS ............................................ 177
Overview........................................................................................................... 177 Book Summaries: Federal Agencies .................................................................. 177 Book Summaries: Online Booksellers ............................................................... 184 The National Library of Medicine Book Index ................................................. 185 Chapters on Tuberculosis ................................................................................. 188 General Home References ................................................................................. 189 Vocabulary Builder........................................................................................... 190
CHAPTER 7. MULTIMEDIA ON TUBERCULOSIS.................................. 193
Overview........................................................................................................... 193 Video Recordings .............................................................................................. 193 Audio Recordings ............................................................................................. 197 Bibliography: Multimedia on Tuberculosis ...................................................... 198 Vocabulary Builder........................................................................................... 200
CHAPTER 8. PERIODICALS AND NEWS ON TUBERCULOSIS............... 203
Overview........................................................................................................... 203 News Services & Press Releases ....................................................................... 203 Newsletters on Tuberculosis............................................................................. 208 Newsletter Articles ........................................................................................... 210 Academic Periodicals covering Tuberculosis.................................................... 211 Vocabulary Builder........................................................................................... 212
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 215
Overview........................................................................................................... 215 NIH Guidelines................................................................................................. 215 NIH Databases.................................................................................................. 216 Other Commercial Databases ........................................................................... 229 The Genome Project and Tuberculosis ............................................................. 229 Specialized References....................................................................................... 234
CHAPTER 10. DISSERTATIONS ON TUBERCULOSIS ............................ 237
Overview........................................................................................................... 237 Dissertations on Tuberculosis .......................................................................... 237 Keeping Current ............................................................................................... 238 Vocabulary Builder........................................................................................... 239
Contents
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PART III. APPENDICES .................................................. 241 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 243
Overview........................................................................................................... 243 Your Medications: The Basics .......................................................................... 244 Learning More about Your Medications .......................................................... 245 Commercial Databases...................................................................................... 248 Contraindications and Interactions (Hidden Dangers) ................................... 251 A Final Warning .............................................................................................. 252 General References............................................................................................ 253 Vocabulary Builder........................................................................................... 253
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 255
Overview........................................................................................................... 255 What Is CAM? ................................................................................................. 255 What Are the Domains of Alternative Medicine?............................................ 256 Can Alternatives Affect My Treatment? ......................................................... 259 Finding CAM References on Tuberculosis....................................................... 260 Additional Web Resources................................................................................ 270 General References............................................................................................ 270 Vocabulary Builder........................................................................................... 306
APPENDIX C. RESEARCHING NUTRITION ......................................... 309
Overview........................................................................................................... 309 Food and Nutrition: General Principles........................................................... 310 Finding Studies on Tuberculosis...................................................................... 314 Federal Resources on Nutrition........................................................................ 317 Additional Web Resources................................................................................ 318 Vocabulary Builder........................................................................................... 335
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 337
Overview........................................................................................................... 337 Preparation ....................................................................................................... 337 Finding a Local Medical Library ...................................................................... 338 Medical Libraries Open to the Public............................................................... 338
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 345
Overview........................................................................................................... 345 Your Rights as a Patient................................................................................... 345 Patient Responsibilities .................................................................................... 349 Choosing an Insurance Plan............................................................................. 350 Medicare and Medicaid .................................................................................... 352 NORD’s Medication Assistance Programs ..................................................... 355 Additional Resources ........................................................................................ 356
ONLINE GLOSSARIES.................................................... 357 Online Dictionary Directories.......................................................................... 359
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Contents
TUBERCULOSIS GLOSSARY ........................................ 361 General Dictionaries and Glossaries ................................................................ 382
INDEX................................................................................... 384
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Tuberculosis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Tuberculosis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to tuberculosis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on tuberculosis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on tuberculosis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching tuberculosis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to tuberculosis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating tuberculosis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with tuberculosis. Part II moves on to advanced research dedicated to tuberculosis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on tuberculosis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with tuberculosis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with tuberculosis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with tuberculosis.
Scope While this sourcebook covers tuberculosis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that tuberculosis is often considered a synonym or a condition closely related to the following: ·
Consumption
·
Disseminated Tb
·
Granulomatous Arthritis
4
Tuberculosis
·
Miliary Tuberculosis
·
Tuberculosis - Disseminated
·
Tuberculosis - Pulmonary
·
Tuberculous Meningitis
In addition to synonyms and related conditions, physicians may refer to tuberculosis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for tuberculosis:4 ·
011.9 pulmonary tuberculosis
·
011.9 pulmonary tuberculosis, unspecified
·
018.94 miliary tuberculosis
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to tuberculosis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with tuberculosis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with tuberculosis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of tuberculosis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on tuberculosis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of tuberculosis to you or even given you a pamphlet or brochure describing tuberculosis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
TUBERCULOSIS:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on tuberculosis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on tuberculosis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on tuberculosis. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Tuberculosis
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with tuberculosis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
·
Centers for Disease Control and Prevention: various fact sheets on infectious diseases at http://www.cdc.gov/health/diseases.htm
Among the above, the National Institute of Allergy and Infectious Diseases (NIAID) is particularly noteworthy. The mission of the NIAID is to provide support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunologic and allergic diseases that afflict people worldwide.6 The NIAID is composed of four extramural divisions: the Division of AIDS; the Division of Allergy, Immunology and Transplantation; the Division of Microbiology and Infectious Diseases; and the Division of Extramural Activities. In addition, NIAID scientists conduct intramural research in laboratories located in Bethesda, Rockville and Frederick, Maryland, and in Hamilton, Montana. The following patient guideline was recently published by the NIAID on tuberculosis.
What Is Tuberculosis?7 Tuberculosis (TB) is a disease that is spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. TB germs are put into the 6 This paragraph has been adapted from the NIAID: http://www.niaid.nih.gov/facts/overview.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250010.htm.
Guidelines 11
air when a person with TB disease of the lungs or throat coughs or sneezes. When a person inhales air that contains TB germs, he or she may become infected. People with TB infection do not feel sick and do not have any symptoms. However, they may develop TB disease at some time in the future. The general symptoms of TB disease include feeling sick or weak, weight loss, fever, and night sweats. The symptoms of TB of the lungs include coughing, chest pain, and coughing up blood. Other symptoms depend on the part of the body that is affected.
The Difference Between Latent TB Infection and TB Disease People with latent TB infection but not TB disease have the germ that causes TB in their bodies. They are not sick because the germs are inactive in their bodies. They cannot spread the germs to others. However, these people may develop TB disease in the future. They are often prescribed treatment to prevent them from developing the disease. People with TB disease are sick from germs that are active in their body. They usually have symptoms of TB, such as feeling sick, coughing, weight loss, fever, or night sweats. Usually, people with TB disease of the lungs or throat are capable of spreading the disease to others. They are prescribed drugs that can cure TB.
How Is TB Spread? TB is spread from person to person through the air. When people with TB disease of the lungs or throat cough or sneeze, they can put TB germs into the air. Then other people who breathe in the air containing these germs can become infected. People with TB disease are most likely to spread it to people they spend time with every day, such as family members or coworkers. If you think you have been around someone who has TB disease, you should go to your doctor or the local health department for tests. It is important to remember that people who have TB infection but not TB disease cannot spread the germs to others.
12 Tuberculosis
What Is a Tuberculin Skin Test? The tuberculin skin test is used for finding out whether a person is infected with the TB germs. It does not tell whether a person has TB disease. For the skin test, a small amount of fluid called tuberculin is injected under the skin in the lower part of the arm. Two or three days later, a health care worker looks for a reaction on the arm.
What Does a Positive Reaction Mean? A positive reaction to the tuberculin skin test usually means that the person has been infected with the TB germ. It does not necessarily mean that the person has TB disease. Other tests, such as a chest x-ray and a sample of phlegm, are needed to see whether the person has TB disease. People who have a positive reaction to the skin test but who do not have TB disease cannot spread the germs to others. They may be given a drug to treat the infection and prevent them from developing TB disease. People who have TB disease must take several drugs to cure the disease.
Skin Testing for Persons Who Have Been Vaccinated with BCG BCG, or bacille Calmette-Guérin, is a vaccine for TB disease. BCG is used in many countries, but it is not generally recommended in the United States. BCG vaccination does not completely prevent people from getting TB. People who have been vaccinated with BCG can be given a tuberculin skin test.
Treatment of Latent TB Infection If you have latent TB infection but not TB disease, your doctor may want you to take a drug to treat the infection and prevent you from developing the disease. The decision about taking treatment for latent infection will be based on your age and on the chances that you will develop the disease. Some people are more likely than others to develop TB disease once they have TB infection; this includes: people with HIV infection, people who were recently exposed to someone with TB disease, and people with certain medical conditions.
Guidelines 13
Treatment for TB Disease TB disease can be cured by taking several drugs for 6 to 12 months. It is very important that people who have TB disease take the drugs exactly as prescribed. If they stop taking the drugs too soon or if they do not take the drugs correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder to treat. In some situations, staff of the local health department meet regularly with patients who have TB to help them remember to take their medications. This is called directly observed therapy (DOT).
For More Information To find out more about TB, you may call CDC’s Voice and Fax Information System at 1-888-CDC-FACT (232-3228) or you may visit the Division of TB Elimination’s Web site at http://www.cdc.gov/nchstp/tb.
More Guideline Sources The guideline above on tuberculosis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to tuberculosis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with tuberculosis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you
14 Tuberculosis
can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on tuberculosis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Your Tuberculosis Test and Adjustment Status: What You Should Know Contact: Massachusetts Department of Public Health/Division of Tuberculosis Prevention and Control, Massachusetts Department of Public Health, Bureau of Communicable Disease Control, Division of Tuberculosis Prevention and Control, State Laboratory Institute, 305 South St, Jamaica Plain, MA, 02130, (617) 983-6970, http://www.state.ma.us/dph/cdc/tb/INDEX.HTM. Summary: This pamphlet discusses latent tuberculosis (TB) infection LTBI and the need for follow-up TB examinations. It discusses the effectiveness of the BCG vaccination and its effects the TB skin test results. It provides contact information for TB clinics in Massachusetts.
Guidelines 15
·
Treatment of Latent Tuberculosis Infection (LTBI) in Children and Adolescents Contact: Charles P Felton National Tuberculosis Center, Harlem Hospital Center, 2238 5th Ave, New York, NY, 10037, (212) 939-8254, http://www.harlemtbcenter.org. Summary: This brochure provides health professionals with information on the treatment of latent tuberculosis (TB) infection in children and adolescents. Tables provide information on the recommended drug regimens for the treatment of LTBI in children and adolescents and candidates for treatment of LTBI based on the category of child/adolescent tested and their tuberculin skin test results. The brochure also provides information on the monitoring of children and adolescents on treatment for LTBI. Drug regimen information includes the interval and duration, pediatric dosages, and criteria for completion for for isoniazid, rifampin, and rifampin with pyrazinamide.
·
Treatment of Tuberculosis (TB) in Adult and Adolescent Patients CoInfected With the Human Immunodeficiency Virus (HIV) Contact: New Jersey Medical School National Tuberculosis Center, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, National Tuberculosis Center, 65 Bergen St Ste GB-1, Newark, NJ, 07107-3001, (973) 972-3270, http://www.umdnj.edu/ntbc. Summary: This brochure provides health professionals with information on the treatment of drug-susceptible tuberculosis (TB) in children and adolescents who have the human immunodeficiency virus (HIV). Specifically it discusses three types of antiretroviral therapy (ART) regimens: (1) Rifabutin-based regimen, high dose; (2) Rifabutin-based regimen, low dose; and (3) Streptomycin-based regimen. It also provides general TB treatment information.
·
Directly Observed Therapy : It Can Help You to Cure Tuberculosis Contact: New York City Department of Health, Bureau of Tuberculosis Control, 125 Worth St Rm 216 Box 74, New York, NY, 10013, (212) 7884155, http://www.ci.nyc.ny.us/nyclink/html/doh/html/tb/tb.html. Summary: This brochure for persons with tuberculosis (TB) discusses the advantages of directly observed therapy (DOT). DOT is a treatment program during which a healthcare worker meets with persons who have TB to observe them taking their medications. New York City (NYC) residents with TB can go to any of the chest clinics in NYC for DOT, or a healthcare worker can make arrangements to meet them at home or in the workplace for DOT. Treatment adherence is difficult for persons with
16 Tuberculosis
TB because treatment requires taking at least two medicines for a minimum of six months. Also, the drugs usually make persons with TB feel better before the regimen is completed, and patients assume they are cured. By failing to complete their treatment regimen, persons with TB can relapse and develop a resistance to TB medications. DOT assures patient adherence because the doctor, patient, and DOT-trained healthcare worker become a team that makes arrangements for the patient to take medications and to address other problems that may interfere with their treatment. DOT has benefits such as free TB medication, incentive programs, free social services, frequent medical checkups, and help with transportation to and from clinic visits. Anyone who lives in New York City and has TB is eligible for DOT. To sign up, the readers can contact a DOT worker. The brochure provides contact information for chest clinics, which provide free TB-related services, in the five boroughs of New York City, NY. ·
Treatment of Latent Tuberculosis Infection (LTBI) in Pregnancy/Postpartum Contact: Charles P Felton National Tuberculosis Center, Harlem Hospital Center, 2238 5th Ave, New York, NY, 10037, (212) 939-8254, http://www.harlemtbcenter.org. Summary: This brochure provides health professionals with information on the treatment of latent tuberculosis infection (LTBI) in pregnant and postpartum women. Tables provide information on the recommended drug regimens for the treatment of LTBI in pregnancy/postpartum and candidates for treatment of LTBI in pregnancy/postpartum based on the category of women tested and their tuberculin skin test results. The brochure also provides information on the monitoring of patients on treatment for LTBI in pregnancy/postpartum. Drug regimen information includes the interval and duration, adult dosage, and criteria for completion for isoniazid, rifampin, and rifampin with pyrazinamide.
·
Short Course Therapy for Tuberculosis Infection Contact: Florida Department of Health Bureau of TB and Refugee Health, 4052 Bald Cypress Way Bin A10, Tallahassee, FL, 32399-1718, (850) 2454350, http://www.doh.state.fl.us/disease_ctrl/refugee/. Summary: This brochure, for individuals with tuberculosis (TB), discusses TB infection, active TB, and the use of directly observed therapy, short-course (DOTS) to prevent the development of active TB. It identifies the drugs used in DOTS including rifampin (RIF)/rifabutin (RBT), pyrazinamide (PZA), isoniazid (INH), and their side effects. It
Guidelines 17
makes suggestions for persons with the human immunodeficiency virus (HIV) and TB. ·
INH: Standing Between You and Tuberculosis Contact: Florida Department of Health Bureau of TB and Refugee Health, 4052 Bald Cypress Way Bin A10, Tallahassee, FL, 32399-1718, (850) 2454350, http://www.doh.state.fl.us/disease_ctrl/refugee/. Summary: This brochure, for persons with tuberculosis (TB), discusses the use of the drug isoniazid (INH) to treat TB. It provides details and tips on taking INH including the length of treatment and INH side effects.
·
Pediatric Tuberculosis: A Video Guide to Diagnosis and Treatment Contact: Francis J Curry National Tuberculosis Center, 3180 18th St Ste 101, San Francisco, CA, 94110-2042, (415) 502-4600, http://www.nationaltbcenter.edu. Summary: This instructional package, for health professionals, provides information about the testing and treatment of tuberculosis (TB) in children. It explains how to conduct the tuberculin skin test and what demographic groups of children should be targeted for this diagnostic test. It defines the results of a TB skin test and includes additional information about diagnostic tests for TB including the chest radiograph and gastric aspirates. The instructional package discusses aspects of treating pediatric TB: drug dosing, drug regimen development, patient adherence, dosing instructions for family, monitoring of patients with active TB, and possible treatments for children with multidrug-resistant TB.
·
Tuberculosis: New Strategies for the Healthcare Worker Contact: Health Edco, Division of WRS Group, Inc., PO Box 21207, Waco, TX, 76702-1207, (254) 776-6461. Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 541-0253. Summary: This continuing education instructional package for healthcare workers provides information on tuberculosis (TB) and the recommendations made by the Centers for Disease Control and Prevention that are designed to prevent TB transmission among healthcare workers and patients. After completing the course, the learner should be able to explain what causes TB, describe the Mantoux skin test, explain the difference between TB infection and TB disease, describe multi-drug resistant TB and list ways a person can acquire it, list CDC-
18 Tuberculosis
recommended ways to prevent transmission, and describe usage of masks and respirators. ·
Self-Study Modules on Tuberculosis 6-9 Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Public Health Practice Program Office, Division of Media and Training Services, 1600 Clifton Rd M/S G21, Atlanta, GA, 30333, (404) 639-3707, http://www.cdc.gov/phtn. Summary: This instructional package provides self study guides with detailed information about tuberculosis (TB) for health care workers and includes modules on contact investigations for TB; confidentiality in TB control; TB surveillance and case management in hospitals and institutions; and patient adherence to TB treatment. The instructional package also comes with a glossary.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “tuberculosis” or synonyms. The following was recently posted: ·
(1) Prevention and treatment of tuberculosis among patients with infected human immunodeficiency virus: Principles of therapy and revised recommendations.(2) Notice to readers: updated guidelines for the use of rifabutin or rifampin for the treatmen Source: Centers for Disease Control and Prevention.; 1998 October 30 (updated 2000 Mar); 59 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1383&sSearch_string=tuberculosis
Guidelines 19
·
(1) Targeted tuberculin testing and treatment of latent tuberculosis infection.(2) Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations United States, 2001. Source: Centers for Disease Control and Prevention.; 2000 June 9; 54 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1528&sSearch_string=tuberculosis
·
Practice guidelines for the treatment of tuberculosis. Source: Infectious Diseases Society of America.; 2000 September; 7 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1889&sSearch_string=tuberculosis
·
Recommendations for prevention and control of tuberculosis among foreign-born persons. Report of the Working Group on Tuberculosis Among Foreign-Born Persons. Source: Centers for Disease Control and Prevention.; 1998 September 18; 35 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1381&sSearch_string=tuberculosis
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Common Antibiotics Summary: A listing of common antibiotics, including penicillins, sulfonamides, urinary antibacterial agents, and anti-tuberculosis agent, by generic name, trade name and type. Source: Alliance for the Prudent Use of Antibiotics http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2848
20 Tuberculosis
·
Division of Tuberculosis Elimination (DTBE) Summary: The mission of the DTBE is to provide leadership in preventing, controlling, and eventually eliminating tuberculosis (TB) from the United States, in collaboration with partners at the community, Source: National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=710
·
FAQ - About Tuberculosis (TB) Summary: Answers to your most commonly asked questions about this bacterial disease. The bacteria that causes TB--Mycobacterium tuberculosis--can attack any part of your body, usually attack the lungs. Source: National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=617
·
Prevention News Update -- HIV/AIDS, STD & TB Summary: Synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases, and tuberculosis. Source: CDC National Prevention Information Network http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4609
·
Test Your Tuberculosis I.Q. Summary: Test your knowledge of tuberculosis. Answer true or false to the statements online and find out what you know about this respiratory disease. Source: American Association for Respiratory Care http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6174
Guidelines 21
·
Tuberculosis Summary: Tuberculosis (TB), a chronic bacterial infection, causes more deaths worldwide than any other infectious disease. With appropriate antibiotic therapy, TB usually can be cured. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=222
·
Tuberculosis Control Program Website Summary: This web site has been created at the University of Pennsylvania Health System as part of a project entitled Tuberculosis Education in an Academic Health System, funded through the National Heart, Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3703
·
Tuberculosis Facts: Exposure to TB Summary: A brief overview of TB (tuberculosis) exposure and TB testing. This fact sheet tells how TB germs can get into a persons body. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6144
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to tuberculosis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We
22 Tuberculosis
can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on tuberculosis, simply go to the following hyperlink: http://www.rarediseases.org/cgibin/nord/alphalist. A complete guide on tuberculosis can be purchased from NORD for a nominal fee.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Guidelines 23
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mycobacterium: An organism of the genus Mycobacterium. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Pyrazinamide: A pyrazine that is used therapeutically as an antitubercular agent. [NIH] Rifabutin: A broad-spectrum antibiotic that is being used as prophylaxis against disseminated Mycobacterium avium complex infection in HIVpositive patients. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Thoracic: Pertaining to or affecting the chest. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria,
24 Tuberculosis
viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU]
Seeking Guidance 25
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with tuberculosis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with tuberculosis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Tuberculosis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
26 Tuberculosis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American College of Chest Physicians Address: American College of Chest Physicians 3300 Dundee Road, Northbrook, IL 60062-2348 Telephone: (847) 498-1400 Toll-free: 1800 654 301 Fax: (847) 498-5460 Email:
[email protected] Web Site: http://www.chestnet.or Background: The American College of Chest Physicians (ACCP) is a medical professional association dedicated to the improvement of cardiopulmonary health and critical care worldwide. The ACCP was founded in 1933 and currently has approximately 16,000 members. The College's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. The ACCP achieves its mission through continuing medical education programs, government relations activities, development of clinical practice guidelines and consensus statements, membership services, professional publications, and philanthropic activities through the ACCP's 'Chest Foundation.' The College's public affairs and government relations activities include initiating, developing, organizing, and implementing policies intended to educate the various branches of the government about the College and its positions on issues including health care reform, antismoking measures, other issues dealing with the prevention of lung and heart disease, and government-sponsored biomedical research. In addition, through its Health and Science Policy Committee, the ACCP is committed to monitoring scientific and clinical developments in the field of cardiopulmonary health and critical care; conducting scientific conferences to discuss the current status of research in the field and make recommendations for future research in the scientific community and appropriate research agencies; and transferring research findings into clinical practice recommendations and identifying
Seeking Guidance 27
gaps in current clinical knowledge by the development, dissemination, and assessment of clinical practice guidelines and consensus statements. In 1996, the Chest Foundation was established as the philanthropic arm of and adjunct to the ACCP. The Foundation is dedicated to providing resources to advance the prevention and treatment of diseases of the chest. The Chest Foundation's current priorities include smoking prevention and cessation; end-of-life issues; diseases including chronic obstructive pulmonary disease (COPD), tuberculosis, and asthma; research initiatives; and ongoing activities including grants, awards, and honor lectureships. The ACCP's professional publications include 'CHEST-The Cardiopulmonary and Critical Care Journal,' the 'ACCP's Educational Coding Manual,' a quarterly scientific publication entitled 'Pulmonary Perspectives,' a quarterly newsletter entitled 'ChestSoundings,' and the annual 'Membership Directory and Referral Guide.'. ·
American Lung Association Address: American Lung Association 1740 Broadway, New York, NY 10019 Telephone: (212) 315-8700 Toll-free: 1800 654 301 Fax: (212) 265-5642 TollEmail:
[email protected] Web Site: http://www.lungusa.or Background: The American Lung Association (ALA) is a national not-forprofit voluntary health organization dedicated to the prevention, cure, and control of all types of lung disease such as asthma, emphysema, tuberculosis, and lung cancer. This is accomplished through programs of community service, public health education, advocacy, and research. The ALA was established in 1904 as the National Association for the Study and Prevention of Tuberculosis. As the number of tuberculosis cases declined over the years, the association widened its focus to include other forms of lung disease and, in 1973, changed its name to the American Lung Association. The Association offers assistance through support groups, genetic counseling, patient networking, referrals, and the development and dissemination of educational materials. Such materials include reports, brochures, audiovisual aids, and Spanish language materials. Relevant area(s) of interest: Tuberculosis
28 Tuberculosis
·
Australian Lung Foundation Address: Australian Lung Foundation PO Box 119, Samford, Queensland, 4520, Australia Telephone: 07 3832 2245 Toll-free: 1800 654 301 Fax: 07 3832 1451 Email:
[email protected] Web Site: http://www.lungnet.org.a Background: The Australian Lung Foundation (ALF) is a not-for-profit organization that is committed to improving the quality of life of individuals affected by lung disease and promoting lung health in Australia. Established in 1990, the Foundation works to fulfill its mission by raising funds in support of lung disease research, distributing research findings, educating patients and the broader public on the treatment and prevention of lung disease, fostering patient support activities, and influencing public and corporate policy to ensure safe living and working environments. The ALF's activities include providing annual research grants and awards; working with industries to enhance employee safety and corporate productivity; and conducting conferences that are open to all members of the respiratory and wider medical community, government and corporate bodies, special interest groups, and patient support organizations. The Foundation's objectives include establishing the ALF Collaborative Research Institute to facilitate cooperative research and interaction both nationally and internationally and provide a centralized data collection site for respiratory disease; creating multidisciplinary consultative groups to enhance collaboration, generate educational material, and provide a source of expert opinion and comment on lung disease issues; and establishing a national network of patient support groups. The Foundation also provides educational materials including patient information leaflets and maintains a web site on the Internet. Relevant area(s) of interest: Tuberculosis
·
British Lung Foundation Address: British Lung Foundation 78 Hatton Garden, London, EC1N 8JR, United Kingdom Telephone: 0171 831 5831 Toll-free: 1800 654 301 Fax: 0171 831 5832 Email:
[email protected] Web Site: http://www.lunguk.org/index.ht
Seeking Guidance 29
Background: The British Lung Foundation is a voluntary, not-for-profit organization in the United Kingdom dedicated to funding medical research into the prevention, treatment, and cure of all forms of lung disease. Since the Foundation was founded in 1985, it has funded over 220 clinical, non-clinical, and epidemiological research grants. The British Lung Foundation is also committed to providing information, support, and resources to individuals affected by lung disease and their family members. The Foundation, which has a head office in London and six branch offices throughout the UK, offers free membership in its 'Breathe Easy Club' to affected individuals, family members, and other caregivers. The club serves as a support and information network throughout the UK for individuals with any form of lung disease and those who care for them. Members of the Breathe Easy Club receive support and information through the 'Keep in Touch' contact service, local support groups, and a quarterly magazine entitled 'Breathe Easy.' The British Lung Foundation also provides information about all aspects of good lung health and the prevention, diagnosis, and treatment of respiratory disease through its leaflet series and 'The Lung Report.' The Foundation also has a web site on the Internet. Relevant area(s) of interest: Tuberculosis ·
Canadian Lung Association Address: Canadian Lung Association 1900 City Park Drive, Suite 508, Blair Business Park, Gloucester, Ontario, K1J 1A3, Canada Telephone: (613) 747-6776 Toll-free: 1800 654 301 Fax: (613) 747-7430 Email:
[email protected] Web Site: http://www.lung.ca Background: The Canadian Lung Association is a national nonprofit organization that is dedicated to improving respiratory health and combating disease of and environmental threats to the lungs. The Association works to fulfill its mission by promoting research, increasing public awareness, and providing patient support programs. Established in 1900, the Association is an umbrella organization that currently consists of 10 provincial and one territorial association. Each provincial association maintains a professional staff including health educators who work with volunteers to develop and conduct community program services. One of the Association's primary objectives is to reduce tobacco use by influencing people to quit or not to start smoking, promoting smoke-free workplaces, and supporting legislation to regulate or prohibit smoking in public enclosed areas. In addition, the Canadian Lung
30 Tuberculosis
Association is committed to supporting respiratory health and respiratory disease research at several levels. Nationally, the Association provides research funding that is administered by the Canadian Thoracic Society, the Canadian Nurses Respiratory Society, and the Physiotherapy Cardio-Respiratory Society. Each member association also supports research at the provincial level. The Canadian Lung Association also provides a variety of educational materials and has a web site on the Internet. Relevant area(s) of interest: Tuberculosis
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about tuberculosis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “tuberculosis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
Seeking Guidance 31
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “tuberculosis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “tuberculosis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with tuberculosis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “tuberculosis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with tuberculosis
32 Tuberculosis
must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 10 11
Seeking Guidance 33
expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about tuberculosis?
·
Really listen to my questions?
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Answer in terms I understood?
·
Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for tuberculosis?
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Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
34 Tuberculosis
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
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It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
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Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
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Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
Seeking Guidance 35
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
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Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
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Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Apnea: A transient absence of spontaneous respiration. [NIH] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
36 Tuberculosis
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU]
Clinical Trials 37
CHAPTER 3. CLINICAL TRIALS AND TUBERCULOSIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning tuberculosis.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for tuberculosis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
38 Tuberculosis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on tuberculosis.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for tuberculosis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment.
How Is a Clinical Trial Conducted? Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on tuberculosis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on tuberculosis. In other clinical trials, where a new surgery or device (not a medicine) is being
Clinical Trials 39
tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on tuberculosis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how tuberculosis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for tuberculosis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history.
40 Tuberculosis
If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Tuberculosis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to tuberculosis.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
A Study of the Effectiveness and Tolerability of Weekly Rifapentine/Isoniazid for Three Months Versus Daily Isoniazid for Nine Months for the Treatment of Latent Tuberculosis Infection Condition(s): Latent TB infection Study Status: This study is currently recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: The primary objective of this open-label Phase III clinical trial is to compare the effectiveness of a three-month (12-dose) regimen of weekly rifapentine and isoniazid (3RPT/INH) to the effectiveness of a nine-month (270-dose) regimen of daily isoniazid (9INH). This trial will be conducted among high-risk tuberculin skin-test reactors, including children and HIV-infected persons, who require treatment of latent infection (TLI) to prevent tuberculosis (TB). The
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 41
3RPT/INH regimen will be given under direct observation and the 9INH regimen will be self-administered. Secondary Objective: Compare the rates of drug discontinuation due to adverse drug reactions associated with 3RPT/INH and 9INH. Compare the rates of drug discontinuation for any reason associated with 3RPT/INH and 9INH. Compare the rates of any grade 3, 4, or 5 drug toxicity associated with 3RPT/INH and 9INH. Compare treatment completion rates of 3RPT/INH and 9INH. Compare the efficacy (i.e., among persons who complete study-phase therapy) of 3RPT/INH and 9INH. Compare the effectiveness and tolerability of 3RPT/INH and 9INH in HIV-infected persons. Compare the effectiveness and tolerability of 3RPT/INH and 9INH in children < 18 years old. Compare the rates of methadone withdrawal associated with 3RPT/INH and 9INH among persons concomitantly receiving methadone. Describe patterns of antibiotic resistance among M. tuberculosis isolates in patients who develop TB despite treatment of latent infection. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023452;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Effectiveness of Anti-HIV Therapy (HAART) in HIV-Infected Patients with Tuberculosis Condition(s): HIV Infections; Tuberculosis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to see if a type of anti-HIV therapy called HAART is effective in lowering levels of HIV and boosting the immune system in HIV-infected patients with tuberculosis (TB). HIVinfected patients with TB have higher levels of HIV and lower CD4 cell counts (cells in the body that fight infection) than HIV-infected patients without TB. HAART has been effective in reducing HIV levels and increasing CD4 cells in patients without TB. However, its effects in HIVinfected patients with TB are unknown. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below
42 Tuberculosis
Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004736;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Intensive Pharmacokinetics of the Nelfinavir-Rifabutin Interaction in Patients with HIV-Related Tuberculosis Treated with a RifabutinBased Regimen Condition(s): Tuberculosis; HIV Infections Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Centers for Disease Control and Prevention Purpose - Excerpt: The primary objective of this multi-center sub-study of USPHS Study 23: "Intensive Pharmacokinetic Study of Intermittent Rifabutin and Isoniazid with Daily Efavirenz in Combination with Two Nucleoside Analogs for Treatment of HIV and Tuberculosis Coinfections," is to compare the pharmacokinetics of rifabutin at 600 mg twice a week in combination with efavirenz 600 mg daily to the pharmacokinetics of rifabutin 300 mg twice a week without efavirenz. Secondary objectives are: (1) To describe pharmacokinetics of both rifabutin and efavirenz in combination regimen, (2) To evaluate the safety of concomitant efavirenz and rifabutin, (3) To assess the effect on absolute neutrophil count by changing rifabutin dose and adding efavirenz to the regimen, (4) To develop models of optimal sampling times for rifabutin dosed twice a week, (5) To describe the pharmacokinetics of isoniazid in combination with efavirenz daily with two NRTIs, (6) To compare the pharmacokinetics of isoniazid with and without efavirenz. Study Type: Interventional Contact(s): North Carolina; Duke University Medical Center, Durham, North Carolina, 27710, United States; Recruiting; Carol D Hamilton, M.D. 919-684-3279 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00018083;jsessionid=4964936 060133250A7A1A5267590D0A3
·
A Non-Comparative Study of the Efficacy of a Largely-Intermittent, Six-Month Tuberculosis Treatment Regimen Among Patients Who Will Not Receive Isoniazid Due to Initial Isoniazid Resistance or Intolerance Condition(s): Tuberculosis
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Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: Primary Objective: To evaluate the efficacy of a directly-observed, largely-intermittent, six-month regimen of rifampin, pyrazinamide, ethambutol among patients with culture confirmed isoniazid-resistant M. tuberculosis. Secondary Objectives: To describe the rate, severity and timing of toxicities and drug intolerances associated with this treatment regimen. To describe the utility of this regimen among patients who are unable to continue the standard 4-drug regimen due to the development of intolerance to isoniazid Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023374;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
A Pilot Study of Methodology to Rapidly Evaluate Drugs for Bactericidal Activity, Tolerance, and Pharmacokinetics in the Treatment of Pulmonary Tuberculosis Using Isoniazid and Levofloxacin Condition(s): HIV Infections; Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To evaluate the methodology for rapidly determining the early bactericidal activity (EBA), tolerance, and pharmacokinetics of isoniazid and levofloxacin in the treatment of pulmonary tuberculosis (TB). Traditionally, in trials for treatment of TB, a new drug is administered in combination with two or more other antituberculous agents of known effectiveness over a long period of time. In this setting, it is difficult to determine the effect of any single drug or dose level. Development of new agents for the treatment of TB may be accelerated by a methodology in which a new agent could be evaluated for activity by administering it as a single agent over a short time period. This study utilizes a method to measure the amount of bacteria present each day in the lungs. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000778;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
A Registry of Tuberculosis Cases in the CPCRA Condition(s): HIV Infections; Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: Primary: To estimate the proportion of tuberculosis patients in the CPCRA who have drug-resistant tuberculosis (TB) and to describe the patterns of drug resistance. SECONDARY: To compare drug resistance data on the Mycobacterium tuberculosis isolates of HIVpositive patients to those of HIV-negative patients who are being followed in the CPCRA. To assess the relationship of resistance data with geographic, demographic, and HIV and TB risk factor information. Geographic areas and demographic subgroups affected by the TB epidemic appear to be congruent and associated with the concurrent HIV epidemic. The total number of CPCRA patients who will develop, or who have experienced, confirmed TB is unknown. It is critical to determine the depth and breadth of the current problem of drug-resistant TB. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000785;jsessionid=4964936 060133250A7A1A5267590D0A3
·
Efficacy of Once-Weekly Rifapentine and Isoniazid in Treatment of Tuberculosis Condition(s): Pulmonary Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: Primary Objective: To compare, at the completion of the follow-up phase, the clinical and bacteriologic relapse rates associated with the two study regimens. Secondary Objectives: To compare the clinical and bacteriologic failure rates of the two study regimens at the completion of the study phase therapy. To compare the clinical and bacteriologic response rates for the two study regimens among patients who began study phase therapy with signs and symptoms of tuberculosis
Clinical Trials 45
or cultures positive for M. tuberculosis. To compare the toxicity associated with the two study regimens by comparing discontinuation rates due to adverse events and occurrence rates of signs and symptoms associated with adverse events during study phase therapy. To compare mortality rates of the two study regimens. To compare the rates of completion of therapy within 22 weeks for the two study regimens. To compare the rate of development of drug-resistant tuberculosis in the two study regimens among study patients classified as treatment failures or relapses. To compare all of the above performance characteristics for the two study regimens in a small subset of HIV seropositive patients. To compare attitudes and beliefs about participation in this study between patients who complete study therapy and those who fail to complete study therapy. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023335;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Intensive Pharmacokinetic Study of Three Doses of Rifapentine and 25-desacetyl Rifapentine Condition(s): Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: Primary objective: To compare the pharmacokinetics of rifapentine and 25-desacetyl rifapentine at three different doses: 600 mg, 900 mg, and 1200 mg. Secondary objective: To describe any correlation between pharmacokinetic parameters of three different doses of rifapentine plus a standard dose of isoniazid and the occurrence of toxicity attributed to anti-tuberculosis treatment. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023387;jsessionid=4964936 060133250A7A1A5267590D0A3
46 Tuberculosis
·
Intensive Pharmacokinetics of the Nelfinavir Rifabutin Interaction in Patients with HIV-Related Tuberculosis Treated with a RifabutinBased Regimen Condition(s): HIV Infections; Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: Primary Objective: To define the impact of nelfinavir (given at 1250mg bid as part of a combination antiretroviral regimen) on peak levels and area under the curve for rifabutin and the rifabutin metabolite, 25-O-desacetyl rifabutin when rifabutin is given at 300 mg biweekly as part of tuberculosis chemotherapy. Secondary Objectives: To compare the pharmacokinetics of nelfinavir given twice daily at 1250 mg bid with twice-weekly isoniazid and rifabutin to the pharmacokinetics of nelfinavir 1250 mg twice-daily in historical HIV-infected patients not receiving isoniazid and rifabutin. To evaluate the correlation between pharmacokinetic parameters of rifabutin and 25-O-desacetyl rifabutin and the occurrence of toxicity attributed to rifabutin in patients with HIVrelated tuberculosis. To define detailed pharmacokinetics of isoniazid given at 15mg/kg or 900 mg in patients with HIV-related tuberculosis. To attempt to derive optimal sampling times for nelfinavir and rifabutin pharmacokinetic studies. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023400;jsessionid=4964936 060133250A7A1A5267590D0A3
·
Interferon Gamma for Drug Resistant Tuberculosis Condition(s): Pneumonia; Pulmonary Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will determine what dose of recombinant interferon-gamma is safe and effective for treating multiple drugresistant tuberculosis. Recombinant interferon-gamma is a genetically engineered form of a substance normally produced by the body and is used to boost immune function. Patients 5 years of age and older with multiply drug-resistant tuberculosis may be eligible for this study. Participants will be admitted to either the NIH Clinical Center in Bethesda, Maryland, the Texas Center for Infectious Diseases in San
Clinical Trials 47
Antonio or the South Texas Hospital or Valley Baptist Hospital, both in Harlingen, Texas. On admission, patients will have a medical history, physical examination, blood and urine tests, sputum culture, X-rays, pulmonary function tests and a computed tomography (CT) scan. CT produces 3-dimensional images of body tissues and organs in small sections. For the procedure, the patient lies still on a table surrounded by the scanner. All patients will continue treatment with anti-tuberculosis antibiotics during and after the study period and may elect whether or not to take gamma interferon in addition to the antibiotic. Five patients will receive only antibiotic treatment, and 5 each will receive one of 3 doses (0.025, 0.05 or 0.1 milligrams per square meter of body surface area) of interferon-gamma injected under the skin 3 times a week. The patient or caregiver will be taught to give the injections, which are similar to insulin injections for diabetes. Patients will be in isolation in the hospital from the start of therapy until sputum samples show no evidence of tuberculosis for 3 consecutive weeks. Following that, they will repeat the tests done on admission (except CT) during follow-up visits (1- to 2-day hospitalizations) at 3, 6, 9, 12, 15, 18 and 24 months after the start of therapy. Patients taking interferon gamma will have blood drawn more frequently (monthly) for the first 6 months, and patients with lung infection will have sputum samples collected more frequently-weekly for the first 3 months or until three consecutive negative samples are obtained and then monthly throughout the course of therapy. Patients with lung infection will also have repeat CT scans at 6 and 12 months while on interferon gamma. In one or two patients on the drug, blood will be drawn frequently following one injection of gamma interferon (just before the injection and again at 0.25, 0.5, 1, 6, 12, 18, 24 and 48 hours after it) to see if a difference in blood levels of the drug can be detected. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001407;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Metabolism of Antituberculosis Drugs in HIV-Infected Persons With Tuberculosis Condition(s): HIV Infections; Tuberculosis
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Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to determine if a relationship exists between the level of antituberculosis drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) in the blood and the outcome of HIV-positive patients with tuberculosis. This study also evaluates how these drugs are absorbed and metabolized in the body. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000950;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Pilot Study to Evaluate Nucleic Acid Amplification Methods in the Diagnosis and Management of Active TB Condition(s): Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: This is a pilot study to evaluate the performance of several nucleic acid amplification methodologies in the diagnosis and management of active tuberculosis Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023439;jsessionid=4964936 060133250A7A1A5267590D0A3
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Prophylaxis Against Tuberculosis (TB) in Patients With Human Immunodeficiency Virus (HIV) Infection and Confirmed Latent Tuberculous Infection Condition(s): HIV Infections; Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To evaluate and compare the effectiveness of a 2month regimen of rifampin and pyrazinamide versus a 1-year course of isoniazid (INH) to prevent the development of tuberculosis in patients who are coinfected with HIV and latent Mycobacterium tuberculosis
Clinical Trials 49
(MTb). Current guidelines recommend 6 to 12 months of treatment with INH for purified protein derivative (PPD)-positive individuals. Problems with this treatment include compliance, adverse reaction, and the possibility of not preventing disease due to INH-resistant organisms. Studies suggest that two or three months of rifampin and pyrazinamide may be more effective than longer courses of INH. A two-month prevention course should help to increase compliance. In addition, the use of two drugs (rifampin and pyrazinamide) may help overcome problems with drug resistance. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000636;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Prophylaxis Against Tuberculosis (TB) in Patients With Human Immunodeficiency Virus (HIV) Infection and Suspected Latent Tuberculous Infection Condition(s): HIV Infections; Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To evaluate the safety and effectiveness of a 6-month course of isoniazid ( INH ) in the prevention of clinical tuberculosis in anergic (having diminished or absent reactions to specific antigens) HIVinfected persons who are at high risk for tuberculous infection. A substantial number of HIV-infected persons are anergic, and thus do not respond to the only currently available diagnostic tool for tuberculosis infection (that is, the PPD (purified protein derivative) skin test). Many of these anergic persons are, however, infected with Mycobacterium tuberculosis and eventually develop reactivation tuberculosis, causing both individual illness and spread of infection to others in the community. This study examines the possibility of using INH prophylaxis (that is, for prevention) in anergic HIV-infected patients at high risk for tuberculosis as a means of decreasing the sharp rise in the incidence of tuberculosis due to HIV infection. INH is inexpensive and relatively safe, and thus may demonstrate an acceptable risk/benefit ratio as a medication that can be given over a limited period of time to a population suspected of having, but not proved to have, M. tuberculosis infection. If this study shows INH to be safe and effective in this setting, it could have a major effect on public health in this country.
50 Tuberculosis
Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000959;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Randomized Study of Interventions to Enhance Adherence to Isoniazid Prevention Therapy for Tuberculosis in Injection Drug Users Condition(s): Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute on Drug Abuse (NIDA); Johns Hopkins University Purpose - Excerpt: Objectives: I. Recruit 300 injection drug users with positive tuberculin skin tests who are candidates for isoniazid chemoprophylaxis into a trial of several interventions to enhance adherence to preventive therapy. II. Compare the effectiveness of selfadministered isoniazid chemoprophylaxis supplemented with peer education and support groups versus directly observed preventive therapy delivered by a licensed nurse versus self-administered therapy with standard clinic follow-up and education. Outcome measures are adherence to prescribed doses of medication and the proportion of patients who complete therapy. III. Compare the impact of monetary incentives on therapy adherence by random assignment to immediate vs. deferred financial incentive. IV. Assess attitudes, knowledge, and beliefs about tuberculosis and preventive therapy in these patients and determine the association of these factors with demographic, social, and clinical characteristics. V. Assess attitudes and beliefs about tuberculosis susceptibility, seriousness, benefits of preventive therapy, barriers to therapy, and self-efficacy as predictors of health-related behaviors as measured by adherence with therapy, and determine the impact of the assigned interventions on these attitudes and beliefs. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004740;jsessionid=4964936 060133250A7A1A5267590D0A3
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·
Study of the Tolerability of Higher Doses of Rifapentine in the Treatment of Tuberculosis Condition(s): Tuberculosis Study Status: This study is no longer recruiting patients. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: This is a randomized, double-blind study of the tolerability of three different doses of rifapanetine Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023426;jsessionid=4964936 060133250A7A1A5267590D0A3
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Behavioral Interventions for Control of TB Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To compare alternative methods to ensure completion of treatment and preventive therapy for TB in inner cities, and to identify the most cost-effective methods to accomplish that. The basis for comparison included adherence rates and cost savings as primary outcomes, and other parameters such as patient satisfaction, development of social networks, and participation in support programs as secondary outcomes. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005739;jsessionid=4964936 060133250A7A1A5267590D0A3
·
Behavioral Interventions for Control of Tuberculosis Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To develop and test various educational strategies targeting primarily minority TB-infected adolescents at two health
52 Tuberculosis
centers in Los Angeles in an experimental design to assess the relative effectiveness on medication adherence, appointment keeping, and completion of therapy. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005742;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Indigenous Outreach Among Injection Drug Users to Treat and Control TB Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The Community Outreach Intervention Project (COIP) implemented and evaluated a TB intervention with injection drug users (IDUs) in two Chicago Neighborhoods, guided by the indigenous outreach leadership model that had been used for AIDS prevention among drug users. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005741;jsessionid=4964936 060133250A7A1A5267590D0A3
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Pilot Randomized Study of Paromomycin (Aminosidine) Streptomycin for Uncomplicated Pulmonary Tuberculosis
vs
Condition(s): Tuberculosis, Pulmonary Study Status: This study is completed. Sponsor(s): FDA Office of Orphan Products Development; University of Illinois Purpose - Excerpt: Objectives: I. Compare the pharmacokinetics and early bactericidal activity of paromomycin (aminosidine) vs streptomycin for the treatment of uncomplicated pulmonary tuberculosis. II. Compare the tolerability of these two drugs in these patients. III. Establish the relationships between achieved serum concentration, minimal inhibitory concentration, and early bactericidal activity of paromomycin and streptomycin.
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Study Type: Interventional Contact(s): Thomas Paul Kanyok 312-996-8639. Study chairs or principal investigators: Thomas Paul Kanyok, Study Chair; University of Illinois Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004444;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Promoting Adherence to TB Regimens in Latino Adolescents Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To test a public health model of screening, preventive isoniazid treatment, and adherence counseling plus medical education of primary care clinicians to enhance their skills and attention to TB control. Also, to test a behavioral adherence intervention for Latino adolescents with latent disease and a medical education program designed to enhance primary care (community clinic) practitioners' treatment of active and latent TB infection. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005738;jsessionid=4964936 060133250A7A1A5267590D0A3
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TB Contact Investigation: Behavioral Intervention Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To develop a behavioral intervention aimed at public health workers who perform tuberculosis contact investigation and designed to enhance the contact investigation process. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005740;jsessionid=4964936 060133250A7A1A5267590D0A3
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·
The Treatment of Tuberculosis in HIV-Infected Patients Condition(s): HIV Infections; Tuberculosis Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: PER 5/30/95 AMENDMENT: To compare the combined rate of failure during therapy and relapse after therapy between two durations of intermittent therapy (6 versus 9 months) for the treatment of pulmonary tuberculosis (TB) in HIV-infected patients. To compare toxicity, survival, and development of resistance in these two regimens. ORIGINAL: To compare the efficacy and safety of induction and continuation therapies for the treatment of pulmonary TB in HIVinfected patients who are either from areas with known high rates of resistance to one or more anti-TB drugs or from areas where TB is expected to be susceptible to commonly used anti-TB drugs. PER 5/30/95 AMENDMENT: In HIV-negative patients, intermittent anti-TB therapy has been shown to be as effective as daily therapy, but the optimal duration of therapy in HIV-infected patients has not been established. ORIGINAL: In some areas of the country, resistance to one or more of the drugs commonly used to treat TB has emerged. Thus, the need to test regimens containing a new drug exists. Furthermore, the optimal duration of anti-TB therapy for HIV-infected patients with TB needs to be determined. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001033;jsessionid=4964936 060133250A7A1A5267590D0A3
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Treatment of HIV-Related Tuberculosis Using a Rifabutin-Based Regimen Condition(s): HIV Infections; Tuberculosis Study Status: This study is suspended. Sponsor(s): Centers for Disease Control and Prevention; Department of Veterans Affairs Purpose - Excerpt: Primary objective: To determine the rate of confirmed treatment failure and relapse with an intermittent rifabutin-based regimen for the treatment of isoniazid and rifamycin-susceptible HIVrelated tuberculosis.
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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023361;jsessionid=4964936 060133250A7A1A5267590D0A3 ·
Tuberculosis in a Multiethnic Inner City Population Condition(s): Acquired Immunodeficiency Syndrome; HIV Infections; Lung Diseases; Tuberculosis; Mycobacterium tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the incidence of tuberculosis in an inner city population, identify risk factors for TB, describe the natural history in adults and children, evaluate the effect of Mycobacterium tuberculosis (Mtb) co-infection on the progression of human immunodeficiency virus disease, and determine factors that contribute to compliance and noncompliance with prophylaxis and treatment. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005379;jsessionid=4964936 060133250A7A1A5267590D0A3
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Tuberculosis Prophylaxis in the Homeless--A Controlled Trial Condition(s): Lung Diseases; Tuberculosis Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To conduct a three-arm, randomized controlled trial of methods to improve adherence to biweekly directly observed prophylaxis (DOPT) for tuberculosis in homeless adults in San Francisco. Study Type: Behavioral Medicine, Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005737;jsessionid=4964936 060133250A7A1A5267590D0A3
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Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for tuberculosis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with tuberculosis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17
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How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for tuberculosis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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·
Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “tuberculosis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Amenorrhea: amenia. [EU]
Absence or abnormal stoppage of the menses; called also
Anergic: 1. characterized by abnormal inactivity; inactive. 2. marked by asthenia or lack of energy. 3. pertaining to anergy. [EU] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH]
Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy:
A general diagnostic term designating primary
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myocardial disease, often of obscure or unknown etiology. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with
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an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Mediator: An object or substance by which something is mediated, such as
64 Tuberculosis
(1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nelfinavir: A potent HIV protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. [NIH]
Neutrophil: Having an affinity for neutral dyes. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paromomycin: An oligosaccharide antibiotic produced by various Streptomyces. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues,
Clinical Trials 65
biotransformation, and excretion. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Tachyarrhythmia: Tachycardia associated with an irregularity in the normal heart rhythm. [EU] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence
66 Tuberculosis
of a toxic microbe or of a poison. [EU] Tubercular: Of, pertaining to, or resembling tubercles or nodules. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on tuberculosis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on tuberculosis. In Part II, as in Part I, our objective is not to interpret the latest advances on tuberculosis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with tuberculosis is suggested.
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CHAPTER 4. STUDIES ON TUBERCULOSIS Overview Every year, academic studies are published on tuberculosis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on tuberculosis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on tuberculosis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and tuberculosis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “tuberculosis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Tuberculosis Treatment Source: City Health Information June 1999;18 (2):1-8. Contact: New York City Department of Health, Bureau of Tuberculosis Control, 125 Worth St Rm 216 Box 74, New York, NY, 10013, (212) 7884155, http://www.ci.nyc.ny.us/nyclink/html/doh/html/tb/tb.html. Summary: This newsletter provides healthcare professionals information on tuberculosis (TB) treatment. It presents ten basics on the diagnosis, treatment, and prevention of TB and information on countries and areas with an estimated or reported high incidence of TB, a therapy timeline for previously untreated TB patients with drug-susceptible active disease, medications used in the treatment of TB, recommended antituberculosis treatment regimens for HIV-infected persons with drug-susceptible TB disease, and the use of antituberculosis medications in special situations, such as pregnancy, TB meningitis, and renal failure. The newsletter lists contact information for resources in New York City providing TB-related services.
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Tuberculosis Commentary : Tuberculosis Control in a Changing Health Care System : Model Contract Specifications for Managed Care Organizations Source: Clinical Infectious Diseases: Volume 27, p. 677-686: 1998. Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for HIV STD and TB Prevention, Division of Tuberculosis Elimination, 1600 Clifton Rd NE MS E10, Atlanta, GA, 30333, (404) 639-8135, http://www.cdc.gov/nchstp/tb/. Summary: This reprint discusses the recent changes in health care from individual to managed care for persons with tuberculosis (TB), the challenges facing this new method of health services delivery, and it provides a model contract for patients with TB and managed care organizations. It explains the purpose of the model contract between TB
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patients and the managed care organizations, and how these contracts can help to overcome the aforementioned challenges. The reprint discusses the ten sections of the model managed care contracts and summarizes the guiding principles for the management of persons with TB or TB infections. The reprint defines a number of terms related to managed care for TB patients. The reprint makes recommendations about how to design each section of the model contract to meet the needs of the provider and the TB patient. ·
Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children Source: American Journal of Respiratory and Critical Care Medicine 1994 (May);149(5):1359-1374. Contact: American Lung Association of Maryland, 11720 Beltsville Drive 3rd FL, Beltsville, MD, 20705, (301) 572-3205. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 4585231, http://cdcnpin.org. Summary: This is an official statement of the American Thoracic Society on the treatment of tuberculosis (TB) and TB infection in adults and children. This paper discusses the following topics: treatment of TB, drugs in current use, potentially effective drugs, initial treatment regimens, monitoring adverse reactions, evaluation of response to treatment, management of patients whose treatment has failed or who have relapsed, management of patients who have drug-resistant disease, TB in children and adolescents, special considerations in treatment, treatment of TB infection, persons for whom preventive therapy is recommended, screening procedures, administration of isoniazid preventive therapy, monitoring preventive therapy, and alternative forms of TB prevention.
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Controlling the Resurgent Tuberculosis Epidemic: A 50 - State Survey of TB Statutes and Proposals for Reform Source: Journal of the American Medical Association; Vol. 269, No. 2. Contact: American Society of Law Medicine and Ethics, 765 Commonwealth Ave Ste 1634, Boston, MA, 02215, (617) 262-4990, http://www.aslme.org. Summary: This article reports on a 50-state survey of tuberculosis (TB) laws, based on an examination of both TB-specific statutes and more general communicable disease statutes. The survey found that many statutes still in force were enacted at the turn of the century or in the early to mid-1900s, before the development of modern concepts of
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constitutional law and the concept of the need to protect public health. The article also recommends the development of an individualized treatment plan for all persons diagnosed with the disease, the balancing of constitutional rights against public health risk, the maintainence of confidentiality and antidiscrimination, and the bringing of communicable disease statutes into conformity with the American With Disabilities Act (ADA). ·
Return of a Plague: The Perils of Tuberculosis in the 90's Source: The Exchange; Issue 21, July 1993. Contact: National Lawyers Guild AIDS Network, 558 Capp St, San Francisco, CA, 94110, (415) 824-8884. Summary: The re-emergence of the tuberculosis (TB) epidemic with its associated medical and legal problems, especially in relation to AIDS, is examined in this journal article. TB, its treatment, and the problem of incomplete treatment are described. The definition of AIDS has been expanded to include pulmonary TB. The article suggests that social reform is required to control TB, including the restructuring of the public health and social service systems. The interdependent reforms include public funding for TB education, emphasizing Directly Observed Therapy (DOT) to use in fighting incomplete treatment, funding research in diagnostics and treatments of TB, and developing guidelines for the legal issues involved. These legal concerns include civil rights with respect to state-mandated quarantine, confidentiality, and employment practices where infection control, not discrimination, prevents disease.
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Tuberculose et Infection par le VIH.. [Tuberculosis and HIV Infection.] Contact: Agence Nationale de Recherches Sur le SIDA, 101 rue de Tolbiac, Paris. Summary: This factsheet explains epidemiology and treatment of tuberculosis (TB) in Persons with AIDS (PWA's). Since 1988, the number of French TB cases has risen, especially among PWA's. Active tuberculosis makes its appearance in one of two ways: a previous infection resurfaces, or a fresh infection is transmitted by another infected individual. Although PWA's experience more serious side effects, drugs are very effective against the tuberculosis bacterium. The drug-resistant strain of TB which has been observed in the United States is very rare in France. The factsheet also outlines the stages of TB and suggests medications for each stage. A short bibliography is appended.
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Tuberculosis Source: Vancouver PWA Newsletter; Issue 73, Nov. 1993. Contact: Vancouver Persons with AIDS Society, 1107 Seymour St, Vancouver, (604) 893-2210. Summary: This newsletter article alerts readers to the potential dangers a tuberculosis (TB) epidemic might pose to people living with HIV/AIDS. It uses a question-and-answer format to address what TB is, how many people are infected worldwide, the symptoms of TB, its treatments, incubation period, and what can be done by community organizations.
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An Outbreak of Tuberculosis With Accelerated Progression Among Persons Infected With the Human Immunodeficiency Virus: An Analysis Using Restriction - Fragment - Length Polymorphisms Source: New England Journal of Medicine; Vol. 326, no. 4. Contact: San Francisco General Hospital, Department of Medicine, Chest Service, Pulmonary Complications of AIDS Study, SFGH-5K1, 1001 Potrero Ave, San Francisco, CA, 94110, (415) 821-8313. Louisiana State University Medical Center, Delta Region AIDS Education and Training Center, 136 S Roman St 3rd Fl, New Orleans, LA, 70112, (504) 568-3855, http://www.lsumc.edu. Summary: This reprint of a journal article analyzes an outbreak of tuberculosis (TB) that took place among residents of a housing facility for persons with HIV infection. As background information, the article points out that TB can develop from either a reactivation of a latent infection or from a primary infection. It then reviews the outbreak, which took place between December 1990 and April 1991, during which time 12 cases of TB were diagnosed. Two patients under treatment for TB had been admitted in the previous six months. Organisms isolated from 11 culture-positive residents had similar patterns, but isolates from the two patients treated prior to the outbreak showed different strains. The article says that this implicates the first of the 12 patients to come down with TB as the source of the outbreak. It concludes that newly acquired TB infection in HIV-positive patients can spread readily and progress rapidly to active disease. There should be heightened TB surveillance in facilities where HIV-positive persons live.
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Prevention and Control of Tuberculosis in Facilities Providing LongTerm Care to the Elderly : Recommendations of the Advisory Committee for Elimination of Tuberculosis Source: Morbidity and Mortality Weekly Report (MMWR). 39 (RR-10): 720; July 13, 1990.
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Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Morbidity and Mortality Weekly Report Series, 1600 Clifton Rd NE M/S C-08, Atlanta, GA, 30333, (404) 332-4555, http://www.cdc.gov. US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: This report discusses managing and preventing tuberculosis (TB) in facilities that provide long-term care for the elderly. It provides a brief epidemiological history of TB among elderly people in the United States, including those in nursing homes. General guidelines for prevention and control of TB in the areas of surveillance, containment, assessment, and education are provided. Recommendations for surveillance include a tuberculin skin testing program for all new residents and employees to detect TB infection and active TB, case reporting, and encouraging HIV counseling and testing. Containment recommendations include information about appropriate isolation and treatment of the elderly resident, and an overview of contact investigations for residents and staff and appropriate preventive therapy. A record-keeping system that includes specific data for annual review and assessment is recommended. The report concludes with the role of the local health department in the management and prevention of TB in long-term care facilities for the elderly. ·
Spinal Tuberculosis Source: Current Opinion in Orthopedics. 11(3): 196-201. June 2000. Summary: This journal article provides health professionals with information on the diagnosis and management of spinal tuberculosis. Tuberculosis of the spine is still a common disease in some endemic regions and is returning to developed countries. The diagnosis is usually made with a high index of suspicion in endemic areas in the presence of pain and appropriate clinical symptoms and signs of a systemic infection. Typical plain radiographic changes include destruction of two adjacent vertebral bodies, narrowing of the intervening disk, scalloping of the anterior vertebrae, and a fusiform paravertebral abscess shadow. The development of the polymerase chain reaction technique and magnetic resonance imaging (MRI) in the past decade has greatly improved diagnostic accuracy. MRI is useful in diagnosing early or multicentric lesions before plain radiographic changes become obvious. The aims of treatment in spinal tuberculosis are eradication of the infection, preservation or restoration of neurologic integrity, and prevention or correction of spinal deformity. Combination chemotherapy remains the most important and effective treatment, whereas surgical intervention
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can help in achieving earlier fusion and less late deformity. Early results of spinal instrumentation with or without fusion appear to be promising in further enhancing good outcome. 1 figure, 2 tables, and 54 references. (AA-M). ·
Primary Pancreatic Tuberculosis Source: Missouri Medicine. 88(11): 766-768. November 1991. Summary: This article describes the first reported case that fulfills the diagnostic criteria for primary pancreatic tuberculosis. After a detailed case presentation, the authors discuss extrapulmonary tuberculosis in general, the clinical presentation, and the diagnostic testing required to determine pancreatic tuberculosis. They also briefly review the literature covering this condition. Diagnostic tests considered include radiographic studies, ultrasound, CT guided needle aspiration of pancreatic masses, and exploratory laparotomy. 1 figure. 14 references.
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Tuberculosis and the Kidney Source: JASN. Journal of the American Society of Nephrology. 12(6): 1307-1314. June 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Website: www.jasn.org. Summary: Tuberculosis of the kidney and urinary tract is, like other forms of the disease, caused by members of the Mycobacterium tuberculosis complex. This article reviews the clinical features of classical renal (kidney) tuberculosis, tuberculous interstitial nephritis, tuberculosis and glomerular disease, end stage renal disease (ESRD) caused by tuberculosis, tuberculosis developing in patients on hemodialysis and peritoneal dialysis, tuberculosis in transplant patients, genital tuberculosis, and hypercalcemia in dialysis patients. The authors also discuss laboratory diagnosis, pathology, the role of immunodeficiency in genitourinary tuberculosis, and treatment options. In developed nations, tuberculosis is relatively uncommon, but the risk of acquiring the disease is increased in immunosuppressed individuals, including patients on dialysis and recipients of kidney transplants. The signs and symptoms of renal tuberculosis mimic those of other infections of the kidney, so diagnostic awareness may prevent unnecessary morbidity (illness or complications). Tuberculosis may involve the kidney as part of generalized infection throughout the body or as localized genitourinary disease. The morphology (shape and appearance) of the lesions depends on the site of infection, the virulence of the organism, and the immune
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status of the patient. Modern short course antituberculosis drug regimens are effective in all forms of tuberculosis. However, special considerations apply to the treatment of tuberculosis in patients with impaired renal (kidney) function, as some drugs may not be metabolized properly. Surgical intervention is indicated in cases of advanced unilateral (involving one kidney) disease complicated by pain or hemorrhage and for bladder augmentation. 5 figures. 49 references. ·
When to Consider Tuberculosis in Evaluating Hematuria Source: Consultant. 39(12): 3225. December 1999. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Tuberculosis of the urinary tract is rare enough to justify the selective use of tuberculosis cultures when evaluating hematuria. Nonpulmonary (not in the lungs) tuberculosis accounts for only about 2 percent of diagnosed cases of tuberculosis. This brief article, one from a regular column that answers clinical questions, addresses the need to consider tuberculosis when evaluating a patient with hematuria (blood in the urine). The author recommends that physicians consider obtaining tuberculosis urine cultures for patients who are at increased risk for genitourinary tuberculosis. Such patients include immunocompromised persons and those with active pulmonary tuberculosis or a history of tuberculosis. A history of travel in or immigration from an area of high tuberculosis activity should also raise the index of suspicion. Readers are also encouraged to seek the advice of an infectious diseases consultant.
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Tuberculosis Remains an Important Factor in the Morbidity and Mortality of Hemodialysis Patients Source: Transplantation Proceedings. 30(3): 846-847. May 1998. Contact: Available from Appleton and Lange. P.O. Box 86, Congers, NY 10920-0086. (203) 406-4623. Summary: Patients with end-stage renal disease (ESRD) are considered moderately immunocompromised and are susceptible to mycobacterial infection, including tuberculosis. This article explores the incidence of tuberculosis, organ involvement, diagnostic parameters, and response to tuberculosis treatment in the hemodialysis population. Based on data from 3 years, the incidence of tuberculosis at the authors hemodialysis unit is 2 percent (23 of 1140 patients). Diagnosis of tuberculosis in these patients is difficult, and biopsy, an invasive procedure, was required for diagnosis in 14 cases in this study. Extrapulmonary involvement (in organs other than the lungs) was a frequent finding in this population.
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The authors stress that, in spite of treatment, the high mortality rate due to this disease underlines tuberculosis as a persistent and significant problem that cannot be underestimated for hemodialysis patients. Because of this, all possible diagnostic methods need to be used in this group, including RT-PCR studies and tissue biopsy. 1 figure. 1 table. 5 references.
Federally-Funded Research on Tuberculosis The U.S. Government supports a variety of research studies relating to tuberculosis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to tuberculosis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore tuberculosis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for tuberculosis: ·
Project Title: A New Tuberculin for the Diagnosis of Tuberculosis Principal Investigator & Institution: Einck, Leo; Sequella, Inc. 9610 Medical Center Dr, Ste 200 Rockville, Md 20850 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 9-SEP-2002 Summary: (provided by applicant):Accurate diagnosis of tuberculosis (TB) infection is one of the pillars of effective TB control programs. The current tool to diagnose infection with Mycobacterium tuberculosis is the tuberculin skin test (TST). Because of the cross-reactive nature of purified
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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protein derivative (PPD) of tuberculin, TST currently does not discriminate between infection with M. tuberculosis, vaccination with M. bovis BCG and sensitization with non-tuberculous mycobacteria found in the environment. The recent achievements in the field of bacterial genomics enable us to undertake a new approach to formulate a M. tuberculosis-specific tuberculin and to overcome poor TST specificity. Comparative genomic analyses show that the M. tuberculosis genome includes regions that do not exist in M. bovis BCG (RD regions). Thus, we can tailor a new, M. tuberculosis-specific tuberculin by selecting from the pool encoded by the RD regions those antigens that elicit TB-specific, cellmediated immune responses. Our specific aims are 1) Identification of candidate antigens. Gene selection will be based on published results of comparative genomic analyses, BLAST protein homology searches, and Southern blot analyses. 2) Antigen screening in guinea pigs. Antigens will be selected that induce skin test reactions in tuberculous guinea pigs but not in control animals sensitized with M. bovis BCG and with nontuberculous mycobacteria. 3) Antigen evaluation in human TB. Antigens selected in guinea pig studies will be evaluated for the ability to induce in vitro lymphoproliferation and cytokine secretion by peripheral blood mononuclear cells (PBMC) of M. tuberculosis-infected persons but not by PBMC of negative control individuals (BCG vaccinees, patients having non-tuberculous mycobacterioses, and healthy, PPD-negative individuals). Antigens selected in the proposed Phase I studies will be used to formulate a multi-antigen tuberculin to be taken to human clinical trials during Phase II work. Proposed Commercial Application: 2.1 Billion people harbor a TB infection. UNICEF reports that tuberculosis poses a serious risk to Asia's sustained socioeconomic development. In a recent National Intelligence Estimate, the Central Intelligence Agency singled out drug-resistant TB-and especially its incidence among immigrants-as a potential threat to national security. Salomon and Murray report that world expenditure on TB therapy and diagnosis was $4.1 Billion (USD) in 1998. Diagnosis of TB worldwide is by sputum smear, with 50% accuracy. This new diagnostic is desperately needed. Short term markets will be in developing countries where the test will replace the current skin test as an adjunct diagnostic. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: CD8+ T Cells and Mycoplasma Tuberculosis Principal Investigator & Institution: Canaday, David H.; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000; Project Start 1-JUL-1999; Project End 0-JUN2004
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Summary: This application for a mentored scientist award (KO-8) seeks 5 years of funding for research training in the cellular immunology and cell biology of M. tuberculosis infection for David H. Canaday, M.D. Research training will be provided by W. Henry Boom, M.D. and Clifford V. Harding, M.D.-Ph.D. in the Division of Infectious Diseases and the Department of Medicine at Case Western Reserve University. The research proposal which will provide the focus for Dr. Canaday's training is outlined below. M. tuberculosis is spread from person to person by inhalation of aerosolized mycobacteria. Most healthy people do not develop clinical tuberculosis. Instead, cellular immune responses become activated and are able to successfully control the active infection. T cells play a crucial role in regulating the cellular immune response. T cell subsets(CD4+, CD8+, gammadelta+), are activated by mycobacterial antigens, yet little is known about the roles and function of the different T cell subsets in the protective immune response to M. tuberculosis. While CD4+ T cells have been the focus of many studies, CD8+ T cells are an important accessory T cell subset in the protective immune response to M. tuberculosis. Recent studies by us and others have demonstrated that human CD8+ T cells serve as CTL for M. tuberculosis infected macrophages, produce IFN-gamma and are activated by mycobacterial antigens. The broad goal of the current studies is to determine the repertoire of mycobacterial proteins which stimulate human CD8+ T cells, to examine the antigen processing mechanism the macrophages use to present M. tuberculosis antigens on MHC class I molecules, and to determine the function of CD8+ T cells in patients with active tuberculosis. The Aims are: Aim 1. To determine the mycobacterial proteins and peptides recognized by human alphabeta TCR+ CD8+ T cells. Aim 2. To determine the mechanism(s) used by M. tuberculosis infected macrophages to process and present mycobacterial proteins by MHC class I molecules. Aim 3. To characterize the functional CD8+ T cell responses to specific proteins and peptides from in patients with active M. tuberculosis infection. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Clinical Research in Tuberculosis Principal Investigator & Institution: Chaisson, Richard E.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 1-SEP-1999; Project End 1-AUG2004 Summary: This application for a Midcareer Investigator Award in Patient-Oriented Research is submitted by Richard E. Chaisson, M.D,
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Professor of Medicine, Epidemiology and International Health at the Johns Hopkins University. The applicant completed subspecialty training in infectious diseases and clinical epidemiology in 1987. Since that time, he has built a successful and productive research program within the Johns Hopkins AIDS Service, a multidisciplinary clinical care enterprise for adults with HIV infection. In addition, he has organized and led the clinical and research efforts of the Baltimore City Health Department Tuberculosis Clinic, and has undertaken field trials in HIV-related tuberculosis in Haiti and South Africa. In 1998 Dr. Chaisson was promoted to Professor and began a refocusing of his academic activities and commitments. This application is intended to support this effort. Dr. Chaisson has relinquished the directorship of the AIDS Service and has appointed a replacement director of the Tuberculosis Clinic in order to devote his full attention to clinical research in tuberculosis and HIV infection. Dr. Chaisson has founded the Johns Hopkins University Center for Tuberculosis Research, an interdivisional, multidisciplinary program dedicated to improving global tuberculosis control through innovations in diagnosis, treatment and prevention. The centerpiece of this initiative is field trial comparing alternative tuberculosis control strategies in communities within high-incidence countries, funded under the US Agency for International Development's Infectious Disease Initiative. This trial will be conducted in several countries and will randomly assign communities to one of three tuberculosis control strategies: i) directly observed therapy (DOT) for active cases; ii) DOT plus screening of household contacts for active disease; and iii) DOT plus screening and preventive therapy for household contacts. This trial will provide important insight into effective strategies for global tuberculosis control. The applicant is also Principal Investigator of the Baltimore Tuberculosis Trials Consortium site, and a funded investigator in other studies of tuberculosis epidemiology and control. With support under this award, he will develop an integrate program in tuberculosis research utilizing the clinical and laboratory resources of the Baltimore Tuberculosis Clinic, the Johns Hopkins University and sites in developing countries with high tuberculosis incidence. Moreover, he will serve as mentor to junior faculty in infectious diseases and related fields who are beginning academic careers in patient-oriented research. A mentoring program organized to enhance professional development and independent scholarly activity will be undertaken with two recent faculty recruits. An award under this program will substantially enhance the research and mentoring capabilities of the applicant, and will contribute to the generation of new knowledge essential for the control of tuberculosis worldwide. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Cost Effective Control of Tuberculosis in the US Principal Investigator & Institution: Brewer, Timothy F.; Assistant Professor of Medicine; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 1-JUL-1997; Project End 0-JUN2002 Summary: In the mid-1980's, the long-standing historical decline in tuberculosis cases in the United States reversed itself and case rates began to rise. With the tuberculosis epidemic came the recognition that this disease was becoming increasingly concentrated in defined segments of the overall population. Though total case rates are falling again, groups in the US at significantly higher risk for tuberculosis than the general population exist. It is unknown whether the current recommendations for the control of tuberculosis in the US general population are as effective for these groups. To address this issue, a desktop Computer based mathematical model has been developed to simultaneously project tuberculosis cases and deaths over a l 0 year period using the best available epidemiological data. By adapting this model for US groups at increased risk for tuberculosis, this project will evaluate tuberculosis control strategies for four high risk groups. The groups are persons infected with human immunodeficiency virus, health care workers, immigrants, and the homeless. For each group, a database of inputs based on the epidemiology of tuberculosis within that group will be created. These databases will draw on the published literature and available government information such as that provided by the Centers for Disease Control and Prevention revised report of verified case of tuberculosis. The following tuberculosis control strategies will be evaluated singly and in combinations: increased coverage and improved efficacy of preventive therapy, increased coverage and improved efficacy of treatment, increased effectiveness of contact tracing, and the introduction of bacille Calmette-Guerin vaccination. The robustness of the model results will be assessed in sensitivity analyses by simultaneously varying all inputs using Latin hypercube sampling. The combination of mathematical modeling and epidemiology provides the most complete evaluation of TB control measures among these high risk groups to date, and forms a basis for improving approaches to control this epidemic among these populations. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Development of Immune Evasion in Tuberculosis Principal Investigator & Institution: Ernst, Joel D.; Professor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122
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Timing: Fiscal Year 2000 Summary: Acquired immunity to intracellular pathogens depends on T cell recognition of HLA-bound microbial peptides. Pathogens that occupy phagosomes are controlled by CD4+ cells that recognized microbial peptides bound to HLA class II. While these interactions occur in response to Mycobacterium tuberculosis, they are only partially efficacious: the human immune system is unable to completely resolve infection with M. tuberculosis. M. tuberculosis has been found to inhibit class II antigen presentation, but the mechanisms has not been determined. The goal of this project is to define the mechanism of inhibition of class II antigen present in human macrophages infected with M. tuberculosis. We have found that M. tuberculosis causes a decrease of cell surface class II (HLA-DR) in macrophages, without a decreased in the total cellular HLA-DR pool. This suggests that M. tuberculosis alters trafficking of class II. We will further characterize the decreased surface expression of class II by determining whether it is directly related to the number of intracellular M. tuberculosis and by comparing expression of HLA-DR on infected macrophages and dendritic cells. We will test the hypothesis that HLA-DR is sequestered in M. tuberculosis phagosomes, and will determine whether HLA-DR is sequestered due to failure of exchange of exogenous peptides for CLIP. We will also further characterize the functional effects of M. tuberculosis down-regulation of HLA-DR. We will determine whether down-regulation of class II inhibits CD4+ cell recognition of extracellularly loaded M. tuberculosis antigens and whether M. tuberculosis antigens and whether M. tuberculosis inhibits allogeneic responses. Finally, we will test the hypothesis that inhibition of class II antigen presentation is an inherent property of mycobacteria by comparing the response of CD4+ T cell lines that recognize a DR3-restricted epitope of M. tuberculosis hsp65 when it is expressed by mycobacteria or by an alternative vehicle. We anticipate that our results will provide new information on the pathogenesis of tuberculosis, and may identify alternative means of delivering M. tuberculosis antigens for vaccination. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Genetic/Immunological Basis of Tuberculosis and Anergy Principal Investigator & Institution: Delgado, Julio C.; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-JUL-2006 Summary: (provided by applicant): The purpose of this Clinical Investigator Development Award is to prepare the candidate, Dr. Julio C. Delgado, MD, for a career as an independent investigator in infectious
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diseases with a special emphasis on the genetic and immunological mechanisms associated with susceptibility to tuberculosis infection. The applicant proposes a 5-year training and research program that will prospectively identify novel host factors that predispose individuals to develop pulmonary tuberculosis in a population from Cambodia and characterize the events associated with the anergic state induced by tuberculosis infection in the intact human host. In Specific Aim 1, he will test the hypothesis that HLA molecules are functionally associated with tuberculosis progression and differential immune response to PPD and whether polymorphisms of the promoter region of certain cytokines are associated with impaired immune response against tuberculosis infection. In Specific Aim 2 and 3, he will characterize immunological and chromatin structural mechanisms associated with anergy to PPD in a cohort of tuberculosis patients from Cambodia with persistent and specific lack of response to PPD. Tuberculosis infection and pathogenesis are the result of a balance between the virulence of a particular invading organism and the host immune response. Susceptibility to tuberculosis in human populations is likely to be due to a complex interaction between several genetic, immunological and environmental factors. The experiments proposed in this application would attempt to identify host genetic factors and unveil abnormal immunological mechanisms leading to increase risk of clinical tuberculosis disease. It is anticipated that these results will be useful in the development of genetic and immune therapeutic strategies to combat tuberculosis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Heterogeneity of T Cells in M Tuberculosis Infection Principal Investigator & Institution: Boom, W H.; Assistant Professor; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000; Project Start 1-FEB-1989; Project End 1-JAN2002 Summary: (Adapted from the applicant's abstract): T cells have a critical role in regulating the protective immune response to Mycobacterium tuberculosis. As a result of studies supported by AI-27243, our understanding of the interaction between human T cells and macrophages in response to M. Tuberculosis has increased substantially during the last five years. First, M. Tuberculosis antigens activate three major T cell subsets from healthy tuberculin positive donors: V delta2 + gamma delta TCR bearing T cells (gamma delta T cells and CD8+ alpha beta (ab) TCR+ T cells (CD 8 T cells) in addition to CD4+ ab T cell receptor (TCR) bearing T cells (CD 4 T cells. Second, all three T cell
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subsets produce IFN-gamma and can serve as cytotoxic effector cells (CTL) against M. Tuberculosis infected macrophages, fitting into a Th-1 like pattern. These findings allow refinement of the model in which control of mycobacterial growth and maintenance of immunity requires the activation not only of CD4+ T cells and gamma delta T cells, but also of CD8+ T cells. This model postulates that there is a defined sequence of T cell subset recruitment and that the antigen processing mechanisms used by M. Tuberculosis infected mononuclear phagocytes are critical in the recruitment of T cell subsets and in determining the antigen repertoire recognized by CD4+, CD8+ and gamma delta T cells. In addition, the model postulates that both secretion of macrophage activating cytokines and CTL effector function are necessary for protective immune responses to M. Tuberculosis. There are three specific aims to test the postulates of this model: 1. To further characterize a 1014KD M. tuberculosis antigen for V delta2+ gamma delta T cells, to determine if the antigen can be detected on the surface of mononuclear phagocytes for presentation to V delta2+ gamma delta T cells and to determine if gamma delta T cells activated by this antigen enhance the production by mononuclear phagocytes of chemokines (MIP1alpha/beta, RANTES) and cytokines (IL-12, IL-15) that promote T cell recruitment and differentiation into CTL. 2. To characterize the antigen processing pathways of M. tuberculosis antigens for class II MHC presentation to CD4+ T cells, using the 30kD 85B antigen as model antigen. 3. To characterize the repertoire of antigens, the antigenprocessing pathway and CTL function of CD8+ T cells reactive to M. tuberculosis in comparison to CD4+ and gamma delta T cells. These studies will provide insight into the regulation of human T cell subsets involved in protective immunity to M. tuberculosis, which is necessary for the design of improved vaccines, and immunotherapies for tuberculosis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Immunological Basis of Susceptibility to Tuberculosis Principal Investigator & Institution: Behar, Samuel M.; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 1-AUG2004 Summary: The long term objectives of this project are to understand the immunological and genetic basis for susceptibility to tuberculosis. As the effectiveness of cellular immunity to Mycobacterium tuberculosis determines whether infection evolves into clinical disease, a better understanding of the immune response and the genes that govern it will
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facilitate a more rational approach to development and use of vaccines, drugs, and biological therapy. An aerosol route of inoculation will be used to infect intact mice that are either inherently resistant or susceptible to tuberculosis. The local immune response in the lung will be compared to the systemic response in the spleen using a variety of techniques including the quantitation of T cell subsets, intracellular cytokines staining, and RNAse protection assays in order to define immunological parameters that indicate a protective immune response. Other investigations will ascertain which genetic loci are critical for disease resistance. With this insight, these techniques will be applied to interventional models to determine how different treatment strategies modify the immune response during primary infection (in the case of vaccines and biological treatments) or after subsequent rechallenge (in the case of chemotherapy). Finally, two different models that approximate the cell mediated defects observed in HIV/AIDS will be examined to determine how the immune response is altered to M. tuberculosis infection in the absence of CD4 plus T cells, and whether therapeutic interventions can beneficially augment the innate and adaptive immune responses under these conditions. The specific aims are as follows: Aim 1. Characterize the immunological differences between mouse strains that are either resistant or susceptible to infection with Mycobacterium tuberculosis after aerosol inoculation. Aim 2. Determine the genetic derangements that correlate with susceptibility and resistance. Aim 3. Identify how the immune response to tuberculosis changes as a consequence of therapeutic interventions in an animal model. Aim 4. Characterize the immune response to tuberculosis in mouse models that simulate the abnormalities of cell mediated immunity typical of HIV/AIDS patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Loss of Oxyr in M Tuberculosis Principal Investigator & Institution: Deretic, Vojo Peter.; Professor; Microbiology and Immunology; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2000; Project Start 1-APR-1998; Project End 1-MAR2003 Summary: (Adapted from the applicant's abstract): M. tuberculosis is a natural mutant in the putative central regulator of oxidative stress response, oxyR. All M. tuberculosis strains investigated to date have nearly identical lesions in oxyR, and the elimination of oxyR function may have coincided with or directly participated in the evolution of M. tuberculosis into the potent contemporary human pathogen. The loss of
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oxyR has a dual significance for M. tuberculosis pathogenesis and treatment of tuberculosis. First, this surprising phenomenon reflects the complexity of host-parasite interactions and its continuing analyses are expected to reveal strategies used by M. tuberculosis for survival in the host. Second, the loss of oxyR and the associated dysfunction of oxidative stress responses most likely contribute to the exceptional sensitivity of M. tuberculosis to isonicotinic acid hydrazide (INH). The goals of this proposal are: (i) to delineate the effects of the loss of oxyR on M. tuberculosis response to reactive oxygen and nitrogen intermediates. This will be accomplished by identifying genes and functions affected by the loss of oxyR, analyzing alternative modes of their regulation, and characterizing M. tuberculosis response to reactive oxygen and nitrogen; (ii) to determine whether and how oxyR inactivation and the resulting dysfunction of oxidative stress responses contribute to the exceptional sensitivity of M. tuberculosis to INH. This will be examined by complementation of the defect in M. tuberculosis using a functional mycobacterial oxyR, by inactivation of oxyR in model mycobacteria, and by determination of the effects that such modifications have on INH sensitivity in vitro and in vivo; (iii) to investigate the role of the loss of oxyR in M. tuberculosis virulence and pathogenesis using mouse bone marrow derived macrophages and human monocytes, and models of tuberculosis in mice and guinea pigs. In addition to conventional analyses of M. tuberculosis survival and histopathology, GFP-based technologies developed in the PI's laboratory will be employed to monitor mycobacterial localization, and potential tissue- and infection stage-specific expression of oxidative stress response genes (e.g. ahpC). These experiments will delineate the effects that the loss of oxyR has on host-pathogen interactions in tuberculosis. The proposed studies are expected to improve understanding of the elusive virulence attributes of M. tuberculosis, and may help explain, at least in part, its high sensitivity to the front-line antituberculosis agent INH. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Lung Cytokine Levels in Tuberculosis Infection Principal Investigator & Institution: Condos, Rany; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2000 Summary: The resurgent tuberculosis epidemic has arisen because of the HIV-1 epidemic. CD4+ T cells appear to play a major role in the defense against tuberculosis. A better understanding of the immune response to tuberculosis may lead to the development of adjunctive therapy to modulate host defenses and improve outcome. In animal models of
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tuberculosis, a T helper 1 (Th1) response characterized by IFN-g and IL-2 release, but no IL-4 or IL-5 release, correlates with an auspicious outcome. We hypothesize that an imbalance of the Th1/Th2 response is important in the pathogenesis of tuberculosis. To test this hypothesis, we will use the powerful research tool of bronchoalveolar lavage (BAL) to obtain cells from tuberculosis-involved and -uninvolved lung segments for cytokine assessment. We will evaluate IL-2, IFN-g, IL-4 and IL-5 using ELISA kits for BAL cell supernatants and BAL fluid. We will assess individual cells and cell types by in situ hybridization, immunohistochemistry and three-color flow cytometry for intracellular cytokines. We will determine the optimum method for characterizing the Th1 response in the lung. Both spontaneous release and gene expression for the Th1/Th2 cytokines will be assessed. We will thus be able to determine if the Th1 response truly controls the host response to M. tuberculosis and whether an altered or lack of Th1 response correlates with disease. The lab wasused for oligonucleotide synthesis, BAL processing, blood separation, RNA isolation, ELISA, PCR analysis, recombinant DNA techniques, laminar flow hoods, ultracentrifugation, DNA isolation, DNA sequencing (manual), Northern analysis, and Western analysis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Mycobactocid, a Novel Antituberculosis Drug Principal Investigator & Institution: Cynamon, Michael H.; Professor; Natural Drug Science, Llc 48 S Franklin Turnpike Ramsey, Nj 07446 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 0-JUN2002 Summary: (provided by applicant):Tuberculosis (TB) poses significant risk to mankind with nearly 8 million people contracting TB and 3 million people dying from it each year. A TB epidemic is becoming more dangerous because of the emergence of multi-drug resistant tuberculosis and the lack of effective new drugs. The main goal of Natural Drug Services is to develop and commercialize a new anti-tuberculosis compound, Mycobactocid (MCB). MCB belongs to a new class of chemical compounds, has low toxicity in mice and is effective against strains of tuberculosis resistant to the known anti-tuberculosis agents. The specific aims of this project include:1) evaluation of the antituberculosis activity of MCB in standard, well-characterized in vitro and in vivo models and, 2) compare it to other regimens of treatment. Previous studies indicate that MCB has potent specific activity against M. tuberculosis, low toxicity, and is effective against multi-drug resistant strains. Further study of MCB will facilitate commercialization of this
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novel class of compounds for treatment of tuberculosis. Proposed Commercial Application: Tuberculosis claims three million lives a year world-wide and reached epidemic proportions in the US, with outbreaks of drug-resistent strains in several cities. The compound under investigation. Mycobactocid, has high specific activity against M. tuberculosis, low toxicity and is active against the resistant strains of M. tuberculosis. The specific goal of this project is to develop preclinical data to facilitate evaluation in human clinical trials and ultimately lead to a commercial product. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Tuberculosis and AIDS Principal Investigator & Institution: Conte, John E.; Clinical Professor; Epidemiology and Biostatistics; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 1999; Project Start 1-DEC-1996; Project End 0-NOV2002 Summary: The long-term objective of this project is to improve the treatment of tuberculosis in HIV-infected and HIV-uninfected patients and to develop pharmacologic data that will facilitate further tuberculosis research. There is one specific aim - to determine and compare the intrapulmonary pharmacokinetics of INH, RlF, and PZA in TB-infected patients with and without AIDS by quantitating drug concentrations in bronchoalveolar lavage (BAL) fluid, alveolar cells (AC) and epithelial lining fluid (ELF). The re-emergence of tuberculosis has become one of our most important public health problems. In the US, co-infection with M. tuberculosis and HIV is estimated to occur in 100,000 individuals and the annual risk for the development of tuberculosis in coinfected individuals is 8%. The pathogenicity of M. tuberculosis is dependent upon its ability to survive within macrophages. However, despite the obligate intracellular location of M. tuberculosis, and the propensity of the organism to cause pulmonary infection, the in vivo intracellular and intrapulmonary pharmacokinetics of antituberculous agents have not been studied in patients with tuberculosis. Significant abnormalities in the gastrointestinal tract of AIDS patients have been demonstrated and have been shown to interfere with drug absorption. By performing bronchoscopy and bronchoalveolar lavage (BAL) in patients with pulmonary tuberculosis and measuring drug levels using highly specific and sensitive chromatographic techniques (HPLC), the intrapulmonary pharmacokinetics of these drugs will be defined and compared in HIVinfected and HIV-uninfected men and women. Alveolar cell separation using the FACSTAR cell sorter, determination of drug concentrations in
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peripheral blood mononuclear cells after Ficoll-Hypaque separation, trilobar lavage and the determination of concentrations of albumin in ELF have been added to the original proposal. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: M TB Survival Regulatory Genes Principal Investigator & Institution: Bishai, William R.; Associate Professor; Molecular Microbiol and Immun; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 1-APR-1997; Project End 1-MAR2002 Summary: (Adapted from the applicant's abstract): This is a revised application in which the PI proposes to analyze an alternate sigma factor of Mycobacterium tuberculosis which may be involved in the intracellular survival of the tubercle bacilli. The PI points out that the ability of M. tuberculosis to adapt to a variety of environmental conditions is an important feature of its pathogenicity. Many bacteria use alternate sigma factors for RNA polymerase to upregulate response genes specific for a needed adaptation. Using degenerate PCR, the PI has identified an alternate sigma factor from M. tuberculosis which he has called SigF. M. tuberculosis SigF is homologous to the SigF and SigB proteins of Bacillus subtilis, which are involved in regulation of sporulation and general stress response gene expression, respectively. Not only does M. tuberculosis SigF have homology with B. subtilis SigF and SigB, but it is preceded by an antisigma and a possible anti-antisigma homologue, just as are the B. subtilis sigma factors. In vitro (i.e., brothgrown cultures), the expression of the M. tuberculosis SigF is upregulated by stress conditions and entry into stationary phase. In vivo, its expression increases 10-fold upon entry into murine macrophages. Hence, the PI hypothesizes that the M. tuberculosis SigF may govern an intracellular survival regulon. In this application, the PI proposes to determine (i) the in vitro and in vivo phenotypes of an M. tuberculosis sigF mutant, (ii) how SigF is regulated (i.e., is an antisigma partner switching mechanism involved?), and (iii) the identities of SigFdependent genes. The PI anticipates that understanding how M. tuberculosis adapts for intracellular survival may lead to novel drug and vaccine targets for tuberculosis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Mycobacterial Genes Antigens and Vaccines Principal Investigator & Institution: Bloom, Barry R.; Dean; Immunology/Infections Diseases; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 1-APR-1986; Project End 1-JUL2001 Summary: (Adapted from applicant's abstract): The basic tenet of this proposal is that vaccines represent the most cost-effective medical intervention to prevent morbidity and mortality from infectious diseases. Worldwide, tuberculosis is the largest cause of death from a single infectious disease and although the PIs have long championed BCG as a vaccine against tuberculosis, in this competitive renewal application, they propose to develop effective and safe live attenuated tuberculosis vaccines by generating defined mutations in the M. tuberculosis genome in addition to generating defined mutations in the BCG genome. The PIs have developed a novel approach for mutagenizing or deleting biosynthetic genes in M. tuberculosis or BCG and for replacing the wild type gene by allelic exchange. Although BCG is the most widely used vaccine in the world, the ability to generate defined mutations will now allow the PIs to develop auxotrophic vaccines that are unable to cause disease, even in immunodeficient hosts. Secondly, the PIs propose to gain understanding of fundamental immunological mechanisms of protection against M. tuberculosis infection and for inducing pathogenicity and tissue damage by using selected gene-disrupted strains of mice and cellular approaches. Thirdly, the PIs propose a novel approach to identify protective antigens and open reading frames of any pathogen, which will facilitate development of recombinant BCG or attenuated M. tuberculosis vaccines able to protect against a variety of viral, bacterial and parasitic infections. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Sterol/Hopanoid Biosynthesis: An Anti-Tb Drug Target Principal Investigator & Institution: Crick, Dean C.; Microbiology; Colorado State University Fort Collins, Co 80523 Timing: Fiscal Year 2001; Project Start 5-JUN-2001; Project End 1-MAY2005 Summary: (provided by applicant): Multi-drug resistant tuberculosis is increasing in prevalence worldwide; therefore, a greater understanding of the basic biochemistry of Mycobacterium tuberculosis is of utmost importance. Analysis of the M. tuberculosis genome suggests that there may be a biosynthetic pathway analogous to eukaryotic sterol synthesis
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in this organism. Preliminary evidence indicates that the M. tuberculosis genome encodes enzymes with structural homology to several eukaryotic sterol synthesis enzymes including farnesyl diphosphate synthase, squalene synthase, squalene epoxidase, oxidosqualene cyclase and lanosterol 14a-demethylase. It has been shown that both the M. tuberculosis farnesyl diphosphate synthase and lanosterol 14ademethylase are functional as well as structural homologs of the eukaryotic enzymes. More importantly, commercial anti-fungal drugs that are known inhibitors of sterol synthesis (specifically oxidosqualene cyclase and lanosterol 14a-demethylase) effectively inhibit the growth of M. tuberculosis in culture. It is hypothesized that M. tuberculosis synthesizes cyclic isoprenoid compounds, perhaps sterols or hopanoids, which are essential to the viability of the organism. Therefore, the specific aims of this proposal are to: 1) identify and characterize cyclic isoprenoid compounds in M. tuberculosis. 2) isolate, enzymatically characterize and determine the essentiality of the sterol synthesis homologs expressed by M. tuberculosis. 3) identify and characterize the active site of the oxidosqualene cyclase homolog. The identification of a sterol/hopanoid biosynthetic pathway in M. tuberculosis and characterization of relevant enzymes represents a novel approach to the identification of previously unsuspected antituberculosis drug targets. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “tuberculosis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for tuberculosis in the PubMed Central database: Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
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In vitro restoration of T cell responses in tuberculosis and augmentation of monocyte effector function against Mycobacterium tuberculosis by natural inhibitors of transforming growth factor [beta] by Christina S. Hirsch, Jerrold J. Ellner, Richard Blinkhorn, and Zahra Toossi; 1997 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20544
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A chemoattractant cytokine associated with granulomas in tuberculosis and silicosis by Gerard J. Nau, Patrick Guilfoile, Geoffrey L. Chupp, Jeffrey S. Berman, Sue J. Kim, Hardy Kornfeld, and Richard A. Young; 1997 June 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21064
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A common mechanism for the biosynthesis of methoxy and cyclopropyl mycolic acids in Mycobacterium tuberculosis by Ying Yuan and Clifton E. Barry, III; 1996 November 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24005
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A Comparison of Seven Tests for Serological Diagnosis of Tuberculosis by Sudha Pottumarthy, Virginia C. Wells, and Arthur J. Morris; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86769&ren dertype=external
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A cooperative oxygen-binding hemoglobin from Mycobacterium tuberculosis by Manon Couture, Syun-Ru Yeh, Beatrice A. Wittenberg, Jonathan B. Wittenberg, Yannick Ouellet, Denis L. Rousseau, and Michel Guertin; 1999 September 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18015
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A mAb recognizing a surface antigen of Mycobacterium tuberculosis enhances host survival by Rachel Teitelbaum, Aharona GlatmanFreedman, Bing Chen, John B. Robbins, Emil Unanue, Arturo Casadevall, and Barry R. Bloom; 1998 December 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28105
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A Multidrug-Resistant Tuberculosis Microepidemic Caused by Genetically Closely Related Mycobacterium tuberculosis Strains by M. Kubin, M. Havelkova, I. Hyncicova, Z. Svecova, J. Kaustova, K. Kremer, and D. van Soolingen; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85324&ren dertype=external
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A PCR-Colorimetric Microwell Plate Hybridization Assay for Detection of Mycobacterium tuberculosis and M. avium from Culture Samples and Ziehl-Neelsen-Positive Smears by Maria Cristina Rossi, Andrea Gori, Gianguglielmo Zehender, Giulia Marchetti, Giulio Ferrario,
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Chiara De Maddalena, Lidia Catozzi, Alessandra Bandera, Anna Degli Esposti, and Fabio Franzetti; 2000 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86584&ren dertype=external ·
A Stationary-Phase Stress-Response Sigma Factor from Mycobacterium tuberculosis by J DeMaio, Y Zhang, C Ko, DB Young, and WR Bishai; 1996 April 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39711
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Activation of the Interleukin 6 Gene by Mycobacterium tuberculosis or Lipopolysaccharide is Mediated by Nuclear Factors NF-IL6 and NF[kappa]B by Y Zhang, M Broser, and WN Rom; 1994 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43343
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An epidemic of tuberculosis with a high rate of tuberculin anergy among a population previously unexposed to tuberculosis, the Yanomami Indians of the Brazilian Amazon by Alexandra O. Sousa, Julia I. Salem, Francis K. Lee, Maria C. Vercosa, Philippe Cruaud, Barry R. Bloom, Philippe H. Lagrange, and Hugo L. David; 1997 November 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24291
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An Integrated Map of the Genome of the Tubercle Bacillus, Mycobacterium tuberculosis H37Rv, and Comparison with Mycobacterium leprae by WJ Philipp, S Poulet, K Eiglmeier, L Pascopella, V Balasubramanian, B Heym, S Bergh, BR Bloom, WR Jacobs, and ST Cole; 1996 April 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39774
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Analysis for a Limited Number of Gene Codons Can Predict Drug Resistance of Mycobacterium tuberculosis in a High-Incidence Community by Annelies Van Rie, Robin Warren, Idris Mshanga, Annemarie M Jordaan, Gian D. van der Spuy, Madalene Richardson, John Simpson, Robert P. Gie, Donald A. Enarson, Nulda Beyers, Paul D. van Helden, and Thomas C. Victor; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87790&ren dertype=external
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Analysis of stress- and host cell-induced expression of the Mycobacterium tuberculosis inorganic pyrophosphatase by James A. Triccas and Brigitte Gicquel; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31412
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Antimicrobial activity of MHC class I-restricted CD8 + T cells in human tuberculosis by Sungae Cho, Vijay Mehra, Sybille Thoma-
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Uszynski, Steffen Stenger, Natalya Serbina, Richard J. Mazzaccaro, JoAnne L. Flynn, Peter F. Barnes, Scott Southwood, Esteban Celis, Barry R. Bloom, Robert L. Modlin, and Alessandro Sette; 2000 October 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17320 ·
Assessment of Morphology for Rapid Presumptive Identification of Mycobacterium tuberculosis and Mycobacterium kansasii by Silvia Attorri, Sherry Dunbar, and Jill E. Clarridge, III; 2000 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86457&ren dertype=external
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Attenuation of virulence in Mycobacterium tuberculosis expressing a constitutively active iron repressor by Yukari C. Manabe, Beatrice J. Saviola, Li Sun, John R. Murphy, and William R. Bishai; 1999 October 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23125
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Automated High-Throughput Genotyping for Study of Global Epidemiology of Mycobacterium tuberculosis Based on Mycobacterial Interspersed Repetitive Units by Philip Supply, Sarah Lesjean, Evgueni Savine, Kristin Kremer, Dick van Soolingen, and Camille Locht; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88389&ren dertype=external
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Bacteriological and Molecular Analysis of Rifampin-Resistant Mycobacterium tuberculosis Strains Isolated in Australia by Lilly K. W. Yuen, David Leslie, and Peter J. Coloe; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85826&ren dertype=external
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Characterization and catalytic properties of the sterol 14[alpha]demethylase from Mycobacterium tuberculosis by Aouatef Bellamine, Anil T. Mangla, W. David Nes, and Michael R. Waterman; 1999 August 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17711
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Characterization of IS6110 Restriction Fragment Length Polymorphism Patterns and Mechanisms of Antimicrobial Resistance for MultidrugResistant Isolates of Mycobacterium tuberculosis from a Major Reference Hospital in Assiut, Egypt by Said Abbadi, Heba G. Rashed, Glenn P. Morlock, Charles L. Woodley, O. El Shanawy, and Robert C. Cooksey; 2001 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88138&ren dertype=external
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Characterization of Mycobacterium tuberculosis Isolates from Patients in Houston, Texas, by Spoligotyping by Hanna Soini, Xi Pan, Amol Amin, Edward A. Graviss, Anees Siddiqui, and James M. Musser; 2000 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86172&ren dertype=external
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Chemokine receptor 2 serves an early and essential role in resistance to Mycobacterium tuberculosis by Wendy Peters, Holly M. Scott, Henry F. Chambers, JoAnne L. Flynn, Israel F. Charo, and Joel D. Ernst; 2001 July 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=35450
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Clinical Evaluation of Anti-Tuberculous Glycolipid Immunoglobulin G Antibody Assay for Rapid Serodiagnosis of Pulmonary Tuberculosis by Ryoji Maekura, Yoshinari Okuda, Masaru Nakagawa, Touru Hiraga, Souichirou Yokota, Masami Ito, Ikuya Yano, Hiroaki Kohno, Masako Wada, Chiyoji Abe, Takeo Toyoda, Toshio Kishimoto, and Takeshi Ogura; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88396&ren dertype=external
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Clinical Evaluation of the BDProbeTec ET System for Rapid Detection of Mycobacterium tuberculosis by John S. Bergmann, William E. Keating, and Gail L. Woods; 2000 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86226&ren dertype=external
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Clinical Evaluation of the Enhanced Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test for Rapid Diagnosis of Tuberculosis in Prison Inmates by John S. Bergmann, Gbo Yuoh, Geoffrey Fish, and Gail L. Woods; 1999 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84791&ren dertype=external
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Clinical Evaluation of the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test for Rapid Detection of Mycobacterium tuberculosis in Select Nonrespiratory Specimens by Gail L. Woods, John S. Bergmann, and Natalie Williams-Bouyer; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87811&ren dertype=external
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Colonic tuberculosis mimicking Crohn's disease: case report by Constantinos Chatzicostas, Ioannis E. Koutroubakis, Maria Tzardi, Maria Roussomoustakaki, Panagiotis Prassopoulos, and Elias A. Kouroumalis; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115203
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Combinatorial Use of Antibodies to Secreted Mycobacterial Proteins in a Host Immune System-Independent Test for Tuberculosis by Christopher P. Landowski, Henry P. Godfrey, Stuart I. Bentley-Hibbert, Xinyan Liu, Zhishan Huang, Ricardo Sepulveda, Kris Huygen, Maria L. Gennaro, Fred H. Moy, Scott A. Lesley, and Mary Haak-Frendscho; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88164&ren dertype=external
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Commentary:Tuberculosis: Old problems and new approaches by Roy M. Anderson; 1998 November 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33914
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Comparative Evaluation of Ligation-Mediated PCR and Spoligotyping as Screening Methods for Genotyping of Mycobacterium tuberculosis Strains by Stefano Bonora, M. Cristina Gutierrez, Giovanni Di Perri, Francesca Brunello, Benedetta Allegranzi, Marco Ligozzi, Roberta Fontana, Ercole Concia, and Veronique Vincent; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85507&ren dertype=external
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Comparison of Enhanced Mycobacterium tuberculosis Amplified Direct Test with COBAS AMPLICOR Mycobacterium tuberculosis Assay for Direct Detection of Mycobacterium tuberculosis Complex in Respiratory and Extrapulmonary Specimens by Claudio Scarparo, Paola Piccoli, Alessandra Rigon, Giuliana Ruggiero, Mariuccia Scagnelli, and Claudio Piersimoni; 2000 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86489&ren dertype=external
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Comparison of Methods Based on Different Molecular Epidemiological Markers for Typing of Mycobacterium tuberculosis Complex Strains: Interlaboratory Study of Discriminatory Power and Reproducibility by K. Kremer, D. van Soolingen, R. Frothingham, W. H. Haas, P. W. M. Hermans, C. Martin, P. Palittapongarnpim, B. B. Plikaytis, L. W. Riley, M. A. Yakrus, J. M. Musser, and J. D. A. van Embden; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85295&ren dertype=external
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Comparison of Nucleic Acid Amplification Tests for Tuberculosis by David J. Dawson; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88689&ren dertype=external
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Comparison of Phenotypic and Genotypic Methods for Pyrazinamide Susceptibility Testing with Mycobacterium tuberculosis by A. P.
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Davies, O. J. Billington, T. D. McHugh, D. A. Mitchison, and S. H. Gillespie; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87457&ren dertype=external ·
Comparison of Recoveries of Mycobacterium tuberculosis Using the Automated BACTEC MGIT 960 System, the BACTEC 460 TB System, and Lowenstein-Jensen Medium by Akos Somoskovi, Csaba Kodmon, Akos Lantos, Zoltan Bartfai, Lilla Tamasi, Judit Fuzy, and Pal Magyar; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86818&ren dertype=external
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Comparison of Susceptibility Testing of Mycobacterium tuberculosis Using the ESP Culture System II with That Using the BACTEC Method by P. Ruiz, F. J. Zerolo, and M. J. Casal; 2000 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87660&ren dertype=external
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Comparison of Variable Number Tandem Repeat and IS6110Restriction Fragment Length Polymorphism Analyses for Discrimination of Highand Low-Copy-Number IS6110 Mycobacterium tuberculosis Isolates by Rachael E. L. Barlow, Deborah M. Gascoyne-Binzi, Stephen H. Gillespie, Anne Dickens, Shabnam Qamer, and Peter M. Hawkey; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88169&ren dertype=external
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Conditionally replicating mycobacteriophages: A system for transposon delivery to Mycobacterium tuberculosis by Stoyan Bardarov, Jordan Kriakov, Christian Carriere, Shengwei Yu, Carlos Vaamonde, Ruth A. McAdam, Barry R. Bloom, Graham F. Hatfull, and William R. Jacobs, Jr.; 1997 September 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23545
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Cord Formation in MB/BacT Medium Is a Reliable Criterion for Presumptive Identification of Mycobacterium tuberculosis Complex in Laboratories with High Prevalence of M. tuberculosis by F. Zuhre Badak, Servet Goksel, Ruchan Sertoz, Asuman Guzelant, Ahmet Kizirgil, and Altinay Bilgic; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85924&ren dertype=external
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Corrections: Activation of the Interleukin 6 Gene by Mycobacterium tuberculosis or Lipopolysaccharide is Mediated by Nuclear Factors NFIL6 and NF-[kappa]B by MA Horwitz, BE Lee, BJ Dillon, and G Harth; 1995 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42553
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Criteria for the control of drug-resistant tuberculosis by Christopher Dye and Brian G. Williams; 2000 July 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=16690
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Cross-Modulation by Transforming Growth Factor [beta] in Human Tuberculosis: Suppression of Antigen-Driven Blastogenesis and Interferon [gamma] Production by CS Hirsch, R Hussain, Z Toossi, G Dawood, F Shahid, and JJ Ellner; 1996 April 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39581
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Crystal structure of cytochrome P450 14[alpha]-sterol demethylase (CYP51) from Mycobacterium tuberculosis in complex with azole inhibitors by Larissa M. Podust, Thomas L. Poulos, and Michael R. Waterman; 2001 March 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=30608
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Database study of antibiotic resistant tuberculosis in the United Kingdom, 1994-6 by Charles Irish, Josephine Herbert, Diane Bennett, Clare Gilham, Francis Drobniewski, Rhian Williams, E Grace Smith, John G Magee, Brian Watt, Maureen Chadwick, and John M Watson; 1999 February 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27743
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Detection of a Previously Unamplified Spacer within the DR Locus of Mycobacterium tuberculosis: Epidemiological Implications by Ingrid Filliol, Christophe Sola, and Nalin Rastogi; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86384&ren dertype=external
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Detection of Rifampin Resistance in Mycobacterium tuberculosis in a Single Tube with Molecular Beacons by Hiyam H. El-Hajj, Salvatore A. E. Marras, Sanjay Tyagi, Fred Russell Kramer, and David Alland; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88498&ren dertype=external
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Detection of Rifampin-Resistant Mycobacterium tuberculosis in Sputa by Nested PCR-Linked Single-Strand Conformation Polymorphism and DNA Sequencing by Bum-Joon Kim, Keun-Hwa Lee, Bo-Na Park,
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Seo-Jeong Kim, Eun-Mi Park, Young-Gil Park, Gil-Han Bai, Sang-Jae Kim, and Yoon-Hoh Kook; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88194&ren dertype=external ·
Detection of rpoB Mutations in Mycobacterium tuberculosis by Biprobe Analysis by K. J. Edwards, L. A. Metherell, M. Yates, and N. A. Saunders; 2001 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88343&ren dertype=external
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Detection of Viable Mycobacterium tuberculosis by Reverse Transcriptase-Strand Displacement Amplification of mRNA by T. J. Hellyer, L. E. DesJardin, L. Teixeira, M. D. Perkins, M. D. Cave, and K. D. Eisenach; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84447&ren dertype=external
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Development of Antigen Detection Assay for Diagnosis of Tuberculosis Using Sputum Samples by Lenka M. Pereira Arias-Bouda, Lan N. Nguyen, Ly M. Ho, Sjoukje Kuijper, Henk M. Jansen, and Arend H. J. Kolk; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86781&ren dertype=external
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Differentiation among Members of the Mycobacterium tuberculosis Complex by Molecular and Biochemical Features: Evidence for Two Pyrazinamide-Susceptible Subtypes of M. bovis by Stefan Niemann, Elvira Richter, and Sabine Rusch-Gerdes; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86043&ren dertype=external
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Differentiation of Clinical Mycobacterium tuberculosis Complex Isolates by gyrB DNA Sequence Polymorphism Analysis by Stefan Niemann, Dag Harmsen, Sabine Rusch-Gerdes, and Elvira Richter; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87363&ren dertype=external
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Differentiation of Mycobacterium tuberculosis Complex and Nontuberculous Mycobacterial Liquid Cultures by Using Peptide Nucleic Acid-Fluorescence In Situ Hybridization Probes by F. A. Drobniewski, P. G. More, and G. S. Harris; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88746&ren dertype=external
100 Tuberculosis
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Discrimination of Multidrug-Resistant Mycobacterium tuberculosis IS6110 Fingerprint Subclusters by rpoB Gene Mutation Analysis by Isabel Portugal, Sara Maia, and Jose Moniz-Pereira; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85442&ren dertype=external
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Distinct Differences in Repertoires of Low-Molecular-Mass Secreted Antigens of Mycobacterium avium Complex and Mycobacterium tuberculosis by Ingrid Olsen, Liv J. Reitan, and Harald G. Wiker; 2000 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87620&ren dertype=external
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Divergent effect of bacillus Calmette --Guerin (BCG) vaccination on Mycobacterium tuberculosis infection in highly related macaque species: Implications for primate models in tuberculosis vaccine research by Jan A. M. Langermans, Peter Andersen, Dick van Soolingen, Richard A. W. Vervenne, Patrice A. Frost, Tridia van der Laan, Laurens A. H. van Pinxteren, Jan van den Hombergh, Saskia Kroon, Inge Peekel, Sandrine Florquin, and Alan W. Thomas; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58758
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DNA Typing of a Nonviable Culture of Mycobacterium tuberculosis in a Homeless Shelter Outbreak by Jeffrey R. Driscoll, Michael A. McGarry, and Harry W. Taber; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84237&ren dertype=external
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Drug resistant tuberculosis in prisons in Azerbaijan: case study by R Coninx, G E Pfyffer, C Mathieu, D Savina, M Debacker, F Jafarov, I Jabrailov, A Ismailov, F Mirzoev, R de Haller, and F Portaels; 1998 May 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28539
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Drug-resistant tuberculosis by Richard Long; 2000 August 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80378&ren dertype=external
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Duplex PCR for Differential Identification of Mycobacterium bovis, M. avium, and M. avium subsp. paratuberculosis in Formalin- Fixed Paraffin-Embedded Tissues from Cattle by Christophe Coetsier, Pascal Vannuffel, Nathalie Blondeel, Jean-Francois Denef, Carlo Cocito, and Jean-Luc Gala; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87183&ren dertype=external
Studies 101
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Ecological analysis of ethnic differences in relation between tuberculosis and poverty by Jeremy I Hawker, Surinder S Bakhshi, Shaukat Ali, and C Paddy Farrington; 1999 October 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28253
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Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomised placebo controlled trials by David Wilkinson, S B Squire, and Paul Garner; 1998 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28654
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Effects of protein calorie malnutrition on tuberculosis in mice by John Chan, Yu Tian, Kathryn E. Tanaka, Ming S. Tsang, Keming Yu, Padmini Salgame, Dinah Carroll, Yvonne Kress, Rachel Teitelbaum, and Barry R. Bloom; 1996 December 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26226
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Efficient allelic exchange and transposon mutagenesis in Mycobacterium tuberculosis by Vladimir Pelicic, Mary Jackson, JeanMarc Reyrat, William R. Jacobs, Jr., Brigitte Gicquel, and Christophe Guilhot; 1997 September 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23543
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Enhanced Amplified Mycobacterium Tuberculosis Direct Test for Detection of Mycobacterium tuberculosis Complex in Positive BACTEC 12B Broth Cultures of Respiratory Specimens by John S. Bergmann and Gail L. Woods; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85048&ren dertype=external
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Epidemiologic Usefulness of Spoligotyping for Secondary Typing of Mycobacterium tuberculosis Isolates with Low Copy Numbers of IS6110 by Wendy A. Cronin, Jonathan E. Golub, Laurence S. Magder, Nancy G. Baruch, Monica J. Lathan, Leonard N. Mukasa, Nancy Hooper, Jafar H. Razeq, Donna Mulcahy, William H. Benjamin, and William R. Bishai; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88414&ren dertype=external
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Ethionamide activation and sensitivity in multidrug-resistant Mycobacterium tuberculosis by Andrea E. DeBarber, Khisimuzi Mdluli, Marlein Bosman, Linda-Gail Bekker, and Clifton E. Barry, 3rd; 2000 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=16924
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Evaluation of a Bacteriophage-Based Assay (Phage Amplified Biologically Assay) as a Rapid Screen for Resistance to Isoniazid, Ethambutol, Streptomycin, Pyrazinamide, and Ciprofloxacin among
102 Tuberculosis
Clinical Isolates of Mycobacterium tuberculosis by I. J. Eltringham, S. M. Wilson, and F. A. Drobniewski; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85685&ren dertype=external ·
Evaluation of Amplified Fragment Length Polymorphism Analysis for Inter- and Intraspecific Differentiation of Mycobacterium bovis, M. tuberculosis, and M. ulcerans by G. Huys, L. Rigouts, K. Chemlal, F. Portaels, and J. Swings; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87455&ren dertype=external
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Evaluation of BACTEC MGIT 960 and BACTEC 460TB Systems for Recovery of Mycobacteria from Clinical Specimens of a University Hospital with Low Incidence of Tuberculosis by Lorenz Leitritz, Soren Schubert, Bettina Bucherl, Adelheid Masch, Jurgen Heesemann, and Andreas Roggenkamp; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88429&ren dertype=external
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Evaluation of BACTEC Mycobacteria Growth Indicator Tube (MGIT 960) Automated System for Drug Susceptibility Testing of Mycobacterium tuberculosis by Fausta Ardito, Brunella Posteraro, Maurizio Sanguinetti, Stefania Zanetti, and Giovanni Fadda; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88562&ren dertype=external
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Evaluation of Etest for Susceptibility Testing of Multidrug-Resistant Isolates of Mycobacterium tuberculosis by Manzour Hernando Hazbon, Maria del Socorro Orozco, Luz Angela Labrada, Rafael Tovar, Kristen A. Weigle, and Audrey Wanger; 2000 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87643&ren dertype=external
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Evaluation of Etest for Susceptibility Testing of Mycobacterium tuberculosis by Moses L. Joloba, Saralee Bajaksouzian, and Michael R. Jacobs; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87486&ren dertype=external
Studies 103
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Evaluation of Mycobacteria Growth Indicator Tube for Direct and Indirect Drug Susceptibility Testing of Mycobacterium tuberculosis from Respiratory Specimens in a Siberian Prison Hospital by Vera Goloubeva, Maryvonne Lecocq, Piotr Lassowsky, Francine Matthys, Francoise Portaels, and Ivan Bastian; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87960&ren dertype=external
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Evaluation of PCR Using TRC4 and IS6110 Primers in Detection of Tuberculous Meningitis by Sujatha Narayanan, Vijayalakshmi Parandaman, P. R. Narayanan, P. Venkatesan, C. Girish, S. Mahadevan, and Sarala Rajajee; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88071&ren dertype=external
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Evaluation of Reverse Transcription-PCR and a Bacteriophage-Based Assay for Rapid Phenotypic Detection of Rifampin Resistance in Clinical Isolates of Mycobacterium tuberculosis by I. J. Eltringham, F. A. Drobniewski, J. A. Mangan, P. D. Butcher, and S. M. Wilson; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85684&ren dertype=external
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Evaluation of the Abbott LCx Mycobacterium tuberculosis Assay for Direct Detection of Mycobacterium tuberculosis Complex in Human Samples by Maria Grazia Garrino, Youri Glupczynski, Josiane Degraux, Henri Nizet, and Michel Delmee; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84218&ren dertype=external
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Evaluation of the BACTEC MGIT 960 and MB BAC/T Systems for Routine Detection of Mycobacterium tuberculosis by Tom Whyte, Belinda Hanahoe, Tom Collins, Geraldine Corbett-Feeney, and Martin Cormican; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87212&ren dertype=external
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Evaluation of the MB/BacT Mycobacterium Detection System for Susceptibility Testing of Mycobacterium tuberculosis by Maria S. DiazInfantes, Maria J. Ruiz-Serrano, Lucia Martinez-Sanchez, Arturo Ortega, and Emilio Bouza; 2000 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86645&ren dertype=external
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Evaluation of the Mycobacterium bovis Restriction Fragment Length Polymorphism Probe pUCD, in Combination with the Direct Repeat Probe, for Molecular Typing of Mycobacterium tuberculosis Strains in
104 Tuberculosis
Ireland by Henrietta Cameron, Rory O'Brien, Anthony Murray, Bartley Cryan, Rosemary Hone, and Mark Rogers; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88556&ren dertype=external ·
Evaluation of Three Nucleic Acid Amplification Methods for Direct Detection of Mycobacterium tuberculosis Complex in Respiratory Specimens by S. X. Wang and L. Tay; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84988&ren dertype=external
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Evidence from Molecular Fingerprinting of Limited Spread of DrugResistant Tuberculosis in Texas by Rebecca W. Wilson, Zhenhua Yang, Michael Kelley, M. Donald Cave, Janice M. Pogoda, Richard J. Wallace, Jr., J. Peter Cegielski, Denise F. Dunbar, David Bergmire-Sweat, L. Bruce Elliott, and Peter F. Barnes; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85543&ren dertype=external
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Evolution and Clonal Traits of Mycobacterium tuberculosis Complex in Guinea-Bissau by Gunilla Kallenius, Tuija Koivula, Solomon Ghebremichael, Sven E. Hoffner, Renee Norberg, Erika Svensson, Francisco Dias, Britt-Inger Marklund, and Stefan B. Svenson; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85833&ren dertype=external
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Evolution of Drug-Resistant Tuberculosis: A Tale of Two Species by MD Iseman; 1994 March 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43383
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Expanding the epidemiologic profile: risk factors for active tuberculosis in people immigrating to Ontario by Wendy L. Wobeser, Lilian Yuan, Monika Naus, Paul Corey, Jeff Edelson, Neil Heywood, and D. Linn Holness; 2000 October 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80504
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Exploring drug-induced alterations in gene expression in Mycobacterium tuberculosis by microarray hybridization by Michael Wilson, Joseph DeRisi, Hans-Henrik Kristensen, Paul Imboden, Sangeeta Rane, Patrick O. Brown, and Gary K. Schoolnik; 1999 October 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23119
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Extensive Cross-Contamination of Specimens with Mycobacterium tuberculosis in a Reference Laboratory by Marcelo de C. Ramos, Hanna
Studies 105
Soini, Glaucia C. Roscanni, Monica Jaques, Maria C. Villares, and James M. Musser; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88624&ren dertype=external ·
False Molecular Clusters due to Nonrandom Association of IS6110 with Mycobacterium tuberculosis by S. H. Gillespie, A. Dickens, and T. D. McHugh; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86733&ren dertype=external
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False-Positive Gen-Probe Direct Mycobacterium tuberculosis Amplification Test Results for Patients with Pulmonary M. kansasii and M. avium Infections by James H. Jorgensen, Jesse R. Salinas, Rosemary Paxson, Karen Magnon, Jan E. Patterson, and Thomas F. Patterson; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84200&ren dertype=external
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False-Positive Results for Mycobacterium celatum with the AccuProbe Mycobacterium tuberculosis Complex Assay by Akos Somoskovi, Jacqueline E. Hotaling, Marie Fitzgerald, Vivian Jonas, Denise Stasik, Linda M. Parsons, and Max Salfinger; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87016&ren dertype=external
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Field Evaluation of Rapid Tests for Tuberculosis Diagnosis by Voahangy Rasolofo and Suzanne Chanteau; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85929&ren dertype=external
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Frequency of rpoB Mutations Inside and Outside the Cluster I Region in Rifampin-Resistant Clinical Mycobacterium tuberculosis Isolates by Markus Heep, Barbara Brandstatter, Ulrich Rieger, Norbert Lehn, Elvira Richter, Sabine Rusch-Gerdes, and Stefan Niemann; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87688&ren dertype=external
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Genetic control of resistance to experimental infection with virulent Mycobacterium tuberculosis by Igor Kramnik, William F. Dietrich, Peter Demant, and Barry R. Bloom; 2000 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26987
106 Tuberculosis
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Genetic Diversity of Mycobacterium tuberculosis in Sicily Based on Spoligotyping and Variable Number of Tandem DNA Repeats and Comparison with a Spoligotyping Database for Population-Based Analysis by Christophe Sola, Severine Ferdinand, Caterina Mammina, Antonino Nastasi, and Nalin Rastogi; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87970&ren dertype=external
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Genetic Heterogeneity in Mycobacterium tuberculosis Isolates Reflected in IS6110 Restriction Fragment Length Polymorphism Patterns as Low-Intensity Bands by Annette S. de Boer, Kristin Kremer, Martien W. Borgdorff, Petra E. W. de Haas, Herre F. Heersma, and Dick van Soolingen; 2000 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87624&ren dertype=external
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Genetic Mutations Occur Gradually in In Vivo Populations of Mycobacterium tuberculosis Bacteria by A. S. de Boer, D. van Soolingen, and M. W. Borgdorff; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88446&ren dertype=external
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Genetic susceptibility to tuberculosis in Africans: A genome-wide scan by Richard Bellamy, Nulda Beyers, Keith P. W. J. McAdam, Cyril Ruwende, Robert Gie, Priscilla Samaai, Danite Bester, Mandy Meyer, Tumani Corrah, Matthew Collin, D. Ross Camidge, David Wilkinson, Eileen Hoal-van Helden, Hilton C. Whittle, William Amos, Paul van Helden, and Adrian V. S. Hill; 2000 July 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=16660
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Genome-Sequence-Based Fluorescent Amplified-Fragment Length Polymorphism Analysis of Mycobacterium tuberculosis by Jonathan N. Goulding, John Stanley, Nick Saunders, and Catherine Arnold; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86353&ren dertype=external
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Genotypic Determination of Mycobacterium tuberculosis Antibiotic Resistance Using a Novel Mutation Detection Method, the Branch Migration Inhibition M. tuberculosis Antibiotic Resistance Test by Y. P. Liu, M. A. Behr, P. M. Small, and N. Kurn; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87452&ren dertype=external
Studies 107
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Glutamine Synthetase of Mycobacterium tuberculosis: Extracellular Release and Characterization of its Enzymatic Activity by G Harth, DL Clemens, and MA Horwitz; 1994 September 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44808
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High-resolution minisatellite-based typing as a portable approach to global analysis of Mycobacterium tuberculosis molecular epidemiology by Edith Mazars, Sarah Lesjean, Anne-Laure Banuls, Michele Gilbert, Veronique Vincent, Brigitte Gicquel, Michel Tibayrenc, Camille Locht, and Philip Supply; 2001 February 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29354
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Human cytolytic and interferon [gamma]-secreting CD8 + T lymphocytes specific for Mycobacterium tuberculosis by Ajit Lalvani, Roger Brookes, Robert J. Wilkinson, Adam S. Malin, Ansar A. Pathan, Peter Andersen, Hazel Dockrell, Geoffrey Pasvol, and Adrian V. S. Hill; 1998 January 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18198
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Identification of a Contaminating Mycobacterium tuberculosis Strain with a Transposition of an IS6110 Insertion Element Resulting in an Altered Spoligotype by William H. Benjamin, Jr., Kerry H. Lok, Randall Harris, Nancy Brook, Lisa Bond, Donna Mulcahy, Nancy Robinson, Virginia Pruitt, deNay P. Kirkpatrick, Michael E. Kimerling, and Nancy E. Dunlap; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87878&ren dertype=external
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Identification of a Gene Involved in the Biosynthesis of Cyclopropanated Mycolic Acids in Mycobacterium tuberculosis by Y Yuan, RE Lee, GS Besra, JT Belisle, and CE Barry, III; 1995 July 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41572
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Identification of differentially expressed mRNA in prokaryotic organisms by customized amplification libraries (DECAL): The effect of isoniazid on gene expression in Mycobacterium tuberculosis by David Alland, Igor Kramnik, Torin R. Weisbrod, Lisa Otsubo, Rosaria Cerny, Lincoln P. Miller, William R. Jacobs, Jr., and Barry R. Bloom; 1998 October 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23765
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Identification of HLA class II-restricted determinants of Mycobacterium tuberculosis-derived proteins by using HLAtransgenic, class II-deficient mice by Annemieke Geluk, Veena Taneja, Krista E. van Meijgaarden, Eric Zanelli, Christiane Abou-Zeid, Jelle E. R.
108 Tuberculosis
Thole, Rene R. P. de Vries, Chella S. David, and Tom H. M. Ottenhoff; 1998 September 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27975 ·
Identification of Mycobacterium tuberculosis DNA in a PreColumbian Peruvian Mummy by WL Salo, AC Aufderheide, J Buikstra, and TA Holcomb; 1994 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43315
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Identification of Mycobacterium tuberculosis RNAs synthesized in response to phagocytosis by human macrophages by selective capture of transcribed sequences (SCOTS) by James E. Graham and Josephine E. Clark-Curtiss; 1999 September 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18072
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Identification of nitric oxide synthase as a protective locus against tuberculosis by John D. MacMicking, Robert J. North, Ron LaCourse, John S. Mudgett, Shrenik K. Shah, and Carl F. Nathan; 1997 May 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24663
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Identification of Rifampin-Resistant Mycobacterium tuberculosis Strains by Hybridization, PCR, and Ligase Detection Reaction on Oligonucleotide Microchips by Vladimir Mikhailovich, Sergey Lapa, Dimitry Gryadunov, Alexander Sobolev, Boris Strizhkov, Nikolai Chernyh, Olga Skotnikova, Olga Irtuganova, Arkadii Moroz, Vitalii Litvinov, Mikhail Vladimirskii, Mikhail Perelman, Larisa Chernousova, Vladislav Erokhin, Alexander Zasedatelev, and Andrei Mirzabekov; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88181&ren dertype=external
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Identification of two Mycobacterium tuberculosis H37Rv ORFs involved in resistance to killing by human macrophages by Barbara H. Miller and Thomas M. Shinnick; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59890
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Implications of Low Frequency of IS6110 in Fingerprinting Field Isolates of Mycobacterium tuberculosis from Kerala, India by Indulakshmi Radhakrishnan, Manju Y. K., R. Ajay Kumar, and Sathish Mundayoor; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88004&ren dertype=external
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Inactivation of Mycobacterium tuberculosis for DNA Typing Analysis by P. Bemer-Melchior and H. B. Drugeon; 1999 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85159&ren dertype=external
Studies 109
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Increased Sensitivity of the BACTEC 460 Mycobacterial Radiometric Broth Culture System Does Not Decrease the Number of Respiratory Specimens Required for a Definitive Diagnosis of Pulmonary Tuberculosis by Jeff D. Harvell, W. Keith Hadley, and Valerie L. Ng; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87444&ren dertype=external
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Inhibitory Effect of Alpha-Tec XPR-Plus Phosphate Buffer on the Enhanced Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test by Phyllis Della-Latta and Vivian Jonas; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88688&ren dertype=external
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Iron Acquisition by Mycobacterium Tuberculosis: Isolation and Characterization of a Family of Iron-Binding Exochelins by J Gobin, CH Moore, JR Reeve, Jr, DK Wong, BW Gibson, and MA Horwitz; 1995 May 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41874
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Is a Large Number of Sputum Specimens Necessary for the Bacteriological Diagnosis of Tuberculosis? by Alessandro Cascina, Anna Fietta, and Lucio Casali; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88755&ren dertype=external
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IS6110 Insertions in Mycobacterium tuberculosis: Predominantly into Coding Regions by Samantha Sampson, Robin Warren, Madalene Richardson, Gian van der Spuy, Paul van Helden, Nancy Dunlap, and William H. Benjamin, Jr.; 2001 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88365&ren dertype=external
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Latent tuberculosis infection: old problem, new priorities by Kevin Schwartzman; 2002 March 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99454&ren dertype=external
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Lipophilic siderophores of Mycobacterium tuberculosis prevent cardiac reperfusion injury by Lawrence D. Horwitz, Nancy A. Sherman, Yinong Kong, Adrian W. Pike, Jovana Gobin, Paul V. Fennessey, and Marcus A. Horwitz; 1998 April 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20249
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Luciferase Reporter Mycobacteriophages for Detection, Identification, and Antibiotic Susceptibility Testing of Mycobacterium tuberculosis in Mexico by N. Banaiee, M. Bobadilla-del-Valle, S. Bardarov, Jr., P. F.
110 Tuberculosis
Riska, P. M. Small, A. Ponce-de-Leon, W. R. Jacobs, Jr., G. F. Hatfull, and J. Sifuentes-Osornio; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88459&ren dertype=external ·
Major Histocompatibility Class I Presentation of Soluble Antigen Facilitated by Mycobacterium tuberculosis Infection by RJ Mazzaccaro, M Gedde, ER Jensen, HMV Santen, HL Ploegh, KL Rock, and BR Bloom; 1996 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38136
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Major Histocompatibility Complex Class I-Restricted T Cells are Required for Resistance to Mycobacterium tuberculosis Infection by JL Flynn, MM Goldstein, KJ Triebold, B Koller, and BR Bloom; 1992 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50688
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Mapping of IS6110 Insertion Sites in Two Epidemic Strains of Mycobacterium tuberculosis by Marjorie L. Beggs, Kathleen D. Eisenach, and M. Donald Cave; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87149&ren dertype=external
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Mass Spectrometric Identification of Mtb81, a Novel Serological Marker for Tuberculosis by Ronald C. Hendrickson, John F. Douglass, Lisa D. Reynolds, Patricia D. McNeill, Darrick Carter, Steven G. Reed, and Raymond L. Houghton; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86802&ren dertype=external
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Misidentification and Diagnostic Delay Caused by a False-Positive Amplified Mycobacterium tuberculosis Direct Test in an Immunocompetent Patient with a Mycobacterium celatum Infection by Jeroen H. T. Tjhie, Arne F. van Belle, Mirjam Dessens-Kroon, and Dick van Soolingen; 2001 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88133&ren dertype=external
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Modeling the impact of global tuberculosis control strategies by Christopher J. L. Murray and Joshua A. Salomon; 1998 November 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24946
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Molecular and Conventional Epidemiology of Mycobacterium tuberculosis in Botswana: a Population-Based Prospective Study of 301 Pulmonary Tuberculosis Patients by Shahin Lockman, Jeffery D.
Studies 111
Sheppard, Christopher R. Braden, Michael J. Mwasekaga, Charles L. Woodley, Thomas A. Kenyon, Nancy J. Binkin, Michael Steinman, Faustina Montsho, Matlhatso Kesupile-Reed, Colette Hirschfeldt, Malebogo Notha, Themba Moeti, and Jordan W. Tappero; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87871&ren dertype=external ·
Molecular and Immunological Characterization of Mycobacterium tuberculosis CFP-10, an Immunodiagnostic Antigen Missing in Mycobacterium bovis BCG by Davin C. Dillon, Mark R. Alderson, Craig H. Day, Teresa Bement, Antonio Campos-Neto, Yasir A. W. Skeiky, Thomas Vedvick, Roberto Badaro, Steven G. Reed, and Raymond Houghton; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87375&ren dertype=external
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Molecular basis for the exquisite sensitivity of Mycobacterium tuberculosis to isoniazid by Y. Zhang, S. Dhandayuthapani, and V. Deretic; 1996 November 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24072
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Molecular Characterization of Mycobacterium tuberculosis H37Rv/Ra Variants: Distinguishing the Mycobacterial Laboratory Strain by P. Bifani, S. Moghazeh, B. Shopsin, J. Driscoll, A. Ravikovitch, and B. N. Kreiswirth; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87354&ren dertype=external
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Molecular Characterization of Rifampin-Resistant Isolates of Mycobacterium tuberculosis from Hungary by DNA Sequencing and the Line Probe Assay by Zoltan Bartfai, Akos Somoskovi, Csaba Kodmon, Nora Szabo, Erzsebet Puskas, Laszlone Kosztolanyi, Eszter Farago, Judit Mester, Linda M. Parsons, and Max Salfinger; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88421&ren dertype=external
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Molecular Epidemiologic Evaluation of Transmissibility and Virulence of Mycobacterium tuberculosis by Jeanne T. Rhee, Amy S. Piatek, Peter M. Small, Lisa M. Harris, Sandra V. Chaparro, Fred Russell Kramer, and David Alland; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84945&ren dertype=external
112 Tuberculosis
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Molecular Epidemiology of Mycobacterium tuberculosis in Norway by Ulf R. Dahle, Per Sandven, Einar Heldal, and Dominique A. Caugant; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88029&ren dertype=external
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Molecular Epidemiology of Mycobacterium tuberculosis Infection in Israel by M. Ravins, H. Bercovier, D. Chemtob, Y. Fishman, and G. Rahav; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87899&ren dertype=external
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Molecular Epidemiology of Tuberculosis in Malaysia by Jeremy W. Dale, Rohana Mat Nor, Soshila Ramayah, Thean Hock Tang, and Zainul F. Zainuddin; 1999 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84747&ren dertype=external
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Molecular Epidemiology Study of Exogenous Reinfection in an Area with a Low Incidence of Tuberculosis by Alessandra Bandera, Andrea Gori, Lidia Catozzi, Anna Degli Esposti, Giulia Marchetti, Chiara Molteni, Giulio Ferrario, Luigi Codecasa, Valeria Penati, Alberto Matteelli, and Fabio Franzetti; 2001 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88113&ren dertype=external
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Molecular Evidence for Heterogeneity of the Multiple-Drug-Resistant Mycobacterium tuberculosis Population in Scotland (1990 to 1997) by Z. Fang, C. Doig, A. Rayner, D. T. Kenna, B. Watt, and K. J. Forbes; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88639&ren dertype=external
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Molecular Markers Demonstrate that the First Described MultidrugResistant Mycobacterium bovis Outbreak Was Due to Mycobacterium tuberculosis by M. C. Gutierrez, J. C. Galan, J. Blazquez, E. Bouvet, and V. Vincent; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88634&ren dertype=external
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Molecular Typing of Mycobacterium tuberculosis Based on Variable Number of Tandem DNA Repeats Used Alone and in Association with Spoligotyping by Ingrid Filliol, Severine Ferdinand, Laetitia Negroni, Christophe Sola, and Nalin Rastogi; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86957&ren dertype=external
Studies 113
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Monitoring of Transmission of Tuberculosis between Wild Boars and Cattle: Genotypical Analysis of Strains by Molecular Epidemiology Techniques by Andrea Serraino, Giulia Marchetti, Valeria Sanguinetti, Maria Cristina Rossi, Renato Giulio Zanoni, Lidia Catozzi, Alessandra Bandera, Walter Dini, Walter Mignone, Fabio Franzetti, and Andrea Gori; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85373&ren dertype=external
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Monitoring Treatment of Patients with Pulmonary Tuberculosis: Can PCR Be Applied? by Vibeke Ostergaard Thomsen, Axel Kok-Jensen, Mauro Buser, Sabine Philippi-Schulz, and H.-J. Burkardt; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85703&ren dertype=external
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Multicenter Evaluation of the Abbott LCx Mycobacterium tuberculosis Ligase Chain Reaction Assay by Richard Lumb, Kirsten Davies, David Dawson, Robert Gibb, Thomas Gottlieb, Clair Kershaw, Katherine Kociuba, Graeme Nimmo, Norma Sangster, Michele Worthington, and Ivan Bastian; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85503&ren dertype=external
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Multicenter Evaluation of the Mycobacteria Growth Indicator Tube for Testing Susceptibility of Mycobacterium tuberculosis to First-Line Drugs by Sabine Rusch-Gerdes, Cornelia Domehl, Giampietro Nardi, Maria Rita Gismondo, Hans-Martin Welscher, and Gaby E. Pfyffer; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84164&ren dertype=external
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Multicenter Laboratory Validation of Susceptibility Testing of Mycobacterium tuberculosis against Classical Second-Line and Newer Antimicrobial Drugs by Using the Radiometric BACTEC 460 Technique and the Proportion Method with Solid Media by Gaby E. Pfyffer, Donald A. Bonato, Adeleh Ebrahimzadeh, Wendy Gross, Jacqueline Hotaling, John Kornblum, Adalbert Laszlo, Glenn Roberts, Max Salfinger, Franziska Wittwer, and Salman Siddiqi; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85522&ren dertype=external
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Multidrug resistant tuberculosis in France 1992-4: two case-control studies by Valerie Schwoebel, Benedicte Decludt, Anne-Claire de Benoist, Sylvie Haeghebaert, Gabriela Torrea, Veronique Vincent, and Jacques Grosset; 1998 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28656
114 Tuberculosis
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Mutation of the Principal [sigma] Factor Causes Loss of Virulence in a Strain of the Mycobacterium tuberculosis Complex by DM Collins, RP Kawakami, GW de Lisle, L Pascopella, BR Bloom, and WR Jacobs, Jr; 1995 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41281
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Mutations in the rpoB Gene of Multidrug-Resistant Mycobacterium tuberculosis Clinical Isolates from India by Cheruvu Mani, N. Selvakumar, Sujatha Narayanan, and P. R. Narayanan; 2001 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88277&ren dertype=external
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Mutations in the rpoB Gene of Multidrug-Resistant Mycobacterium tuberculosis Isolates from Brazil by Andreia Rosane M. Valim, Maria Lucia R. Rossetti, Marta O. Ribeiro, and Arnaldo Zaha; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87207&ren dertype=external
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Mutations in the rpoB Gene of Rifampin-Resistant Mycobacterium tuberculosis Isolates in Spain and Their Rapid Detection by PCR -Enzyme-Linked Immunosorbent Assay by Lucia Garcia, Mercedes Alonso-Sanz, Maria J. Rebollo, Juan C. Tercero, and Fernando Chaves; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88031&ren dertype=external
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Mutations in the rpoB Gene of Rifampin-Resistant Mycobacterium tuberculosis Strains Isolated Mostly in Asian Countries and Their Rapid Detection by Line Probe Assay by Kazue Hirano, Chiyoji Abe, and Mitsuyoshi Takahashi; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85308&ren dertype=external
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Mycobacterium microti Llama-Type Infection Presenting as Pulmonary Tuberculosis in a Human Immunodeficiency Virus-Positive Patient by Matthias A. Horstkotte, Ingo Sobottka, Carl K. Schewe, Peter Schafer, Rainer Laufs, Sabine Rusch-Gerdes, and Stefan Niemann; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87746&ren dertype=external
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Mycobacterium tuberculosis Expresses Two Chaperonin-60 Homologs by TH Kong, ARM Coates, PD Butcher, CJ Hickman, and TM Shinnick; 1993 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46144
Studies 115
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Mycobacterium tuberculosis signal transduction system required for persistent infections by Thomas C. Zahrt and Vojo Deretic; 2001 October 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60118
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Mycolic Acid Index Susceptibility Method for Mycobacterium tuberculosis by Jose M. Viader-Salvado, Elvira Garza-Gonzalez, Ramon Valdez-Leal, M. de los Angeles del Bosque-Moncayo, Rolando TijerinaMenchaca, and Martha Guerrero-Olazaran; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88200&ren dertype=external
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New Agar Medium for Testing Susceptibility of Mycobacterium tuberculosis to Pyrazinamide by Leonid Heifets and Tracy Sanchez; 2000 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86474&ren dertype=external
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Osteoarticular tuberculosis: a case report and discussion by Kira Payne and Jae Yang; 2002 March 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99407&ren dertype=external
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Peptide methionine sulfoxide reductase from Escherichia coli and Mycobacterium tuberculosis protects bacteria against oxidative damage from reactive nitrogen intermediates by Gregory St. John, Nathan Brot, Jia Ruan, Hediye Erdjument-Bromage, Paul Tempst, Herbert Weissbach, and Carl Nathan; 2001 August 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=55550
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Performance Characteristics of the BDProbeTec System for Direct Detection of Mycobacterium tuberculosis Complex in Respiratory Specimens by Gaby E. Pfyffer, Pascale Funke-Kissling, Eva Rundler, and Rainer Weber; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84189&ren dertype=external
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Phospholipase Region of Mycobacterium tuberculosis Is a Preferential Locus for IS6110 Transposition by Lucio Vera-Cabrera, Marco A. Hernandez-Vera, Oliverio Welsh, Wendy M. Johnson, and Jorge CastroGarza; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88379&ren dertype=external
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pncA mutations in clinical Mycobacterium tuberculosis isolates from Korea by Soon Kew Park, Jung Yoo Lee, Chulhun Ludgerus Chang, Min
116 Tuberculosis
Ki Lee, Han Chul Son, Cheol Min Kim, Hyun Jung Jang, Hee Kyung Park, and Seok Hoon Jeong; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33507 ·
Protein splicing in trans by purified N- and C-terminal fragments of the Mycobacterium tuberculosis RecA intein by Kenneth V. Mills, Belinda M. Lew, Shu-qin Jiang, and Henry Paulus; 1998 March 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19872
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Public Health:Can you get tuberculosis twice? by John Hoey; 2002 February 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99361&ren dertype=external
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Pyrazinamide-Monoresistant Mycobacterium tuberculosis in the United States by Margaret M. Hannan, Edward P. Desmond, Glenn P. Morlock, Gerald H. Mazurek, and Jack T. Crawford; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87792&ren dertype=external
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Quality control and data-handling in multicentre studies: the case of the Multicentre Project for Tuberculosis Research by Teresa Caloto, Consuelo Huerta, Teresa Moreno, Dolores Guerra, Jose Alcaide, Concha Castells, Jose I. Cardenal, Angela Dominguez, Pilar Gayoso, Gonzalo Gutierrez, Maria J. Lopez, Francisco Munoz, Carmen Navarro, Miguel Pico, Francisco Pozo, Jose R. Quiros, Francisco Robles, Jose M. Sanchez, Hermelinda Vanaclocha, Tomas Vega, Mercedes Diez, and the MPTR Study Group; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=65548
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Quantitative Analysis of mRNA as a Marker for Viability of Mycobacterium tuberculosis by T. J. Hellyer, L. E. DesJardin, G. L. Hehman, M. D. Cave, and K. D. Eisenach; 1999 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84288&ren dertype=external
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Rapid Detection of Mycobacterium tuberculosis in Contaminated BACTEC 12B Broth Cultures by Testing with Amplified Mycobacterium Tuberculosis Direct Test by Xiaotian Zheng, Minnie Pang, Howard D. Engler, Sherri Tanaka, and Thomas Reppun; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88416&ren dertype=external
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Rapid Detection of Smear-Negative Mycobacterium tuberculosis by PCR and Sequencing for Rifampin Resistance with DNA Extracted
Studies 117
Directly from Slides by Madhumita Patnaik, Karsten Liegmann, and James B. Peter; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87678&ren dertype=external ·
Rapid Diagnosis of Tuberculous Meningitis by a Dot Immunobinding Assay To Detect Mycobacterial Antigen in Cerebrospinal Fluid Specimens by M. G. Sumi, A. Mathai, C. Sarada, and V. V. Radhakrishnan; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85846&ren dertype=external
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Rapid Differentiation of "Mycobacterium canettii" from Other Mycobacterium tuberculosis Complex Organisms by PCR-Restriction Analysis of the hsp65 Gene by Khye Seng Goh, Eric Legrand, Christophe Sola, and Nalin Rastogi; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88413&ren dertype=external
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Rapid Film-Based Determination of Antibiotic Susceptibilities of Mycobacterium tuberculosis Strains by Using a Luciferase Reporter Phage and the Bronx Box by Paul F. Riska, Ya Su, Svetoslav Bardarov, Lawrence Freundlich, Gary Sarkis, Graham Hatfull, Christian Carriere, Vanaja Kumar, John Chan, and William R. Jacobs, Jr.; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88662&ren dertype=external
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Rapid Identification of Laboratory Contamination with Mycobacterium tuberculosis Using Variable Number Tandem Repeat Analysis by Deborah M. Gascoyne-Binzi, Rachael E. L. Barlow, Richard Frothingham, Grant Robinson, Timothy A. Collyns, Ruth Gelletlie, and Peter M. Hawkey; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87682&ren dertype=external
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Rapid Immunochromatographic Assay for Diagnosis of Tuberculosis: Antibodies Detected May Not Be Specific by Roger Freeman, John Magee, Anne Barratt, Janice Wheeler, Michael Steward, Maureen Lee, and Nigel Piggott; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85054&ren dertype=external
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Rapid, Efficient Detection and Drug Susceptibility Testing of Mycobacterium tuberculosis in Sputum by Microscopic Observation of Broth Cultures by Luz Caviedes, Tien-Shun Lee, Robert H. Gilman, Patricia Sheen, Emily Spellman, Ellen H. Lee, Douglas E. Berg, Sonia
118 Tuberculosis
Montenegro-James, and The Tuberculosis Working Group in Peru; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86377&ren dertype=external ·
Recombinant bacillus Calmette --Guerin (BCG) vaccines expressing the Mycobacterium tuberculosis 30-kDa major secretory protein induce greater protective immunity against tuberculosis than conventional BCG vaccines in a highly susceptible animal model by Marcus A. Horwitz, Gunter Harth, Barbara Jane Dillon, and Sasa Maslesa-Galic; 2000 December 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17665
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Regulation of the Mycobacterium tuberculosis hypoxic response gene encoding [alpha]-crystallin by David R. Sherman, Martin Voskuil, Dirk Schnappinger, Reiling Liao, Maria I. Harrell, and Gary K. Schoolnik; 2001 June 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=34703
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Relative contributions of distinct MHC class I-dependent cell populations in protection to tuberculosis infection in mice by Alexandra O. Sousa, Richard J. Mazzaccaro, Robert G. Russell, Francis K. Lee, Oliver C. Turner, Seokmann Hong, Luc Van Kaer, and Barry R. Bloom; 2000 April 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18197
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Reliability of the MB/BacT System for Testing Susceptibility of Mycobacterium tuberculosis Complex Isolates to Antituberculous Drugs by Francesca Brunello and Roberta Fontana; 2000 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86230&ren dertype=external
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Removal of PCR Inhibitors by Silica Membranes: Evaluating the Amplicor Mycobacterium tuberculosis Kit by Boris Boddinghaus, Thomas A. Wichelhaus, Volker Brade, and Thomas Bittner; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88425&ren dertype=external
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Research Paper:Automated Tuberculosis Detection by George Hripcsak, Charles A. Knirsch, Nilesh L. Jain, and Ariel Pablos-Mendez; 1997 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61255
Studies 119
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Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionarily recent global dissemination by Srinand Sreevatsan, Xi Pan, Kathryn E. Stockbauer, Nancy D. Connell, Barry N. Kreiswirth, Thomas S. Whittam, and James M. Musser; 1997 September 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23284
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Restriction Fragment Length Polymorphism Analysis of Mycobacterium tuberculosis Isolated from Countries in the Western Pacific Region by Young-Kil Park, Gill-Han Bai, and Sang-Jae Kim; 2000 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88694&ren dertype=external
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Retrospective Analysis of the Beijing Family of Mycobacterium tuberculosis in Preserved Lung Tissues by Lishi Qian, Jan D. A. Van Embden, Adri G. M. Van Der Zanden, Evert F. Weltevreden, Hongjin Duanmu, and James T. Douglas; 1999 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84346&ren dertype=external
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Reverse Dot Blot Assay (Insertion Site Typing) for Precise Detection of Sites of IS6110 Insertion in the Mycobacterium tuberculosis Genome by Lauren M. Steinlein and Jack T. Crawford; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87843&ren dertype=external
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Risk of Mycobacterium tuberculosis Transmission in a Low-Incidence Country Due to Immigration from High-Incidence Areas by Troels Lillebaek, Ase B. Andersen, Jeanett Bauer, Asger Dirksen, Steffen Glismann, Petra de Haas, and Axel Kok-Jensen; 2001 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87841&ren dertype=external
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Role of IS6110-Targeted PCR, Culture, Biochemical, Clinical, and Immunological Criteria for Diagnosis of Tuberculous Meningitis by M. Caws, S. M. Wilson, C. Clough, and F. Drobniewski; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87341&ren dertype=external
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rpoB Mutations in Multidrug-Resistant Strains of Mycobacterium tuberculosis Isolated in Italy by G. Pozzi, M. Meloni, E. Iona, G. Orru, O. F. Thoresen, M. L. Ricci, M. R. Oggioni, L. Fattorini, and G. Orefici; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88675&ren dertype=external
120 Tuberculosis
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Safe Determination of Susceptibility of Mycobacterium tuberculosis to Antimycobacterial Agents by Flow Cytometry by Andrea V. Moore, Scott M. Kirk, Steven M. Callister, Gerald H. Mazurek, and Ronald F. Schell; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84439&ren dertype=external
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Secondary Typing of Mycobacterium tuberculosis Isolates with Matching IS6110 Fingerprints from Different Geographic Regions of the United States by Z. H. Yang, J. H. Bates, K. D. Eisenach, and M. D. Cave; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88010&ren dertype=external
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Sequence Polymorphism in the rrs Gene of Mycobacterium tuberculosis Is Deeply Rooted within an Evolutionary Clade and Is Not Associated with Streptomycin Resistance by Thomas C. Victor, Annelies van Rie, Annemie M. Jordaan, Madalene Richardson, Gian D. van der Spuy, Nulda Beyers, Paul D. van Helden, and Robin Warren; 2001 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88513&ren dertype=external
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Serial counts of Mycobacterium tuberculosis in sputum as surrogate markers of the sterilising activity of rifampicin and pyrazinamide in treating pulmonary tuberculosis by Richard Brindle, Joseph Odhiambo, and Denis Mitchison; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60677
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Serological Expression Cloning and Immunological Evaluation of MTB48, a Novel Mycobacterium tuberculosis Antigen by Michael J. Lodes, Davin C. Dillon, Raodoh Mohamath, Craig H. Day, Darin R. Benson, Lisa D. Reynolds, Patricia McNeill, Diana Pedral Sampaio, Yasir A. W. Skeiky, Roberto Badaro, David H. Persing, Steven G. Reed, and Raymond L. Houghton; 2001 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88174&ren dertype=external
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Simple and Rapid Identification of the Mycobacterium tuberculosis Complex by Immunochromatographic Assay Using Anti-MPB64 Monoclonal Antibodies by Chiyoji Abe, Kazue Hirano, and Tetsuo Tomiyama; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85727&ren dertype=external
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Simple and Rational Approach to the Identification of Mycobacterium tuberculosis, Mycobacterium avium Complex Species, and Other
Studies 121
Commonly Isolated Mycobacteria by Derek A. Wong, Peter C. W. Yip, Danny T. L. Cheung, and Kai Man Kam; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88430&ren dertype=external ·
Simultaneous Infection with Two Drug-Susceptible Mycobacterium tuberculosis Strains in an Immunocompetent Host by Marion Pavlic, Franz Allerberger, Manfred P. Dierich, and Wolfgang M. Prodinger; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85908&ren dertype=external
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Single-Tube Balanced Heminested PCR for Detecting Mycobacterium tuberculosis in Smear-Negative Samples by Albert Garcia-Quintanilla, Lourdes Garcia, Griselda Tudo, Maria Navarro, Julia Gonzalez, and Maria T. Jimenez de Anta; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86365&ren dertype=external
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Site-Specific Integration of Mycobacteriophage L5: IntegrationProficient Vectors for Mycobacterium smegmatis, Mycobacterium tuberculosis, and Bacille Calmette-Guerin by MH Lee, L Pascopella, WR Jacobs, Jr, and GF Hatfull; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51395
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Specificity of IS6110-Based DNA Fingerprinting and Diagnostic Techniques for Mycobacterium tuberculosis Complex by Willie A. Githui, Stuart M. Wilson, and Francis A. Drobniewski; 1999 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88683&ren dertype=external
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Spoligotyping and Polymorphic GC-Rich Repetitive Sequence Fingerprinting of Mycobacterium tuberculosis Strains Having Few Copies of IS6110 by Z. H. Yang, K. Ijaz, J. H. Bates, K. D. Eisenach, and M. D. Cave; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87438&ren dertype=external
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Spread of Drug-Resistant Pulmonary Tuberculosis in Estonia by Annika Kruuner, Sven E. Hoffner, Heinart Sillastu, Manfred Danilovits, Klavdia Levina, Stefan B. Svenson, Solomon Ghebremichael, Tuija Koivula, and Gunilla Kallenius; 2001 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88341&ren dertype=external
122 Tuberculosis
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Stability of IS6110 Restriction Fragment Length Polymorphism Patterns of Multidrug-Resistant Mycobacterium tuberculosis Strains by Stefan Niemann, Elvira Richter, and Sabine Rusch-Gerdes; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85468&ren dertype=external
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Stability of IS6110 Restriction Fragment Length Polymorphism Patterns of Mycobacterium tuberculosis Strains in Actual Chains of Transmission by Stefan Niemann, Sabine Rusch-Gerdes, Elvira Richter, Heiko Thielen, Helga Heykes-Uden, and Roland Diel; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86969&ren dertype=external
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Stability of Mycobacterium tuberculosis IS6110 Restriction Fragment Length Polymorphism Patterns and Spoligotypes Determined by Analyzing Serial Isolates from Patients with Drug-Resistant Tuberculosis by Stefan Niemann, Elvira Richter, and Sabine RuschGerdes; 1999 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84323&ren dertype=external
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Sterilization of Mycobacterium tuberculosis Erdman Samples by Antimicrobial Fixation in a Biosafety Level 3 Laboratory by J. Reid Schwebach, William R. Jacobs, Jr., and Arturo Casadevall; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87817&ren dertype=external
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Surfactant Protein A Promotes Attachment of Mycobacterium tuberculosis to Alveolar Macrophages During Infection with Human Immunodeficiency Virus by JF Downing, R Pasula, JR Wright, HL Twigg, III, and WJ Martin, II; 1995 May 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41804
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The 16-kDa [alpha]-crystallin (Acr) protein of Mycobacterium tuberculosis is required for growth in macrophages by Ying Yuan, Deborah D. Crane, R. Mark Simpson, YaQi Zhu, Mark J. Hickey, David R. Sherman, and Clifton E. Barry, III; 1998 August 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21381
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The dynamics of repeated elements: Applications to the epidemiology of tuberculosis by Mark M. Tanaka, Peter M. Small, Hugh Salamon, and Marcus W. Feldman; 2000 March 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=16274
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The ESAT-6 gene cluster of Mycobacterium tuberculosis and other high G+C Gram-positive bacteria by Nico C. Gey van Pittius, Junaid
Studies 123
Gamieldien, Winston Hide, Gordon D. Brown, Roland J. Siezen, and Albert D. Beyers; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=57799 ·
The IS6110 Restriction Fragment Length Polymorphism in Particular Multidrug-Resistant Mycobacterium tuberculosis Strains May Evolve Too Fast for Reliable Use in Outbreak Investigation by Alicia Alito, Nora Morcillo, Silvia Scipioni, Alberto Dolmann, Maria I. Romano, Angel Cataldi, and Dick van Soolingen; 1999 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84556&ren dertype=external
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The MB/BacT Is a Sensitive Method of Isolating Mycobacterium tuberculosis from Clinical Specimens in a Laboratory with a Low Rate of Isolation by William H. Benjamin, Jr., Ken B. Waites, and Stephen A. Moser; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87213&ren dertype=external
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The salicylate-derived mycobactin siderophores of Mycobacterium tuberculosis are essential for growth in macrophages by James J. De Voss, Kerry Rutter, Benjamin G. Schroeder, Hua Su, YaQi Zhu, and Clifton E. Barry, III; 2000 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15586
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The Susceptibility of Mycobacterium tuberculosis to Isoniazid and the Arg[right arrow]Leu Mutation at Codon 463 of katG Are Not Associated by H. R. van Doorn, E. J. Kuijper, A. van der Ende, A. G. A. Welten, D. van Soolingen, P. E. W. de Haas, and J. Dankert; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87976&ren dertype=external
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The Urease Locus of Mycobacterium tuberculosis and Its Utilization for the Demonstration of Allelic Exchange in Mycobacterium bovis Bacillus Calmette- Guerin by J Reyrat, F Berthet, and B Gicquel; 1995 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41048
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Transmission Dynamics and Molecular Characterization of Mycobacterium tuberculosis Isolates with Low Copy Numbers of IS6110 by Hanna Soini, Xi Pan, Larry Teeter, James M. Musser, and Edward A. Graviss; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87705&ren dertype=external
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Transmission Dynamics of Tuberculosis in a High-Incidence Country: Prospective Analysis by PCR DNA Fingerprinting by W. H. Haas, G.
124 Tuberculosis
Engelmann, B. Amthor, S. Shyamba, F. Mugala, M. Felten, M. Rabbow, M. Leichsenring, O. J. Oosthuizen, and H. J. Bremer; 1999 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85859&ren dertype=external ·
Treatment of Mycobacterium tuberculosis with antisense oligonucleotides to glutamine synthetase mRNA inhibits glutamine synthetase activity, formation of the poly-L-glutamate /glutamine cell wall structure, and bacterial replication by Gunter Harth, Paul C. Zamecnik, Jin-Yan Tang, David Tabatadze, and Marcus A. Horwitz; 2000 January 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26678
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Tuberculosis Transmission in Botswana by S. Bonora, M. Boffito, S. Audagnotto, and G. Di Perri; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88447&ren dertype=external
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Two Liquid Medium Systems, Mycobacteria Growth Indicator Tube and MB Redox Tube, for Mycobacterium tuberculosis Isolation from Sputum Specimens by L. Heifets, T. Linder, T. Sanchez, D. Spencer, and J. Brennan; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86383&ren dertype=external
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Use of Nucleic Acid Probes for Identification of Mycobacterium tuberculosis Directly from MB/BacT Bottles by F. Zuhre Badak, Servet Goksel, Ruchan Sertoz, Bedii Nafile, Safak Ermertcan, Cengiz Cavusoglu, and Altinay Bilgic; 1999 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84847&ren dertype=external
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Use of Pulsed-Field Gel Electrophoresis for Molecular Epidemiologic and Population Genetic Studies of Mycobacterium tuberculosis by Samir P. Singh, Hugh Salamon, Carol J. Lahti, Mehran Farid-Moyer, and Peter M. Small; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84986&ren dertype=external
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Use of Real-Time PCR and Fluorimetry for Rapid Detection of Rifampin and Isoniazid Resistance-Associated Mutations in Mycobacterium tuberculosis by Maria J. Torres, Antonio Criado, Jose C. Palomares, and Javier Aznar; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87353&ren dertype=external
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Use of Recommended Laboratory Testing Methods among Patients with Tuberculosis in California by Steffi Kellam, Lisa Pascopella, Edward Desmond, Arthur Reingold, and Daniel P. Chin; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88060&ren dertype=external
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Use of Spoligotyping To Study the Evolution of the Direct Repeat Locus by IS6110 Transposition in Mycobacterium tuberculosis by Eric Legrand, Ingrid Filliol, Christophe Sola, and Nalin Rastogi; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87977&ren dertype=external
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Use of the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test for Early Detection of Mycobacterium tuberculosis in BACTEC 12B Medium by E. P. Desmond and K. Loretz; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88067&ren dertype=external
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Usefulness of Spoligotyping To Discriminate IS6110 Low-CopyNumber Mycobacterium tuberculosis Complex Strains Cultured in Denmark by Jeanett Bauer, Ase B. Andersen, Kristin Kremer, and Hakan Miorner; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85294&ren dertype=external
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Value of Examining Three Acid-Fast Bacillus Sputum Smears for Removal of Patients Suspected of Having Tuberculosis from the "Airborne Precautions" Category by David W. Craft, Melissa C. Jones, Cherie N. Blanchet, and Roy L. Hopfer; 2000 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87587&ren dertype=external
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Virulence of a Mycobacterium tuberculosis clinical isolate in mice is determined by failure to induce Th1 type immunity and is associated with induction of IFN-[alpha] /[beta] by Claudia Manca, Liana Tsenova, Amy Bergtold, Sherry Freeman, Michael Tovey, James M. Musser, Clifton E. Barry, III, Victoria H. Freedman, and Gilla Kaplan; 2001 May 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33285
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign
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references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with tuberculosis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “tuberculosis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “tuberculosis” (hyperlinks lead to article summaries): ·
Patient compliance with tuberculosis treatment in Ghana: factors influencing adherence to therapy in a rural service programme. Author(s): van der Werf TS, Dade GK, van der Mark TW. Source: Tubercle. 1990 December; 71(4): 247-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2267678&dopt=Abstract
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Polyphosphate-glucose phosphotransferase. Purification of Mycobacterium tuberculosis H37Ra enzyme to apparent homogeneity. Author(s): Szymona M, Kowalska H, Pastuszak I. Source: Acta Biochim Pol. 1977; 24(2): 133-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=406755&dopt=Abstract
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Practical clinical application of the Bi-Digital O-Ring Test in the diagnosis, treatment and follow-up of tuberculosis & parasitic infection. Author(s): Ong G, Omura Y. Source: Acupunct Electrother Res. 1986; 11(3-4): 243-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2880471&dopt=Abstract
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Preventive therapy for tuberculosis. Author(s): Strachan DP, Millard JF, Maxwell JD.
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
22
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Source: Lancet. 1995 June 3; 345(8962): 1439. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7760628&dopt=Abstract ·
Problems of tuberculosis management in Sabah. Author(s): Roy RN. Source: N Z Med J. 1972 August; 76(483): 97-101. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4508817&dopt=Abstract
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Proceedings: Social and cultural factors in treatment of tuberculosis. Author(s): Maddison D. Source: Bull Int Union Tuberc. 1974 August; 49 Suppl 1: 33-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4377534&dopt=Abstract
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Properties of lymphocytes which confer adoptive immunity to tuberculosis in rats. Author(s): Lefford MJ, McGregor DD, Mackaness GB. Source: Immunology. 1973 October; 25(4): 703-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4753404&dopt=Abstract
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Properties of peritoneal exudate lymphocytes that mediate tuberculin delayed-type hypersensitivity and anti-tuberculosis immunity. I. The effect of cytotoxic agents. Author(s): Lefford MJ. Source: Immunology. 1980 November; 41(3): 635-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7461705&dopt=Abstract
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Prophylaxis for tuberculosis in Europe--ongoing research. Author(s): Carosi G, Matteelli A. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1996 April; 22 Suppl 1: S55-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8785258&dopt=Abstract
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Pulmonary tuberculosis in Kweneng District, Botswana: delays in diagnosis in 212 smear-positive patients. Author(s): Steen TW, Mazonde GN. Source: Int J Tuberc Lung Dis. 1998 August; 2(8): 627-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9712276&dopt=Abstract
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Purification, characterization, and genetic analysis of Mycobacterium tuberculosis urease, a potentially critical determinant of host-pathogen interaction. Author(s): Clemens DL, Lee BY, Horwitz MA. Source: Journal of Bacteriology. 1995 October; 177(19): 5644-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7559354&dopt=Abstract
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Recombinant expression and characterization of the major betalactamase of Mycobacterium tuberculosis. Author(s): Voladri RK, Lakey DL, Hennigan SH, Menzies BE, Edwards KM, Kernodle DS. Source: Antimicrobial Agents and Chemotherapy. 1998 June; 42(6): 137581. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9624479&dopt=Abstract
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Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency? Author(s): Finch PJ, Millard FJ, Maxwell JD. Source: Thorax. 1991 January; 46(1): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1871690&dopt=Abstract
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Robert W. Philip (1857-1939), pioneer of the holistic approach to tuberculosis and its voluntary movement. Author(s): Dubovsky H. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1973 June 16; 47(23): 1007-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4576831&dopt=Abstract
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Should we ban B6 supplementation of INH therapy in childhood tuberculosis? Author(s): Mathur GP, Mathur S, Rastogi S.
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Source: Indian J Pediatr. 1993 November-December; 60(6): 717-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8200694&dopt=Abstract ·
Social and cultural factors in the successful control of tuberculosis. Author(s): Rubel AJ, Garro LC. Source: Public Health Reports (Washington, D.C. : 1974). 1992 NovemberDecember; 107(6): 626-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1454974&dopt=Abstract
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Sociocultural aspects of tuberculosis control in Ethiopia. Author(s): Vecchiato NL. Source: Med Anthropol Q. 1997 June; 11(2): 183-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9186960&dopt=Abstract
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Sociocultural aspects of tuberculosis defaultation: a case study. Author(s): Ndeti K. Source: Social Science & Medicine (1982). 1972 June; 6(3): 397-412. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5049317&dopt=Abstract
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Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Author(s): Needham DM, Foster SD, Tomlinson G, Godfrey-Faussett P. Source: Tropical Medicine & International Health : Tm & Ih. 2001 April; 6(4): 256-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11348515&dopt=Abstract
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Some aspects of traditional beliefs as they affect tuberculosis treatment. Author(s): Mthembu C. Source: Curationis. 1981 December; 4(3): 28. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6915817&dopt=Abstract
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The antigens of Mycobacterium tuberculosis, H37Rv, studied by crossed immunoelectrophoresis. Comparison with a reference system
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for Mycobacterium bovis, BCG. Author(s): Wiker HG, Harboe M, Bennedsen J, Closs O. Source: Scandinavian Journal of Immunology. 1988 February; 27(2): 22339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3124264&dopt=Abstract ·
The contribution of hydrogen peroxide resistance to virulence of Mycobacterium tuberculosis during the first six days after intravenous infection of normal and BCG-vaccinated guinea-pigs. Author(s): Jackett PS, Aber VR, Mitchison DA, Lowrie DB. Source: Br J Exp Pathol. 1981 February; 62(1): 34-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6784743&dopt=Abstract
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The glutaraldehyde test as a rapid screening method for pulmonary tuberculosis: a preliminary report. Author(s): Larsson S, Shrestha MP, Pokhrel BM, Upadhyay MP, Shrestha KB. Source: Annals of Tropical Medicine and Parasitology. 1990 April; 84(2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2116775&dopt=Abstract
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The white plague in Utopia: tuberculosis in nineteenth-century Shaker communes. Author(s): Murray JE. Source: Bulletin of the History of Medicine. 1994 Summer; 68(2): 278-306. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8049601&dopt=Abstract
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Three models of social work intervention with tuberculosis patients. Author(s): Andrews AB, Williams H, Kinney J. Source: Health & Social Work. 1988 Fall; 13(4): 288-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3229681&dopt=Abstract
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Traditional healers and pulmonary tuberculosis in Malawi. Author(s): Brouwer JA, Boeree MJ, Kager P, Varkevisser CM, Harries AD.
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Source: Int J Tuberc Lung Dis. 1998 March; 2(3): 231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9526196&dopt=Abstract ·
Traditional healers as tuberculosis treatment supervisors: precedent and potential. Author(s): Wilkinson D, Gcabashe L, Lurie M. Source: Int J Tuberc Lung Dis. 1999 September; 3(9): 838-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10488894&dopt=Abstract
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Tuberculosis and the Aboriginal Territorian. Author(s): Soong FS. Source: Aust Nurses J. 1976 March; 5(9): 23-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1046981&dopt=Abstract
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Tuberculosis and the assimilation of germ theory in China, 1895-1937. Author(s): Andrews BJ. Source: Journal of the History of Medicine and Allied Sciences. 1997 January; 52(1): 114-57. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9071849&dopt=Abstract
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Tuberculosis and the haemopoietic system. Author(s): Knox-Macaulay HH. Source: Baillieres Clin Haematol. 1992 January; 5(1): 101-29. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1596588&dopt=Abstract
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Tuberculosis in aboriginal Canadians. Author(s): Hoeppner VH, Marciniuk DD. Source: Can Respir J. 2000 March-April; 7(2): 141-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10859400&dopt=Abstract
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Tuberculosis in Bombay: new insights from poor urban patients. Author(s): Nair DM, George A, Chacko KT.
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Source: Health Policy and Planning. 1997 March; 12(1): 77-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10166105&dopt=Abstract ·
Tuberculosis in the 1990s. Issues for primary care physicians. Author(s): Fitzgerald JM. Source: Can Fam Physician. 1995 June; 41: 1030-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7780315&dopt=Abstract
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Tuberculosis outbreak among Rastafarians in Birmingham. Author(s): Packe GE, Patchett PA, Innes JA. Source: Lancet. 1985 March 16; 1(8429): 627-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2857958&dopt=Abstract
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Tuberculosis patients and practitioners in private clinics in India. Author(s): Uplekar M, Juvekar S, Morankar S, Rangan S, Nunn P. Source: Int J Tuberc Lung Dis. 1998 April; 2(4): 324-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9559404&dopt=Abstract
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Tuberculosis screening and prevention for foreign-born students: eight years experience at Ohio University. Author(s): Nelson ME, Fingar AR. Source: American Journal of Preventive Medicine. 1995 May-June; 11(3 Suppl): 48-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7669364&dopt=Abstract
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Tuberculosis since Lettsom. Author(s): Andrews RH. Source: Trans Med Soc Lond. 1973; 89: 292-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4617954&dopt=Abstract
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Tuberculosis, malnutrition and wasting. Author(s): Schwenk A, Macallan DC.
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Source: Current Opinion in Clinical Nutrition and Metabolic Care. 2000 July; 3(4): 285-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10929675&dopt=Abstract ·
Vegetarian diet and cobalamin deficiency: their association with tuberculosis. Author(s): Chanarin I, Stephenson E. Source: Journal of Clinical Pathology. 1988 July; 41(7): 759-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3410971&dopt=Abstract
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Vegetarian diet and tuberculosis in immigrant Asians. Author(s): Davis L. Source: Thorax. 1995 August; 50(8): 915-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7570453&dopt=Abstract
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Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians. Author(s): Strachan DP, Powell KJ, Thaker A, Millard FJ, Maxwell JD. Source: Thorax. 1995 February; 50(2): 175-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7701458&dopt=Abstract
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When tuberculosis treatment fails. A social behavioral account of patient adherence. Author(s): Sumartojo E. Source: Am Rev Respir Dis. 1993 May; 147(5): 1311-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8484650&dopt=Abstract
Vocabulary Builder Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for
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immunodiffusion and immunoelectrophoresis. [NIH] Ambroxol: A metabolite of bromhexine that stimulates mucociliary action and clears the air passages in the respiratory tract. It is usually administered as the hydrochloride. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anthropology: The science devoted to the comparative study of man. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Aspiration: The act of inhaling. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Audiology: The study of hearing and hearing impairment. [NIH] Bacillus: A genus of bacteria of the family Bacillaceae, including large aerobic or facultatively anaerobic, spore-forming, rod-shaped cells, the great majority of which are gram-positive and motile. The genus is separated into 48 species, of which three are pathogenic, or potentially pathogenic, and the remainder are saprophytic soil forms. Many organisms historically called Bacillus are now classified in other genera. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of
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abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coitus: Sexual connection per vaginam between male and female. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constitutional: 1. affecting the whole constitution of the body; not local. 2. pertaining to the constitution. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: The prevention of conception or impregnation. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Criterion: A standard by which something may be judged. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases,
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transferases, hydrolases, lyases, isomerases, and ligases. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Ficoll: A sucrose polymer of high molecular weight. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU]
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Haemopoietic: Haematopoietic; pertaining to or effecting the formation of blood cells. [EU] Hematuria: Presence of blood in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Monocytes:
Large, phagocytic mononuclear leukocytes produced in the
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vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycobacteriophages: Viruses whose host is one or more Mycobacterium species. They include both temperate and virulent types. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neurologic: Pertaining to neurology or to the nervous system. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical anti-inflammatory. It is also commonly used as an embedding material in histology. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Paratuberculosis: An infectious disease caused by mycobacterium paratuberculosis. Characteristics include chronic debilitation and weight loss. [NIH] Pathogen: Any disease-producing microorganism. [EU] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the
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plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Phagosomes: Membrane-bound cytoplasmic vesicles formed by invagination of phagocytized material. They fuse with lysosomes to form phagolysosomes in which the hydrolytic enzymes of the lysosome digest the phagocytized material. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] RANTES: A chemokine that is a chemoattractant for eosinophils, monocytes, and lymphocytes. It is a potent and selective eosinophil chemotaxin that is stored in and released from platelets and activated T-cells. [NIH]
Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH]
Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further
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necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]
Patents 141
CHAPTER 5. PATENTS ON TUBERCULOSIS Overview You can learn about innovations relating to tuberculosis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with tuberculosis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with tuberculosis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Tuberculosis By performing a patent search focusing on tuberculosis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on tuberculosis: ·
Mycrobacterial proteins, microorganisms producing same and uses of said proteins in vaccines and for detecting tuberculosis Inventor(s): Laqueyrerie; Anne (Paris, FR), Marchal; Gilles (Ivry sur Seine, FR), Pescher; Pascale (Paris, FR), Romain; Felix (Fontenay les Briis, FR) Assignee(s): Institut Pasteur (Paris, FR) Patent Number: 6,379,902 Date filed: August 1, 1997 Abstract: Mycobacterium tuberculosis protein having a molecular weight of 28 779 Da, and hybrid proteins containing at least portions of its sequence.These proteins may in particular be used in vaccines or for the detection of specific tuberculosis antibodies. Excerpt(s): It also relates to the use of these proteins in vaccines or for the detection of tuberculosis. ... At present, a definite diagnosis made by the demonstration of cultivatable bacilli in a sample taken from the patient is only obtained in less than half the cases of tuberculosis. Even for pulmonary tuberculosis, which represents 80 to 90% of the tuberculosis cases, and which is the form of the disease for which the detection of the bacilli is the easiest, the examination of expectorations is only positive for less than half the cases. ... The detection of specific antibodies directed against Mycobacterium tuberculosis should thus be of assistance in the diagnosis of the common forms of the disease for which the detection of the bacilli themselves is difficult or impossible. Web site: http://www.delphion.com/details?pn=US06379902__
Patents 143
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Nucleic acid encoding M. tuberculosis algu protein Inventor(s): Lam; Kelvin T. (Belmont, MA) Assignee(s): Anadys Pharmaceuticals, Inc. (Waltham, MA) Patent Number: 6,355,469 Date filed: January 16, 1998 Abstract: The invention relates to Mycobacterium tuberculosis RNA polymerase algU sigma subunit protein, DNA encoding, and methods of detecting inhibitors of the RNA polymerase. Excerpt(s): The disease caused by M. tuberculosis is a progressive, deadly illness that tends to develop slowly and follows a chronic course (Plorde, 1994). It is presently estimated that one-third of the world's population is infected with M. tuberculosis, 30 million of whom have active disease (Plorde, 1994). An additional 8 million people develop the disease annually (Plorde, 1994). Most infections are caused by inhalation of droplet nuclei carrying the mycobacterium. A single cough can generate 3000 infected droplet nuclei and even 10 bacilli may be sufficient to cause a pulmonary infection. In addition to the primary infection, reactivation of the disease can occur in older people and in immunocompromised patients. ... When intracellular pathogens, such as Mycobacterium tuberculosis, are ingested by macrophages the bacteria are under environmental stress. The genes required for survival following uptake by macrophages can provide insight into mycobacterial pathogenesis, and provide novel targets for developing antibacterial agents. The ability to adapt to the intracellular stress requires regulation of complex gene expression and this regulation may be mediated in part by one or more alternative sigma factors. Therefore stress response alternative sigma factors (sigE family) from M. tuberculosis are potential novel targets for antibacterial therapeutics. ... Rifampicin, a highly specific inhibitor of mycobacterium/RNA polymerase, is one of the primary drugs of choice for treatment of tuberculosis. Combination treatment with isoniazid is typical if there is no risk of developing multi-drug resistance. Prolonged treatment regimens are necessary and can take up to nine months. Failure to complete the prolonged treatment course is one of the contributing factors in the development of resistant bacterial strains. Rifabutin is an effective analog of rifampicin, but 70% of rifampicin-resistant strains are also rifabutin-resistant. Web site: http://www.delphion.com/details?pn=US06355469__
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M. tuberculosis RNA polymerase alpha subunit Inventor(s): Healy; Judith M. (Lexington, MA), Bodorova; Jana (Rockville, MA), Lam; Kelvin T. (Belmont, MA), Lesoon; Andrea J. (Cambridge, MA) Assignee(s): Anadys Pharmaceuticals, Inc. (Waltham, MA) Patent Number: 6,355,464 Date filed: January 26, 1999 Abstract: The present invention provides isolated nucleic acids encoding RNA polymerase alpha subunit from M. tuberculosis, vectors comprising the nucleic acids, cells comprising the vectors, and methods for producing M. tuberculosis alpha subunit. The invention also provides in vitro and in vivo methods for high-throughput screening to identify inhibitors of M. tuberculosis RNA polymerase. Excerpt(s): The present invention relates to novel nucleic acids encoding RNA polymerase alpha subunit from M. tuberculosis and methods for use thereof. ... The intracellular pathogen Mycobacterium tuberculosis is the causative agent of tuberculosis in humans and is responsible for millions of deaths worldwide each year (Bloom et al. Science 257:1055, 1992). The emergence of multidrug resistant forms of tuberculosis has mandated the development of new antibiotics effective against refractory M. tuberculosis strains. Novel drugs which, like rifampin (Vall-Spinosa et al., N. Eng. J. Med. 283: 616, 1970), may be capable of inhibiting the prokaryotic transciptional machinery, could contribute significantly to the development of therapies to combat M. tuberculosis. ... Discovery of inhibitors of M. tuberculosis RNA polymerase is hampered by a lack of information concerning components of the M. tuberculosis transcriptional apparatus, difficulties in obtaining sufficient yields of active enzymes for biochemical studies, and biosafety concerns. Establishment of an in vitro transcription system employing purified and reconstituted RNA polymerase would greatly advance efforts to identify new therapeutic agents active against tuberculosis. Web site: http://www.delphion.com/details?pn=US06355464__
Patents 145
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Compositions and methods for the prevention and treatment of M. tuberculosis infection Inventor(s): Reed; Steven G. (Bellevue, WA), Skeiky; Yasir A. W. (Seattle, WA), Dillon; Davin C. (Redmond, WA) Assignee(s): Corixa Corporation (Seattle, WA) Patent Number: 6,350,456 Date filed: April 7, 1998 Abstract: Compositions and methods for treatment and vaccination against tuberculosis are disclosed. In one aspect the compositions provided include at least two polypeptides that contain an immunogenic portion of a M. tuberculosis antigen or at least two DNA molecules encoding such polypeptides. In a second aspect, the compositions provided include a fusion protein comprising at least two polypeptides that contain an immunogenic portion of a M. tuberculosis antigen. Such compositions may be formulated into vaccines and/or pharmaceutical compositions for immunization against M. tuberculosis infection, or may be used for the diagnosis of tuberculosis. Excerpt(s): The present invention relates generally to compositions for the prevention and treatment of tuberculosis. The invention is more particularly related to compositions comprising at least two Mycobacterium tuberculosis antigens, and the use of such compositions for treating and vaccinating against Mycobacterium tuberculosis infection. ... Tuberculosis is a chronic, infectious disease, that is generally caused by infection with Mycobacterium tuberculosis. It is a major disease in developing countries, as well as an increasing problem in developed areas of the world, with about 8 million new cases and 3 million deaths each year. Although the infection may be asymptomatic for a considerable period of time, the disease is most commonly manifested as an acute inflammation of the lungs, resulting in fever and a nonproductive cough. If left untreated, serious complications and death typically result. ... Although tuberculosis can generally be controlled using extended antibiotic therapy, such treatment is not sufficient to prevent the spread of the disease. Infected individuals may be asymptomatic, but contagious, for some time. In addition, although compliance with the treatment regimen is critical, patient behavior is difficult to monitor. Some patients do not complete the course of treatment, which can lead to ineffective treatment and the development of drug resistance. Web site: http://www.delphion.com/details?pn=US06350456__
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DNA sequences for strain analysis in Mycobacterium tuberculosis Inventor(s): Fleischmann; Robert David (Gaithersburg, MD), White; Owen Richardson (Rockville, MD), Fraser; Claire Marie (Potomac, MD), Venter; John Craig (Potomac, MD) Assignee(s): The Institute for Genomic Research (Rockville, MD) Patent Number: 6,294,328 Date filed: June 24, 1998 Abstract: The present invention is directed to novel methodology whereby different populations of the tuberculosis bacterial pathogen, Mycobacterium tuberculosis, or related Mycobacteria, can be genetically classified in relation to other isolates. Sites in the genome of Mycobacterium, which define previously unrecognized points of variability, are disclosed. The existence of this variability is of use to the clinician in order to consistently determine the identity of isolates of Mycobacterium responsible for individual cases of disease or disease outbreaks, thus suggesting appropriate choices for treatment protocols. Excerpt(s): The present invention is directed to novel methodology, and DNA sequence libraries that result therefrom, whereby different strains of the tuberculosis bacterial pathogen, Mycobacterium tuberculosis, can be definitively identified, based upon the identification of differences in their respective DNA sequences. The invention has valuable application in the fields of tuberculosis genetics, epidemiology, patient treatment, and epidemic monitoring. ... Although certain chemotherapy and vaccine protocols have become available for he treatment of tuberculosis, the disease continues to claim more lives per year than any other infectious disease (see S. Cole et al., Nature, 393, pp.537-544, 1998). In fact, despite the widespread availablity of health measures in the industrialized world, the incidence of tuberculosis has been spreading in both the industrialized and developing nations. This increased incidence is of particular concern in view of the emergence of novel drug-resistant strains, and the strong presence of the disease in HIV-afflicted patients. ... It has been the recognized understanding in the art (see S. Cole et al., and S. Sreevatsan et al., Proc. Natl. Acad. Sci, USA, 94, pp.9869-9874, 1997) that M. tuberculosis is a member of a complex of closely related species. The complex is understood to substantially lack interstrain genetic diversity, nucleotide changes being very rare. It has thus been the perception that both vaccine development and strain characterization would continue to be difficult, given that most proteins were expected to be identical between strains. Web site: http://www.delphion.com/details?pn=US06294328__
Patents 147
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Molecular differences between species of the M. tuberculosis complex Inventor(s): Behr; Marcel (Montreal, CA), Small; Peter (Stanford, CA), Schoolnik; Gary (Stanford, CA), Wilson; Michael A. (Stanford, CA) Assignee(s): The Board of Trustees of the Leland Stanford Junior University (Palo Alto, CA) Patent Number: 6,291,190 Date filed: May 25, 1999 Abstract: Specific genetic deletions are identified in mycobacteria isolates, including variations in the M. tuberculosis genome sequence between isolates, and numerous deletion present in BCG as compared to M. tb. These deletions are used as markers to distinguish between pathogenic and avirulent strains, and as a marker for particular M. tb isolates. Deletions specific to vaccine strains of BCG are useful in determining whether a positive tuberculin skin test is indicative of actual tuberculosis infection. The deleted sequences may be re-introduced into BCG to improve the efficacy of vaccination. Alternatively, the genetic sequence that corresponds to the deletion(s) are deleted from M. bovis or M. tuberculosis to attenuate the pathogenic bacteria. Excerpt(s): Tuberculosis is an ancient human scourge that continues to be an important public health problem worldwide. It is an ongoing epidemic of staggering proportions. Approximately one in every three people in the world is infected with Mycobacterium tuberculosis, and has a 10% lifetime risk of progressing from infection to clinical disease. Although tuberculosis can be treated, an estimated 2.9 million people died from the disease last year. ... There are significant problems with a reliance on drug treatment to control active M. tuberculosis infections. Most of the regions having high infection rates are less developed countries, which suffer from a lack of easily accessible health services, diagnostic facilities and suitable antibiotics against M. tuberculosis. Even where these are available, patient compliance is often poor because of the lengthy regimen required for complete treatment, and multidrugresistant strains are increasingly common. ... Prevention of infection would circumvent the problems of treatment, and so vaccination against tuberculosis is widely performed in endemic regions. Around 100 million people a year are vaccinated with live bacillus Calmette-Guerin (BCG) vaccine. BCG has the great advantage of being inexpensive and easily administered under less than optimal circumstances, with few adverse reactions. Unfortunately, the vaccine is widely variable in its efficacy, providing anywhere from 0 to 80% protection against infection with M. tuberculosis.
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Web site: http://www.delphion.com/details?pn=US06291190__ ·
Compounds and methods for immunotherapy and diagnosis of tuberculosis Inventor(s): Reed; Steven G. (Bellevue, WA), Skeiky; Yasir A. W. (Seattle, WA), Dillon; Davin C. (Redmond, WA), Campos-Neto; Antonio (Bainbridge Island, WA), Houghton; Raymond (Bothell, WA), Vedvick; Thomas S. (Federal Way, WA), Twardzik; Daniel R. (Bainbridge Island, WA) Assignee(s): Corixa Corporation (Seattle, WA) Patent Number: 6,290,969 Date filed: March 13, 1997 Abstract: Compounds and methods for inducing protective immunity against tuberculosis are disclosed. The compounds provided include polypeptides that contain at least one immunogenic portion of one or more M. tuberculosis proteins and DNA molecules encoding such polypeptides. Such compounds may be formulated into vaccines and/or pharmaceutical compositions for immunization against M. tuberculosis infection, or may be used for the diagnosis of tuberculosis. Excerpt(s): The present invention relates generally to detecting, treating and preventing Mycobacterium tuberculosis infection. The invention is more particularly related to polypeptides comprising a Mycobacterium tuberculosis antigen, or a portion or other variant thereof, and the use of such polypeptides for diagnosing and vaccinating against Mycobacterium tuberculosis infection. ... Tuberculosis is a chronic, infectious disease, that is generally caused by infection with Mycobacterium tuberculosis. It is a major disease in developing countries, as well as an increasing problem in developed areas of the world, with about 8 million new cases and 3 million deaths each year. Although the infection may be asymptomatic for a considerable period of time, the disease is most commonly manifested as an acute inflammation of the lungs, resulting in fever and a nonproductive cough. If left untreated, serious complications and death typically result. ... Although tuberculosis can generally be controlled using extended antibiotic therapy, such treatment is not sufficient to prevent the spread of the disease. Infected individuals may be asymptomatic, but contagious, for some time. In addition, although compliance with the treatment regimen is critical, patient behavior is difficult to monitor. Some patients do not complete the course of treatment, which can lead to ineffective treatment and the development of drug resistance.
Patents 149
Web site: http://www.delphion.com/details?pn=US06290969__ ·
Carbohydrate complex extracted from Mycobacterium tuberculosis and process for the preparation thereof Inventor(s): Chung; Tai-Ho (Cheongun Apt. 7-309, #111-1, Daebongdong, Jung-gu, Daegu, KR), Chung; Chong-Chan (Garden Heights 1st. 101-601, #300, Bumeo 4-dong, Suaeong-gu, Daegu, KR) Assignee(s): none reported Patent Number: 6,274,356 Date filed: December 9, 1999 Abstract: A carbohydrate complex, which is a mixture of low molecularweight polysaccharides of an arabinomannan structure extracted from Mycobacterium tuberculosis, is highly effective in treating various cancer patients without incurring any adverse side effects. Excerpt(s): The present invention relates to a carbohydrate complex extracted from Mycobacterium tuberculosis, which has an anticancer activity, and to a process for the preparation thereof. ... It is generally known that the anticancer activity of Mycobacterium tuberculosis is attributable to active agents in the cytoplasmic membrane thereof, particularly the polysaccharide and lipid derivatives. ... For instance, Azuma et al. succeeded in isolating N-acetylmuramyl-L-alanyl-Disoglutamin(MDP) which is an active component of M. tuberculosis [Azuma, L. et al., J. Bact., 96, 1885-1887(1968)]. Web site: http://www.delphion.com/details?pn=US06274356__
·
Mycobacterium tuberculosis immunostimulatory peptides
DNA
sequences
encoding
Inventor(s): Nano; Francis E. (Victoria, CA) Assignee(s): University of Victoria Innovation and Development Corp. (Victoria, CA) Patent Number: 6,228,371 Date filed: December 15, 1997 Abstract: Nucleotide sequences isolated from Mycobacterium tuberculosis are disclosed. These sequences are shown to encode immunostimulatory peptides. The invention encompasses, among other things, vaccine preparations formulated using these peptides.
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Excerpt(s): Over the past few years the editors of the Morbidity and Mortality Weekly Report have chronicled the unexpected rise in tuberculosis cases. It has been estimated that worldwide there are one billion people infected with M. tuberculosis, with 7.5 million active cases of tuberculosis. Even in the United States, tuberculosis continues to be a major problem especially among the homeless, Native Americans, African-Americans, immigrants, and the elderly. HIV-infected individuals represent the newest group to be affected by tuberculosis. Of the 88 million new cases of tuberculosis expected in this decade approximately 10% will be attributable to HIV infection. ... The emergence of multi-dug resistant strains of M. tuberculosis has complicated matters further and even raises the possibility of a new tuberculosis epidemic. In the U.S. about 14% of M. tuberculosis isolates are resistant to at least one drug, and approximately 3% are resistant to at least two drugs. M. tuberculosis strains have even been isolated that are resistant to all seven drugs in the repertoire of drugs commonly used to combat tuberculosis. Resistant strains make treatment of tuberculosis extremely difficult: for example, infection with M. tuberculosis strains resistant to isoniazid and rifampin leads to mortality rates of approximately 90% among HIV-infected individuals. The mean time to death after diagnosis in this population is 4-16 weeks. One study reported that of nine immunocompetent health care workers and prison guards infected with drug resistant M. tuberculosis, five died. The expected mortality rate for infection with drug sensitive M. tuberculosis is 0%. ... Infection with M. tuberculosis can take on many manifestations. The growth in the body of M. tuberculosis and the pathology that it induces is largely dependent on the type and vigor of the immune response. From mouse genetic studies it is known that innate properties of the macrophage play a large role in containing disease (1). Initial control of M. tuberculosis may also be influenced by reactive .gamma..delta. T cells. However, the major immune response responsible for containment of M. tuberculosis is via helper T cells (Th1) and to a lesser extent cytotoxic T cells (2). Evidence suggests that there is very little role for the humoral response. The ratio of responding Th1 to Th2 cells has been proposed to be involved in the phenomenon of suppression. Web site: http://www.delphion.com/details?pn=US06228371__
Patents 151
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Antibodies Which Bind Mycobacterial Tuberculosis Proteins Inventor(s): Laqueyrerie; Anne (Paris, FR), Marchal; Gilles (Ivry Sur Seine, FR), Pescher; Pascale (Paris, FR), Romain; Felix (Fontenay les Briis, FR) Assignee(s): Institut Pastuer (Paris, FR) Patent Number: 6,221,353 Date filed: August 11, 1998 Abstract: Antibodies that bind Mycobacterium tuberculosis 28 kDa proteins and immune complexes between the antibodies and proteins. Excerpt(s): It also relates to the use of these proteins in vaccines or for the detection of tuberculosis. ... At present, a definite diagnosis made by the demonstration of cultivatable bacilli in a sample taken from the patient is only obtained in less than half the cases of tuberculosis. Even for pulmonary tuberculosis, which represents 80 to 90% of the tuberculosis cases, and which is the form of the disease for which the detection of the bacilli is the easiest, the examination of expectorations is only positive for less than half the cases. ... The detection of specific antibodies directed against Mycobacterium tuberculosis should thus be of assistance in the diagnosis of the common forms of the disease for which the detection of the bacilli themselves is difficult or impossible. Web site: http://www.delphion.com/details?pn=US06221353__
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Desaturase antigen of Mycobacterium tuberculosis Inventor(s): Jackson; Mary (Paris, FR), Gicquel; Brigitte (Paris, FR) Assignee(s): Institut Pasteur (FR) Patent Number: 6,204,038 Date filed: October 22, 1999 Abstract: The present invention relates to the isolation of a new gene, des, which encodes a M. tuberculosis protein named DES. The des gene appears to be conserved among different Mycobacteria species. The amino acid sequence of the DES protein contains two sets of motifs that are characteristic of the active sites of enzymes from the class II diironoxo protein family. Among this family of proteins, DES shares significant homology with soluble stearoyl-ACP desaturases. DES is a highly antigenic protein, which is recognized by human sera from patients infected with M. tuberculosis and M. leprae but not by sera from
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tuberculous cattle. Thus, the DES protein provides a useful tool for the serodiagnostic analysis of tuberculosis. Excerpt(s): Tuberculosis and leprosy, caused by the bacilli from the Mycobacterium tuberculosis complex and M. leprae respectively are the two major mycobacterial diseases. Pathogenic mycobacteria have the ability to survive within host phagocytic cells. From the interactions between the host and the bacteria results the pathology of the tuberculosis infection through the damages the host immune response causes on tissues (Andersen & Brennan, 1994). Alternatively, the protection of the host is also dependent on its interactions with mycobacteria. ... Through the years, various strategies have been followed for identifying mycobacterial antigens. Biochemical tools for fractionating and analysing bacterial proteins permitted the isolation of antigenic proteins selected on their capacity to elicit B or T cell responses (Romain et al., 1993; Sorensen et al., 1995). The recent development of molecular genetic methods for mycobacteria (Jacobs et al., 1991; Snapper et al., 1990; Hatful, 1993; Young et al., 1985) allowed the construction of DNA expression libraries of both M. tuberculosis and M. leprae in the .lambda.gtl1 vector and their expression in E. coli. The screening of these recombinant libraries using murine polyclonal or monoclonal antibodies and patient sera led to the identification of numerous antigens (Braibant et al., 1994; Hermans et al., 1995; Thole & van der Zee, 1990). However, most of them turned out to belong to the group of highly conserved heat shock proteins (Thole & van der Zee, 1990; Young et al., 1990). ... The observation in animal models that specific protection against tuberculosis was conferred only by administration of live BCG vaccine, suggested that mycobacterial secreted proteins might play a major role in inducing protective immunity. These proteins were shown to induce cell mediated immune responses and protective immunity in guinea pig or mice model of tuberculosis (Pal & Horwitz, 1992; Andersen, 1994; Haslov et al., 1995). Recently, a genetic methodology for the identification of exported proteins based on PhoA gene fusions was adapted to mycobacteria by Lim et al. (1995). It permitted the isolation of M. tuberculosis DNA fragments encoding exported proteins. Among them, the already known 19 kDa lipoprotein (Lee et al., 1992) and the ERP protein similar to the M. leprae 28 kDa antigen (Berthet et al., 1995). Web site: http://www.delphion.com/details?pn=US06204038__
Patents 153
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DNA molecule conferring on Mycobacterium tuberculosis resistance against antimicrobial reactive oxygen and nitrogen intermediates Inventor(s): Riley; Lee W. (Berkeley, CA), Nathan; Carl F. (Larchmont, NY), Ehrt; Sabine (Berkeley, CA) Assignee(s): Cornell Research Foundation, Inc. (Ithaca, NY) Patent Number: 6,177,086 Date filed: April 28, 1998 Abstract: The present invention relates to a DNA molecule conferring on Mycobacterium tuberculosis resistance to antimicrobial reactive oxygen intermediates and reactive nitrogen intermediates. The protein encoded by this DNA molecule is useful in vaccines to prevent invention by Mycobacterium tuberculosis, while the antibodies raised against this protein can be employed in passively immunizing those already infected by the organism. Both these proteins and antibodies may be utilized in diagnostic assays to detect Mycobacterium tuberculosis in tissue or bodily fluids. The protein or polypeptide is also useful as a therapeutic in treating conditions mediated by the production of reactive oxygen intermediates and nitrogen intermediates. Excerpt(s): The present invention relates to a DNA molecule conferring on Mycobacterium tuberculosis resistance against antimicrobial reactive oxygen and nitrogen intermediates and its use in drugs, vaccines, and diagnostic tests. ... Tuberculosis is the leading cause of death in the world with an estimated 9 million new cases of tuberculosis and 2.9 million deaths occurring from the disease each year. In the United States, the steadily declining incidents of tuberculosis has been reversed since 1985. This problem is compounded by the increasing incidence of drugresistant strains of Mycobacterium tuberculosis. ... Recent outbreaks of tuberculosis have involved settings in which a large number of HIVinfected persons resided in close proximity (e.g., AIDS wards in hospitals, correctional facilities, and hospices). Transmission of tuberculosis to health care workers occurred in these outbreaks; 18 to 50% of such workers showed a conversion in their skin tests. See F. Laraque et. al., "Tuberculosis in HIV-Infected Patients," The AIDS Reader (September/October 1992), which is hereby incorporated by reference. Web site: http://www.delphion.com/details?pn=US06177086__
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Diagnostic skin test for tuberculosis Inventor(s): Hasl.o slashed.v; Kaare (S.o slashed.borg, DK), Andersen; .ANG.se Bengaard (Br.o slashed.nsh.o slashed.j, DK), Oettinger; Thomas (Hellerup, DK) Assignee(s): Statens Seruminstitut (Copenhagen, DK) Patent Number: 6,120,776 Date filed: February 12, 1996 Abstract: Diagnostic methods capable of discriminating between cell mediated immunologic responses due to on the one hand active tuberculosis caused by bacteria belonging to the tuberculosis complex (Mycobacterium tuberculosis, Mycobacterium africanum and Mycobacterium bovis) and on the other hand vaccination with an immunogenic agent conferring immunity to tuberculosis. A diagnostic kit is also provided, comprising a polypeptide (e.g. MPT64) capable of eliciting a delayed type hypersensitivity reaction (Dth) in animals with active tuberculosis, but not in animals vaccinated against TB with an immunogenic agent (e.g. M. bovis BCG strain: Danish 1331). Also provided are polypeptide fragments comprising a T-cell epitope of MPT64 as well as nucleic acid fragments encoding these polypeptide fragments. Excerpt(s): The present invention relates to a kit comprising as one part of the kit a vaccine containing as the effective component an immunogenic agent (e.g. mycobacteria from the BCG strain: Danish 1331) capable of conferring substantially increased immunity to tuberculosis, and as the other part of the kit at least one diagnostic skin test comprising a pharmaceutical composition containing a polypeptide with which lymphoid cells previously primed with mycobacteria belonging to the tuberculosis-complex are capable of reacting and with which lymphoid cells previously primed with the immunogenic agent are not capable of reacting, or a variant which is immunologically equivalent to the polypeptide, as well as a method of diagnosing tuberculosis caused by Mycobacterium tuberculosis, Mycobacterium africanum or Mycobacterium bovis in a person, comprising intradermally injecting, in the person, the skin test, a positive skin response at the location of injection being indicative of the person having or having had tuberculosis, and a negative skin response at the location of injection being indicative of the person not having or not having had tuberculosis, the polypeptide preferably being MPT64 or an immunologically equivalent variant, analogue or subsequence thereof. The invention further relates to a pharmaceutical composition comprising the polypeptide, a DNA fragment encoding a polypeptide which is an
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immunological equivalent to MPT64, the polypeptide which is an immunological equivalent to MPT64, as well as a method for vaccinating one or more persons in a population and subsequently subjecting the population to a diagnostic test for tuberculosis by the method described above. ... Tuberculosis remains a major world health problem. In fact, the incidence is increasing in both the so-called developing part of the world as well as in industrialized countries like the United States of America. Recently, tuberculosis was ranked by the World Health Organization as the most frequent cause of death ascribable to a single infectious agent (Memorandum from a WHO meeting: Tuberculosis control and research strategies for the 1990s. Bulletin of the World Health Organization 70:1721, 1992). ... The means to effectively intervene transmission and thereby ultimately to get the disease under control are based on early diagnosis and treatment combined with vaccination of the populations at risk. The currently available anti-tuberculosis vaccine was developed in the beginning of this century by Calmette and Guerin and is often referred to as "the Bacille Calmette et Guerin (BCG)". The vaccine strain evolved after serial passages of a virulent isolate of M. bovis on a bile containing growth medium. The resultant strain appeared to be avirulent for humans. The nature of the loss of virulence is still not clearly understood at the molecular level. However, the BCG vaccine is estimated to be the most widely used live vaccine in the world and the remarkable low number of serious complications observed as a consequence of the use of BCG clearly demonstrate that the strain is fully attenuated (Lotte et al., Adv. Tuberc. Res. 21, 107-193 (1984)). When the reports of the first successful vaccinations were published, several laboratories and vaccine producers around the world requested the strain from Calmette and Guerin and the strain was subcultured locally under conditions which varied from one laboratory to another. This is the historical background for the occurrence of several substrains of BCG. Modern BCG producers make use of freeze-lot systems which ensure that the genetic composition of the bacteria--the product--has been conserved. Despite the widely accepted use of the BCG vaccine in many countries some countries never introduced it for use in general population vaccination programmes. This is the case in e.g. USA and Belgium. One of the reasons for these countries to be reluctant is that vaccination with BCG interferes with the use of tuberculin skin testings for diagnosing tuberculosis and for use in population surveys. Web site: http://www.delphion.com/details?pn=US06120776__
156 Tuberculosis
Patent Applications on Tuberculosis As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to tuberculosis: ·
Nucleic acid fragments and polypeptide fragments derived from M. tuberculosis Inventor(s): Andersen, Peter; (Bronshoj, DK), (Frederiksberg C, DK), Oettinger, Thomas; (Hellerup, Peter Birk; (Kobenhaven O, DK), Rosenkrands, Ida ; DK), Weldingh, Karin; (Kobenhaven N, DK), (Frederiksberg C, DK)
Nielsen, Rikke; DK), Rasmussen, (Kobenhaven O, Florio, Walter;
Correspondence: Frommer Lawrence & Haug LLP; 745 Fifth Avenue; New York; NY; 10151; US Patent Application Number: 20020094336 Date filed: February 20, 2001 Abstract: The present invention is based on the identification and characterization of a number of M. tuberculosis derived novel proteins and protein fragments (SEQ ID NOs: 2, 4, 6, 8, 10, 12, 14, 16, 17-23, 42, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72-86, 88, 90, 92, 94, 141, 143, 145, 147, 149, 151, 153, and 168-171). The invention is directed to the polypeptides and immunologically active fragments thereof, the genes encoding them, immunological compositions such as vaccines and skin test reagents containing the polypeptides. Another part of the invention is based on the surprising discovery that fusions between ESAT-6 and MPT59 are superior immunogens compared to each of the unfused proteins, respectively. Excerpt(s): The present invention relates to a number of immunologically active, novel polypeptide fragments derived from the Mycobacterium tuberculosis, vaccines and other immunologic compositions containing the fragments as immunogenic components, and methods of production and use of the polypeptides. The invention also relates to novel nucleic acid fragments derived from M. tuberculosis which are useful in the preparation of the polypeptide fragments of the invention or in the diagnosis of infection with M. tuberculosis. The invention further relates to certain fusion polypeptides, notably fusions between ESAT-6 and MPT59. ... Human tuberculosis (hereinafter designated "TB") caused by 24
This has been a common practice outside the United States prior to December 2000.
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Mycobacterium tuberculosis is a severe global health problem responsible for approximately 3 million deaths annually, according to the WHO. The worldwide incidence of new TB cases has been progressively falling for the last decade but the recent years has markedly changed this trend due to the advent of AIDS and the appearance of multidrug resistant strains of M. tuberculosis. ... Immunity to M. tuberculosis is characterized by three basic features; i) Living bacilli efficiently induces a protective immune response in contrast to killed preparations; ii) Specifically sensitized T lymphocytes mediate this protection; iii) The most important mediator molecule seems to be interferon gamma (INF.gamma.). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Recombination M. Tuberculosis Mycobacterium Auxotrophic for Leucine and Vaccines using Same Inventor(s): Hondalus, Mary K. ; (Northborough, MA), Bloom, Barry R. ; (Hastings on Hudson, NY), Jacobs, William R. JR. ; (City Island, NY) Correspondence: Craige J Arnold; Amster Rothstein & Ebenstein; 90 Park Avenue; New York; NY; 10016 Patent Application Number: 20020068067 Date filed: July 8, 1999 Abstract: The present invention provides a recombinant M. tuberculosis mycobacterium that is auxotrophic for leucine. The present invention also provides a vaccine comprising a recombinant M. tuberculosis mycobacterium that is auxotrophic for leucine, as well as a method for treating or preventing tuberculosis in a subject comprising administering to the subject a recombinant M. tuberculosis mycobacterium that is auxotrophic for leucine in an amount effective to treat or prevent tuberculosis in the subject. Excerpt(s): Approximately one third of the world's population is infected with Mycobacterium tuberculosis (MTB), the causative agent of human tuberculosis (TB). MTB is responsible for 2-3 million deaths annually, giving it the dubious distinction of being the leading cause of death due to a single infectious agent. In addition, TB ranks seventh in causes of global mortality and disability, and if current predictions prove correct, it will remain among the top 10 causes of disease, well into the next century (Murray and Lopez, Lancet, 349:1498-1504 (1997)). Directly observed treatment, short-course (DOTS) is the tactic proposed by the World Health Organization (WHO) to control the global TB crisis (Murray and Solomon, PNAS USA, 95:13881-13886 (1998)). DOTS has proven to be an
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effective strategy in several national TB control programs, with cure rates approaching 90% (Lancet, 347:358-362 (1996)). However, since global implementation of DOTS programs is occurring at a slow-moving pace, it is likely that additional measures will be needed to stem the tide of TB mortality. It has been estimated that the introduction of a new vaccine of only 50% efficacy could decrease the incidence of TB by 36 million cases, saving 9 million lives (Murray and Salomon, 1998). Thus, by coupling efficacious vaccination with effective treatment, greater success in global TB management would be anticipated. ... Bacille Calmette-Guerin (BCG), an attenuated strain of M. bovis, is the currently available vaccine for the prevention of tuberculosis. It was created empirically by repeated passage in the laboratory, and for reasons that are as yet undefined, it is avirulent in immunocompetent hosts. In several animal models of infection, BCG has been demonstrated to induce protective immunity against MTB. Since its implementation in 1928 as a TB vaccine, more doses of BCG have been administered than any other vaccine, as an estimated 3 billion people have received BCG vaccination for the prevention of tuberculosis. Although the use of BCG is unquestionably safe in immunocompetent individuals, it has shown itself to be of variable efficacy. While in certain populations, vaccination with BCG has been highly effective in preventing tuberculosis, in others it has failed miserably. In the largest clinical trial that took place in India involving more that 100,000 persons, BCG exhibited a calculated protective efficacy of zero. Thus, the generation of an improved vaccine(s) to replace BCG and to prevent tuberculosis is urgently needed. ... Relative to wildtype M. tuberculosis, 15-16 regions of the MTB genome are not represented in BCG. Eleven of these segments cannot be found even in virulent strains of M. bovis; of the remaining 5, 4 are missing from all BCG strains examined. It is probable that one or more of the 38 open reading frames (ORFs) specifically missing from BCG are required for virulence. Of interest, is the finding that a number of predicted transcriptional regulators identified by the H37Rv genome sequencing project (Cole, et al., Nature, 393:537-544 (1998)) would be located in these BCG deletions. The loss of a regulatory protein would be expected to affect multiple genetic loci and could lead to deranged gene expression in vivo. Consistent with this hypothesis, is the demonstration that reintroduction of one of these deleted regions into BCG results in the repression of at least 10 proteins and the upregulated expression of others. It is conceivable that potentially immunogenic and immunoprotective antigens might be missing from or inappropriately expressed in BCG, and therefore, compromising the immune response generated from this vaccine. For example, it has been noted that the gene for ESAT 6, a highly immunogenic, secreted protein of M. tuberculosis, is located within one
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of these deleted chromosomal regions. It has demonstrated that protective immunity against experimental tuberculosis can be provided by prior immunization with supernatants containing a mixture of MTB secreted antigens, of which ESAT 6 is one. It is possible, that if one or more of the proteins encoded within the deleted regions were present at vaccination, the immune response elicited might be more efficacious. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Mycobacterium tuberculosis CYP51 polypeptides and nucleic acids and therapeutic and screening methods relating to same Inventor(s): Waterman, Michael R. ; (Nashville, TN), Bellamine, Aouatef ; (Nashville, TN) Correspondence: Jenkins & Wilson, PA; 3100 Tower Blvd; Suite 1400; Durham; NC; 27707; US Patent Application Number: 20020052031 Date filed: July 20, 2001 Abstract: A cytochrome p450 14.alpha.-demethylase enzyme isolated from Mycobacterium tuberculosis designated as MT CYP51. A crystalline form of MT CYP51 is also disclosed. Nucleic acid molecules encoding MT CYP51 are also disclosed. Recombinant host cells, recombinant nucleic acids and recombinant proteins are also disclosed, along with methods of producing each. Isolated and purified antibodies to MT CYP51, and methods of producing the same, are also disclosed. MT CYP51 is characterized as having 14.alpha.-demethylase biological activity. Thus, therapeutic and drug screening methods pertaining to this activity are also disclosed. Excerpt(s): The present invention relates generally to isolated and purified polypeptides and to isolated and purified nucleic acids encoding such polypeptides. More particularly, the present invention relates to isolated and purified Mycobacterium tuberculosis CYP51 polypeptides and isolated and purified nucleic acid molecules encoding the same. ... The present invention contemplates an isolated and purified Mycobacterium tuberculosis (MT) cytochrome P450 14.alpha.demethylase (MT P45014DM or MT CYP51) polypeptide. Preferably, the polypeptide is biologically active. More preferably, a polypeptide of the invention is a recombinant polypeptide. Even more preferably, a polypeptide of the present invention comprises the amino acid residue sequence of any of SEQ ID NO's:2, 4, 6, 8 and 10. ... As used herein, the term "DNA segment" refers to a DNA molecule which has been isolated free of total genomic DNA of a particular species. Furthermore, a DNA
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segment encoding a MT CYP51 refers to a DNA segment which contains MT CYP51 coding sequences, yet is isolated away from, or purified free from, total genomic DNA of Mycobacterium tuberculosis. Included within the term "DNA segment" are DNA segments and smaller fragments of such segments, and also recombinant vectors, including, for example, plasmids, cosmids, phages, viruses, and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Isolated and purified nonpeptide antigens from mycobacterium tuberculosis Inventor(s): Liu, Gui ; (Medford, MA), Beltz, Gerald ; (Lexington, MA), LeClair, Kenneth ; (Needham, MA), Cox, Daniel ; (Medway, MA), Kensil, Charlotte ; (Milford, MA) Correspondence: Pennie and Edmonds; 1155 Avenue of the Americas; New York; NY; 100362711 Patent Application Number: 20020044951 Date filed: April 4, 2001 Abstract: Nonpeptide antigens were isolated and purified from Mycobacterium tuberculosis. The antigens were used in vaccine compositions, pharmaceutical compositions and methods to elicit an immune response to Mycobacterium tuberculosis in a mammal. Excerpt(s): The invention described herein is related to vaccine compositions that are used to elicit an immune response specific for Mycobacterium tuberculosis in a mammal, as well as methods to elicit the immune response specific for Mycobacterium tuberculosis. The invention also pertains to immunogenic or vaccine compositions comprising at least one nonpeptide antigen isolated from Mycobacterium tuberculosis, wherein the isolated nonpeptide antigen elicits a specific immune response against Mycobacterium tuberculosis, and may further comprise one or more T-cell stimulating compounds. Several inventive isolated and purified nonpeptide antigens from the mycobacteria Mycobacterium tuberculosis are described herein. ... Immunity from a bacterial pathogen may be mediated by a protein, but may also be mediated by a nonpeptide antigen such as a polysaccharide or a lipid. Some lipid, glycolipid, and phospholipid antigens have already been identified from various Mycobacterium species. These include mycolic acid, inositol-containing phospholipids (e.g., lipoarabinomannan (LAM) and phosphatidylinositol mannosides (PIMs)), and mycolyl glycolipids (e.g., glucose monomycolate (GMM)), all of which may be purified from mycobacterial cell walls (Beckman, et al., Nature 372:691 (1994); Sieling, et al., Science
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269:227 (1995); and Moody, et al., Science 278:283 (1997)). Some of these molecules share similar structural features consisting of a relatively hydrophilic polar head group linked to a single or dual branched hydrophobic acyl chain(s). It has been hypothesized that these molecules may be presented by the CD1 pathway of antigen presentation. A nonpeptide antigen (e.g., from bacteria or parasites) is ingested by an antigen presenting cell ("APC") (e.g., macrophage, B-cell or dendritic cell) and may then be presented in conjunction with a CD1 molecule, to thereby induce T-cell proliferation. (Porcelli, et al., Current Opinion in Immunology 8:510-516 (1996)). This pathway is referred to herein as the "CD1 antigen-presenting pathway." These lipid or nonpeptide antigens are processed independently from the major histocompatability complex ("MHC") peptide antigen-presenting pathway. The immune response that results from the CD1 antigen presenting pathway is referred to as a "CD1-restricted response." The immunologic role of CD1 presentation of hydrophobic nonpeptide antigens has been demonstrated in M. tuberculosis infection. The presentation of mycobacterial lipid and glycolipid antigens by CD1 molecules initiates an MHC-independent pathway of host defense against mycobacterial infection in vivo by both cytolytic- and cytokine-based mechanisms. Specifically, CD8.sup.+ or CD8.sup.-/CD4.sup.- (double negative) T-cells recognize nonpeptide microbial antigens when presented in the context of CD1 molecules. These CD1-restricted T-cells are cytolytic and kill mycobacterial infected monocytes (Stenger, et al., Science 276:1684 (1997)). CD8.sup.+, CD1restricted M. tuberculosis specific T-cell lines derived from the blood of human donors produce Th1-type cytokines, such as interferon, which may facilitate control of mycobacterial infections, and may play a role in clearing intracellular microbial infections. ... The results disclosed herein demonstrate compounds from M. tuberculosis that may be utilized as vaccine candidates. These compounds may be tested as vaccine candidates in a variety of ways. They may be tested for their potential to induce T-cell antigen-specific cytolytic or proliferative responses. They may also be tested for their potential to induce compound-specific antibodies. Moreover, the vaccine compositions described herein may be tested for reduction of colony counts in animals vaccinated with the novel M. tuberculosis compounds compared to negative control groups after a challenge with M. tuberculosis. The vaccines of the present invention may be used both prophylactictically as well as therapeutically. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Monoclonal Antibodies to Mycobacterium Tuberculosis and a Modified Elisa Assay Inventor(s): Glatman-Freedman, Aharona ; (Irvington, NY), Casadevall, Arturo ; (Pelham, NY) Correspondence: Amster Rothstein and Ebenstein; 90 Park Avenue; New York; NY; 10016 Patent Application Number: 20020034763 Date filed: June 4, 1997 Abstract: The present invention provides for monoclonal antibodies, the hybridoma cell lines which produce these antibodies, and the use of such monoclonal antibodies in the detection of M. tuberculosis. More specifically, the present invention provides for monoclonal antibodies that react with surface epitopes of M. tuberculosis and the use of these monoclonal antibodies for detecting and diagnosing M. tuberculosis. Also provided by the present invention is a modified ELISA assay for detection of microorganisms, and a modified ELISA assay employing the monoclonal antibodies of the present invention for detecting M. tuberculosis. Excerpt(s): Tuberculosis continues to be a major worldwide health problem and is responsible for most incidences of death by an infectious agent. The worldwide incidence of tuberculosis was estimated by the World Health Organization to be 8.8 million in 1995, with a mortality estimate of 3.0 million persons, and is expected to rise to 10.2 million by the year 2000 (Dolin, et al., Bull. WHO. 72: 213-220 (1994)). The tuberculosis problem has been compounded by the development of the AIDS epidemic and the growing number of HIV-related cases of tuberculosis (Dolin, et al., Bull. WHO. 72: 213-220 (1994)). ... As the incidence of tuberculosis increases, major problems also develop concerning this disease. For example, the lack of a sensitive and rapid laboratory method of diagnosing tuberculosis makes it difficult to differentiate between M. tuberculosis and M. avium-intracellulare, both of which are frequently present in HIV infected patients. Multiple methods of detection of M. tuberculosis employing polyclonal and monoclonal antibodies have been described (Cho, et al., Yonsei Med. J. 31:333-338 (1990); Cho, et al., J. Clin. Microbiol. 30: 3065-3069 (1992); Friedman, et al., Am. Rev. Respir. Dis. 140: 668-671 (1989); Kadival, et al., J. Clin. Microbiol. 23: 901-904 (1986); Mason, et al., Tubercle Lung Dis. 74:195-199 (1993); Papa, et al., Res. Microbiol. 143: 327-331 (1992); Sada, et al., Lancet 2 651-652 (1983); Schoningh, et al., J. Clin. Microbiol. 28: 708713 (1990); Verstijnen, et al., J. Clin. Microbiol. 29:1372-1375 (1991) Watt, et al., J Infect Dis. 158:681-686 (1988);, Wu, et al., Chin. J. Microbiol.
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Immunol. 22:173-180 (1989); Yanez, et al., Clin. Microbiol. 23: 822-825 (1986)), but none have acquired a widespread role in the diagnosis of tuberculosis as these antibodies cross-react with other mycobacterial strains (Cho, et al., Yonsei Med. J. 31:333-338 (1990); Friedman, et al., Am. Rev. Respir. Dis. 140:668 -671 (1989); Kadival, et al., J. Clin. Microbiol. 23: 901-904 (1986); Wu, et al., Chin. J. Microbiol. Immunol. 22:173-180 (1989); Yanez, et al., J. Clin. Microbiol. 23:822 -825 (1986)). In addition, in order to obtain significant results, a large amount of mycobacteria or mycobacterial antigen is required (Cho, et al., J. Clin. Microbiol. 30:3065 3069 (1992); Mason, et al., Tubercle Lung Dis. 74:195-199 (1993); Papa, et al., Res. Microbiol. 143: 327-331 (1992); Schoningh, et al., J. Clin. Microbiol. 28:708 -713 (1990); Verstijnen, et al., J. Clin. Microbiol. 29:13721375 (1991)). Improvements in antibody-based diagnostic tests for the detection of M. tuberculosis would require specific antibody reagents with high affinity for mycobacterial antigens. Several monoclonal antibodies have been generated against surface components of M. tuberculosis (Cho, et al., Yonsei Med. J. 31:333-338 (1990); Cho, et al., J. Clin. Microbiol. 30: 3065-3069 (1992); Mauch, et al., J. Clin. Microbiol. 26:1691-1694 (1988)) but they are often cross reactive with other strains or cytoplasmic fractions (Cho, et al., Yonsei Med. J. 31:333-338 (1990); Mauch, et al., J. Clin. Microbiol. 26:1691-1694 (1988)). There is thus a need for a monoclonal antibody that selectively binds to M. tuberculosis and does not cross react with other strains of mycobacteria. ... An additional problem concerns the protocol used for detecting M. tuberculosis. The protocols described thus far for detecting mycobacteria, such as direct ELISA (Mason, et al., Tubercle Lung Dis. 74:195-199 (1993); Schoningh, et al., J. Clin. Microbiol. 28: 708-713 (1990); Verstijnen, et al., J. Clin. Microbiol. 29:1372-1375 (1991)), capture ELISA (Cho, et al., Yonsei Med. J. 31:333-338 (1990); Cho, et al., J. Clin. Microbiol. 30: 3065-3069 (1992); Friedman, et al., Am. Rev. Respir. Dis. 140: 668-671 (1989); Kadival, et al., J. Clin. Microbiol. 23: 901-904 (1986); Rattan, et al., Tubercle Lung Dis. 74: 200-203 (1993); Sada, et al., Lancet 2 651-652 (1983); Watt, et al., J Infect Dis. 158:681-686 (1988); Wu, et al., Chin. J. Microbiol. Immunol. 22:173180 (1989); Yanez, et al., J. Clin. Microbiol. 23: 822-825 (1986)) and DOT ELISA (Cho, et al., J. Clin. Microbiol. 30: 3065-3069 (1992); Papa, et al., Res. Microbiol. 143: 327-331 (1992)), are deficient in many areas. For example, none of the methods listed above allow for visualization of single captured microorganisms. Furthermore, many of these methods require the use of polyclonal immunoglobulins which have the potential disadvantages of lot to lot variation, reliance on animal sources and unwanted cross-reactivities. Accordingly, there is an outstanding need for a method of detecting M. tuberculosis which eliminates the problems existing in current methods of detection.
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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Polynucleotide Tuberculosis Vaccine Inventor(s): Content, Jean ; (Rhode-Saint-Genese, BE), Huygen, Kris ; (Brussels, BE), Liu, Margaret A. ; (Rosemont, PA), Montgomery, Donna ; (Chalfont, PA), Ulmer, Jeffrey ; (Chalfont, PA) Correspondence: John W Wallen III; Merck & Co Inc; Patent Dept; P O Box 2000; Rahway; NJ; 070650907 Patent Application Number: 20020032162 Date filed: January 22, 1998 Abstract: Genes encoding Mycobacterium tuberculosis (M.tb) proteins were cloned into eukaryotic expression vectors to express the encoded proteins in mammalian muscle cells in vivo. Animals were immunized by injection of these DNA constructs, termed polynucleotide vaccines or PNV, into their muscles. Immune antisera was produced against M.tb antigens. Specific T-cell responses were detected in spleen cells of vaccinated mice and the profile of cytokine secretion in response to antigen 85 was indicative of a T.sub.h1 type of helper T-cell response (i.e., high IL-2 and IFN-.gamma.). Protective efficacy of an M.tb DNA vaccine was demonstrated in mice after challenge with M.bovis BCG, as measured by a reduction in mycobacterial multiplication in the spleens and lungs of M.tb DNA-vaccinated mice compared to control DNAvaccinated mice or primary infection in naive mice. Excerpt(s): M. tuberculosis is an intracellular pathogen that infects macrophages and is able to survive within the harsh environment of the phagolysosome in this type of cell. Most inhaled bacilli are destroyed by activated alveolar macrophages. However, the surviving bacilli can multiply in macrophages and be released upon cell death, which signals the infiltration of lymphocytes, monocytes and macrophages to the site. Lysis of the bacilli-laden macrophages is mediated by delayed-type hypersensitivity (DTH) and results in the development of a solid caseous tubercle surrounding the area of infected cells. Continued DTH causes the tubercle to liquefy, thereby releasing entrapped bacilli. The large dose of extracellular bacilli triggers further DTH, causing damage to the bronchi and dissemination by lymphatic, hematogenous and bronchial routes, and eventually allowing infectious bacilli to be spread by respiration. ... Immunity to TB involves several types of effector cells. Activation of macrophages by cytokines, such as interferon-.gamma., is an effective means of minimizing intracellular mycobacterial multiplication. However, complete eradication of the bacilli by this
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means is often not achieved. Acquisition of protection against TB requires T lymphocytes. Among these, both CD8.sup.+ and CD4.sup.+ T cells seem to be important [Orme et al, 1993, J. Infect. Dis. 167, 1481]. These cell types secrete interferon-.gamma. in response to mycobacteria, indicative of a T.sub.h1 immune response, and possess cytotoxic activity to mycobacteria-pulsed target cells. In recent studies using .beta.-2 microglobulin- and CD8-deficient mice, CTL responses have been shown to be critical in providing protection against M. tuberculosis [Flynn et al, 1992, Proc. Natl. Acad. Sci. USA 89, 12013; Flynn et al, 1993, J. Exp. Med. 178, 2249; Cooper et al, 1993, J. Exp. Med. 178, 2243]. In contrast, B lymphocytes do not seem to be involved, and passive transfer of antimycobacterial antibodies does not provide protection. Therefore, effective vaccines against TB must generate cell-mediated immune responses. ... Several potentially protective T cell antigens have been identified in M. tuberculosis and some of these are being investigated as vaccine targets. Recent work has indicated that the predominant T-cell antigens are those proteins that are secreted by mycobacteria during their residence in macrophages, such as: i) the antigen 85 complex of proteins (85A, 85B, 85C) [Wiker and Harboe, 1992, Microbiol. Rev. 56, 648], ii) a 6 kDa protein termed ESAT-6 [Andersen 1994, Infect. Immunity 62, 2536], iii) a 38 kDa lipoprotein with homology to PhoS [Young and Garbe, 1991, Res. Microbiol. 142, 55; Andersen, 1992, J. Infect. Dis. 166, 874], iv) the 65 kDa GroEL heat-shock protein [Siva and Lowrie, 1994, Immunol. 82, 244], v) a 55 kDa protein rich in proline and threonine [Romain et al, 1993, Proc. Natl. Acad. Sci. USA 90, 5322], and vi) a 19 kDa lipoprotein [Faith et al, 1991, Immunol. 74, 1]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Mycobacterium tuberculosis CYP51 high resolution structure, polypeptides and nucleic acids, and therapeutic and screening methods relating to same Inventor(s): Waterman, Michael R. ; (Nashville, TN), Bellamine, Aouatef ; (Nashville, TN), Podust, Larissa M. ; (Hermitage, TN) Correspondence: Jenkins & Wilson, PA; 3100 Tower Blvd; Suite 1400; Durham; NC; 27707; US Patent Application Number: 20020031782 Date filed: February 28, 2001 Abstract: A cytochrome P450 14.alpha.-demethylase enzyme isolated from Mycobacterium tuberculosis designated as MT CYP51. A crystalline form of MT CYP51 is also disclosed. Nucleic acid molecules encoding MT
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CYP51 are also disclosed. Recombinant host cells, recombinant nucleic acids and recombinant proteins are also disclosed, along with methods of producing each. Isolated and purified antibodies to MT CYP51, and methods of producing the same, are also disclosed. MT CYP51 is characterized as having 14.alpha.-demethylase biological activity. Thus, therapeutic and drug screening methods pertaining to this activity are also disclosed. Excerpt(s): The present invention relates generally to isolated and purified polypeptides, to isolated and purified nucleic acids encoding such polypeptides, and to high resolution x-ray structures of these polypeptides. More particularly, the present invention relates to isolated and purified Mycobacterium tuberculosis CYP51 polypeptides, to isolated and purified nucleic acid molecules encoding the same, and to high resolution x-ray structures of these polypeptides. ... The present invention also relates generally to the structure of Mycobacterium tuberculosis CYP51, and more particularly to the crystalline structure of Mycobacterium tuberculosis CYP51 complexed with 4-phenylimidazole and the crystalline structure of Mycobacterium tuberculosis CYP51 complexed with fluconazole. The invention further relates to methods by which modulators and ligands of Mycobacterium tuberculosis CYP51, can be identified. ... The present invention also relates generally to the structure of Mycobacterium tuberculosis CYP51, and more particularly to the crystalline structure of Mycobacterium tuberculosis CYP51 complexed with 4-phenylimidazole and the crystalline structure of Mycobacterium tuberculosis CYP51 complexed with fluconazole. The invention further relates to methods by which modulators and ligands of Mycobacterium tuberculosis CYP51, can be identified. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Fusion Proteins of Mycobacterium Tuberculosis Antigens and Their Uses Inventor(s): Reed, Steven G. ; (Bellevue, WA), Skeiky, Yasir a. ; (Seattle, WA), Dillon, Davin C. ; (Redmond, WA), Alderson, Mark ; (Bainbridge Island, WA), Campos-Neto, Antonio ; (Bainbridge, WA) Correspondence: Annette S. Parent; Townsend and Townsend and Crew Llp; Two Embarcadero Center; 8th Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20020009459 Date filed: April 7, 1999
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Abstract: The present invention relates to fusion proteins containing at least two Mycobacterium tuberculosis antigens. In particular, it relates to bi-fusion proteins which contain two individual M. tuberculosis antigens, tri-fusion proteins which contain three M. tuberculosis antigens, tetrafusion proteins which contain four M. tuberculosis antigens, and pentafusion proteins which contain five M. tuberculosis antigens, and methods for their use in the diagnosis, treatment and prevention of tuberculosis infection. Excerpt(s): The present invention relates to fusion proteins containing at least two Mycobacterium tuberculosis antigens. In particular, it relates to bi-fusion proteins which contain two individual M. tuberculosis antigens, tri-fusion proteins which contain three M. tuberculosis antigens, tetrafusion proteins which contain four M. tuberculosis antigens, and pentafusion proteins which contain five M. tuberculosis antigens, and methods for their use in the diagnosis, treatment and prevention of tuberculosis infection. ... Tuberculosis is a chronic infectious disease caused by infection with M. tuberculosis. It is a major disease in developing countries, as well as an increasing problem in developed areas of the world, with about 8 million new cases and 3 million deaths each year. Although the infection may be asymptomatic for a considerable period of time, the disease is most commonly manifested as an acute inflammation of the lungs, resulting in fever and a nonproductive cough. If untreated, serious complications and death typically result. ... Although tuberculosis can generally be controlled using extended antibiotic therapy, such treatment is not sufficient to prevent the spread of the disease. Infected individuals may be asymptomatic, but contagious, for some time. In addition, although compliance with the treatment regimen is critical, patient behavior is difficult to monitor. Some patients do not complete the course of treatment, which can lead to ineffective treatment and the development of drug resistance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Agar medium for the growth of Mycobacterium tuberculosis Inventor(s): Heifets, Leonid ; (Denver, CO), Sanchez, Tracy ; (Lafayette, CO) Correspondence: Angela Dallas-Pedretti; Sheridan Ross P.C.; 1560 Broadway, Suite 1200; Denver; CO; 80202-5141; US Patent Application Number: 20010055787 Date filed: March 20, 2001
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Abstract: A novel agar medium for the isolation, sub-cultivation, and indirect or direct drug-susceptibility testing of Mycobacterium tuberculosis is disclosed. Also disclosed are methods of isolating and growing Mycobacterium tuberculosis and methods of drug-resistance screening using the agar medium of the invention. Excerpt(s): This application claims the benefit of priority under 35 U.S.C. .sctn. 119(e) from U.S. Provisional Application Ser. No. 60/190,701, filed Mar. 20, 2000, and entitled "New Agar Medium For Mycobacterium tuberculosis". The entire disclosure of U.S. Provisional Application Ser. No. 60/190,701 is incorporated herein by reference. ... This invention relates to a novel agar medium for the isolation, sub-cultivation, and indirect or direct drug-susceptibility testing of Mycobacterium tuberculosis. The invention also relates to methods of isolating and growing Mycobacterium tuberculosis and to methods of drug-resistance screening using the agar medium of the invention. ... At first glance, it seems that nothing is new in the cultivation of Mycobacterium tuberculosis. The first attempts of M. tuberculosis cultivation on agar medium go back to the report by Fannie and Walter Hesse in 1881. In 1882, Robert Koch used blood serum coagulated on glass slides for M. tuberculosis cultivation. Apparently, he was not too much concerned about the biosafety of such a procedure. He later improved this method, which was called the "plate technique", by adding peptone, some salts and glycerol. Also, in 1882, Richard Petri invented the petri dish to be used instead of a glass slide. These attempts at cultivation on a transparent type of media were interrupted in 1903 with introduction of the first egg-based media by Dorset (Dorset, Science. 17:374, 1903), followed by a variety of egg-based media recipes (American Trudeau Society, Handbook of Tuberculosis Laboratory Methods, Washington, D.C., 1962; IUAT, Bull Int Union Tuberc Lung Dis. 24:78, 1954; Jensen, Abteilung Originale. 125:222-239, 1932; Ogawa et al., Kekkaku. 24:13-29, 1949; Petragnani, Bollettino dell'Istituto sieroterapico Milanese. 5:173185,1926; Petroff, J. Exp. Med. 21:38-42, 1915; Stonebrink, Acta Tuberc. Scand. 35:67-80, 1958). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Method for detecting mycobacterium tuberculosis amplification of REP13E12 repeated sequence
by
PCR
Inventor(s): Lee, Tae-Yoon ; (Daegu-shi, KR), Kim, Sung-Kwang ; (Daegu-shi, KR), Lee, Jong-Seok ; (Daegu-shi, KR), Lee, Jai-Youl ; (Daegu-shi, KR) Correspondence: Merchant & Gould; P O Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20010023065 Date filed: February 16, 2001 Abstract: A method for detecting Mycobacterium tuberculosis by the polymerase chain reaction (PCR) amplification of the REP13E12 repeated sequence, and more particularly, to a method for detecting Mycobacterium tuberculosis in clinical specimen by the PCR amplification of all or some of the REP1 3E1 2 repeated sequence is provided. Since the Mycobacterium tuberculosis detecting method by the PCR amplification for amplifying the REP13E12, which is the repeated sequence cloned from the microbial cells of Mycobacterium tuberculosis, which are separated from Korea, shows excellent sensitivity and specificity, it is possible to effectively detect Mycobacterium tuberculosis in specimen using the method. Excerpt(s): The present invention relates to a method for detecting Mycobacterium tuberculosis by the polymerase chain reaction (PCR) amplification of the REP13E12 repeated sequence, and more particularly, to a method for specially detecting the Mycobacterium tuberculosis in clinical specimen with high sensitivity by the PCR amplification of all or some of the REP1 3E1 2 repeated sequence. ... Tuberculosis is a very severe infectious disease, by which 1/3 of the world population, that is, about 1,700,000,000 are infected, by which about 800,000,000 patients are newly infected every year, and from which 34% of the new patients, that is 2,700,000, die. It is estimated that the tuberculosis patients of about 700,000 exist in our country. It is reported that 140,000 patients are newly infected by tuberculosis every year and that 5,000 patients die from tuberculosis. This is a very severe public health problem. ... Tuberculosis is a chronic infectious disease caused by the Mycobacterium tuberculosis. The prevalence rate of tuberculosis is increasing all over the world as well as in our country as a complication of acquired immune deficiency syndrome (AIDS). Since many of recently generated Mycobacterium tuberculosis have multiple tolerances to tuberculosis drugs, it is more difficult to cure tuberculosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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DNA molecule fragments encoding for mycobacterium tuberculosis and uses thereof
cellular
uptake
of
Inventor(s): Riley, Lee W. ; (New York, NY), Chong, Pele ; (Richmond Hill, CA) Correspondence: Michael L. Goldman, Esq.; NIXON PEABODY LLP; Clinton Square; P. O. Box 31051; Rochester; NY; 14603; US Patent Application Number: 20010019716 Date filed: January 4, 2001 Abstract: The present invention relates to a DNA molecule conferring on Mycobacterium tuberculosis an ability to enter mammalian cells and to survive within macrophages. Peptides, proteins, or polypeptides (e.g. the Mycobacterium cell entry protein or Mcep) encoded by this gene fragment are useful in vaccines to prevent infection by Mycobacterium tuberculosis, while the antibodies raised against these peptides, proteins, or polypeptides can be employed in passively immunizing those already infected by the organism. These proteins, peptides, polypeptides, and antibodies may be utilized in diagnostic assays to detect Mycobacterium tuberculosis in tissue or bodily fluids. The peptides, proteins, or polypeptides of the present invention can be associated with various other therapeutic materials, for administration to mammals, particularly humans, to achieve uptake of those materials by such cells. Synthetically constructed peptides based on the disclosed amino acid sequences exhibit the same mammalian cell uptake activity observed with Mcep. Excerpt(s): The present invention relates to a DNA molecule encoding for uptake of Mycobacterium tuberculosis and its use in drugs, vaccines, and diagnostic tests. ... Tuberculosis is the leading cause of death in the world with an estimated 9 million new cases of tuberculosis and 2.9 million deaths occurring from the disease each year. In the United States, the steadily declining incidents of tuberculosis has been reversed since 1985. This problem is compounded by the increasing incidence of drugresistant strains of Mycobacterium tuberculosis. ... Recent outbreaks of tuberculosis have involved settings in which a large number of HIVinfected persons resided in close proximity (e.g., AIDS wards in hospitals, correctional facilities, and hospices). Transmission of tuberculosis to health care workers occurred in these outbreaks; 18 to 50% of such workers showed a conversion in their skin tests. See F. Laraque et. al., "Tuberculosis in HIV-Infected Patients," The AIDS Reader (September/October 1992), which is hereby incorporated by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compounds for Diagnosis of Tuberculosis and Methods of Their Use Inventor(s): Alderson, Mark R. ; (Bainbridge Island, WA), Dillon, Davin C. ; (Redmond, WA), Skeiky, Yasir A.W. ; (Seattle, WA), Campos-Neto, Antonio ; (Bainbridge Island, WA) Correspondence: Pennie & Edmonds; 1155 Avenue of the Americas; New York; NY; 100362711 Patent Application Number: 20010012888 Date filed: May 5, 1998 Abstract: Compounds and methods for diagnosing tuberculosis are disclosed. The compounds provided include polypeptides that contain at least one antigenic portion of one or more M. tuberculosis proteins, and DNA sequences encoding such polypeptides. Diagnostic kits containing such polypeptides or DNA sequences and a suitable detection reagent may be used for the detection of M. tuberculosis infection in patients and biological samples. Antibodies directed against such polypeptides are also provided. Excerpt(s): The present invention relates generally to the detection of Mycobacterium tuberculosis infection. The invention is more particularly related to polypeptides comprising a Mycobacterium tuberculosis antigen, or a portion or other variant thereof, and the use of such polypeptides for the serodiagnosis of Mycobacterium tuberculosis infection. ... Tuberculosis is a chronic, infectious disease, that is generally caused by infection with Mycobacterium tuberculosis. It is a major disease in developing countries, as well as an increasing problem in developed areas of the world, with about 8 million new cases and 3 million deaths each year. Although the infection may be asymptomatic for a considerable period of time, the disease is most commonly manifested as an acute inflammation of the lungs, resulting in fever and a nonproductive cough. If left untreated, serious complications and death typically result. ... Although tuberculosis can generally be controlled using extended antibiotic therapy, such treatment is not sufficient to prevent the spread of the disease. Infected individuals may be asymptomatic, but contagious, for some time. In addition, although compliance with the treatment regimen is critical, patient behavior is difficult to monitor. Some patients do not complete the course of treatment, which can lead to ineffective treatment and the development of drug resistance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Methods of Treating and Protecting against Tuberculosis Using a Monoclonal Antibody Selective for Mycobacterium Tuberculosis Inventor(s): Glatman-Freedman, Aharona; (Irvington, NY), Casadevall, Arturo ; (Pelham, NY) Correspondence: Amster Rothstein and Ebenstein; 90 Park Avenue; New York; NY; 10016 Patent Application Number: 20010007660 Date filed: June 4, 1997 Abstract: The present invention is directed to compositions comprising a monoclonal antibody that reacts with surface epitopes of M. tuberculosis, methods of treating tuberculosis by passively immunizing a subject using the antibody compositions, antigenic determinants for use as a vaccine to protect against M. tuberculosis infection, and a method of using the vaccine to prevent infections of M. tuberculosis. Excerpt(s): Tuberculosis continues to be a major worldwide health problem and is responsible for most incidences of death by an infectious agent. The worldwide incidence of tuberculosis was estimated by the World Health Organization to be 8.8 million in 1995, with a mortality estimate of 3.0 million persons, and is expected to rise to 10.2 million by the year 2000 (Dolin, et al., Bull. WHO. 72:213-220 (1994)). The tuberculosis problem has been compounded by the development of the AIDS epidemic and the growing number of HIV-related cases of tuberculosis (Dolin, et al., Bull. WHO. 72:213-220 (1994)). Effective treatment of tuberculosis is generally prolonged, especially in patients also infected with HIV. In the past, infection with drug-sensitive strains of the M. tuberculosis complex had been cured with certain antibiotics, including isoniazid, rifampicin, ethionamide and pyrazinamide. However, resistance to isoniazid and other antibiotics has developed in many strains of M. tuberculosis. The only licensed vaccine, the BCG vaccine, is controversial in regard to its efficacy, and its effectiveness varies markedly from country to country. This has resulted in the continued search for an effective vaccine against M. tuberculosis. ... Mycobacterium tuberculosis is an intracellular pathogen, thought not to be reached by antibody immunity. Recent studies suggest that some IgA antibodies can neutralize viruses inside cells (Mazanec, et al. 1992) and that monoclonal antibodies inhibit intracellular Toxoplasma gondii (Mineo, et al. 1994). It is known that patients with tuberculosis mount high levels of serum antibodies (Favez, et al. 1966). This antibody response is polyclonal and may contain protective, non-protective, and enhancing antibodies. In such a case, monoclonal antibody technology can be used to identify the protective antibodies. Passive antibody
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therapy was used to treat tuberculosis in the pre-antibiotic era in the form of serum therapy. The results of that treatment were equivocal, but some investigators published positive results (Maragliano 1896, Paquin 1895, and Marmorek 1903). Since that time, antimicrobial therapy has been the only treatment available for tuberculosis. The rise in antimicrobial resistance, however, has created a sense of urgency for the development of alternative methods of therapy for tuberculosis. ... The present invention provides for compositions comprising a monoclonal antibody that reacts with a surface epitope of M. tuberculosis, methods of treating tuberculosis by passively immunizing a subject using the antibody composition, and antigenic determinates for use as a vaccine to protect against M. tuberculosis infection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with tuberculosis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “tuberculosis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on tuberculosis. You can also use this procedure to view pending patent applications concerning tuberculosis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Asymptomatic: Showing or causing no symptoms. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH]
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Bronchial: Pertaining to one or more bronchi. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Immunization: The induction of immunity. [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Leprosy: A chronic granulomatous infection caused by mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Lipoprotein:
Any of the lipid-protein complexes in which lipids are
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transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Mannosides: Glycosides formed by the reaction of the hydroxyl group on the anomeric carbon atom of mannose with an alcohol to form an acetal. They include both alpha- and beta-mannosides. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Refractory: Not readily yielding to treatment. [EU] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Toxoplasma: A genus of protozoa parasitic to birds and mammals. T. gondii is one of the most common infectious pathogenic animal parasites of man. [NIH]
Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 6. BOOKS ON TUBERCULOSIS Overview This chapter provides bibliographic book references relating to tuberculosis. You have many options to locate books on tuberculosis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on tuberculosis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “tuberculosis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on tuberculosis:
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Tuberculosis Prevention Guide for Homeless Service Providers Contact: Homeless Health Care Los Angeles, 1010 S Flower St 5th Fl, Los Angeles, CA, 90015, (213) 744-0724. Summary: This monograph, for health professionals who serve homeless persons, can be used as a guide in developing policies and procedures to decrease the risk of tuberculosis (TB) in homeless person facilities. The monograph discusses the epidemiology of TB among homeless persons in Los Angeles. It outlines how TB is transmitted, the difference between TB infection (LTBI) and TB disease, and TB risk factors. It examines treatments for persons with TB, persons co-infected with TB and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), pregnant women with TB, and individuals with multidrug-resistant TB.
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Tuberculosis Contact: Millbrook Press, 2 Old New Milford Rd, Brookfield, CT, 06804, (800) 568-2665, http://www.millbrookpress.com. Summary: This monograph provides general information on tuberculosis (TB). It discusses what TB is, its history, who is at risk, symptoms and complications, diagnosis and treatment, the challenges TB poses to society, the roles of different types of organizations in addressing TB, and future directions in TB management. The monograph also presents personal anecdotes of individuals who have TB.
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Taking Precautions Against Tuberculosis: Health-Care Staff Handbook Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channingbete.com. Summary: This study guide, for health professionals, provides information about the prevention of tuberculosis (TB) in healthcare settings. It discusses the risk factors for TB; national agencies involved in TB precautions; standard and transmission-based precautions to prevent the spread of TB; engineering and policy controls for health care facilities to prevent TB; and how to prevent transmission from patients to health professionals through the use of patient care guidelines, personal protective equipment (e.g., gloves), and sanitation and hygiene. The study guide provides an overview of health professional staff screening for TB.
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Ending Neglect : The Elimination of Tuberculosis in the United States Contact: National Academy Press, 2101 Constitution Ave NW, Box 285, Washington, DC, 20055, (202) 334-3313. Summary: This monograph provides government and nongovernment entities involved in tuberculosis (TB) elimination with background on the pathology of TB, its history and status in the United States, and the public and private response, with illustrative case studies. It explores strategies to ensure that success in curbing TB will not lead to another period of neglect and yet another resurgence; the case for targeted TB screening in high-risk populations and treatment of latent infection, including privacy issues and implications for immigration; and research needs in diagnosis, treatment, and prevention.
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Management of Tuberculosis: A Guide for Low Income Countries Contact: International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, (011) 33144320360, http://www.iuatld.org. Summary: This tuberculosis (TB) guide is for use in low-income countries and written for health professionals, governmental, and international agencies, and organizations. The guide contains a description of TB and its identification; treatment modalities including directly observed therapy, short-course (DOTS) and preventive therapy; and patient care. The treatment of TB and the organization and management of TB services and the structure within which these services can be delivered, even under the most stringent socio-economic conditions are outlined. The rationale for developing a community TB program I discussed. A technical guide for smear microscopy is provided.
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Epidemiologic Basis of Tuberculosis Control Contact: International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, (011) 33144320360, http://www.iuatld.org. Summary: This monograph delineates the determinants of exposure, infection, disease, and death from tuberculosis (TB) using descriptive and etiologic epidemiological data. The monograph reviews statistics regarding exposure to TB including the number of incident cases, the duration of infection in these cases, and the number of case contact interactions per unit of time. Etiologic and descriptive epidemiology are used to asses the risk factors for infection once an exposure has occurred, the incidence and prevalence of infection, and the formation of a paradigm of the risk of infection. Risk factors for the formation of active
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TB once an infection has occurred, the morbidity of active TB, and the prospects for the course of the epidemic are discussed in terms of descriptive and etiologic epidemiology. These two types of epidemiology also are used to analyze the mortality of TB, the risk factors for death resulting from TB, and the expected death toll of TB in the future. Based on these findings, the monograph draws conclusions and makes recommendations for the prevention and surveillance of TB worldwide. ·
Tuberculosis : Six Case Studies Contact: Charles P Felton National Tuberculosis Center, Harlem Hospital Center, 2238 5th Ave, New York, NY, 10037, (212) 939-8254, http://www.harlemtbcenter.org. Summary: The case studies presented in this study guide exemplify presentations of tuberculosis (TB) infection and active disease frequently encountered in general practice and are divided into teaching segments that represent a logical order of events, beginning with the initial visit and continuing through significant follow-up visits, adverse events, and final discharge. Possible recommendations or actions follow each segment. Users should check all responses that they consider appropriate. The actual recommended management decisions are contained in the Scoring and Comment section of the study guide. The six case studies involve a positive tuberculin skin test in a 29-year-old man, a positive tuberculin skin test in a 25-year-old pregnant woman, a positive tuberculin skin test in a 5-year-old girl (younger sister of Case 4), a positive tuberculin skin test in a 17-year-old girl (older sister of Case 3), back pain in an 80-year-old man, and a positive tuberculin skin test in a 27-year-old woman.
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Tuberculosis Handbook Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This monograph is intended for staff in low- and middleincome countries who are responsible for planning, organizing, and supervising tuberculosis (TB) control activities. It provides basic information and references that are key to developing skills for (1) assessing the epidemiology of the TB burden of a country, region, or community; (2) specifying how an existing national TB program (NTP) should be revised; (3) evaluating the effectiveness of an NTP in reducing infection, morbidity, and mortality, and identifying technical and managerial elements in need of revision or reorientation; (4) analyzing the available institutional, human, and financial resources, and
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identifying those that can be mobilized to support NTP revision; (5) organizing logistics to ensure a regular supply of drugs and laboratory materials; (6) setting up a laboratory network; (7) planning training, health education, and communication; (8) planning supervision, monitoring, and evaluation; (9) preparing a budget and mobilizing local and external resources for an NTP; and (10) coordinating with other programs and the private sector. The monograph is divided into nine parts, corresponding to the objectives listed above. ·
Guidelines for Conducting a Review of a National Tuberculosis Programme Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This monograph provides guidelines for the appropriate government agencies of countries around the world and for national organizations to conduct an assessment of their national tuberculosis (TB) programs (NTP). NTPs must be reviewed to improve their effectiveness; raise awareness about TB; increase political commitment for TB control; develop coalitions for TB control with non-governmental organizations (NGO), the private sector, and donors; and increase problem solving and supervisory skills of NTP staff participating in it. Directly observed therapy, short-course (DOTS) is described as the only viable means for controlling TB and involves government commitment for an NTP. The monograph describes the three components involved in the review of an NTP: planning and preparation, conducting the review, and follow up. It also includes information about how to plan a chart and checklist for a program review; a sample of an agenda for program review, data collection tools, a checklist for a visit to a treatment center, and a press release for NTP review; the items required for preparing introductory tools, the structure of a TB program review report, the methodology for economic analysis, and the elements of a review of basic training for health professionals.
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Tuberculosis Control in Refugee Situations : An Inter-Agency Field Manual Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This monograph, for health professionals, organizations, and government agencies, discusses tuberculosis (TB) and TB control among refugees. It reviews the specific health risks posed by living in a refugee
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camp and the epidemiology of TB worldwide and among refugee populations. It discusses how to implement and manage TB control programs in refugee situations and presents guidelines for the prevention and surveillance of TB among refugee populations. ·
Anti-Tuberculosis Drug Resistance in the World : The WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This monograph provides findings from the First Phase of the World Health Organization's (WHO) and the International Union Against Tuberculosis (TB) and Lung Disease's (IUATLD) Global Project on anti-TB drug resistance surveillance. Data was gathered from 35 countries in five continents. Surveillance or surveys were conducted on approximately 50,000 TB cases sampled from areas representing 20% of the world's population. Findings show that (1) drug resistance was found in all countries surveyed; (2) there were several "hot spots" where multidrug-resistance (MDR) TB prevalence was high and could threaten control programs (i.e., Latvia, Estonia, Russia, the Dominican Republic, Argentina, and the Ivory Coast); (3)there was a strong correlation between both the overall quality of TB control and use of standardized short course chemotherapy and low levels of drug resistance; and (4) the MDR TB level was a useful indicator of national TB program performance.
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Guidelines for the Management of Drug-Resistant Tuberculosis Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This monograph provides guidelines from the World Health Orgnaization (WHO) on the management of multidrug-resistant tuberculosis (MDR TB). Chapter titles include Basic Principals for Management of MDR TB, Assessing the Individual Case of Apparent MDR TB, Available Drugs for MDR TB, Choosing a Chemotherapy Regimen for a Patient with Apparent MDR TB, and The Place of Surgery. The appendix provides information on second-line antituberculosis drugs.
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The White Plague : Tuberculosis, Man, and Society Contact: Rutgers University Press, 109 Church St, New Brunswick, NJ, 08901, (908) 932-7365. Summary: First printed in 1952, this monograph presents the argument that the great increase in tuberculosis in the nineteenth century was intimately connected with the rise of an industrial, urbanized society and that the progress of medical science had very little to do with the marked decline in TB in the twentieth century. It examines the interrelations among disease agents, characteristics of the host, and the broader sociocultural and environmental context. This reprint includes new introductory writings by practitioners of sociology and the history of medicine.
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Tuberculosis Exposure Control and Prevention Manual Contact: Coastal Training Technologies Corporation, 500 Studio Dr, Virgina Beach, VA, 23542, (800) 725-3418, http://www.coastal.com. Summary: This manual, for health professionals, provides guidelines for the prevention of the occupational transmission of tuberculosis (TB) in healthcare settings. It discusses the basic facts about TB and outlines a workplace TB control plan. It explains how to perform workplace risk assessments and identify and manage TB patients.The manual reviews precautionary practices including the use of isolation rooms, respiratory protection, and health professional counseling and training. It cites occupational TB safety manuals set forth by the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) and makes recommendations regarding workplace policy documentation.
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Tuberculosis Control and Training Resource Guide Contact: Association for Professionals in Infection Control and Epidemiology, 1016 16th St NW 6th Floor, Washington, DC, 20036, (202) 296-2742. Summary: This monograph, for health professionals, businesses, and government agencies, serves as a resource guide and directory for tuberculosis control training. It provides information on program and management resources including general management assistance, prevention or control, engineering controls, and respiratory protection; training programs and materials; worker education materials or resources; non-English language resources; publications and resources for clinicians; and state and territorial health departments.
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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to tuberculosis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Advances in Tuberculosis Research by H. Birkhaeuser (Editor), W. Fox (Editor) (1980); ISBN: 3805529546; http://www.amazon.com/exec/obidos/ASIN/3805529546/icongroupin terna
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National Tuberculosis Association 1904-1954: A Study of the Voluntary Health Movement in the United States (1977); ISBN: 0405098316; http://www.amazon.com/exec/obidos/ASIN/0405098316/icongroupin terna
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Prehistoric Tuberculosis in the Americas by J. E. Buikstra (Editor) (1981); ISBN: 0942118103; http://www.amazon.com/exec/obidos/ASIN/0942118103/icongroupin terna
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Resistance to Tuberculosis: Experimental Studies in Native and Acquired Defensive Mechanisms by Max B. Lurie (1965); ISBN: 0674765168; http://www.amazon.com/exec/obidos/ASIN/0674765168/icongroupin terna
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Short History of Tuberculosis by George N. Meachen (1978); ISBN: 0404132952; http://www.amazon.com/exec/obidos/ASIN/0404132952/icongroupin terna
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Textbook of Tuberculosis by K.N. Rao (1981); ISBN: 9998033063; http://www.amazon.com/exec/obidos/ASIN/9998033063/icongroupin terna
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Tuberculosis by Jay A. Meyers, Jay A. Myers (1970); ISBN: 087527059X; http://www.amazon.com/exec/obidos/ASIN/087527059X/icongroupi nterna
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Tuberculosis As a Disease of the Masses & How to Combat It (Public Health in America) by S. Adolphus Knopf, Adolphus S. Knopf (1977); ISBN: 0405098243;
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http://www.amazon.com/exec/obidos/ASIN/0405098243/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “tuberculosis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·
Adequacy of the tuberculosis health care system and compensation payments in Lesotho: the people's perspective. Author: by T. Matobo; Year: 1998; Roma, Lesotho: Institute of Southern African Studies, National University of Lesotho, 1998
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Analysis of interaction between TB and HIV. Author: AIDS programmes in Sub-Saharan Africa / Sarah R. Anderson and Dermot Maher; Year: 2001; [Geneva]: World Health Organization, c2001
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And the spark became a flame: the beginnings of mass chest x-ray. Author: by Alton L. Blakeslee; Year: 1954; [New York?]: National Tuberculosis Association, 1954
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Assessing the efficacy of ultraviolet germicidal irradiation and ventilation in removing mycobacterium tuberculosis. Author: Farhad Memarzadeh, principal investigator; Year: 2000; Bethesda, Md.: Division of Engineering Services, Office of Research Services, Office of the Director, National Institutes of Health, [2000]; ISBN: 0160613981
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Common sense treatment of tuberculosis of the lungs: treatise. Author: by Norman Baker; Year: 1936; Muscatine, Iowa: N. Baker Investment Co., c1936
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Fighting the scourge of tuberculosis. Author: editor, Dene C. Peters; Year: 2000; Auckland; Philadelphia: Adis International, c2000; ISBN: 0864710879 http://www.amazon.com/exec/obidos/ASIN/0864710879/icongroupin terna
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History of tuberculosis in Lesotho (1900-80) with special reference to control policy and practice. Author: by T. Tsikoane; Year: 1998; Roma, Lesotho: Institute of Southern African Studies, National University of Lesotho, 1998
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Honouring the warrior spirit: bringing change through protecting, preparing and providing: a collaborative report on the occurence of human immunodeficiency virus, hepatitis C and tuberculosis in aboriginal injection drug users in Vancouver. Author: Jones, Greta; Year: 2001; Vancouver, BC; Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, [2001]
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Imaging of tuberculosis: with epidemiological, pathological, and clinical correlation. Author: P.E.S. Palmer, with contributions by S.J. Wambani and P. Reeve; consultants, M.M. Reeder, D.H. Connor, and I.J. Dunn; Year: 2001; New York: Springer, 2001; ISBN: 3540418210 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540418210/icongroupin terna
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Involving private practitioners in tuberculosis control: issues, interventions, and emerging policy framework. Author: Uplekar, Mukund; Year: 2001; Geneva: World Health Organization, 2001
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Life histories of pulmonary TB patients: patients' experiences and perceptions about the disease. Author: by M.G. Makoae; Year: 1998; Roma, Lesotho: Institute of Southern African Studies, National University of Lesotho, 1998
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Life in a tuberculosis hospital: a look under the lid. Author: by Henry Arvin; [edited by E. Haldeman-Julius]; Year: 1948; Girard, Kansas: Haldeman-Julius Publications, c1948
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New vistas in therapeutics: from drug design to gene therapy. Author: edited by Sonia I. Skarlatos, Paul Velletri, and Mariana Morris. Drugresistant tuberculosis: from molecules to macro-economics / edited by Peter Davies; Year: 2001; New York, N.Y.: New York Academy of Sciences, 2001; ISBN: 1573313882 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1573313882/icongroupin terna
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Pioneers of medicine and their impact on tuberculosis. Author: Thomas M. Daniel; Year: 2000; Rochester, NY: University of Rochester Press, 2000; ISBN: 1580460674 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1580460674/icongroupin terna
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Progress in DOTS-Plus and the management of multidrug-resistant tuberculosis (MDR-TB): proceedings of the meeting of the Stop TB Working Group on DOTS-Plus for MDR-TB, Lima, Peru, 25-27 January 2001. Author: Stop TB Working Group on DOTS-Plus for MDR-TB; Year: 2001; Geneva: Communicable Diseases, Stop TB, World Health Organization, c2001
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Standards for the diagnosis, classification, and treatment of pulmonary and glandular tubersulosis in adults and children [microform]. Author: prepared for the Framingham Community Health and Tuberculosis Demonstration of the National Tuberculosis Association; Year: 1920; New York City: The Association, 1920
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Tuberculosis control in prisons: a manual for programme managers. Author: Angie Bone ... [et al.]; Year: 2000; Geneva: World Health Organization: International Committee of the Red Cross, c2000
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Tuberculosis in Pakistan: the forgotten plague. Author: Herman Meulemans (ed.); Year: 2000; Leuven, Belgium: Acco, 2000; ISBN: 9033445662
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Tuberculosis in the workplace. Author: Marilyn J. Field, editor; Committee on Regulating Occupational Exposure to Tuberculosis, Division of Health Promotion and Disease Prevention, Institute of Medicine; Year: 2001; Washington, D.C.: National Academy Press, c2001; ISBN: 0309073308 http://www.amazon.com/exec/obidos/ASIN/0309073308/icongroupin terna
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Tuberculosis, past and present = Tuberculosis, múlt és jelen = Tuberculose, passé et présent. Author: edited by György Pálfi ... [et al.]; Year: 1999; [Budapest]: Golden Book Publisher; [Szeged]: Tuberculosis Foundation, c1999; ISBN: 9638232846
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Weariness, the fever, and the fret: the campaign against tuberculosis in Canada, 1900-1950. Author: Katherine McCuaig; Year: 1999; Montreal; Ithaca: McGill-Queen's University Press, c1999; ISBN: 0773518339 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0773518339/icongroupin terna
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Chapters on Tuberculosis Frequently, tuberculosis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with tuberculosis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and tuberculosis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “tuberculosis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on tuberculosis: ·
Mycobacterial Diseases: Tuberculosis and Leprosy Source: in Maddison, P.J.; et al., Eds. Oxford Textbook of Rheumatology. Volume 2. NewYork, NY: Oxford University Press, Inc. 1993. p. 574-581. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals presents an overview of tuberculosis and leprosy. They are infectious diseases characterized by inflammation. The epidemiology, pathogenesis, immunology, pathology, clinical manifestations, diagnosis, and treatment of these diseases are discussed. Tuberculosis can affect bones or joints. It is diagnosed through microbiological cultures and radiographs, and it is treated with anti tuberculous drugs. Surgical intervention may also be used in selected cases. Leprosy affects the skin and nerves. Progressive degenerative joint changes may occur because of lesions of the peripheral nerve. Leprosy is diagnosed through microbiological, serological, and radiographic tests, and it is treated with multi drug therapy. 58 references, 3 figures, and 1 table.
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Genitourinary Tuberculosis Source: in Suki, W.N.; Massry, S.G., eds. Therapy of Renal Diseases and Related Disorders, 2nd ed. Hingham, MA: Kluwer Academic Publishers. 1991. p. 387-393. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018. (617) 871-6600. Price: $315. ISBN: 0792306767. Summary: This chapter, from a medical text on the therapy of renal disease and related disorders, discusses genitourinary tuberculosis. The
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author reviews the diagnostic tests used in investigating genitourinary tuberculosis; the management of the disease; the use of chemotherapy with antituberculous drugs; the use of steroids; hypersensitivity reactions to drug therapy; and the role of surgery, including reconstructive surgery, in the management of genitourinary tuberculosis. 2 figures. 4 tables. 7 references. ·
Reemergence of Mycobacterium Tuberculosis Infection as a Major Occupational Risk for Health Professionals Source: in Greenspan, J.S.; Greenspan, D., eds. Oral Manifestations of HIV Infection: Proceedings of the Second International Workshop on the Oral Manifestations of HIV Infection. Carol Stream, IL: Quintessence Publishing Company, Inc. 1995. p. 296-308. Contact: Available from Quintessence Publishing Company, Inc. 551 North Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223; Fax (630) 682-3288; E-mail:
[email protected]; http://www.quintpub.com. Price: $64.00 plus shipping and handling. ISBN: 0867152869. Summary: This chapter on the reemergence of Mycobacterium tuberculosis (TB) infections as a major occupational risk is from the proceedings of the Second International Workshop on the Oral Manifestations of HIV Infection, held in February 1993 in San Francisco, California. The authors discuss the etiology, transmission, and progression of this infectious disease, current risk factors, management of infected patients, and effectiveness of established infection control guidelines. The authors conclude with a discussion of the implications of TB for dentistry, including infection control concerns and guidelines. 2 figures. 5 tables. 38 references.
General Home References In addition to references for tuberculosis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Encyclopedia of Infectious Diseases (Encyclopedia of Infectious Diseases, 1998) by Carol Turkington, Bonnie Ashby; Library Binding - 384 pages (September 1998), Facts on File, Inc.; ISBN: 0816035121; http://www.amazon.com/exec/obidos/ASIN/0816035121/icongroupinterna
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· Epidemic! The World of Infectious Disease by Rob Desalle (Editor), American Museum of Natural History; Paperback - 246 pages, 1st edition (September 1999), New Press; ISBN: 1565845463; http://www.amazon.com/exec/obidos/ASIN/1565845463/icongroupinterna · The Hidden Epidemic: Confronting Sexually Transmitted Diseases by Institute of Medicine, et al; Hardcover - 432 pages (April 1997), National Academy Press; ISBN: 0309054958; http://www.amazon.com/exec/obidos/ASIN/0309054958/icongroupinterna · Outbreak Alert: Responding to the Increasing Threat of Infectious Diseases by Jason Eberhart-Phillips, M.D.; Paperback - 292 pages (July 2000), New Harbinger Publications; ISBN: 1572242019; http://www.amazon.com/exec/obidos/ASIN/1572242019/icongroupinterna · Sexually Transmitted Diseases: A Physician Tells You What You Need to Know (Johns Hopkins Press Health Book) by Lisa Marr; Paperback - 263 pages (January 1999), Johns Hopkins University Press; ISBN: 0801860431; http://www.amazon.com/exec/obidos/ASIN/0801860431/icongroupinterna · Sexually Transmitted Diseases: Vaccines, Prevention and Control by Lawrence R. Stanberry (Editor), David I. Bernstein (Editor); Hardcover 468 pages, 1st edition (February 15, 2000), Academic Press; ISBN: 0126633304; http://www.amazon.com/exec/obidos/ASIN/0126633304/icongroupinterna · Sexually Transmitted Diseases Sourcebook: Basic Information... by Linda M. Ross (Editor), Peter Dresser (Editor); Library Binding - 600 pages (June 1997), Omnigraphics, Inc.; ISBN: 0780802179; http://www.amazon.com/exec/obidos/ASIN/0780802179/icongroupinterna
Vocabulary Builder Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas
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exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU]
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CHAPTER 7. MULTIMEDIA ON TUBERCULOSIS Overview Information on tuberculosis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on tuberculosis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on tuberculosis is the Combined Health Information Database. You will need to limit your search to “video recording” and “tuberculosis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “tuberculosis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on tuberculosis:
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Tuberculosis : DOTS Contact: Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, (202) 974-3000, http://www.paho.org. Summary: This video, for health professionals, government agencies, and organizations, provides information about the use and success of directly observed therapy, short-course (DOTS) in helping to treat and prevent the spread of tuberculosis (TB) and in lowering TB morbidity and mortality rates. It reviews the global epidemiology of TB and the factors contributing to its resurgence around the world.
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Tuberculosis Contact: Columbia Broadcasting System News, 555 W 57th St, New York, NY, 10019, (212) 975-4321. Summary: This videorecording provides the general public with information on the rise of tuberculosis in the United States and in Russian prisons. The video, which is a segment from a '60 Minutes' broadcast, examines the rise of TB in the late twentieth century and the likely causes for its resurgence in the United States. It outlines the symptoms of TB and briefly reviews some of the treatments available for it. It discusses TB as an epidemic in the Russian prison system and the epidemiology of this infectious disease among incarcerated Russians. The video explains why TB is widespread in Russian correctional facilities, citing government financial issues, crowding, and a lack of TB resources. The video details plans for the Russian correctional facilities to partner with the Centers for Disease Control and Prevention (CDC) to reduce incidence rates of TB.
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Tuberculosis Challenge: An Update Contact: Quality Line Enterprises, 1424 Fourth St, Ste 800, Santa Monica, CA, 90401, (310) 451-5994. Summary: This video provides information about tuberculosis (TB) and the prevention of occupational transmission of TB using administrative and engineering controls, personal protective equipment, and universal precautions. It explains how TB is transmitted, the difference between latent TB infection (LTBI) and active TB, how to administer and read a TB skin test, and TB treatment.
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Creating a Plan to Control Tuberculosis Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm.
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Summary: This video, for health professionals and administrators, discusses the establishment of a tuberculosis (TB) control plan in correctional facilities. It provides guidelines about how to conduct a risk assessment for a TB control plan; it recommends that all facility health staff be trained in TB and tuberculin skin testing, and that facilities identify key people and their functions in infection control; it examines establishing TB screening procedures and schedules; it provides information about the isolation of prisoners with active TB in rooms with engineering controls or local hospitals if no such rooms are available; and it suggests how to maintain and transfer (if necessary) prisoner medical records, and how to create a TB training program for staff. ·
Tuberculosis Screening and Diagnosis in Correctional Facilities Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm. Summary: This video, for health professionals, discusses tuberculosis (TB) screening and diagnosis in correctional facilities. It identifies and describes the two types of TB screening; it lists the elements of a TB screening program for correctional facilities and outlines the steps of the complete diagnostic process; it examines special circumstances that may require further testing (e.g., in persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and in persons who have received the BCG vaccine); it discusses how and when to use two-step TB skin testing and makes recommendations regarding medical record maintenance and transferals; and it explains how to treat and monitor patients with TB and stresses the importance of maintaining patient confidentiality.
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Preventing Tuberculosis in Correctional Facilities Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm. Summary: This video, for health professionals, provides information about tuberculosis (TB) prevention and control in correctional facilities. It discusses TB transmission; the difference between active TB and latent TB infection (LTBI); active TB symptoms and symptoms for groups at risk for contracting LTBI or developing active TB; and TB control measures by category: engineering controls, administrative controls, and universal precautions. The video demonstrates how to use respirators to prevent TB.
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Safely Transporting Inmates With Tuberculosis Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm. Summary: This video, for correctional facility personnel, discusses policies regarding the transfer or deportation of incarcerated persons with active tuberculosis (TB). It outlines the possible reasons for prisoner transports, the procedures for how to deal with suspected cases of active TB in incarcerated individuals, and how to decline transport on medical grounds. It reviews specific procedures for clearing prisoners for transport and makes recommendations regarding the timely transfer of the medical records of individuals with TB, informing transport personnel of the risks on a case by case basis, and training all personnel on TB prevention. The video examines what universal precautions should be taken when moving prisoners with active TB and how to ensure continued treatment of incarcerated individuals upon their release to the public or their deportation.
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Tuberculosis (Correctional Officers) Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm. Summary: This video, for correctional facilities and their staff, provides information about tuberculosis and occupational transmission prevention. It discusses the prevalence of TB among incarcerated populations and prison populations; ways for correctional personnel to protect themselves and other incarcerated individuals from contracting TB through the use of universal precautions, isolation in cells, and hospital wards; and the role of the correctional officer in helping to maintain adherence to anti-TB regimens among incarcerated individuals.
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Tuberculosis 2000: Fundamentals of Clinical Tuberculosis and Tuberculosis Control: Part I Contact: Francis J Curry National Tuberculosis Center, 3180 18th St Ste 101, San Francisco, CA, 94110-2042, (415) 502-4600, http://www.nationaltbcenter.edu. Summary: This video, for health professionals, provides information about diagnosing, treating, and screening for tuberculosis (TB). It identifies the different tests used in the TB diagnostic process and how to administer each test, and it examines how to treat TB including how to determine drug regimens and dosages. The video identifies which
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demographic populations are at risk for TB and how to conduct screening on these populations. ·
What You Don't Know About Tuberculosis... Could Kill You Contact: Texas Department of Health, Tuberculosis Elimination Division, 1100 W 49th St, Austin, TX, 78756-3199, (512) 458-7447, http://www.tdh.state.tx.us/tb/default.htm. Summary: This video, for incarcerated person, discusses tuberculosis (TB). It identifies populations at risk for TB, methods of transmission, the tuberculin skin test, and the symptoms of active TB. It differentiates between active TB and latent TB infection (LTBI). The video discusses available treatments for tuberculosis and their possible side effects; it reviews how individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and TB are treated; and stresses the importance of patient adherence to TB medicines.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “tuberculosis” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on tuberculosis: ·
Pediatric Tuberculosis: An Audiotape for Clinicians Contact: Francis J Curry National Tuberculosis Center, 3180 18th St Ste 101, San Francisco, CA, 94110-2042, (415) 502-4600, http://www.nationaltbcenter.edu. Summary: This audiocassette and its accompanying study guide, for health professionals, discuss the diagnosis and treatment of tuberculosis (TB) in children. The audiocassette identifies the risk factors associated with pediatric exposure to TB and lists the procedures for evaluating a young child exposed to an adult with contagious TB. The audiocassette covers how prior vaccination with BCG impacts the placement and interpretation of the tuberculin skin test. It describes the steps for and the proper placement and interpretation of the tuberculin skin test. It outlines
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the current recommendations for the treatment of latent TB infection (LTBI) and active TB. ·
Diagnosis and Treatment of Latent Tuberculosis Infection in the 21st Century: An Audio Recording for Clinicians Contact: Francis J Curry National Tuberculosis Center, 3180 18th St Ste 101, San Francisco, CA, 94110-2042, (415) 502-4600, http://www.nationaltbcenter.edu. Summary: This CD and study guide, designed for health professionals, discusses the diagnosis and treatment of latent tuberculosis (TB) infection (LTBI), especially in special populations including individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). It discusses the major risk factors for developing active TB once LTBI has been contracted; the tuberculin skin test process and how to evaluate the results of this diagnostic test; the medical treatment options for individuals with LTBI and HIV-infected patients; and how patients being treated for LTBI should be monitored. It provides an overview of the drugs used to treat LTBI and their possible side effects.
Bibliography: Multimedia on Tuberculosis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in tuberculosis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on tuberculosis. For more information, follow the hyperlink indicated: ·
[motion picture]. Source: [production company unknown]; Year: 1926; Format: TB sanitorium and preventorium; United States: [s.n., 1926]
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[motion picture]. Source: [production company unknown]; Year: 1998; Format: Reminiscences of TB sanitorium and preventorium; United States: National Library of Medicine, [1998]
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Caring for the person with tuberculosis. Source: produced and distributed by Video Press, School of Medicine, Univ. of Maryland of Baltimore; Year: 1994; Format: Videorecording; Baltimore, Md.: The Press, c1994
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Core curriculum on tuberculosis : what the clinician should know. Source: Centers for Disease Control and Prevention; Year: 1994; Format: Slide; [Springfield, VA: National Technical Information Service, 1994]
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Hospital controls for tuberculosis : OSHA's role. Source: American Hospital Association; a production of Westcott Communications, Inc; Year: 1994; Format: Videorecording; Chicago, Ill.: AHA, c1994
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Nitric oxide and NO resistance genes : lessons from tuberculosis. Source: Medical Arts and Photography Branch; Year: 1998; Format: Videorecording; [Bethesda, Md.: National Institutes of Health, 1998]
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Nursing management of the patient with tuberculosis. Source: [presented by] Mosby; Samuel Merritt College, Studio Three Productions; Year: 1995; Format: Videorecording; St. Louis, MO: Mosby-Year Book, c1995
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Regulatory and compliance training presentation of guarding against tuberculosis in healthcare facilities. Source: [presented by] AIMS Media; Year: 1994; Format: Videorecording; Chatsworth, Calif.: AIMS, c1994
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T.B. nurse Wallace. Source: produced by Motion Picture and Recording Studio, the Pennsylvania State College; [presented by] the Bureau of Tuberculosis Control, Department of Health, Commonwealth of Pennsylvania; Year: 1952; Format: Motion picture; United States: Commonwealth of Pennsylvania, [1952]
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TB precautions II. Source: Medfilms; Videorecording; Tucson, Ariz.: Medfilms, c2001
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TB prevention and control : the new challenges. Source: Envision Incorporated; APIC, Association for Professionals in Infection Control and Epidemiology, Inc; Year: 2001; Format: Videorecording; Nashville, TN: Envision, [2001?]
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TB, forgotten plague. Source: written & produced by Katharine Everett; a presentation of Films for the Humanities & Sciences; Year: 1994; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1994
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Tuberculosis : a videoconference series. Source: [a production of] South Carolina ETV ... [et al.]; [presented by] the Health Communications Network, the American Lung Association of South Carolina, and the South Carolina Department of Health a; Year: 1995; Format: Videorecording; Charleston, S.C.: Medical University of South Carolina; [Columbia, S.C.]: South Carolina Educational Television, c1995
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Tuberculosis : back from the past. Source: Coastal Health+Care; produced by Coastal Video Communications Corp; Year: 1993; Format:
Year:
2001;
Format:
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Videorecording; Virginia Beach, VA: Coastal Video Communications, c1993 ·
Tuberculosis : current perspectives and management. Source: [presented by] Medi-Sim; Year: 1994; Format: Electronic resource; Baltimore, Md.: Willimas & Wilkins, c1994
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Tuberculosis : its origins and effects. Source: a presentation of Films for the Humanities & Sciences; produced for the Academic Unit of Pathological Sciences, Department of Clinical Medicine by Leeds University Television; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998
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Tuberculosis : new strategies for the healthcare worker. Source: presented by Medcom; produced by Medcom/Trainex, Inc.; writers, John Shannon, Rand Rodriguez; Year: 2000; Format: Videorecording; Cypress, CA: Medcom, Inc., c2000
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Tuberculosis : prevention and practices for healthcare workers. Source: [presented by] Medcom, Inc; Year: 1996; Format: Videorecording; Cypress, CA: Medcom, c1996
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Tuberculosis awareness. Source: produced by Coastal Video Communications Corp; Year: 1994; Format: Videorecording; Virginia Beach, VA: Coastal, c1994
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Tuberculosis in America : the people's plague. Source: a film by Diane Garey and Lawrence R. Hott; written by Kage Kleiner; Year: 1995; Format: Videorecording; Santa Monica, CA: Direct Cinema, c1995
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Tuberculosis in the nineties. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1993; Format: Videorecording; Marshfield, WI: The Clinic, [1993]
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Tuberculosis. Source: The Wellcome Trust; Year: 1998; Format: Electronic resource; Wallingford, Oxon; New York: CABI Publishing, CAB International, 1998
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Tuberculosis. Source: Medcom; Year: 1998; Format: Electronic resource; Cypress, CA: Medcom, c1998
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Tuberculosis. Source: a co-production of the Regional Audio Visual Center and Regional Staff Education; Year: 1994; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1994
Vocabulary Builder Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective
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tissue, and by their shape. [EU] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Tuberculoma: A tumor-like mass resulting from the enlargement of a tuberculous lesion. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON TUBERCULOSIS Overview Keeping up on the news relating to tuberculosis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on tuberculosis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover tuberculosis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on tuberculosis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “tuberculosis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Novel Drug Targets for Treatment of Tuberculosis Identified Summary: DALLAS, June 28 /PRNewswire-FirstCall/ -- eXegenics, Inc. (Nasdaq: EXEG) today announced the demonstration that enzyme targets to which it has proprietary rights can serve in the development of novel drugs to fight tuberculosis, the world's most dangerous bacterial killer. eXegenics has obtained exclusive commercial rights from the University of California and the University of British Columbia to use the targets to create new drugs. The findings will be presented tomorrow at the Fifth International Conference on the Pathogenesis of Mycobacterial Infections held in Stockholm, Sweden. The research, conducted under the leadership of Dr. Yossef Av-Gay at the University of British Columbia, demonstrated a direct correlation between depletion of mycothiol and susceptibility to antibiotics. Thus, drugs that inhibit eXegenics' proprietary target enzymes that produce mycothiol may render the deadly tuberculosis germ susceptible to ordinary antimicrobial treatment and make treatment of TB simpler, easier and most cost-effective. Dr. Av-Gay's conference presentation will detail the research results, which employed mutants of Mycobacterium smegmatis that are deficient in mycothiol production. The research has shown that mycothiol is a compound that Mycobacteria (including the bacterium that causes tuberculosis) produce to protect themselves from antibiotic compounds. These mutant strains were found to possess increased sensitivity to the free radicals and alkylating agents, including ones that are produced in the body to defend against tuberculosis. They also became highly vulnerable to a broad range of antimicrobial drugs, including erythromycin, azithromycin, vancomycin, penicillin G, rifamycin and rifampin.
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"Our findings suggest that enzymes essential to the production of mycothiol make attractive drug targets," said Dr. Av-Gay. "Agents that reliably and safely inhibit mycothiol production seem likely to compromise the tuberculosis bacterium's ability to defend itself. Working with Dr. R. C. Fahey and his research group at the University of California San Diego, we have identified two enzymes that are key to the metabolism of mycothiol. eXegenics has obtained the rights to use these enzymes as targets for novel drugs against tuberculosis, and we look forward to conducting further research in this area using QCT(TM), eXegenics' proprietary drug design methodology." Dr. Ronald L. Goode, president and CEO of eXegenics, said, "Developing new therapies for cancer and infectious diseases is our mission at eXegenics, and we are making rapid progress in building a development pipeline of candidate drug leads using our proprietary drug creation platform. Dr. Av-Gay and his colleagues have significantly advanced our understanding of mycothiol and how inhibitors that we create with QCT can potentially provide more effective remedies to the scourge of TB. We are optimistic about the potential for developing these enzymes into drug targets, and we are proud to be participating in the global fight against tuberculosis." eXegenics recently announced that the company is advancing into preclinical development a series of drug lead candidates that demonstrate remarkable in vitro activity against methicillin-resistant Staphylococcus aureus, a $2 billion per year healthcare problem.
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Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to tuberculosis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “tuberculosis” (or synonyms). The following was recently listed in this archive for tuberculosis: ·
Early diagnosis of smear-negative tuberculosis possible using clinical criteria Source: Reuters Medical News Date: July 05, 2002 http://www.reuters.gov/archive/2002/07/05/professional/links/20020 705clin024.html
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WHO warns Europe of tuberculosis threat Source: Reuters Health eLine Date: June 06, 2002 http://www.reuters.gov/archive/2002/06/06/eline/links/20020606elin 032.html
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UK tuberculosis test firm Biotec plans IPO. Source: Reuters Industry Breifing Date: May 17, 2002 http://www.reuters.gov/archive/2002/05/17/business/links/20020517 inds005.html
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Tuberculosis transmission trends have changed in New York over time Source: Reuters Medical News Date: May 08, 2002 http://www.reuters.gov/archive/2002/05/08/professional/links/20020 508publ004.html
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Ofloxacin use can shorten tuberculosis treatment Source: Reuters Industry Breifing Date: March 22, 2002 http://www.reuters.gov/archive/2002/03/22/business/links/20020322 clin013.html
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India tops global tuberculosis list Source: Reuters Medical News Date: March 20, 2002 http://www.reuters.gov/archive/2002/03/20/professional/links/20020 320publ005.html
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·
Global tuberculosis epidemic fuels US trend Source: Reuters Health eLine Date: February 07, 2002 http://www.reuters.gov/archive/2002/02/07/eline/links/20020207elin 043.html
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Tuberculosis vaccine trials set to begin in Britain Source: Reuters Health eLine Date: November 06, 2001 http://www.reuters.gov/archive/2001/11/06/eline/links/20011106elin 024.html The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “tuberculosis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “tuberculosis” (or synonyms). If you know the name of a company that is relevant to tuberculosis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “tuberculosis” (or synonyms).
Newsletters on Tuberculosis Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “tuberculosis.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “tuberculosis” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Medical Herbalism: Clinical Newsletter for the Herbal Practitioner Source: Portland, OR: Bergner Communications. 1989 -. Quarterly. [24 p. average]. Contact: Available from Bergner Communications, Inc. PO Box 20512, Boulder, CO 80308. 503-255-5976. Price: $29.00. Summary: Medical Herbalism, published quarterly, is a newsletter for herbal practitioners. It focuses on the clinical practice of herbalism, rather than theoretical or academic knowledge. Its purpose is to preserve and
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develop the art of herbal medicine, and to promote communication and sharing of clinical methods and experiences. Regular features include case reviews with commentary by experienced clinicians, indepth articles on botanical therapeutics, translations and abstracts of current European journal articles, reviews and tips from Eclectic medicine, book and computer software reviews, lists of educational resources, and a letters forum. A typical issue might address such topics as contraindications for echinacea in tuberculosis, leukemia, acquired immunodeficiency syndrome, and restrictions on its long-term use; herbal treatments for lower urinary tract infections; obstacles to licensure of medical herbalists in the United States; and the diagnosis and treatment of mycoplasma pneumonia. ·
Special Focus: School Health: Reducing the Burden of Chronic Disease: Promoting Healthy Behaviors Among Youth Source: Chronic Disease Notes and Reports. 14(1):1-36, Winter 2001. Contact: Centers for Disease Control and Prevention, Mail Stop K-11, 4770 Buford Highway, NE., Atlanta, GA 30341-3717. (770) 488-5050. FAX: (770) 488-5095. Internet/Email: http://www.cdc.gov/nccdphp;
[email protected]. Summary: The focus of this newsletter issue is on using school health programs to reduce the impact of chronic disease and risky behavior by promoting healthy lifestyles. Years spent in the education process in the United States could vastly improve the health of the future adults of this nation if additional emphasis and understanding could be placed on the importance of physical activity, fruit and vegetable consumption, and reduced tobacco use. Schools could help prevent cardiovascular diseasse, cancer, and diabetes. The Centers for Disease Control and Prevention (CDC) employs four national strategies to improve young people's health: (1) Monitor critical health events and school policies and programs, (2) synthesize and apply research to improve school policies and programs, (3) enable constituents to help schools implement effective policies and programs, and (4) evaluate to improve policies and programs. Key to monitoring chronic disease risk factors is the Youth Risk Behavior Surveillance System. The School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, provides a checklist questionnaire to rate school policies and programs against CDC standards. The Fit, Healthy and Ready to Learn tool serves as a guide to school health policy development. The CDC has developed an eight-component model to assist in the development of coordinated school health programs: (1) Health education, (2) physical education, (3) health services, (4) nutrition services, (5) health promotion for staff, (6)
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counseling and psychological services, (7) healthy school environment, and (8) parent/community involvement. Reaching and protecting young people at risk for human immunodeficiency virus infection is also reviewed in this report as it pertains to school health program efforts. State efforts target physical activity, absenteeism linked to asthma attacks, and oral health. Finally, the efforts of the CDC in the area of international school health activities are discussed.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “tuberculosis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on tuberculosis: ·
Obesity and Physical Health: Looking for Shades of Gray Source: The Weight Control Digest. p.537, 540-542, July/August 1996. Contact: Weight Control Digest, 1555 W. Mockingbird Lane, Suite 203, Dallas, TX 75235. (800) 736-7323. Summary: This report summarizes some of the many studies of the health risks of obesity. In general, obesity increases the risk of certain diseases or conditions (diabetes, osteoarthritis, hypertension, et al.), makes it more difficult to treat some of these conditions, and decreases longevity. On the other hand, the overweight individual is less likely to suffer from osteoporosis or tuberculosis, and is, obviously, more likely to survive periods of scarce food (an admittedly rare occurrence these days). On balance, however, the authors say, the risks of obesity outweigh the few benefits, and the risks that are associated with weight loss are less than those of overweight, as well.
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Academic Periodicals covering Tuberculosis Academic periodicals can be a highly technical yet valuable source of information on tuberculosis. We have compiled the following list of periodicals known to publish articles relating to tuberculosis and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on tuberculosis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on tuberculosis: ·
Antimicrobial Agents and Chemotherapy. (Antimicrob Agents Chemother) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=An timicrobial+Agents+and+Chemotherapy&dispmax=20&dispstart=0
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Bulletin of the History of Medicine. (Bull Hist Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bu lletin+of+the+History+of+Medicine&dispmax=20&dispstart=0
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Health & Social Work. (Health Soc Work) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=He alth+&+Social+Work&dispmax=20&dispstart=0
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Journal of Bacteriology. (J Bacteriol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Bacteriology&dispmax=20&dispstart=0
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·
Journal of Clinical Microbiology. (J Clin Microbiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Microbiology&dispmax=20&dispstart=0
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Journal of Clinical Pathology. (J Clin Pathol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Pathology&dispmax=20&dispstart=0
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Journal of Pharmaceutical Sciences. (J Pharm Sci) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Pharmaceutical+Sciences&dispmax=20&dispstart=0
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Medical Anthropology. (Med Anthropol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M edical+Anthropology&dispmax=20&dispstart=0
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Scandinavian Journal of Immunology. (Scand J Immunol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Immunology&dispmax=20&dispstart=0
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Social Science & Medicine (1982). (Soc Sci Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=So cial+Science+&+Medicine+(1982)&dispmax=20&dispstart=0
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The Journal of Nutrition. (J Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Nutrition&dispmax=20&dispstart=0
Vocabulary Builder Absenteeism: Chronic absence from work or other duty. [NIH] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH]
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Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Translations: Products resulting from the conversion of one language to another. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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·
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/health/diseases.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat tuberculosis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and tuberculosis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “tuberculosis” (or synonyms) into the
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“For these words:” box above, you will only receive results on fact sheets dealing with tuberculosis. The following is a sample result: ·
Preventing and Controlling Tuberculosis Along the US-Mexico Border: Work Group Report Source: Morbidity and Mortality Weekly Report 2001; 50(No. RR-1):1-28. Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Morbidity and Mortality Weekly Report Series, 1600 Clifton Rd NE M/S C-08, Atlanta, GA, 30333, (404) 332-4555, http://www.cdc.gov. US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: This report, for health professionals, organizations, and government agencies, provides recommendations for the improvement of tuberculosis (TB) infection control and prevention along the border between the United States (US) and Mexico. It addresses the challenges created by border-crossing populations, for example, Mexico's higher TB rate, low socioeconomic status and limited access to health care, frequent border crossing and travel to the United States, and a lack of coordinated care across health jurisdictions in Mexico and the US. Surveillance needs, case management and therapy completion, performance indicators and program evaluation, and research needs are discussed.
·
Tuberculosis in the Workplace Contact: National Academy Press, 2101 Constitution Ave NW, Box 285, Washington, DC, 20055, (202) 334-3313. Summary: This report, which was requested by the United States Congress in 1999, provides findings of a short-term study to examine the risk of tuberculosis (TB) among health care workers and the possible effects of federal guidelines and regulations intended to protect workers from this risk. It discusses responses to resurgent TB and proposed strategies for the elimination of TB in the Unites States and worldwide; TB transmission, infection, and disease; the Occupational Safety and Health Act of 1970 (OSHA) and its administration; a comparison of the Centers for Disease Control and Prevention's guidelines on preventing TB transmission in health care facilities with the proposed OSHA rule; occupational risk of TB; implementation and effects of CDC guidelines; and regulation and the future of TB in the workplace.
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·
Tuberculosis: Compliance Guide and Trainer's Kit Contact: Safety Priority Consultants LLC, 120 Ledyard St, Hartford, CT, 06114, (860) 296-1654, http://www.safetypriority.com. Summary: This manual, for settings where formal compliance with worker protection from tuberculosis (TB) is required or where worker awareness is desired, contains the latest information available from the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) on tuberculosis compliance. It covers enforcement procedures and scheduling for occupational exposure to TB; a TB infection control plan and support documents including information on TB infection and TB disease, how to do a risk assessment, the role of emergency service agencies, and universal precautions; respiratory protection program and support documents; trainer's presentation notes; instructional media, handouts, quiz, evaluation, and other forms for copying; and the 1994 CDC Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities.
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NIAID Global Health Research Plan for HIV/AIDS, Malaria, and Tuberculosis Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Instiute of Allergy and Infectious Diseases, Division of AIDS, 505 E King St, Room 304, Carson City, NV, 89710, (702) 687-4804. Summary: This report discusses the National Institute of Allergy and Infectious Diseases (NIAD) long term strategy for supporting research that will lead to effective human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and malaria prevention and treatment for individual countries struggling with these diseases. The report outlines NIAID's short-term, intermediate, and long-term goals for addressing the challenges put forth by the G8 nations in July 2000 for strengthening the Institute's role in collaborative international research. It discusses NIAID international projects in HIV/AIDS including epidemiological data related to the worldwide incidence of AIDS; HIV vaccine research; non-vaccine HIV prevention research; HIV therapeutics research; and capacity building, training, communications, and outreach, and the NIAID global research plan for malaria and TB including vaccine development, drug development, diagnostics tools, and strengthening of infrastructure and research capability.
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·
Global Tuberculosis Control : WHO Report 2000 Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This report discusses the global epidemiology of tuberculosis (TB) based on the results of a study performed by the World Health Organization (WHO). The report explains the methodology of data collection for this study. It examines and analyzes the results of the study in the areas of directly observed therapy short-term (DOTS) and provides the numbers of new and cured cases and deaths. A discussion on the progress of tuberculosis prevention on the global and regional/country level and developments in TB monitoring and evaluation is included. Statistical information is broken down in several appendices into regional and demographic categories including age, race, gender, country, and region.
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Supplement to the Tuberculosis Training and Education Resource Guide Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://cdcnpin.org. Summary: This resource guide supplement lists educational materials from the Centers for Disease Control and Prevention's (CDC) National Prevention Information Network's (NPIN) Educational Materials Database and includes fact sheets, guides, reports, and videos on tuberculosis (TB). Materials are listed alphabetically and grouped into two categories: (1) patient and public education and (2) professional education. Since materials target multiple audiences, overlap exists between the sections.
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The Economic Impacts of Tuberculosis Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This report discusses the economic impacts of tuberculosis (TB) on global populations. Section topics include (1) the morbidity and mortality burden of TB, (2) the economic and social burden of TB (treatment and non-treatment costs borne by patients and their families, costs from estimates of simulation studies, and psychological and social costs), (3) household coping strategies, and (4) benefits and costs of new strategies of dealing with TB (intervention strategies for TB control,
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simulation studies of alternative TB treatment regimes, and obstacles to the adoption of directly observed treatment, short-course [DOTS]). ·
Tuberculosis Exposure Control Plan : Template for the Clinic Setting Contact: Francis J Curry National Tuberculosis Center, 3180 18th St Ste 101, San Francisco, CA, 94110-2042, (415) 502-4600, http://www.nationaltbcenter.edu. Summary: This guideline provides a clinic exposure control plan (ECP) template designed to assist clinic management in developing and documenting effective tuberculosis (TB) ECP. The template focuses on exposure control of staff who work primarily in the clinic and addresses facility risk assessment, employee categories at risk for TB exposure, administrative and engineering controls, respiratory protection, and program evaluation. The guideline was produced in a template format, which can be customized by each facility to reflect facility characteristics, needs, and preferences. The template is issued in disk and written form to provide broad access and ease of use.
·
Tuberculosis : Back From the Past Contact: Coastal Training Technologies Corporation, 500 Studio Dr, Virgina Beach, VA, 23542, (800) 725-3418, http://www.coastal.com. Summary: This pamphlet, for health professionals, examines the risk of tuberculosis (TB) in health care settings and how to prevent TB transmission. It discusses TB, multiple drug-resistant TB, environmental controls to prevent the spread of TB in the workplace, respiratory protection, and TB testing. The pamphlet reviews possible work restrictions placed upon healthcare professionals who have TB.
·
Information on Tuberculosis for Criminal Justice Workers Contact: New York Department of Health, Bureau of Tuberculosis Control, Corning Tower Rm 840, Albany, NY, 12237-0669, (518) 474-7000, http://www.ci.nyc.ny.us/html/doh/html/tb/tb.html. Summary: This brochure, for criminal justice workers, provides information about tuberculosis (TB). The brochure describes TB and the tuberculin skin test, it distinguishes between TB infection and active TB, it identifies persons at risk for contracting or developing either, it explains the symptoms and available treatments for TB, and it discusses how TB is transmitted from person to person and what criminal justice workers can do to help to control its spread in correctional facilities.
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·
Information on Tuberculosis for Health Care Workers Contact: New York City Department of Health, Bureau of Tuberculosis Control, 125 Worth St Rm 216 Box 74, New York, NY, 10013, (212) 7884155, http://www.ci.nyc.ny.us/nyclink/html/doh/html/tb/tb.html. Summary: This brochure, for healthcare workers and professionals, provides information about tuberculosis (TB). The brochure describes TB, its transmission, and symptoms; it discusses multidrug-resistant TB (MDRTB) and how it develops; it identifies individuals at risk for TB infection and active TB; it discusses the importance of testing healthcare professionals for TB; and it reviews the tuberculin skin test procedure and the medical treatments available for active TB and TB infection. The brochure examines what healthcare facilities and personnel can do to prevent the spread of TB in the workplace.
·
About Tuberculosis Precautions for Law Enforcement, Correctional, Parole, and Probation Personnel Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channingbete.com. Summary: This brochure, for correctional and law enforcement personnel, discusses tuberculosis (TB) and its prevention in the workplace. It provides information on TB transmission, the difference between active TB and latent TB infection (LTBI), TB symptoms, multidrug-resistant TB (MDRTB), and the tuberculin skin test. It identifies individuals at risk for TB, and examines how TB can be controlled and prevented in the correctional facility setting through the use inmate containment, environmental measures, preventive therapy, personal protective equipment, workplace policies, and universal precautions.
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Stop Tuberculosis Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This pamphlet, for health professionals, organizations, and government agencies, provides information about the World Health Organization's Stop Tuberculosis (TB) initiative, which includes the use of directly observed therapy, short-course (DOTS) to help treat TB. It reviews the epidemiology of TB worldwide, and discusses the structure, mission, and objectives of Stop TB.
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·
Managing Tuberculosis and HIV Infection in Today's General Workplace Contact: CDC Business and Labor Resource Service, PO Box 6003, Rockville, MD, 20849-6003, (301) 562-1098, http://www.brta-lrta.org. Summary: This brochure discusses the management of tuberculosis (TB) in workplaces among employees with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The brochure provides information about TB, and differentiates between TB infection and active TB. It discusses TB transmission and prevention techniques. The brochure explains TB in the workplace and what measures should be taken upon discovering that an employee has TB. It examines the facts about HIV/AIDS, its modes of transmission, and the additional threat TB poses to HIV-positive employees. The brochure discusses how the Americans with Disabilities Act (ADA) applies to employees with HIV/AIDS and TB, and whether or not co-workers should be notified if an employee has TB infection or active TB. It provides general guidelines for handling TB and HIV/AIDS in the workplace.
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A Deadly Partnership: Tuberculosis in the Era of HIV Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org. Summary: This brochure is a component of an international prevention education campaign designed to reverse the dual epidemics of tuberculosis and HIV. The program is a multi-sector response that includes educational, developmental, financial, and medical components. The brochure outlines the international incidence and prevalence of this dual epidemic and emphasizes the importance of addressing the problem quickly. Basic facts about tuberculosis and HIV are presented including a discussion of risk factors and the impact on the health care system. Intervention strategies are also discussed.
·
Tuberculosis : Prevention and Practices for Healthcare Workers Contact: Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 5410253. Summary: This information kit, for health professionals, provides information about tuberculosis (TB) and prevention methods in healthcare settings. The video covers TB transmission and the tuberculosis epidemic, multi-drug resistant TB (MDRTB), and TB prevention. It differentiates between active TB and latent TB infection
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(LTBI), identifies the symptoms of active TB, and lists persons at risk for TB. It outlines steps that can be taken to help prevent the occupational transmission of TB including patient testing and screening, and reducing air contamination through engineering controls and the use of respirators. ·
Prevention and Control of Tuberculosis in the Health Care Setting Contact: University of Texas Health Center, Center for Pulmonary Infectious Disease Control, PO Box 2003, Tyler, TX, (903) 877-7790. Summary: This teaching aid discusses ways to prevent tuberculosis (TB) in a health care setting. The teaching aid describes TB, its methods of transmission, symptoms, and pathogenesis from infection to disease. It explains the diagnostic test and the TB skin test used to screen for the infection/disease. It describes infection control and administrative measures that can be taken to prevent the spread of TB in a health care setting. The teaching aid explains preventive therapy and the medical treatments available to care for persons with active TB and comes with information that may be made into transparencies, to reinforce the information in the text version.
·
Examining Relationships Between HIV/AIDS and Tuberculosis Programs in Title I Eligible Metropolitan Areas Contact: US Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, Bureau of Health Resources Development, Division of HIV Services, Parklawn Bldg Rm 7A-55, 5600 Fishers Ln, Rockville, MD, 20857, (301) 443-9091. Summary: This report provides information on an evaluation study by the Health Resources and Services Administration (HRSA) that addresses the lack of knowledge regarding the relationship between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB) programs in Title I cities experiencing a high prevalence of both diseases. The study discusses the (1) factors that affect the delivery of TB-related services in HIV care settings, (2) successful models of collaboration between HIV/AIDS and TB prevention and control programs, (3) the provision of TB services in HIV care settings to control the spread of TB, and (4) the effect of separate funding streams and programming on program collaboration at the provider/client level. It provides information on the methodology used in the study; findings; recommendations to Federal, State, and local HIV and TB programs; and study participants.
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·
Tuberculosis Control : The DOTS Strategy (Directly Observed Treatment Short-Course) : An Annotated Bibliography Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This bibliography provides a number of citations about topics related to tuberculosis (TB) control and directly-observed therapy, shortcourse (DOTS). The bibliography provides a listing of sources concerning TB-related and DOTS topics such as case finding, intermittent treatment, and treatment for persons with TB and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). For each of these sources, the bibliography provides information such as title, author, journal of origin or publisher, date published, pages of reference, and a brief abstract.
·
World Tuberculosis Day: Guide to Obtaining Media Coverage Contact: World Health Organization, Information Resource Center, 20 avenue Appia, 1211 Geneva 27, (41) 227913504. Summary: This manual contains suggestions and instructions for planning and implementing a creative media event on or before World Tuberculosis (TB) Day, March 24, 1997. Because competition for news media attention can be intense, its use is vital for capturing maximal media attention. The manual provides background information on World TB Day and discusses the theme of directly observed treatment, shortcourse (DOTS). The manual describes some of the successful media events that took place in different regions of the world on previous World TB Days. The tactics section presents examples of media activities including letters to the editor, a message point checklist, and strategies for maximizing the effectiveness of announcements, opinion-editorials, radio and television talk shows, interviews, press conferences, and photo opportunities.
·
Managing Tuberculosis at District Level : A Training Course Contact: World Health Organization, Communicable Diseases, Tuberculosis Strategy and Operations Unit, 20 Avenue Appia CH-1211, Geneva, http://www.who.int/gtb/index.htm. Summary: This information kit serves as curriculum to educate individuals about the treatment and control of tuberculosis (TB) on a regional and local level. It examines how to identify persons with TB through screening and selective testing of high-risk groups. The curriculum discusses how to administer quality treatment to individuals
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with TB, how to monitor treatment, and how to maintain a supply of medicines and other necessary materials to effectively complete treatment. It covers topics related to conducting supervisory visits to patients for directly observed therapy, short-course; providing laboratory support for TB testing; case reporting; and performing quarterly evaluations of treatment and epidemiological reporting. ·
Safety and Compliance Training : Guarding Against Tuberculosis Contact: SAVANT Audiovisuals, Inc., PO Box 3670, Fullerton, CA, 92634, (714) 870-7880. Summary: This information kit serves as a curriculum to educate individuals about the prevention and control of tuberculosis (TB) in health care settings. The topics covered in this program provide employees with general knowledge about how to prevent the spread of TB and include: (1) The History of Tuberculosis as a Disease, (2) Epidemiology and Symptoms of Tuberculosis, (3) Modes by which Tuberculosis is Transmitted, (4) The Centers for Disease Control and Prevention (CDC) Tuberculosis Guidelines, (5) The Exposure Control Plan, (6) Recognizing Exposure Situations, (7) Practices to Use to Prevent Exposure, (8) Administrative Controls, (9) Engineering Controls, and (10) Selection and Use of Respirators. A video reinforces TB prevention methods.
·
Prevention and Control of Tuberculosis in Correctional Facilities : Recommendations of the Advisory Council for the Elimination of Tuberculosis Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://cdcnpin.org. Summary: This monograph examines the prevalence of tuberculosis (TB) in correctional facilities, screening for TB in correctional facilities, and methods for TB treatment and elimination. The demography and epidemiology of TB in prisons is reviewed, and methods for preventing and controlling a TB outbreak in a correctional facility are explained. It discusses prisoner screening methods, such as the tuberculin skin test and diagnosing prisoners based on the physical evidence. The TB case reporting process for the local department of health and prison officials is explained, as well as how to isolate a prisoner with TB from the rest of the population to control the spread of the disease. Medical treatment and preventive therapy for prisoner patients is reviewed. It includes a general assessment of TB in correctional facilities, the role of the correctional facility in preventing TB outbreaks, and the role of the public health department.
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The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “tuberculosis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 344196 Books / Periodicals / Audio Visual 2563 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 350244
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 29
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HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “tuberculosis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 31 32
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Tuberculosis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to tuberculosis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
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Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “tuberculosis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for tuberculosis: ·
Mycobacterium Tuberculosis, Susceptibility to Infection by Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300259
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
37
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Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
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Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in
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the drop box next to “Search.” In the box next to “for,” enter “tuberculosis” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “tuberculosis” (or synonyms) into the search box, and review the results. If Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38
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more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in tuberculosis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · 2002 Pocket Book of Infectious Disease Therapy by John G. Bartlett; Paperback - 348 pages, 11th edition (November 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781734320; http://www.amazon.com/exec/obidos/ASIN/0781734320/icongroupinterna · Current Diagnosis & Treatment in Infectious Diseases by Walter R. Wilson (Editor), et al; Paperback - 985 pages, 1st edition (June 22, 2001), McGraw-Hill Professional Publishing; ISBN: 0838514944; http://www.amazon.com/exec/obidos/ASIN/0838514944/icongroupinterna · Diagnosis in Color: Sexually Transmitted Diseases by Anthony Wisdom, David A. Hawkins; Paperback, 2nd edition (July 1997), Mosby-Year Book; ISBN: 0723424969; http://www.amazon.com/exec/obidos/ASIN/0723424969/icongroupinterna · Hunter’s Tropical Medicine and Emerging Infectious Diseases by George W. Hunter (Editor), et al; Hardcover - 1192 pages, 8th edition (January 15, 2000), W B Saunders Co; ISBN: 0721662234; http://www.amazon.com/exec/obidos/ASIN/0721662234/icongroupinterna · Ibn Al-Jazzar on Sexual Diseases and Their Treatment (The Sir Henry Wellcome Series) by Ibn Al-Jazzar, Gerrit Bos; Hardcover - 430 pages (May 15, 1997), Kegan Paul International; ISBN: 0710305699; http://www.amazon.com/exec/obidos/ASIN/0710305699/icongroupinterna · Infectious Disease by Barbara Bannister, et al; Paperback - 506 pages, 2nd edition (August 15, 2000), Blackwell Science Inc.; ISBN: 0632053194; http://www.amazon.com/exec/obidos/ASIN/0632053194/icongroupinterna · Infectious Disease Epidemiology: Theory and Practice by Kenrad E. Nelson, et al; Hardcover - 600 pages (May 2000), Aspen Publishers, Inc.; ISBN: 083421766X; http://www.amazon.com/exec/obidos/ASIN/083421766X/icongroupinterna
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· Mandell, Douglas, and Bennett’s Principles & Practice of Infectious Diseases (2 Vol. Set) by Gerald L. Mandell (Editor), et al; Hardcover - 3263 pages, 5th edition (June 15, 2000), Churchill Livingstone; ISBN: 044307593X; http://www.amazon.com/exec/obidos/ASIN/044307593X/icongroupinterna · Molecular Epidemiology of Infectious Diseases by R. C. Andrew Thompson; Hardcover - 326 pages, 1st edition (October 15, 2000), Edward Arnold; ISBN: 0340759097; http://www.amazon.com/exec/obidos/ASIN/0340759097/icongroupinterna · Sexually Transmitted Diseases by King K. Holmes, M.D., PhD (Editor), et al; Hardcover - 1344 pages, 3rd edition (December 18, 1998), McGraw-Hill Professional Publishing; ISBN: 007029688X; http://www.amazon.com/exec/obidos/ASIN/007029688X/icongroupinterna · Sexually Transmitted Diseases: A Practical Guide by Niaid Staff (Editor), Robert J. Banis; Paperback - 150 pages (November 1997), Banis & Associates; ISBN: 1888725060; http://www.amazon.com/exec/obidos/ASIN/1888725060/icongroupinterna · Sexually Transmitted Diseases: Epidemiology, Pathology, Diagnosis, and Treatment by Kenneth A. Borchardt (Editor), et al; Hardcover - 349 pages (January 15, 1997), CRC Press; ISBN: 0849394767; http://www.amazon.com/exec/obidos/ASIN/0849394767/icongroupinterna
Dissertations 237
CHAPTER 10. DISSERTATIONS ON TUBERCULOSIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to tuberculosis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Tuberculosis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to tuberculosis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with tuberculosis: ·
A Computer Simulation of the Spread of Tuberculosis in Prehistoric Populations of the Lower Illinois River Valley by Mcgrath, Janet Winifred, Phd from Northwestern University, 1986, 302 pages http://wwwlib.umi.com/dissertations/fullcit/8621833
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·
A Consumptives' Refuge: Colorado and Tuberculosis by Stout, Cynthia Kay, Phd from The George Washington University, 1997, 257 pages http://wwwlib.umi.com/dissertations/fullcit/9726673
·
'an Antitoxin of Self Respect': North American Debates over Vaccination against Tuberculosis, 1890-1960 (koch, United States, Canada) by Feldberg, Georgiana Danielle, Phd from Harvard University, 1989, 476 pages http://wwwlib.umi.com/dissertations/fullcit/9013207
·
'and I? I Am in a Consumption:' the Tuberculosis Patient, 1780-1930 (medicine, United States, Europe) by Mcmurry, Nan Marie, Phd from Duke University, 1985, 330 pages http://wwwlib.umi.com/dissertations/fullcit/8614438
·
Attitudinal Components of Selected Occupational Groups in Tuberculosis Hospitals by Guerrin, Robert Francis, Phd from New York University, 1970, 128 pages http://wwwlib.umi.com/dissertations/fullcit/7019002
·
Benefit-cost Analysis and Public Health: a Case Study of the Tuberculosis Control Program in Ontario, 1948-1966 by Sharma, Ram Karan, Phd from The University of Western Ontario (canada), 1973 http://wwwlib.umi.com/dissertations/fullcit/f407559
·
Brucellosis and Tuberculosis As Factors Limiting Population Growth of Northern Bison by Joly, Damien Oliver; Phd from The University of Saskatchewan (canada), 2001, 188 pages http://wwwlib.umi.com/dissertations/fullcit/NQ63882
·
Crystal Structures of Glutamine Synthetase from Mycobacterium Tuberculosis & Salmonella Typhimurium: Illumination of Enzymatic Inhibition, Reaction Mechanism, and Regulation by Gill, Harindarpal Singh; Phd from University of California, Los Angeles, 2001, 158 pages http://wwwlib.umi.com/dissertations/fullcit/9998978
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to tuberculosis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you
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should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Antitoxin: A purified antiserum from animals (usually horses) immunized by injections of a toxin or toxoid, administered as a passive immunizing agent to neutralize a specific bacterial toxin, e.g., botulinus, tetanus or diphtheria. [EU] Brucellosis: Infection caused by bacteria of the genus brucella mainly involving the reticuloendothelial system. This condition is characterized by fever, weakness, malaise, and weight loss. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH]
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with tuberculosis and related conditions.
Researching Your Medications 243
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with tuberculosis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for tuberculosis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of tuberculosis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of tuberculosis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with tuberculosis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for tuberculosis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 245
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for tuberculosis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for tuberculosis. One such
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source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of tuberculosis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to tuberculosis: Aminoglycosides ·
Systemic - U.S. Brands: Amikin; Garamycin; G-Mycin; Jenamicin; Kantrex; Nebcin; Netromycin http://www.nlm.nih.gov/medlineplus/druginfo/aminoglycoside ssystemic202027.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
41
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Aminosalicylate Sodium ·
Systemic - U.S. Brands: Tubasal http://www.nlm.nih.gov/medlineplus/druginfo/aminosalicylate sodiumsystemic202028.html
Ascorbic Acid (Vitamin C) ·
Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/ascorbicacidvita mincsystemic202071.html
Cycloserine ·
Systemic - U.S. Brands: Seromycin http://www.nlm.nih.gov/medlineplus/druginfo/cycloserinesyste mic202175.html
Ethambutol ·
Systemic - U.S. Brands: Myambutol http://www.nlm.nih.gov/medlineplus/druginfo/ethambutolsyste mic202229.html
Isoniazid ·
Systemic - U.S. Brands: Laniazid; Nydrazid http://www.nlm.nih.gov/medlineplus/druginfo/isoniazidsystem ic202307.html
Pyrazinamide ·
Systemic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/isoniazidsystem ic202307.html
Rifabutin ·
Systemic - U.S. Brands: Mycobutin http://www.nlm.nih.gov/medlineplus/druginfo/rifabutinsystemi c202683.html
Rifampin ·
Systemic - U.S. Brands: Rifadin; Rimactane http://www.nlm.nih.gov/medlineplus/druginfo/rifampinsystemi c202511.html
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Rifampin and Isoniazid ·
Systemic - U.S. Brands: Rifamate http://www.nlm.nih.gov/medlineplus/druginfo/rifampinandiso niazidsystemic202512.html
Rifampin, Isoniazid, and Pyrazinamide ·
Systemic - U.S. Brands: Rifater http://www.nlm.nih.gov/medlineplus/druginfo/rifampinisoniazi dandpyrazinami202775.html
Rifapentine ·
Systemic - U.S. Brands: Priftin http://www.nlm.nih.gov/medlineplus/druginfo/rifapentinesyste mic203609.html
Tuberculin, Purified Protein Derivative (Ppd) ·
Injection - U.S. Brands: Aplisol; Aplitest; Tubersol http://www.nlm.nih.gov/medlineplus/druginfo/tuberculinpurifi edproteinderiv202761.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with tuberculosis (including those with contraindications):42 ·
42
Aminosalicylate Sodium http://www.reutershealth.com/atoz/html/Aminosalicylate_Sodium.ht m
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 249
·
Aminosalicylate Sodium (Para-Aminosalicylate Sodium;PAS) http://www.reutershealth.com/atoz/html/Aminosalicylate_Sodium_(P ara-Aminosalicylate_Sodium;PAS).htm
·
Atorvastatin Calcium http://www.reutershealth.com/atoz/html/Atorvastatin_Calcium.htm
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Cycloserine http://www.reutershealth.com/atoz/html/Cycloserine.htm
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Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
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Dipyridamole Aspirin http://www.reutershealth.com/atoz/html/Dipyridamole_Aspirin.htm
·
Ergoloid Mesylates (Dihydrogenated Ergot Alkaloids; Dihydroergotoxine) http://www.reutershealth.com/atoz/html/Ergoloid_Mesylates_(Dihydr ogenated_Ergot_Alkaloids;_Dihydroergotoxine).htm
·
Ergoloid Mesylates(Dihydrogenated Ergot Alkaloids; Dihydroergotoxine) http://www.reutershealth.com/atoz/html/Ergoloid_Mesylates(Dihydr ogenated_Ergot_Alkaloids;_Dihydroergotoxine).htm
·
Gemfibrozil http://www.reutershealth.com/atoz/html/Gemfibrozil.htm
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Heparin http://www.reutershealth.com/atoz/html/Heparin.htm
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Iodine http://www.reutershealth.com/atoz/html/Iodine.htm
·
Isoniazid (Isonicotinic Acid Hydrazide; INH) http://www.reutershealth.com/atoz/html/Isoniazid_(Isonicotinic_Acid _Hydrazide;_INH).htm
·
Lovastatin http://www.reutershealth.com/atoz/html/Lovastatin.htm
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Measles Mumps and Rubella Vaccine Live http://www.reutershealth.com/atoz/html/Measles_Mumps_and_Rubel la_Vaccine_Live.htm
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Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
·
Nicardipine HCL http://www.reutershealth.com/atoz/html/Nicardipine_HCL.htm
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·
Pentazocine http://www.reutershealth.com/atoz/html/Pentazocine.htm
·
Prednisolone http://www.reutershealth.com/atoz/html/Prednisolone.htm
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Prednisone http://www.reutershealth.com/atoz/html/Prednisone.htm
·
Pyrazinamide http://www.reutershealth.com/atoz/html/Pyrazinamide.htm
·
Raloxifene HCl http://www.reutershealth.com/atoz/html/Raloxifene_HCl.htm
·
Raloxifene Hydrochloride http://www.reutershealth.com/atoz/html/Raloxifene_Hydrochloride.h tm
·
Rifabutin http://www.reutershealth.com/atoz/html/Rifabutin.htm
·
Rifampin http://www.reutershealth.com/atoz/html/Rifampin.htm
·
Rifapentine http://www.reutershealth.com/atoz/html/Rifapentine.htm
·
Sparfloxacin http://www.reutershealth.com/atoz/html/Sparfloxacin.htm
·
Thioridazine HCl http://www.reutershealth.com/atoz/html/Thioridazine_HCl.htm
·
Torsemide http://www.reutershealth.com/atoz/html/Torsemide.htm
·
Tuberculin Purified Protein Derivative http://www.reutershealth.com/atoz/html/Tuberculin_Purified_Protein _Derivative.htm
·
Verapamil HCI http://www.reutershealth.com/atoz/html/Verapamil_HCI.htm
·
Zileuton http://www.reutershealth.com/atoz/html/Zileuton.htm
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Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with tuberculosis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat tuberculosis or potentially create deleterious side effects in patients with tuberculosis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause
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unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with tuberculosis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with tuberculosis. The FDA warns patients to watch out for43: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
43
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Interactions in Infectious Diseases (Infectious Disease) by Stephen C. Piscitelli (Editor), et al; Hardcover - 372 pages (September 2000), Humana Press; ISBN: 0896037509; http://www.amazon.com/exec/obidos/ASIN/0896037509/icongroupinterna · Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance by Arch G., Ph.D. Mainous (Editor), et al; Hardcover - 350 pages, 1st edition (January 15, 2001), Humana Press; ISBN: 0896038211; http://www.amazon.com/exec/obidos/ASIN/0896038211/icongroupinterna · Manual of Antibiotics and Infectious Diseases: Treatment and Prevention by John E. Conte; Paperback - 755 pages, 9th edition (December 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781723167; http://www.amazon.com/exec/obidos/ASIN/0781723167/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Cycloserine: Antibiotic substance produced by Streptomyces garyphalus. It may be used in the treatment of resistant tuberculosis as part of a multi-drug regimen. It has also been used in urinary tract infections. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total
254 Tuberculosis
cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Mesylates: Organic salts or esters of methanesulfonic acid. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to tuberculosis. Finally, at the conclusion of this chapter, we will provide a list of readings on tuberculosis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Tuberculosis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for tuberculosis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “tuberculosis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options.
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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to tuberculosis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “tuberculosis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to tuberculosis: ·
(+)-Totarol from Chamaecyparis nootkatensis and activity against Mycobacterium tuberculosis. Author(s): Constantine GH, Karchesy JJ, Franzblau SG, LaFleur LE. Source: Fitoterapia. 2001 June; 72(5): 572-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11429259&dopt=Abstract
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A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Author(s): Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, Schlebusch H, van der Meer JW. Source: The American Journal of Clinical Nutrition. 2002 April; 75(4): 7207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11916759&dopt=Abstract
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Absence of antimycobacterial synergism between garlic extract and antituberculosis drugs. Author(s): Abbruzzese MR, Delaha EC, Garagusi VF. Source: Diagnostic Microbiology and Infectious Disease. 1987 October; 8(2): 79-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3123123&dopt=Abstract
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Activity of bromhexine and ambroxol, semi-synthetic derivatives of vasicine from the Indian shrub Adhatoda vasica, against Mycobacterium tuberculosis in vitro. Author(s): Grange JM, Snell NJ.
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Source: Journal of Ethnopharmacology. 1996 January; 50(1): 49-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8778507&dopt=Abstract ·
Anti-Kp 90 IgA antibodies in the diagnosis of active tuberculosis. Author(s): Arikan S, Tuncer S, Us D, Unal S, Ustacelebi S. Source: Chest. 1998 November; 114(5): 1253-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9823997&dopt=Abstract
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Anti-tuberculosis activity of quassinoids. Author(s): Rahman S, Fukamiya N, Okano M, Tagahara K, Lee KH. Source: Chemical & Pharmaceutical Bulletin. 1997 September; 45(9): 15279. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9332005&dopt=Abstract
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Attitudes regarding tuberculosis among Samoans. Author(s): AhChing LP, Sapolu M, Yamada S. Source: Pac Health Dialog. 2001 March; 8(1): 15-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12017816&dopt=Abstract
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Attitudes toward Tuberculosis in Vietnamese Immigrants. Author(s): Nguyen L, Yamada S, Matsunaga DS, Caballero J. Source: Asian Am Pac Isl J Health. 2000 Winter; 8(1): 69-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11567514&dopt=Abstract
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Auditory disorder in central nervous system miliary tuberculosis: case report. Author(s): Stach BA, Westerberg BD, Roberson JB Jr. Source: Journal of the American Academy of Audiology. 1998 August; 9(4): 305-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9733241&dopt=Abstract
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Bacillary disease and health seeking behavior among Filipinos with symptoms of tuberculosis: implications for control. Author(s): Tupasi TE, Radhakrishna S, Co VM, Villa ML, Quelapio MI, Mangubat NV, Sarol JN, Rivera AB, Pascual ML, Reyes AC, Sarmiento A, Solon M, Solon FS, Burton L, Mantala MJ.
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Source: Int J Tuberc Lung Dis. 2000 December; 4(12): 1126-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11144454&dopt=Abstract ·
Can stress cause disease? Revisiting the tuberculosis research of Thomas Holmes, 1949-1961. Author(s): Lerner BH. Source: Annals of Internal Medicine. 1996 April 1; 124(7): 673-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8607596&dopt=Abstract
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Care seeking behaviour and diagnostic processes in patients with smear-positive pulmonary tuberculosis in Malawi. Author(s): Salaniponi FM, Harries AD, Banda HT, Kang'ombe C, Mphasa N, Mwale A, Upindi B, Nyirenda TE, Banerjee A, Boeree MJ. Source: Int J Tuberc Lung Dis. 2000 April; 4(4): 327-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10777081&dopt=Abstract
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Chemical constituents of Gentianaceae XXIV: Anti-Mycobacterium tuberculosis activity of naturally occurring xanthones and synthetic analogs. Author(s): Ghosal S, Biswas K, Chaudhuri RK. Source: Journal of Pharmaceutical Sciences. 1978 May; 67(5): 721-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=565403&dopt=Abstract
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Conceptions of tuberculosis and therapeutic choices in Highland Chiapas, Mexico. Author(s): Menegoni L. Source: Med Anthropol Q. 1996 September; 10(3): 381-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8873025&dopt=Abstract
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Contribution of 'TB clubs' to tuberculosis control in a rural district in Ethiopia. Author(s): Getahun H, Maher D. Source: Int J Tuberc Lung Dis. 2000 February; 4(2): 174-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10694097&dopt=Abstract
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Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania. Author(s): Wandwalo ER, Morkve O. Source: Int J Tuberc Lung Dis. 2000 February; 4(2): 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10694091&dopt=Abstract
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Development and evaluation of a simple latex agglutination test for diagnosis of tuberculosis. Author(s): Cole RV, Lazarus AW, Hedrick HG. Source: Appl Microbiol. 1972 October; 24(4): 525-34. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4628793&dopt=Abstract
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Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children. Author(s): Manary MJ, Hotz C, Krebs NF, Gibson RS, Westcott JE, Arnold T, Broadhead RL, Hambidge KM. Source: The Journal of Nutrition. 2000 December; 130(12): 2959-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11110854&dopt=Abstract
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Different tuberculosis in men and women: beliefs from focus groups in Vietnam. Author(s): Long NH, Johansson E, Diwan VK, Winkvist A. Source: Social Science & Medicine (1982). 1999 September; 49(6): 815-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10459892&dopt=Abstract
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Diminished adherence and/or ingestion of virulent Mycobacterium tuberculosis by monocyte-derived macrophages from patients with tuberculosis.Author(s): Zabaleta J, Arias M, Maya JR, Garcia LF. Source: Clinical and Diagnostic Laboratory Immunology. 1998 September; 5(5): 690-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9729537&dopt=Abstract
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Direct ex vivo analysis of antigen-specific IFN-gamma-secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals: associations with clinical disease state and effect of treatment.
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Author(s): Pathan AA, Wilkinson KA, Klenerman P, McShane H, Davidson RN, Pasvol G, Hill AV, Lalvani A. Source: Journal of Immunology (Baltimore, Md. : 1950). 2001 November 1; 167(9): 5217-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11673535&dopt=Abstract ·
Directly observed therapy, short-course: the best way to prevent multidrug-resistant tuberculosis. Author(s): Yew WW. Source: Chemotherapy. 1999; 45 Suppl 2: 26-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10449895&dopt=Abstract
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DOTS and beyond: towards a holistic approach to the conquest of tuberculosis. Author(s): Grange JM. Source: Int J Tuberc Lung Dis. 1997 August; 1(4): 293-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9432381&dopt=Abstract
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Effect of decalcifying agents on the staining of Mycobacterium tuberculosis. Author(s): Anderson G, Coup AJ. Source: Journal of Clinical Pathology. 1975 September; 28(9): 744-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=51859&dopt=Abstract
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Effect of oxygen tension on the aldolases of Mycobacterium tuberculosis H37Rv. Author(s): Bai NJ, Pai MR, Murthy PS, Venkitasubramanian TA. Source: Febs Letters. 1974 September 1; 45(1): 68-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4213059&dopt=Abstract
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Effects of panax ginseng extracts on the growth of Mycobacterium tuberculosis H37Rv. Author(s): Chang MW, Tasaka H, Kuwabara M, Watanabe T, Matsuo Y.
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Source: Hiroshima J Med Sci. 1979 June; 28(2): 115-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=113372&dopt=Abstract ·
Fluoroquinolones and tuberculosis. Author(s): Bryskier A, Lowther J. Source: Expert Opinion on Investigational Drugs. 2002 February; 11(2): 233-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11829714&dopt=Abstract
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Health culture and the clinical encounter: Vietnamese refugees' responses to preventive drug treatment of inactive tuberculosis. Author(s): Ito KL. Source: Med Anthropol Q. 1999 September; 13(3): 338-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10509313&dopt=Abstract
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History of tuberculosis among Aborigines. Author(s): Metcalf C, Yach D. Source: Med J Aust. 1989 July 17; 151(2): 116. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2661979&dopt=Abstract
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HIV-related tuberculosis in British Columbia: indications of a rise in prevalence and a change in risk groups. Author(s): Blenkush MF, Korzeniewska-Kozela M, Elwood RK, Black W, FitzGerald JM. Source: Clinical and Investigative Medicine. Medecine Clinique Et Experimentale. 1996 August; 19(4): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8853575&dopt=Abstract
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Hydrogen peroxide and superoxide release by alveolar macrophages from normal and BCG-vaccinated guinea-pigs after intravenous challenge with Mycobacterium tuberculosis. Author(s): Jackett PS, Andrew PW, Aber VR, Lowrie DB. Source: Br J Exp Pathol. 1981 August; 62(4): 419-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6271160&dopt=Abstract
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Identification of an elastolytic protease in stationary phase culture filtrates of M. tuberculosis. Author(s): Rowland SS, Ruckert JL, Burall BN Jr. Source: Fems Microbiology Letters. 1997 June 1; 151(1): 59-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9198282&dopt=Abstract
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Identification of Mycobacterium tuberculosis and Mycobacterium avium-M. intracellulare directly from primary BACTEC cultures by using acridinium-ester-labeled DNA probes. Author(s): Evans KD, Nakasone AS, Sutherland PA, de la Maza LM, Peterson EM. Source: Journal of Clinical Microbiology. 1992 September; 30(9): 2427-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1401010&dopt=Abstract
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In vitro experiments with Centella asiatica: investigation to elucidate the effect of an indigenously prepared powder of this plant on the acidfastness and viability of M. tuberculosis. Author(s): Herbert D, Paramasivan CN, Prabhakar R, Swaminathan G. Source: Indian J Lepr. 1994 January-March; 66(1): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7983394&dopt=Abstract
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In vitro inhibition of drug-resistant and drug-sensitive strains of Mycobacterium tuberculosis by ethnobotanically selected South African plants. Author(s): Lall N, Meyer JJ. Source: Journal of Ethnopharmacology. 1999 September; 66(3): 347-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10473184&dopt=Abstract
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Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Author(s): Wilkinson RJ, Llewelyn M, Toossi Z, Patel P, Pasvol G, Lalvani A, Wright D, Latif M, Davidson RN. Source: Lancet. 2000 February 19; 355(9204): 618-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10696983&dopt=Abstract
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Inhibition of drug-sensitive and drug-resistant strains of Mycobacterium tuberculosis by diospyrin, isolated from Euclea natalensis. Author(s): Lall N, Meyer JJ. Source: Journal of Ethnopharmacology. 2001 December; 78(2-3): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11694367&dopt=Abstract
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Involuntary confinement for tuberculosis control: the Jewish view. Author(s): Rosner F. Source: The Mount Sinai Journal of Medicine, New York. 1996 January; 63(1): 44-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8935848&dopt=Abstract
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Involvement of antilipoarabinomannan antibodies in classical complement activation in tuberculosis. Author(s): Hetland G, Wiker HG, Hogasen K, Hamasur B, Svenson SB, Harboe M. Source: Clinical and Diagnostic Laboratory Immunology. 1998 March; 5(2): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9521145&dopt=Abstract
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Is vitamin B6 supplementation of isoniazid therapy useful in childhood tuberculosis. Author(s): Mbala L, Matendo R, Nkailu R. Source: Trop Doct. 1998 April; 28(2): 103-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9594683&dopt=Abstract
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Knowledge and practice pattern of non-allopathic indigenous medical practitioners regarding tuberculosis in a rural area of India. Author(s): Anandhi CL, Nagaraj VK, Kumar R. Source: Int J Tuberc Lung Dis. 2002 June; 6(6): 553-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12068991&dopt=Abstract
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Local perceptions of tuberculosis in a rural district in Malawi. Author(s): Banerjee A, Harries AD, Nyirenda T, Salaniponi FM.
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Source: Int J Tuberc Lung Dis. 2000 November; 4(11): 1047-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11092717&dopt=Abstract ·
Medical and social consequences of tuberculosis in rural Ethiopia. Author(s): Getahun H. Source: Ethiop Med J. 1999 July; 37(3): 147-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11957311&dopt=Abstract
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Metal ions modulate the plastic nature of Mycobacterium tuberculosis chaperonin-10. Author(s): Taneja B, Mande SC. Source: Protein Engineering. 2001 June; 14(6): 391-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11477217&dopt=Abstract
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Miliary tuberculosis with acute respiratory failure and histiocytic hemophagocytosis. Successful treatment with extracorporeal lung support and epipodophyllotoxin VP 16-213. Author(s): Monier B, Fauroux B, Chevalier JY, Leverger G, Nathanson M, Costil J, Tournier G. Source: Acta Paediatrica (Oslo, Norway : 1992). 1992 September; 81(9): 725-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1421920&dopt=Abstract
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Molecular cloning and expression of an alpha-mannosidase gene in Mycobacterium tuberculosis. Author(s): Rivera-Marrero CA, Ritzenthaler JD, Roman J, Moremen KW. Source: Microbial Pathogenesis. 2001 January; 30(1): 9-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11162181&dopt=Abstract
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Ngaka ya setswana, ngaka ya sekgoa or both? Health seeking behaviour in Batswana with pulmonary tuberculosis. Author(s): Steen TW, Mazonde GN. Source: Social Science & Medicine (1982). 1999 January; 48(2): 163-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10048775&dopt=Abstract
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Partial purification and characterization of an alcohol dehydrogenase of Mycobacterium tuberculosis var. bovis (BCG). Author(s): De Bruyn J, Johannes A, Weckx M, Beumer-Jochmans MP. Source: J Gen Microbiol. 1981 June; 124(Pt 2): 359-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7035614&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of
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general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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Natural Alternatives to Antibiotics by John McKenna; Paperback - 176 pages (November 1998), Avery Penguin Putnam; ISBN: 0895298392; http://www.amazon.com/exec/obidos/ASIN/0895298392/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna
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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
The following is a specific Web list relating to tuberculosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Tuberculosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html
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Alternative Therapy Apitherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,669, 00.html Chinese System of Food Cures Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Color therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683, 00.html
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Daniel's Diet Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Grape Cure Alternative names: grape diet Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/g.html Holoenergetic healing Alternative names: Holoenergetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Nutrition Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Nutriti oncm.html ·
Chinese Medicine Baiji Alternative names: Common Bletilla Tuber; Rhizoma Bletillae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Guifu Lizhong Wan Alternative names: Guifu Lizhong Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Guifu%20Lizhong %20Wan&mh=10&sb=---&view_records=View+Records Loulu Alternative names: Globethistle Root; Yuzhou loulu; Radix Echinopsis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
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Maozhaocao Alternative names: Catclaw Buttercup Root; Radix Ranunculi Ternati Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shancigu Alternative names: Appendiculate Cremastra Pseudobulb or Common Pleione Pseudobulb; Pseudobulbus Cremastrae seu Pleiones Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Suanzaoren Alternative names: Spine Date Seed; Semen Ziziphi Spinosae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tubeimu Alternative names: Paniculate Bolbostemma; Rhizoma Bolbostemmae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yuzhou loulu Alternative names: Globethistle Root; Radix Echinopsis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Herbs and Supplements 5-Hydroxytryptophan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/5-HTP.htm Adenosine Monophosphate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Adenosine_Monophosp hate.htm Adrenal Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Adrenal_Extract.htm
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ALA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Alph aLinolenicAcidALAcs.html Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Alph aLinolenicAcidALAcs.html American Ginseng Alternative names: Panax quinquefolius Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginseng_American.htm Anti-Infective Agents Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anti_Infectives.htm Antitubercular Agents Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Antituberculars.htm Antituberculosis Agents Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsAntituberculosisAgentscl.html Arnica Alternative names: Arnica montana L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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Astragalus sp Alternative names: Vetch, Rattlepod, Locoweed; Astragalus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Berberis Alternative names: Barberry; Berberis sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Beta_Carotene.htm Black Cohosh Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000110.html Blue Cohosh Alternative names: Caulophyllum thalictroides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Blue_Cohosh.htm Blue-Green Algae Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Blue_Green_Algae.htm Borago Alternative names: Borage; Borago officinalis Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Caffeine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Caffeine.htm Calciferol Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Calciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Calcitrol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTeach. html Carotenoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carotenes.htm Carotenoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,763, 00.html Cat's Claw Alternative names: Uncaria tomentosa
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CatsClawch. html Caulophyllum Alternative names: Blue Cohosh; Caulophyllum thalictroides (MICH.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cayenne.htm Centella Alternative names: Gotu Kola; Centella asiatica (Linn.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Cholecalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Cobalamin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Comfrey Alternative names: Symphytum officinale, Knitbone Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Comfreych. html Conjugated Linoleic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/CLA.htm Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 19,00.html Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Cycloserine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cycloserine.htm Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Cyst einecs.html DHA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Doco sahexaenoicAcidDHAcs.html Docosahexaenoic Acid (DHA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Doco sahexaenoicAcidDHAcs.html Echinacea
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Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Echinacea.htm Echinacea Alternative names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinaceach .html Echinacea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000149.html Echinacea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,775, 00.html Echinacea angustifolia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinaceach .html Echinacea pallida Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinaceach .html Echinacea purpurea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinaceach .html Eicosapentaenoic Acid (EPA)
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Eicos apentaenoicAcidEPAcs.html Elecampane Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsd-f.htm EPA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Eicos apentaenoicAcidEPAcs.html Equisetum Alternative names: Horsetail; Equisetum arvense L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Erocalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fiber.htm Flaxseed Alternative names: Linum usitatissimum, Linseed Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Fructo-oligosaccharides (FOS) and Other Oligosaccharides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/FOS.htm Garcinia cambogia Alternative names: Citrin, Gambooge Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginger.htm Ginger Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000166.html Glutathione Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,854, 00.html Glyburide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Glyburide.htm Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Green_Tea.htm
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Green Tea Alternative names: Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTeach. html Green Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000175.html Gymnema Alternative names: Gurmar; Gymnema sylvestre Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Hops Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000181.html Horsetail Alternative names: Equisetum arvense Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horsetail.htm Horsetail Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,101 05,00.html Hydrastis Alternative names: Goldenseal; Hydrastis canadensis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Indole-3-Carbinol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Indole_3_Carbinol.htm Insulin Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Insulin.htm Interferon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Isoflavones Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000190.html Isoniazid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Isoniazid.htm Isoniazid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Isoniazid Alternative names: Laniazid, Nydrazid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000383.html Kava Alternative names: Piper methysticum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Kava.htm Knitbone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Comfreych. html Kudzu Alternative names: Pueraria lobata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Kudzu.htm
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Kudzu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,858, 00.html Lepidium meyenii1 Alternative names: Maca; Lepidium meyenii Walp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Licorice.htm Linseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Linum usitatissimum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Liver Extracts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Liver_Extracts.htm Lycopene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lycopene.htm Lycopene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,803, 00.html
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Lysine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,862, 00.html Matricaria Alternative names: Chamomile; Matricaria chamomilla Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Mentha Alternative names: Pennyroyal; Mentha/Hedeoma pulegium Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Metoclopramide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Metoclopramide.htm Momordica Alternative names: Bitter Gourd, Karela; Momordica charantia Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Mullein flower Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,865, 00.html Musa Banana Alternative names: Plantain, Banana; Musa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Nettle.htm Panax
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Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Peppermint.htm Pimpinella Alternative names: Anise; Pimpinella anisum (L) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Piper Alternative names: Kava; Piper methysticum Forst.f Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Piper nigrum Alternative names: Black Pepper Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Probiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Probiotics.htm Pueraria Alternative names: Kudzu; Pueraria lobata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinaceach .html Pyrazinamide Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Resveratrol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,104 0,00.html Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Royal_Jelly.htm Skullcap Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000235.html Soy isoflavones Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 57,00.html Swertia Alternative names: Swertia sp Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Symphytum Alternative names: Comfrey; Symphytum officinale L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Symphytum officinale Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Comfreych. html Syzygium Clove Alternative names: Clove, Jamun; Syzygium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tanacetum Alternative names: Feverfew; Tanacetum parthenium (L.) Schultz-Bip. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Taraxacum Alternative names: Dandelion; Taraxacum officinale (Dhudhal) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thymus Alternative names: Thyme; Thymus vulgaris Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Trigonella Alternative names: Fenugreek; Trigonella foenum graecum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Uncaria tomentosa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CatsClawch. html Valproic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000362.html Walnut leaf Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,101 10,00.html Warfarin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Warfarin.htm Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsw-z.htm Yerba Santa Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000250.html Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ ·
Related Conditions Acne Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Acnecc .html Age-Related Cognitive Decline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/ARCD.htm AIDS and HIV Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/HIVan dAIDScc.html Alcohol Withdrawal Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Alcohol.htm Alcoholism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Amenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Amenorrhea.htm Amenorrhea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Amyloidosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Amyloi dosiscc.html Angina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Angina.htm Appendicitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Appen dicitiscc.html Asthma Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Atherosclerosis
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Atherosclerosis.htm Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000263.html Athletic Performance Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Athletic_Performance .htm Birth Defects Prevention Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Birth_Defects.htm Blood Pressure, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Brain Inflammation, Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menin gitiscc.html Breast Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Breast.htm Breast Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Breastcc.html Bronchitis
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Burns Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Burnsc c.html Cancer Prevention (Reducing the Risk) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000272.html Cancer Prevention and Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Diet.htm Cancer, Breast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Breastcc.html Cancer, Colorectal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Colorectalcc.html Cancer, Prostate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiac_Arrhythmia. htm
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Cardiomyopathy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiomyopathy.htm Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiovascular_Dise ase.htm Cataracts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cataracts.htm Cataracts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Catara ctscc.html Celiac Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Cholesterol, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Chronic_Candidiasis. htm Cluster Headache Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cluster_Headache.htm
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Colds and Flus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000282.html Colon Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Colon.htm Colorectal Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Colorectalcc.html Congestive Heart Failure Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Congestive_Heart.htm Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Crohns.htm Depression Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Depression.htm Diabetes Mellitus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Diverticular Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm Dysmenorrhea
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Dysmenorrhea.htm Eating Disorders Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Endometriosis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Endometriosis.htm Erythema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SkinDi sordersErythemacc.html Female Infertility Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Infertility_Female.htm Fibrocystic Breast Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Fibrocystic_Breast.htm Flu Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Flucc.h tml Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Gastritis Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Gestational Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gestational_Hyperte nsion.htm Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Heart_Attack.htm Heat Exhaustion Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/HeatEx haustioncc.html High Blood Pressure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Cholesterol.htm High Cholesterol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html High Homocysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Homocysteine. htm
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High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Triglycerides.h tm Histoplasmosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Histopl asmosiscc.html HIV and AIDS Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/HIVan dAIDScc.html Hypercholesterolemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm Hypertension Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Immune Function Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Immune_Function.htm Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Influenza Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Flucc.h tml Insomnia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insomn iacc.html Insulin Resistance Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insulin_Resistance_S yndrome.htm Kidney Stones Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Kidney_Stones.htm Leukoplakia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Leukoplakia.htm Liver Cirrhosis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Liver_Cirrhosis.htm Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Low_Back_Pain.htm Lung Cancer Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Lung.htm Macular Degeneration Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Macular_Degeneratio n.htm Macular Degeneration Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Macula rDegenerationcc.html Macular Degeneration Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000257.html Male Infertility Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Infertility_Male.htm Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menin gitiscc.html Menopausal Symptoms (Other Than Osteoporosis) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000276.html Menopause Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Menopause.htm Menopause Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menop ausecc.html Menstruation, Absence of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Migraine.htm Miscarriage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Miscar riagecc.html MSG Sensitivity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/MSG_Sensitivity.htm Multiple Sclerosis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Multiple_Sclerosis.htm Nausea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000299.html Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Osteoporosis.htm Osteoporosis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000270.html Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pancreatic_Insufficie ncy.htm Parasitic Infection, Histoplasmosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Histopl asmosiscc.html Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Parkinsons_Disease.h tm Phenylketonuria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Phenylketonuria.htm Photosensitivity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Photosensitivity.htm Preeclampsia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Preeclampsia.htm Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pregnancy.htm Premenstrual Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/PMS.htm Prostate Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Prostate.htm Prostate Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html Prostate Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Prostatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Prostatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Psoriasis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Psoriasis.htm Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Rheumatoid_Arthriti s.htm Rheumatoid Arthritis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000265.html Sarcoidosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sarcoid osiscc.html Seasonal Affective Disorder Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Seasonal_Affective_D isorder.htm Sinus Congestion Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Sinus_Congestion.htm Skin Disorders, Erythema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SkinDi sordersErythemacc.html Sleeplessness Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insomn iacc.html Spontaneous Abortion Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Miscar riagecc.html
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Stroke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Stroke.htm Stroke, Transient Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Systemic Lupus Erythematosus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lupus.htm TIAs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Transient Ischemic Attacks Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stroke Transientcc.html Ulcerative Colitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Ulcerative_Colitis.htm Ulcerative Colitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/UTI.htm Uveitis
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Uveitis cc.html Warts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Warts.htm
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Colorectal: Pertaining to or affecting the colon and rectum. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Metmyoglobin: Myoglobin which is in the oxidized ferric or hemin form. The oxidation causes a change in color from red to brown. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Pediatrics:
A medical specialty concerned with maintaining health and
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providing medical care to children from birth to adolescence. [NIH] Postmenopausal: Occurring after the menopause. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with tuberculosis. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with tuberculosis may be given different recommendations. Some recommendations may be directly related to tuberculosis, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of tuberculosis. We will then show you how to find studies dedicated specifically to nutrition and tuberculosis.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
·
Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
·
Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
·
Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?48
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.50 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Tuberculosis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
51
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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “tuberculosis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on tuberculosis: ·
Nationwide food consumption survey, 1987. Source: Peterkin, B.B. Rizek, R.L. Tippett, K.S. Nutrition-today (USA). (February 1988). volume 23(1) page 18-24. usa food consumption nutrient uptake consumption surveys databases nutritional status 0029-666X Summary: etats unis consommation alimentaire absorption de substances nutritives consommation enquete banque de donnees etat nutritionnel
·
Nationwide food consumption survey: CSFII. Source: Nutrition-today (USA). (October 1987). volume 22(5) page 36-39. usa women children food consumption nutrient uptake surveys diet 0029-666X Summary: etats unis femme enfant consommation alimentaire absorption de substances nutritives enquete regime alimentaire
·
Relationship of knowledge of food group servings recommendations to food group consumption. Author(s): Center for Nutrition Policy and Promotion. Source: Guthrie, J.F. Fulton, L.H. Family-economics-and-nutrition-review (USA). (1995). volume 8(4) page 2-17. usa human nutrition foods food consumption women food intake nutrient intake meal patterns diet age households income weight height ethnic groups education urbanization seasonal variation surveys 1085-9985 Summary: etats unis nutrition humaine produit alimentaire consommation alimentaire femme prise alimentaire homme ingestion de substances nutritives schema alimentaire regime alimentaire age menage revenu poids hauteur groupe ethnique education urbanisation variation saisonniere enquete
The following information is typical of that found when using the “Full IBIDS Database” when searching using “tuberculosis” (or a synonym): ·
Antifungal, antibacterial, antiviral and cytotoxic activity of novel thioand seleno-azoles. Author(s): Cattedra di Microbiologia Applicata, Istituto di Medicina Interna, Universita degli studi di Cagliari, 09124 Cagliari (Italy)
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Source: Deidda, D. Lampis, G. Maullu, C. Pompei, R. Isaia, F. Lippolis, V. Verani, G. Pharmacological-Research (United Kingdom). (1997). volume 36(3) page 193-197. escherichia coli staphylococcus aureus mycobacterium tuberculosis candida albicans pyrenophora graminea botrytis cinerea phomopsis rhizoctonia solani fungicides antifungal properties antimicrobial properties pathogens fungal diseases azoles Summary: escherichia coli staphylococcus aureus mycobacterium tuberculosis candida albicans pyrenophora graminea botrytis cinerea phomopsis rhizoctonia solani fongicide propriete antifongique propriete antimicrobienne agent pathogene maladie fongique azole
Additional physician-oriented references include: ·
Familial Mediterranean fever. No role of Mycobacterium tuberculosis in ten patients. Author(s): Kultur Mah. Namik Kemal Sok. Pestemalci, Apt. No:8/5, 14310 Duzce / BOLU, Turkey.
[email protected]. Source: Akcan, Y Tuncer, S Unal, S Sokmensuer, C Haznedaroglu, C I Arslan, S Eur-J-Med-Res. 1999 April 27; 4(4): 161-4 0949-2321
·
Gallium-67 citrate scan in extrapulmonary tuberculosis. Author(s): Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan.
[email protected] Source: Lin, W Y Hsieh, J F Nuklearmedizin. 1999; 38(6): 199-202 00295566
·
Immune mediated 'HAART' attack during treatment for tuberculosis. Highly active antiretroviral therapy. Author(s): Department of Medical Microbiology and Immunology, University of Alberta, Canada.
[email protected] Source: Kunimoto, D Y Chui, L Nobert, E Houston, S Int-J-Tuberc-LungDis. 1999 October; 3(10): 944-7 1027-3719
·
Miliary sarcoidosis following miliary tuberculosis. Author(s): Department of Pneumonology, Medical School, University of Crete, Heraklion, Greece.
[email protected] Source: Hatzakis, K Siafakas, N M Bouros, D Respiration. 2000; 67(2): 21922 0025-7931
·
Plants from Puerto Rico with anti-Mycobacterium tuberculosis properties. Author(s): Inter American University of Puerto Rico, San Juan, PR 009191293.
[email protected] Source: Frame, A D Rios Olivares, E De Jesus, L Ortiz, D Pagan, J Mendez, S P-R-Health-Sci-J. 1998 September; 17(3): 243-52 0738-0658
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·
Rapid cultivation of Mycobacterium tuberculosis in liquid medium. Author(s): Voluntary Health Services, Adyar, Chennai. Source: Sarma, L V Indian-J-Med-Sci. 1998 August; 52(8): 352-6 0019-5359
·
Regulation of IL-10 secretion after phagocytosis of Mycobacterium tuberculosis by human monocytic cells. Author(s): Department of Infectious Diseases, Imperial College of Science, Technology and Medicine, London, UK. Source: Shaw, T C Thomas, L H Friedland, J S Cytokine. 2000 May; 12(5): 483-6 1043-4666
·
Serum vitamin A levels during tuberculosis and human immunodeficiency virus infection. Author(s): Centre Universitaire de Sante Publique, Butare, Rwanda. Source: Rwangabwoba, J M Fischman, H Semba, R D Int-J-Tuberc-LungDis. 1998 September; 2(9): 771-3 1027-3719
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to tuberculosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Folic_Acid.htm Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Folic_Acid.htm Niacin Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Pyridoxine Alternative names: Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB6Pyridoxinecs.html Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_A.htm Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 67,00.html Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin B3 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000188.html Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html
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Vitamin B6 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000225.html Vitamin B6 (Pyridoxine) Alternative names: Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB6Pyridoxinecs.html Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin D Alternative names: Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminDcs.html Vitamin D Alternative names: Calciferol, Calcitrol, Cholecalciferol, Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minDcs.html Vitamin D Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000129.html
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Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905, 00.html Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_E.htm Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html ·
Minerals Biotin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Biotin.htm Biotin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 08,00.html Calcium: Which Form is Best? Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Calcium_Best.htm Cheese, aged (firm & grating) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,277,00.ht ml Iodine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Iodin ecs.html
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L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carnitine.htm Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000226.html ·
Food and Diet Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Artichoke.htm Asparagus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Asparagus.htm Atkins Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Atkins_Diet.htm Avocado Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Avocado.htm Beef Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,85,00.ht ml Beets Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Beets.htm
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Blackberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,142,00.ht ml Broccoflower Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Broccoflower.htm Broccoli Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Broccoli.htm Brussels Sprouts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Brussels_Sprouts. htm Cabbage Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cabbage.htm Cantaloupe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,125,00.ht ml Cauliflower Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cauliflower.htm Chicken Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,86,00.ht ml
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Chicory Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chicory.htm Chocolate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chocolate.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Coffee.htm Collards Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Collards.htm Dairy Substitutes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Dairy_Substitutes .htm Dairy-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Dairy_Free_Diet.htm Dandelion Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Dandelion_Green s.htm Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diabetes.htm
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Diabetes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Eggs Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,98,00.ht ml Fat Alternatives and Fat Replacers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Fat_Alternatives_ Replacers.htm Fava Beans Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Fava_Beans.htm Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Flaxseeds.htm Flour, nonwheat Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,303,00.ht ml Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Garlic.htm Garlic Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Gluten-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Gluten_Free_Diet.htm Grapes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,53,00.ht ml Guava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,139,00.ht ml High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/High_Fiber_Diet.htm Jerusalem Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Jerusalem_Artich oke.htm Jicama Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Jicama.htm Juices Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Juices.htm
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Kale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kale.htm Kohlrabi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kohlrabi.htm Kombu Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kombu.htm Lamb Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,90,00.ht ml Leeks Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Leeks.htm Low-Fat Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Fat_Diet.htm Low-Oxalate Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Oxalate_Diet.htm Low-Purine Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Purine_Diet.htm Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Salt_Diet.htm Mackerel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Mackerel.htm Macrobiotic Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Macrobiotic_Diet.htm Melons Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,57,00.ht ml Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Milk Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,95,00.ht ml Millet Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,72,00.ht ml Mustard Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Mustard_Greens. htm
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Non-Nutritive and Artificial Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Non_Nutritive_A rtificial_Sweeteners.htm Okra Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Okra.htm Olives Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,318,00.ht ml Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ome ga3FattyAcidscs.html Omega-3 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,992, 00.html Omega-6 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ome ga6FattyAcidscs.html Onions Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Onions.htm Oyster Mushrooms Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Oyster_Mushroo ms.htm Parsnips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Parsnips.htm Peanuts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Peanuts.htm Porcini Mushrooms Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Porcini_Mushroo ms.htm Radishes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Radishes.htm Raisins & Currants Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,67,00.ht ml Raspberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,109,00.ht ml
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Rice, white Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,75,00.ht ml Romaine Lettuce Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Romaine_Lettuce .htm Rutabagas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Rutabagas.htm Saturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Saturated_Fats.ht m Sea Vegetables Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sea_Vegetables.h tm Shark Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Shark.htm Snow Peas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Snow_Peas.htm Soy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Soy.htm
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Soy Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000185.html Soy products Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,135,00.ht ml Soybeans Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,105,00.ht ml Strawberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,108,00.ht ml Summer Squash Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Summer_Squash. htm Sunflower Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sunflower_Seeds. htm Sweet Peppers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweet_Peppers.htm Sweet Potatoes Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweet_Potatoes.h tm Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweeteners.htm Swordfish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Swordfish.htm Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tea.htm The Dean Ornish Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Dean_Ornish_Diet.htm The Pritikin Diet Program Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Pritikin_Diet.htm Tilefish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tilefish.htm Tomatoes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tomatoes.htm Trans-Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Trans_Fats.htm
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Tuna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tuna.htm Turnips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Turnips.htm Vegetarian Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tuberc ulosiscc.html Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Water.htm Winter Squash Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Winter_Squash.htm Yams Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Yams.htm Yogurt Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,97,00.ht ml Zucchini Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Zucchini.htm
Researching Nutrition 335
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Botrytis: A mitosporic Leotiales fungal genus of plant pathogens. It has teleomorphs in the genus Botryotina. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Fungicide: An agent that destroys fungi. [EU] Gallium: A rare, metallic element designated by the symbol, Ga, atomic number 31, and atomic weight 69.72. [NIH] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Rhizoctonia: A mitosporic Ceratobasidiaceae fungal genus that is an important plant pathogen affecting potatoes and other plants. There are numerous teleomorphs. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It
336 Tuberculosis
occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Urbanization: The process whereby a society changes from a rural to an urban way of life. It refers also to the gradual increase in the proportion of people living in urban areas. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH]
Finding Medical Libraries 337
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 339
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
340 Tuberculosis
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 341
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
342 Tuberculosis
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 343
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 345
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with tuberculosis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.54 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
54Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
346 Tuberculosis
·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 347
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
348 Tuberculosis
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 349
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.55
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”56 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 55
350 Tuberculosis
·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.57 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.58 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 58 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 57
Your Rights and Insurance 351
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.59
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.60 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
60
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:61 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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Online Glossaries 357
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to tuberculosis and keep them on file. The NIH, in particular, suggests that patients with tuberculosis visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Tuberculosis Pulmonary tuberculosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm TB Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
·
Signs & Symptoms for Tuberculosis Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Hemoptysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm Hepatosplenomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003275.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm
·
Diagnostics and Tests for Tuberculosis AMP Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003368.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm
Online Glossaries 359
Chest X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm Liver biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003895.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 361
TUBERCULOSIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Aborigines: Native inhabitants or indigenous individuals of a country. [NIH] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Absenteeism: Chronic absence from work or other duty. [NIH] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH] Alcoholics Anonymous: An organization of self-proclaimed alcoholics who meet frequently to reinforce their practice of abstinence. [NIH] Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Ambroxol: A metabolite of bromhexine that stimulates mucociliary action and clears the air passages in the respiratory tract. It is usually administered as the hydrochloride. [NIH] Amenorrhea: amenia. [EU]
Absence or abnormal stoppage of the menses; called also
Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anergic: 1. characterized by abnormal inactivity; inactive. 2. marked by asthenia or lack of energy. 3. pertaining to anergy. [EU] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH]
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Anthropology: The science devoted to the comparative study of man. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antitoxin: A purified antiserum from animals (usually horses) immunized by injections of a toxin or toxoid, administered as a passive immunizing agent to neutralize a specific bacterial toxin, e.g., botulinus, tetanus or diphtheria. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Aspiration: The act of inhaling. [EU]
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Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiology: The study of hearing and hearing impairment. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacillus: A genus of bacteria of the family Bacillaceae, including large aerobic or facultatively anaerobic, spore-forming, rod-shaped cells, the great majority of which are gram-positive and motile. The genus is separated into 48 species, of which three are pathogenic, or potentially pathogenic, and the remainder are saprophytic soil forms. Many organisms historically called Bacillus are now classified in other genera. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Botrytis: A mitosporic Leotiales fungal genus of plant pathogens. It has teleomorphs in the genus Botryotina. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH]
Brucellosis: Infection caused by bacteria of the genus brucella mainly involving the reticuloendothelial system. This condition is characterized by fever, weakness, malaise, and weight loss. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH]
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Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coitus: Sexual connection per vaginam between male and female. [EU]
Glossary 365
Colorectal: Pertaining to or affecting the colon and rectum. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constitutional: 1. affecting the whole constitution of the body; not local. 2. pertaining to the constitution. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: The prevention of conception or impregnation. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Criterion: A standard by which something may be judged. [EU] Crowding: Behavior with respect to an excessive number of individuals, human or animal, in relation to available space. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cycloserine: Antibiotic substance produced by Streptomyces garyphalus. It may be used in the treatment of resistant tuberculosis as part of a multi-drug regimen. It has also been used in urinary tract infections. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure. [NIH] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
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Dysmenorrhea: Painful menstruation. [NIH] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Dyspnea: Difficult or labored breathing. [NIH] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation
Glossary 367
and assembly of proteins. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Ficoll: A sucrose polymer of high molecular weight. [NIH] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Fungicide: An agent that destroys fungi. [EU] Gallium: A rare, metallic element designated by the symbol, Ga, atomic number 31, and atomic weight 69.72. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of
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action has not been definitely established. [NIH] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haemopoietic: Haematopoietic; pertaining to or effecting the formation of blood cells. [EU] Hematuria: Presence of blood in the urine. [NIH] Hemoptysis: Bronchial hemorrhage manifested with spitting of blood. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Pertaining to the liver. [EU]
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Hepatitis: Inflammation of the liver. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU]
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Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Inhalation: The drawing of air or other substances into the lungs. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin
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plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Intravenous: Within a vein or veins. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Leprosy: A chronic granulomatous infection caused by mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein:
Any of the lipid-protein complexes in which lipids are
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transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mannosides: Glycosides formed by the reaction of the hydroxyl group on the anomeric carbon atom of mannose with an alcohol to form an acetal. They include both alpha- and beta-mannosides. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mesylates: Organic salts or esters of methanesulfonic acid. [NIH] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metmyoglobin: Myoglobin which is in the oxidized ferric or hemin form. The oxidation causes a change in color from red to brown. [NIH]
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Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycobacteriophages: Viruses whose host is one or more Mycobacterium species. They include both temperate and virulent types. [NIH] Mycobacterium: An organism of the genus Mycobacterium. [EU] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Myocardium: The muscle tissue of the HEART composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the
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treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nelfinavir: A potent HIV protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. [NIH]
Neonatal: Pertaining to the first four weeks after birth. [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH]
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Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical anti-inflammatory. It is also commonly used as an embedding material in histology. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Paratuberculosis: An infectious disease caused by mycobacterium paratuberculosis. Characteristics include chronic debilitation and weight loss. [NIH] Paromomycin: An oligosaccharide antibiotic produced by various Streptomyces. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Phagosomes: Membrane-bound cytoplasmic vesicles formed by invagination of phagocytized material. They fuse with lysosomes to form phagolysosomes in which the hydrolytic enzymes of the lysosome digest the phagocytized material. [NIH]
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Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Postmenopausal: Occurring after the menopause. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and
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placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pyrazinamide: A pyrazine that is used therapeutically as an antitubercular agent. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] RANTES: A chemokine that is a chemoattractant for eosinophils, monocytes, and lymphocytes. It is a potent and selective eosinophil chemotaxin that is stored in and released from platelets and activated T-cells. [NIH]
Reactivation: The restoration of activity to something that has been inactivated. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface
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receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refractory: Not readily yielding to treatment. [EU] Regulon: In eukaryotes, a genetic unit consisting of a noncontiguous group of genes under the control of a single regulator gene. In bacteria, regulons are global regulatory systems involved in the interplay of pleiotropic regulatory domains. These regulatory systems consist of several operons. [NIH]
Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rhizoctonia: A mitosporic Ceratobasidiaceae fungal genus that is an important plant pathogen affecting potatoes and other plants. There are numerous teleomorphs. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rifabutin: A broad-spectrum antibiotic that is being used as prophylaxis against disseminated Mycobacterium avium complex infection in HIVpositive patients. [NIH] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the
Glossary 379
lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are
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designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tachyarrhythmia: Tachycardia associated with an irregularity in the normal heart rhythm. [EU] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thermoregulation: Heat regulation. [EU] Thoracic: Pertaining to or affecting the chest. [EU] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxoplasma: A genus of protozoa parasitic to birds and mammals. T. gondii is one of the most common infectious pathogenic animal parasites of man. [NIH]
Translations: Products resulting from the conversion of one language to another. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Trustees: Board members of an institution or organization who are entrusted with the administering of funds and the directing of policy. [NIH] Tubercular: Of, pertaining to, or resembling tubercles or nodules. [EU] Tuberculoma: A tumor-like mass resulting from the enlargement of a tuberculous lesion. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Urbanization: The process whereby a society changes from a rural to an urban way of life. It refers also to the gradual increase in the proportion of people living in urban areas. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU]
382 Tuberculosis
Ventricular: Pertaining to a ventricle. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN:
Glossary 383
0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna ·
Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
384 Tuberculosis
INDEX A Abscess .................................................74 Absenteeism........................................210 Agar .....................................................168 Alkaloid ........................134, 335, 364, 374 Ambroxol .............................................261 Anaesthesia...................................63, 370 Analogous..............................................90 Anergic ............................................49, 83 Antibacterial...........................19, 143, 315 Antibody..61, 64, 135, 137, 140, 163, 172, 362, 365, 369, 372, 379 Antifungal.............................174, 316, 367 Antitoxin.........................................65, 379 Antiviral ..................................64, 315, 374 Anxiety...........................................64, 375 Arterial .........................................213, 369 Aspiration...............................................75 Assay...................................................162 Asymptomatic ..............145, 148, 167, 171 Autonomic......................................64, 374 Azithromycin ........................................204 B Bacillus ................................100, 118, 147 Bile...............................................155, 363 Biochemical .........................................144 Biopsy............................................76, 359 Botrytis.................................................316 Bronchi ..........65, 134, 164, 174, 363, 380 Bronchial..............................................164 Bronchoscopy........................................88 C Capsules..............................................313 Carbohydrate.........62, 149, 174, 312, 368 Cardiac ................................109, 306, 373 Cardiopulmonary ...................................26 Cardiovascular.....................................209 Cervical........................................254, 379 Chemotherapy ...46, 74, 85, 146, 182, 189 Cholesterol ..175, 254, 310, 312, 367, 372 Chromosomal ......................................159 Chronic ...21, 27, 138, 143, 145, 148, 167, 169, 171, 174, 209, 346, 371, 375 Constitutional.........................................72 Contamination .....................................224 Crowding .............................................194 Cyclic .....................................................91 Cytokines .............83, 84, 85, 87, 161, 164 D Degenerative ......188, 190, 213, 311, 375, 378
Demography ....................................... 226 Dendritic........................................ 82, 161 Diarrhea .............................................. 310 Dysplasia ............................................ 231 E Echinacea ........................................... 209 Emphysema .......................................... 27 Endemic ........................................ 74, 147 Enzyme ...... 23, 126, 135, 140, 159, 165, 204, 366, 377, 381 Epidemic .. 44, 72, 73, 81, 86, 87, 93, 146, 147, 150, 162, 172, 180, 194, 207, 223 Epidemiological ....... 29, 74, 81, 179, 186, 219, 226 Epitopes ...................................... 162, 172 Erythromycin ....................................... 204 Escherichia ......................................... 316 Exogenous ............................ 82, 136, 367 Extracorporeal .................................... 269 Exudate............................... 127, 136, 367 F Fatigue .......................................... 61, 362 Fluconazole......................................... 166 Fluorescence .............................. 136, 367 G Gastrointestinal ..... 88, 134, 136, 364, 367 Genital................... 75, 134, 136, 364, 368 Genitourinary .......................... 75, 76, 188 Glomerular ............................................ 75 Glucose........... 62, 63, 126, 160, 368, 371 Glycerol............................................... 168 H Haemopoietic ...................................... 131 Hematuria ............................................. 76 Hemorrhage .................................. 76, 368 Hepatitis .............................................. 186 Homologous.......................... 89, 140, 379 Hormones ................... 135, 139, 365, 378 Hospices ..................................... 153, 170 Humoral .............................................. 150 Hybridization ................................. 87, 104 Hydrophilic .......................................... 161 Hydrophobic........ 161, 174, 175, 369, 372 Hypercalcemia ...................................... 75 Hypersensitivity.. 127, 140, 154, 164, 189, 379 Hypertension....................................... 210 I Idiopathic..................... 213, 336, 369, 379 Immunity .. 23, 82, 84, 118, 125, 127, 148, 152, 154, 158, 172, 174, 370, 381
Index 385
Immunization ..63, 65, 140, 145, 148, 159, 174, 370, 379 Immunogenic ......145, 148, 154, 156, 158, 160 Immunohistochemistry ..........................87 Immunotherapy....................................148 Incubation ..............................................73 Indicative .......64, 147, 154, 164, 165, 374 Induction ........................54, 125, 174, 370 Infarction......................................139, 378 Infiltration .............................................164 Inflammation .......136, 145, 148, 167, 171, 188, 367 Ingestion ......................................313, 315 Inhalation .......................................79, 143 Inorganic ................................................93 Insulin ........................47, 62, 63, 368, 371 Intermittent...............................43, 54, 225 Interstitial ...............................75, 138, 374 Intoxication ....................................66, 382 Intravenous..................................130, 266 Invasive .................................................76 Ischemia ......................................139, 378 Isoniazid .....15, 16, 17, 40, 42, 43, 45, 46, 48, 49, 50, 53, 54, 71, 107, 111, 143, 150, 172, 268 L Leprosy........................................152, 188 Lesion ..........136, 137, 201, 368, 372, 381 Leucine ................................................157 Lipid ......63, 149, 160, 174, 253, 367, 368, 371 Lipoprotein...................152, 165, 175, 372 Localization..............64, 86, 137, 370, 376 M Malaise ........................................239, 363 Mannosides .........................160, 175, 372 Mediator...............................................157 Membrane ...........138, 149, 213, 373, 375 Meningitis ..............70, 137, 174, 367, 372 Mental ............62, 255, 258, 348, 367, 377 Metabolite ......................46, 134, 313, 361 Methionine ...........................................115 Microbiology ....................61, 64, 363, 373 Microorganism .............................138, 375 Microscopy ..........................................179 Molecular ....107, 136, 139, 142, 149, 152, 155, 216, 228, 230, 254, 367, 368, 377 Monocytes ......65, 86, 139, 161, 164, 377, 380 Mutagenesis ........................................101 Mycobacteriophages .............................97 Mycobacterium ...143, 157, 160, 169, 170, 185, 316 Mycoplasma ........................................209
N Naltrexone..................................... 64, 374 Necrosis ........ 65, 140, 336, 378, 379, 380 Nelfinavir ............................................... 46 Nephritis................................................ 75 Neural ................................. 174, 311, 369 Neurologic............................................. 74 Neutrophil.............................................. 42 Niacin .................................................. 311 Nicotine ....................................... 253, 361 Nitrogen ................................ 86, 115, 153 Norepinephrine ........................... 306, 366 O Osteoarthritis ...................................... 210 Osteoporosis....................................... 210 Overdose ............................................ 311 P Parasitic ........................ 90, 126, 175, 381 Paratuberculosis ................................. 100 Paromomycin ........................................ 52 Pathogen ....... 85, 90, 128, 137, 144, 146, 160, 164, 172, 335, 370, 378 Pelvic .......................................... 307, 377 Phagocytosis .............................. 108, 317 Phagosomes ......................... 82, 138, 375 Pharmacokinetics ... 42, 43, 45, 46, 52, 88 Pharmacologic ...................................... 88 Phenotype................................... 139, 376 Plague......... 130, 139, 187, 199, 200, 376 Plasmids ............................................. 160 Pneumonia.......................................... 209 Polypeptide . 137, 153, 154, 156, 159, 369 Potassium ........................................... 312 Preclinical.............................................. 88 Prevalence ... 90, 169, 179, 182, 196, 223, 224, 226, 266 Progressive ........................... 64, 143, 374 Proline................................................. 165 Prophylaxis ....................... 23, 49, 55, 378 Protease................................ 64, 267, 374 Psychiatry ........................... 191, 377, 381 Pyrazinamide ..... 15, 16, 19, 43, 48, 120, 172 R Reagent .............................................. 171 Receptor ................... 61, 83, 95, 267, 362 Recombinant.... 46, 87, 90, 152, 157, 159, 166 Refractory ........................................... 144 Regulon................................................. 89 Reperfusion......................... 109, 140, 378 Rhizoctonia ......................................... 316 Riboflavin ............................................ 310 Rifabutin...................... 16, 42, 46, 54, 143 S Sanitation ............................................ 178
386 Tuberculosis
Sarcoidosis ..........................................316 Secretion .........78, 84, 140, 164, 317, 379 Selenium..............................................312 Sensitization ..........................................78 Serum ......52, 65, 168, 172, 253, 367, 379 Species ....... 23, 100, 134, 136, 138, 140, 146, 147, 151, 159, 160, 175, 213, 363, 367, 373, 376, 379, 380, 381, 382 Sputum ....................................47, 78, 120 Staphylococcus ...................................316 Stomach ......................................136, 367 Systemic ..........74, 85, 254, 336, 376, 379 T Thermoregulation ................................310 Threonine ............................................165 Tomography ..........................................47 Toxicity ..........................41, 45, 46, 54, 87 Translations .........................................209 U Urbanization ........................................315
Urease ................................................ 128 Urinary ..... 19, 75, 76, 134, 136, 209, 253, 306, 364, 365, 366, 368 V Vaccination .. 12, 14, 78, 81, 82, 100, 145, 147, 154, 155, 158, 197 Vaccine ...... 12, 23, 89, 90, 100, 146, 147, 149, 152, 154, 157, 158, 160, 164, 165, 172, 195, 207, 219, 381 Vancomycin ........................................ 204 Ventilation ........................... 185, 190, 381 Vertebral ............................................... 74 Virulence ...... 65, 75, 83, 86, 94, 130, 155, 158, 381 Viruses ..... 23, 24, 64, 140, 160, 172, 175, 335, 362, 373, 381, 382 W Withdrawal ............................................ 41
Index 387
388 Tuberculosis
Index 389
390 Tuberculosis
