Hypoproteinaemia After Partial Gastrectomy Corrected by Gluten-free Diet
Authors: J. W. B. Forshaw
Journal: BMJ (1958)

Some years before, in another area, the mother was found to have pulmonary tuberculosis and had two 90-day courses of streptomycin and P.A.S. Later, in August, 1952, typical acid-fast bacilli were demonstrated in sputum specimens on two occasions, but no further specimens have yielded acid- fast bacilli.The sensitivity patterns of the strain are not known, since the organism was not grown on culture.The father also was found to have a pulmonary lesion believed to be inactive, though it was still being observed at three- monthly intervals.The only other member of the family in the home, a brother of 19 years, had a lung cavity demonstrated radiologically in 1956, but at no time have acid-fast bacilli been observed or isolated from sputum specimens.The appearance of this lesion is improving on combined streptomycin and isoniazid therapy.The source of infection of the child is not known for certain.A possible sequence of events is that the brother may have been infected from the mother, and he, in turn, may have infected his sister, since he had probably the most active disease in the family at the time of the baby's infec- tion.Until the patient became ill, the family of four resided in a caravan which, however commodious in itself, was a "single apartment."Since three members of the family had evidence of tuberculosis the ready transference of infection is understandable.BacteriologyIsolation.-PairedLowenstein-Jensen slopes inoculated with spider-web clot and deposit fron two specimens of cerebrospinal fluid yielded innumerable discrete colonies after 26 days' incubation.Although it was noted at the time that the colonies tended to appear less craggy and dry than the typical human variety, they were not considered to be bovine in origin.Sensitivity Pattern.-Thestrain was sensitive to 10 pg. of streptomycin per ml., 0.2 u'g. of P.A.S. per ml., and 0.2 pig.of isoniazid per ml.Virulence: Catalase Test.-The method used differed from that recommended by Middlebrook et al. (1954) in that individual colonies were selected and transferred to tubes containing equal quantities of 20-volume H202 and 10% "tween 80" solution.Control tubes containing a com- parable inoculum of the H37Rv variety of Mycobacterium tuberculosis and a selection of recently isolated strains in- cluding atypical mycobacteria allowed of a comparison of the enzyme activity to be made.The time of appearance and the amount of oxygen liberated, shown by the bubbles at the surface with the strain under investigation, were simi- lar to that of H37Rv and recently isolated virulent strains.Animal Inociulation.-Variousweighed inocula, 0.1-0.5 mg. of the test strain, were injected intraperitoneally and intramuscularly into four guinea-pigs.Examination at necropsy six to eight weeks later showed progressive generalized tuberculosis.Typical acid-fast bacilli were demonstrated in the spleen, liver, and lung, and, in addition, after intramuscular inoculation caseous lymph nodes were observed in inguinal, lumbar, and tracheo-bronchial sites.Typical cultures were isolated from such lesions.Following intravenous injection the strain did not produce progressive tuberculosis in a rabbit. SummaryA case of tuberculous meningitis is described occur- ring in an 11-months-old baby who had been given B.C.G. vaccine nine months previously.The infecting organism was shown to be a virulent strain of Myco- bacterium tuberculosis of the human variety.Our thanks are due to Dr. W. H. Findlay, area chest physician, Perth, for details of the medical history of the family.