Faculty Bibliography

That was the case in Tugela Ferry, a rural town in KwaZulu-Natal province in South Africa, when an outbreak of extremely drug- resistant tuberculosis -- XDR-TB for short -- killed 52 of its 53 victims, all of whom were also infected with HIV. The outbreak was detected in 2005, but it did not receive international attention until it was reported at the international AIDS meeting in Toronto last August. Using statistics from recent years, [Karin Weyer] said her team estimated that 6,000 new cases of multi-drug-resistant tuberculosis occurred in South Africa each year and that the rate of treatment failure was about 10 per cent. Assuming that most failures were due to the extremely drug-resistant form, a conservative estimate is 600 cases of XDR-TB in her country each year, Weyer said. The outbreak is not limited to Africa. Dr. Paul Nunn, a tuberculosis expert at the World Health Organization, told the meeting here that one or more cases of XDR-TB had been found in at least 28 countries. Extrapolating from data about the multi-drug- resistant form of tuberculosis, Nunn estimated that two-thirds of the XDR-TB cases were from China, India and Russia

The outbreak resembles one last year that was linked to a different manufacturer's lens solution and a different microbe. In both instances, the cornea, the eye's transparent outer covering, is at risk. But why two different microbes caused the outbreaks is not known. ''It is beyond comprehension,'' said Dr. Dan B. Jones, the chairman of ophthalmology at Baylor College of Medicine in Houston, who detected a case of acanthamoeba keratitis, which is behind the current outbreak, on Friday. Acanthamoeba infections have been reported in many countries. Dr. Jones's team is credited for first identifying a corneal infection from acanthamoeba in the United States, in a rancher who was injured in an accident in Texas in 1973. That case did not involve contact lenses: while the rancher was working in a field, a piece of wire and hay hit his eye

[John W. Mellors], who was not involved in the studies but has been a consultant to the manufacturers of the drugs, said he 'wouldn't be going out on a limb' to say the new results were as exciting as those from the mid-1990s, when researchers first discovered that cocktails of drugs could significantly prolong lives. While there are now 20 approved drugs to treat HIV and AIDS, there are only four different mechanisms by which the drugs work. In many patients, the rapidly replicating virus evolves resistance to one or more drugs, usually because patients don't take their drugs on time as prescribed

The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti-TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. ''But no laboratory test for any disease is 100 percent,'' said one member of the panel, Dr. Karin Weyer of the South African Medical Research Council. ''Labs often have problems and can and do make mistakes,'' Dr. Weyer said. The panel also recommended using molecular tests to detect rifampicin resistance as a proxy for MDR tuberculosis. Use of such tests could reliably determine XDR in less than two months, compared with the several months that are often needed now, Dr. Weyer said. Standard tests take weeks to complete because tuberculosis bacteria grow slowly

The findings also extend to an earlier study that found a reduced frequency of malaria among H.I.V.-infected adults in Uganda who took the antibiotic and slept under bed nets. Dr. Jonathan Mermin of the Centers for Disease Control and Prevention in Atlanta led the adult study, which was published in The Lancet last year. But Dr. [Anne Gasasira] said that because the adult and pediatric studies used different methodologies, the findings could not be directly compared. In the past, doctors assumed that a child who came to a clinic for fever in Uganda had malaria until it was proved otherwise. But because malaria was far less common among the participants who received the combination therapy, Dr. Gasasira said, doctors now assume that any fever in a young child must be investigated for a cause other than malaria. Dr. [Elaine Abrams], the Columbia expert, said in an interview that the Uganda findings had additional implications for treating H.I.V.-infected children in malarious areas. Because pediatricians are concerned that prolonged use of cotrimoxazole could lead to resistant malaria, they often stop the drug among AIDS patients when tests show significant improvement in the health of their immune system after antiretroviral therapy

Still, the effort is ''a remarkable success'' considering that only 2 percent of infected patients needing antiretroviral therapy were receiving it three years ago, said Dr. Kevin De Cock, the H.I.V./AIDS director at the World Health Organization, a United Nations agency in Geneva. Many numbers were discouraging. In 2006, about six times as many people became infected with H.I.V. as started treatment, meaning prevention efforts are faltering or not in place, Dr. De Cock told reporters by telephone. The Bush administration's emergency plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria were paying for care of about 1.27 million of the two million total, the United Nations said

An ultrasound revealed a deep venous thrombosis, a blood clot, in the lower portion of his left leg. He was treated with anticoagulant medication, which he will take for several months, and he returned to work. Although blood clots in the leg can be dangerous if left untreated, experts say most are successfully treated with the anticoagulant drugs that the White House says [Dick Cheney] is now receiving. In September 2005, Cheney underwent surgery to repair aneurysms, bulges in the arteries that can spawn dangerous blood clots, behind both knees. Doctors implanted devices known as stent-grafts in each of Cheney's legs. The blood clot that was discovered in Cheney's leg on Monday was in a vein, not an artery, and several independent experts said there was most likely no connection between it and the 2005 surgery. Dr. Cameron Akbari, a senior vascular surgeon at Washington Hospital Center in the District of Columbia, said Cheney's history of heart disease put him at only 'a very slightly increased risk' of developing a deep venous thrombosis

Dr. [Anthony S. Fauci], who has directed the National Institute of Allergy and Infectious Diseases since 1984, marshaled scientific evidence to construct the United States' responses to these two global crises. The Lasker Foundation also cited Dr. Fauci for his role ''in explaining issues of great concern like the science behind emerging biological hazards'' to the public. Although dendritic cells comprise only 1 percent of mouse spleen cells, Dr. [Ralph M. Steinman] found that they were the most powerful cell in priming the immune system. The dendritic cell can adjust the body's defenses by stimulating different T immune cells. ''No one had anticipated that any cell could so efficiently goad T cells into action,'' said Dr. Joseph L. Goldstein, the chairman of the Lasker jury and a Nobel laureate from the University of Texas Southwestern Medical Center in Dallas

The most celebrated example of such discordant findings involved Andrew Speaker, the Atlanta lawyer who caused an international health scare after traveling to Europe in May with what was believed to be extensively drug-resistant tuberculosis, known as XDR. This month, Speaker's doctors downgraded his type of tuberculosis to multidrug-resistant, or MDR, after repeating tests that initially gave a different result. The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti- TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. Reliable tests to determine resistance to first-line drugs were developed when the drugs were first marketed about a half-century ago. Fewer resistance tests exist for the newer, second-line drugs needed to treat MDR and XDR tuberculosis, and many of them are difficult to perform

''The new analyses are both disappointing and puzzling'' because they offer no explanation for the vaccine's failure, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, a partner in the vaccine trial. The findings raise questions about whether adenovirus can ever be used as a crucial ingredient in an AIDS vaccine and whether new tacks will be needed. Use of a modified virus as a vector to deliver H.I.V. genes is a new and evolving way to make an AIDS vaccine. The Merck vaccine included three synthetic H.I.V. genes. ''We did a beautiful experiment, but it definitely was a disappointment,'' Dr. Larry Corey of the University of Washington, who led the investigators, said in an interview. ''One lesson is that scientists will have to look at vector-based immunity more thoroughly than we have in the past.''