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• W2436117788 abstract "1 he crucial discoveries of Pasteur led to identification of specific agents of disease by such investigators as Neisser, Hansen, Eberth, and Sternberg just before or almost simultaneously with Koch's discovery of the tubercle bacillus. Koch's discovery and his exposition of the postulates set the tone of bacteriologic investigation during the next decade (1). Neither isolation nor identification of an agent of disease, however, was an endpoint in itself. As other investigators were showing for other organisms, the growth of organisms released substances that might constitute elements of the disease process or produce inhibitory substances that could lead to subsidence of infection. Koch naturally turned his attention in these directions, and by 1890 he had produced a substance he called tuberculin. He hoped that tuberculin might stimulate immunity and, therefore, heal the human infection. That hope was disappointed, but the demonstration of a delayed type of hypersensitivity and the discovery of a useful epidemiologic and diagnostic tool offered partial compensation. Whenever an organism was discovered to be responsible for human disease, its means of transmission became a topic of major concern. The idea of transmission from human to human was generally understood in Koch's time. The fact that cows also frequently had tuberculosis suggested transmission (presumably by milk) from animals to humans. However, it was not known whether the acid-fast organisms were the same or whether there was some source outside the animal or human from which infections of both species occurred. During the 1890s and early 1900s, this question led to extensive search of the environment, animal and human foodstuffs (2), excreta (3), water, and soil (4) for a potential common source of organisms. Many acidfast organisms were isolated, but none was capable of producing disease in test animals. From a medical point of view, these organisms seemed to be laboratory curiosities. Now and then, reports appeared describing some unidentified Mycobacterium that clearly was not Mycobacterium tuberculosis, but was pathogenic in a human (5). Theobald Smith's demonstration in 1898 that the bovine tubercle bacillus was a definable variety (6) led to another line of research. If humans and cattle had their own special varieties of tubercle organisms, it might prove rewarding to investigate other animal life for varieties adapted to the conditions of their hosts. The result was discovery of the avian organism (7), and subsequently, of several varieties that at various times were called Mycobacterium ranae, Mycobacterium piscium, Mycobacterium chelonei, and Mycobacterium thamnopheos. After the identification of Mycobacterium avium, investigators had to consider the possibility that human infection might occur as a result of infection with this organism. In 1908, Duvall reported a case in which a young woman first developed a cervical node and then overwhelming miliary disease. The colonial morphologic features of the organism did not resemble those of the human tubercle bacillus, and it proved pathogenic for chickens (8). In veterinary medicine it was known that domestic birds frequently exhibited tuberculosis (9); the possibility of human disease through various routes of infection deserved attention. In 1943 Feldman and associates (10) established that the infection in a patient with silicotuberculosis was caused by an organism that generally exhibited other features of M. avium, but was not pathogenic for fowls. Later, Dragsted (11) described six cases of infection in Denmark in which the organism exhibited the characteristics described by Feldman and colleagues. Subsequently, mycobacteria were cultured less frequently, medical exigency overriding the need for basic knowledge. What mattered so far as a patient was concerned was whether the organism produced typical disease in guinea pigs. If it failed to do so, it was of no importance. In a few laboratories, however, more basic study continued. In 1935, Pinner (12) reported a number of strains, some smooth and unpigmented, others rough and pigmented, that appeared to be the sole agents of disease in a very small group of patients. These organisms produced only local disease in guinea pigs and rabbits, but there appeared to be no other cause for disease in humans from whom they had been isolated. A very important observation followed. Wenkle and associates (13) showed that Pinner's pigmented organisms produced immune reactions in animals and that these reactions crossed both subcutaneously and serologically with antigens from human M. tuberculosis. Furthermore, they provided a certain degree of immunity against challenge by the human Mycobacterium. The development of effective antimycobacterial agents that followed the conclusion of World War II materially changed clinical consideration of tuberculosis. Cultures were essential to successful management. Because many patients failed to produce sputum or to conserve their sputum for proper examination, culture of gastric washings became widespread. Within a very short time, laboratories were cluttered with cultures of acid-fast organisms that exhibited a wide variety of colonial characteristics, rates of growth, and shades of pigmentation. As a rule, these organisms were partly or completely resistant to available antimicrobial agents. In a certain proportion of patients they constituted the only organisms recovered, both on initial and on all subsequent isolations. On the other hand, gastric washings of perfectly normal subjects also contained varieties of the same kinds (14)." @default.
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• W2436117788 date "1982-03-01" @default.
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• W2436117788 title "The atypical mycobacteria." @default.
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