TB Notes Newsletter

No. 2, 2012

COMMUNICATIONS, EDUCATION, AND BEHAVIORAL STUDIES BRANCH UPDATES

DTBE Launches Spanish TB Website

DTBE’s Communications, Education, and Behavioral Studies Branch (CEBSB) is excited to announce the launch of the Spanish TB website. This website targets the general public and provides a variety of TB information in Spanish. It includes fact sheets, publications, posters, and video and audio podcasts.

Dr. Castro Provides Expert Commentary for Medscape on 12-Dose Regimen

Medscape from WebMD provides medical news features, commentary, and reference content for physicians, nurses, pharmacists, and other health professionals. CDC and Medscape collaborate to produce a special series of CDC expert commentaries designed to deliver guidance directly to Medscape's physicians and other health care professionals. In this series, experts from CDC offer video commentaries on current topics.

In March 2012, DTBE participated in the CDC Expert Commentary Series. DTBE Director Dr. Kenneth Castro recorded the commentary, New Regimen Makes Treating Latent TB Infection Easier at CDC’s broadcast studios in Atlanta. This commentary details the new 12-dose treatment regimen for latent TB infection. The commentary was posted on May 22, 2012, on Medscape's website where it can be viewed after a short registration process. As an alternative, it can be viewed on the DTBE website on the Treatment for Latent TB Infection web page under “12-dose Regimen Products.”

Other examples of Medscape’s CDC Expert Commentary Series, including the 2011 commentary Dr. Castro recorded titled, What’s New in Blood Testing for TB Infection?, are available on Medscape’s “CDC Expert Commentary” webpage.

—Reported by Nicole Richardson-Smith, MA
Div of TB Elimination

Tuberculosis … Soap?

I get excited when I find that “perfect” gift for a family member or friend. The perfect gift can be any number of things: an outfit that will look stunning; an item that reflects an individual’s personality or adds to a collection; or something that brings forth laughter.  My personal favorites are the silly little things that can make a person laugh out loud and smile each time they glance over at or use the gift.

This past Christmas, Judy, a good friend and microbiologist, had me laughing repeatedly when she presented me with a “petri dish soap” designed to look like Haemophilus influenzae on a chocolate agar plate, with a chocolate scent.

I started my professional career as a medical technologist with one of the largest county hospital systems in the Southeast. The laboratory was huge and I specialized in hematology, coagulation, flow cytometry, and microbiology. Consequently, my medical technologist side was tickled by the message on the back of the handmade soap that read, “This petri dish soap is designed to look exactly like what you’re trying to wash off: bacteria! This particular soap is modeled after Haemophilus influenzae. H. influenza type b (Hib) is the cause of pneumonia, bacteremia, and acute bacterial meningitis” (www.Cleaner Science.com  … Making Science a Little Cleaner).

Photo of the prototype soap with packaging

The next time I sat down at my computer, I logged on to the website and found petri dish soaps for a variety of bacteria, as well as soaps in the shape of red blood cells. Then I saw a grape-scented petri dish soap with Pseudomonas aeruginosa. Immediately I thought of my preceptor in clinical microbiology, who taught me that if you open the incubators and get a whiff of “grapes” you know P. aeruginosa is growing in some of those petri dishes you are pulling from the incubator. Wondering if the owner and creator of the website, who had written “I make nerdy soaps,” would be willing to try to make a soap modeled after Mycobacterium tuberculosis growing on a Lowenstein-Jensen media (LJ) slant in a test tube, I sent an e-mail and waited.

Sara Jezierski wrote back and explained that she had been planning to attempt making test tube soaps for a while and was more than willing to start with a “TB soap.” When I asked if she was a microbiologist or medical technologist, she replied that she was pursuing a doctorate in Pharmacy, but her ideas for her soaps had come from previous work in a microbiology department.

Over the next few weeks Sara crafted and cured a mold for the test tube soaps, sent photos of the “prototype,” and planned the packaging. Confident she could have an order of “TB soaps” ready for World TB Day, we planned the packaging text to educate a person about TB and raise awareness as to how many people around the globe are affected by the bacterium. Incorporating text from the CDC DTBE website and statistics compiled by the World Health Organization, we decided the label would read, “Always cover your cough! This soap is modeled to look like Mycobacterium tuberculosis on an LJ slant.  M. tuberculosis is the cause of tuberculosis (TB). TB usually affects the lungs, but it can also affect other parts of the body. The germs are spread from person to person through the air. More than two billion people, or one third of the world’s total population, are infected with TB.”

Photo of the soap from the Cleaner Science webpage.

The week before World TB Day 2012, the soaps arrived. Like a kid at Christmas, I ripped open the box to find rows of soaps that looked even better than the photographs Sara had sent. Borrowing from the Stop TB Partnership’s World TB Day 2012 campaign that encourages people all over the world to make an individual call to stop TB in their lifetimes, I tucked little notes into the boxes indicating I want a quick, sensitive, specific & cheap TB test to diagnose the disease.

World TB Day is not a typical gift-giving occasion, so my TB colleagues and mentors were surprised to receive a small present to mark the occasion. Colleagues have been impressed by how realistic the soaps look. However, the soaps do not have the screw-cap tops found on real LJ slants. Thus, as one of my former lab colleagues walked into a room to show her soap to co-workers, she was scolded for walking around with an uncapped tube!

Two soaps accompanied Dr. Castro, DTBE Director, and Ann Cronin, DTBE Associate Director for Policy and Issues Management, on a trip to Washington, DC, for a Congressional hearing on U.S. and global TB.

There have been plenty of laughs from the soaps. One colleague put her “TB soap” in the guest bathroom – only to have some friends wonder if she was doing an experiment. Two colleagues thought I had given them candy shaped like TB. Another indicated she was going to use her soap for “show and tell” at an upcoming training course. However, one of my mentors summed it up best in an e-mail “What a wonderful gift for a TB nerd, from a TB nerd.”

If you too would like to gift a TB nerd with a TB soap, or need a visual aid to educate your friends and family about your professional life, visit Sara Jezierski’s website: www.cleanerscience.com

—Submitted by Joan M Mangan, BSMT, MST, PhD
Div of TB Elimination

Lowenstein-Jensen (LJ) medium is used in the laboratory for the cultivation of Mycobacterium tuberculosis and other mycobacterial species.

But do you know … ?

Q: Why Lowenstein-Jensen media is “slanted” in the test tube?
A: Like a petri dish, slanted agar provides a solid surface for growth of bacteria in a laboratory. Unlike the petri dish, the tubes are easier to store and transport. Slanting the media in the test tube increases the surface area that the bacteria can grow on.

Q: What gives the medium its pretty green color?
A: Malachite green dye.

Q: Who was Lowenstein?
A: Dr. Ernst Löwenstein originally formulated a medium for cultivation of mycobacteria in which congo red and malachite green dyes were incorporated for the partial inhibition of other bacteria. Dr. Löwenstein was lecturer and professor of experimental pathology at the Medical School of the University of Vienna. In 1932 he was nominated for (but did not win) the Nobel Prize in Physiology or Medicine by Prof. Albert Calmette of the Pasteur Institute, one of the men who developed the tuberculosis vaccine, bacille Calmette-Guerin. As a Jew, Lowenstein was persecuted by the Nazis; he lost his position and was thrown out of the university on April 22, 1938. He eventually emigrated to the United States.

Q: And who was Jensen?
A: Dr. K.A. Jensen developed the present formula for the media. Jensen’s formula does not contain congo red, and has an increased malachite green concentration. Dr. Jensen was Chief of the University Institute of General Pathology, University of Copenhagen, Denmark. Among his contributions, he examined the physical characteristics of the tubercle bacilli isolated from men and cattle. At the time, two methods of typing were available. In one, the appearance of bacterial colonies growing on culture medium served as a basis of classification; the other method was based on the virulence of the strains to rabbits and guinea pigs. He reported that by using suitable culture medium, it was possible to differentiate types of the tubercle bacillus. He also advocated for cooperation between veterinarian authorities and physicians in addressing bovine tuberculosis.

Q: In what years did Dr. Lowenstein publish his recipe (formula) for a culture media on which to grow mycobacteria in a laboratory?
A: 1931 and 1933

Q: If you want to read Lowenstein and Jensen’s original articles with the recipes (formulas) for the media … in what language do you need to be fluent?
A: German

Q: What do TB bacteria eat for breakfast (as well as lunch and dinner) when growing in a tube of Lowenstein-Jensen media?
A: Two major ingredients in the media are whole eggs and gylcerol. These ingredients provide the fatty acids and protein required for mycobacteria metabolism.

Q: How many days after the LJ media is inoculated with a patient’s specimen will the lab staff start looking for TB bacteria?
A: Cultures are read within 5–7 days after inoculation and once a week thereafter for up to 8 weeks. In most laboratories, LJ is now used in conjunction with liquid media, such as a “MGIT” tube; growth of TB can be detected much sooner in the liquid media than on the solid LJ slant.

Q: When Mycobacterium tuberculosis grows on an LJ slant, what does it look like?
A: The lab professionals will tell you, when they look at the LJ slants they are looking for colonies of bacteria that look “rough and buff.”  Colonies of TB bacteria are rough in texture, not smooth. “Buff” refers to the pale tan color of the bacteria.

Q: Can you ship an LJ slant with TB bacteria growing on it through the US Postal Service?
A: No! Mycobacterium tuberculosis that is growing in culture is considered a “Category A” Infectious Substance by the Department of Transportation. This Category is not accepted by the US Postal Service for shipment. However, patient specimens, such as sputum, that are known or thought to contain TB can be sent through the mail. FedEx or a courier must be used for Category A Infectious Substances, including TB growing in culture.

CDC Reference Librarian Kathleen Connick is gratefully acknowledged for her able and speedy assistance in finding much of the biographical information about Dr. Ernst Löwenstein.

References

1. Quality Control Procedures. BBL™ Lowenstein-Jensen Medium / BBL™ Lowenstein-Jensen Medium with 5% Sodium Chloride. L007464 Rev. 09; February 2011.Available at http://www.bd.com/ds/productCenter/220908.asp; accessed 4/10/2012.
2. World Health Organization. Advances in the Control of Zoonoses. Presentations from the WHO/FAO Seminar on Zoonoses, Vienna, Austria, Nov. 24-29, 1952. Monograph series No. 19. WHO: Geneva; 1953.

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