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This study used a known-groups design to examine the classification accuracy of the Test of Memory Malingering in detecting cognitive malingering in patients claiming cognitive deficits due to exposure to environmental and industrial toxins. Thirty-three patients who met Slick et al. criteria for Malingered Neurocognitive Dysfunction were compared to 17 toxic exposure patients negative for evidence of malingering, 14 TBI patients and 22 memory disorder patients, both groups without incentive. The original cutoffs (45) for Trial 2 and Retention demonstrated perfect specificity (0% false positive error rate) and impressive sensitivity (50%). These findings indicate the TOMM can be used with confidence as an indicator of negative response bias in cases of cognitive deficits attributed to exposure to alleged neurotoxic substances.

Management of mycobacterial infection is species specific ; however, treatment is prompted by positive smears or cultures, often several weeks before species identification. The objective of this study was to determine the species distribution of mycobacterial isolates from various body sites in patients infected with human immunodeficiency virus (HIV). All mycobacterial isolates recovered at St. Paul's Hospital (Vancouver, British Columbia, Canada) from April 1989 to March 1993 were reviewed. Among 357 HIV-positive patients with mycobacterial infections, 64% (96) of the sputum isolates were Mycobacterium avium complex (MAC), 18% were Mycobacterium tuberculosis, and 17% were Mycobacterium kansasii. Lymph node involvement (25 patients) was due to either MAC (72%) or M. tuberculosis (24%). Two hundred ninety-eight episodes of mycobacteremia were due to MAC (98%), M. tuberculosis (1%), and M. kansasii (1%). Similarly, cultures of 84 bone marrow biopsy specimens (99%), 19 intestinal biopsy specimens (100%), and 30 stool specimens (97%) yielded predominantly MAC. These results have implications for initial therapy, particularly in areas where rapid methods for species identification are not readily available. Because of considerable geographic variation, development of guidelines for selection of initial therapy depends on regional determination of species distribution in HIV-related mycobacterial infections.