Kekkaku(Tuberculosis)
Online ISSN : 1884-2410
Print ISSN : 0022-9776
ISSN-L : 0022-9776
Volume 51, Issue 1
Displaying 1-4 of 4 articles from this issue
  • Harukata BABA, Yo AZUMA
    1976 Volume 51 Issue 1 Pages 1-5
    Published: January 15, 1976
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    1. The MIC of Rifampicin to tubercle bacilli isolated from 1, 779 Rifampicin untreated patients who were admitted to our hospital from June 1970 to June 1975 was studied by using 1% Ogawa medium.
    2. There were 4 cases resistant to 50mcg of Rifampicin, but 3 of them had enough reason to be considered as they had been treated already by the drug, and the technical failure was suspected in the remaining one case.
    3. By indirect method, there were 7 patients (0.7%), whose bacilli grew 1% to 10% on 10 mcg of Rifampicin medium among 1, 065 patients and no bacilli grew over 11% on that medium. However, by direct method, there were 115 cases (16.1%) whose bacilli grew 1% to 10% on 10 mcg medium among 714 cases and 6 cases (0.8%) over 11%.
    By the direct method, bacilli grew more easily than by the indirect method on the medium containing the critical drug concentration; in other words, the drug resistance was expressed higher by the direct method (Table 2). The growth of bacilli seems to be more active on the direct method.
    4. The bacilli from the patients admitted after July 1974, showed apparently higher rate of resistance than those admitted before (Table 3-4). This can be explained by the change in the stopper from cork type to M type. The latter stopper was invented by Futamura of our laboratory, which is usually air tight but allows the air leak into a tube any time when neccessary. Moreover it prevents the drying up of the medium often seen when the air enters too much. Thus, the improvement of the growing condition of bacilli was achieved.
    5. MIC of Rifampicin was 10% for the indirect method and 50% for the direct method with a few exception both on the 10mcg Rifampicin medium. However, for the clinical significance of Rifampicin resistance, the criteria seem to be more reasonable if we take 50% growth or more on the 10 mcg Rifampicin medium, and we may add 1% growth or more on the 50mcg Rifampicin medium which will be discussed in the 2nd report.
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  • Harukata BABA, Yo AZUMA
    1976 Volume 51 Issue 1 Pages 7-12
    Published: January 15, 1976
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Following the study mentioned in Report 1, clinical investigations were made on the emergence and reversion of resistance to rifampicin (RFP), and the results were summarized as follows:
    1) The previous study showed that the bacillary growth of 1 to 10% on 10 mcg RFP medium was 112 cases (6.9%) among 1, 779 cases, the growth of 11 to 50% was 5 cases (0.3%) and only 1 case (0.06%) grew over 50%. During the course of RFP treatment for 366 cases, 97 cases became resistant to RFP, and all these cases except 2 showed growth of 1% or more on 10 mcg as well as on 50 mcg RFP medium (Table 1). This fact leads us to believe that the error might be less to take the bacillary growth of either over 50% on 10 mcg or 1% or more on 50 mcg RFP medium for the clinical significance of RFP resistance than the criteria mentioned in the previous report.
    2) The following characteristics were found when bacilli became resistant to RFP.
    a) The amount of bacilli decreased or disappeared rapidly after starting RFP treatment, and the appearance of resistance to RFP coincided with the reappearance of bacilli or increase of bacilli amount (Fig. 1).
    b) Among cases became resistant, 65% appeared within the first 3 months after starting RFP treatment, and if once it became resistant, it reached to the high grade of resistance at once (Table 1).
    c) The appearance of resistance to the combined drugs was usually delayed except EB (Fig. 2). The emergence of resistance to RFP and EB among cases treated by the combination of RFP and EB, the number of cases showing resistance to RFP faster than to EB was 4 times more than that showing resistance to EB faster than to RFP. There were no other drugs except INH which became resistant faster than RFP. In the case of INH, all INH-sensitive cases converted to negative by the combined therapy with RFP until now.
    d) The combined drugs remained sensitive for a long period after RFP became resistant. This indicates that RFP inhibits the growth of bacilli stronger than other drugs, and the rank of efficacy of other combined drugs can be determined by the length of time during which combined drugs remain sensitive.
    3) There were 7 cases which remained bacilli positive and sensitive to RFP. Detailed analysis was made on 3 of them, and the above fact might be explained partly by the lower dose of drugs, as some cases like No.3 continuously discharging bacilli under RFP 0.3g and EB 1.0g twice weekly regimen converted to negative after changing the regimen to RFP 0.45g and EB 1.0g daily.
    4) There were 4 cases in which resistance to 50mcg RFP returned to sensitive to 10mcg RFP. The frequency of this reversion of resistance was 4.2% among 95 bacteriologically relapsed cases and 9.3% among 43 cases in which bacilli were examined 6 months after the suspension of RFP. One example was shown in Fig. 3, and it was difficult to explain the reason of this reversion, as the number of cases was too small. These 4 cases were treated for the second time by RFP after RFP resistance reverted to sensitive, but all failed to convert to negative and became resistant again. This might be explained by the lack of sufficiently intensive combined drugs.
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  • Kiyo SUSHIDA, Fuka OSADA
    1976 Volume 51 Issue 1 Pages 13-17
    Published: January 15, 1976
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    The PH phage specifically lyses M. tuberculosis, which had been maintained as the standard strain in our laboratory. Lytic activity of this phage against M. tuberculosis isolated from tuber culous patients was, however, somewhat different from that of our standard strain, namely, the phage susceptibility of patient's strains was lower than that of the standard strain. Strains of M. tuberculosis isolated from patients were slow growing rough colonies, cord forming acid-fast bacilli, absence of pigment formation, niacin biosynthetic and susceptible to INH, PAS and SM. Of the total 200 strains isolated from 106 patients, 25 strains (12.5%) obtained from 11 patients, of whom 8 had no clinical signs or previous history of tuberculosis, were susceptible to the PH phage when tested by means of spotting method. These phage susceptible mycobacteria were all sensitive to anti-tuberculous drugs; INH, PAS, SM and others. After the bacteriological confirmation of diagnosis, patients were treated usually by the triple conbination of INH, PAS and SM, and in some cases by rifampicin, ethambutol or kanamycin. Acid-fast bacilli converted to negative soon after the introduction of treatment. The phage susceptibility of strains isolated from the same patient at different times was always similar. In contrast, the drug resistant bacilli isolated from 11 patients with a long term history of pulmonary tuberculosis were all resistant to the phage. It has been said that no relationship exists between phage susceptibility and the drug resistance, however, the results of our present investigation suggest that there may be some relationship between drug resistance and the PH phage susceptibility.
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  • Michio TSUKAMURA
    1976 Volume 51 Issue 1 Pages 19-23
    Published: January 15, 1976
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Two patients, 57 year-old male and 72 year-old female, who were hospitalized as generallung fibrosis, excreted Mycobacterium nonchromogenicum and Mycobacterium intracellulare, respectively, 7 and 8 times during the periods of 3 years and 3 years and a half by monthly sputum examinations. The amounts of excretions were one to 10 colonies on each isolation. The patients finally showed fibro-caseous process in their lungs. The state before manifestation of the disease may be called as ‘parasitism’, as excretions of the organisms occurred without manifestation of the disease. Continuous excretions of ‘atypical’ mycobacteria are believed to be important as a preceding sign of manifestation of lung disease due to ‘atypical’ mycobacteria, even though their amounts were small. The present author (Tsukamura, M.: Kekkaku 49: 327-333, 1974) reported previously the importance of frequent excretions of M. intracellulare occurring not only as large amounts but also as small amounts for the diagnosis of lung disease due to this organism. The second case in the present study supports this previous observation,
    The patients had shown obstructive ventilatory insufficiency. Decrease of clearance capacity in respiratory way seems to become a favorable condition for manifestation of the disease, as it provides a chance for multiplication of ‘atypical’ mycobacteria in a locus.
    The present author also stated previously (Tsukamura, M.: Kekkaku 50: 17-30, 1975) that the characteristics of primary lung infection due to M. intracellulare tended to caseate which soon lead to cavity formation and lacking fibrotic process, but it has been shown from the obser vations in the present study that patients who have had general lung fibrosis before infection do not show significant cavity formation but fibrocaseous process. The fact may concern with immunologic state of the patients with lung fibrosis.
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