Kekkaku(Tuberculosis)
Online ISSN : 1884-2410
Print ISSN : 0022-9776
ISSN-L : 0022-9776
Volume 52, Issue 9
Displaying 1-8 of 8 articles from this issue
  • I. Observations in a Mouse Experimental Model Using a Streptomycin-dependent Strain
    Eiko KONDO, Koomi KANAI
    1977 Volume 52 Issue 9 Pages 411-415
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Mice were infected intravenously with a streptomycin-dependent strain of tubercle bacilli which had been brought into the antibiotic-starved condition by growing them on streptomycin-free Sauton medium. Chemotherapy with isoniazid, isoniazid plus pyradinamide, or ethambutol exerted little influence on the persisting or declining fate of these infecting bacilli, but rifampicin reduced markedly their viable counts in the spleen and lung down to the undetectable level. From this result in the highly artificial model, a suggestion was made that rifampicin, unlike isoniazid and ethambutol, might be effective even against the resting or persisting bacilli in tuberculous lesions.
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  • Part II Studies on Registration Status
    Midori SAITO
    1977 Volume 52 Issue 9 Pages 417-422
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Out of 593 cases reported as tuberculosis death to Tanashi Health Center, Tokyo, during the period 1 January 1962 to 31 December 1972, 202 cases or 34. 1% were not registered as Tuberculosis patients at the Health Center, in spite of compulsory reporting system under the tuberculosis Control Law in Japan (Table 1). To know the characteristics of the patients who were not registered before death, sex, age, occupation, place of death and causes of death of non-registered cases were compared with those of registered ones (Table 1, 2, 3 and 4), and no difference was found between registered and non-registered cases concerning above-mentioned background factors.
    The reasons why the patients were not registered as tuberculosis at health centers were analyzed by sending inquiries to the attending physicians who had prepared the death certificate for 31 non-registered cases died of tuberculosis during 1971 and 1972. The reasons of no-regis tration were summerized as follows:
    1) Seventeen case (58.6%) were registered at other health centers. Out of them 15 cases were registered at the health centers of the area where the patients were receiving services by the Daily Life Security Law. Two other cases died before transfering the registration card to the present health center from the former one.
    2) Twelve cases (41.4%) were not reported. Out of them five cases were considered by the attending physicians to have been reported already by the former doctors, but actually not. Three of them died shortly after the admission or doctor's visit and the doctors considered that such advanced cases should be reported already and were not reported. Two cases were examined after death.
    3) Out of non-registered 12 cases, seven were not reported because the physicians considered that there was no economical merit to the patients as the expenses for treatment were completely covered by health insurance or Veterans Security Law.
    It is worth mentioning that more than 10% of patients, including very severe cases were not reported to any health centers. To carry out contact examination of the family and other close contacts of the patients more completely, the author considered that the importance of reporting should be stressed more and more to all the physicians so as to have 100% reporting of tuberculosis in the future.
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  • Hideo MASAI
    1977 Volume 52 Issue 9 Pages 423-428
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    The test in the clinical laboratory should be done simply and reliably and the final results of the test would desirablly be brought out as early as possible. Considering those requirements, the following seven features were selected to be tested for the identification of clinical isolates of Mycobacteria: 1) colour tone of the colonies, 2) roughness of the colonies, 3) photoactive pigment production, 4) niacin production, 5) nitrate reduction, 6) heat stable phosphatase activity and 7) Tween hydrolysis. To fulfil the above described requirements, test paper methods were employed in cases of niacin test and nitrate reduction test, and the commercial reagent kit for blood chemistry was employed in case of the heat stable phosphatase test.
    Since these tests except the roughness of colonies were carried out by reading the colour change, the results of these tests were read simply and reliably. In addition, every test could be done within a few hours except the Tween hydrolysis, and the species name of the tested strain could be brought out on the day of examination in many occasions. Dividing the above described test combinations into two steps, the author succeeded to identify various strains of Mycobacteria of typical characteristics, such as M. tuberculosis, M. kansasii, M. intracellulare (M. avium-intracellulare complex), M. scrofulaceum and M. fortuitum by performing five or six tests out of the above seven tests.
    The test system herein described would contribute to the routine identification method of Mycobacteria in clinical laboratories.
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  • Michio TSUKAMURA
    1977 Volume 52 Issue 9 Pages 429-434
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    There are many reports on the clinical symptoms and X-ray picture of lung disease due to' atypical' mycobacteria. All these reports, however, lack actual comparison between the mycobac terioses and lung tuberculosis. No report has shown the actual state of clinical picture of lung tuberculosis under present complex chemotherapy. The purpose of the present study is to do this comparison. Clinical picture of 304 tuberculous patients who showed M. tuberculosis once or more in their sputum were studied and compared with those of lung diseases due to M. intracellulare (32 patients) and M. chelonei subspecies chelonei (10 patients). M. tuberculosis was identified by the absence of growth on Ogawa egg medium containing 0.5 mg/ml p-nitrobenzoic acid.
    Occurrence of fever was not significantly different between lung tuberculosis and diseases due to atypical mycobacteria. Occurrence of hemoptysis or hemosputum also showed no significant difference between disease due to M. intracellulare and lung tuberculosis, but they appeared more frequently in disease due to M. chelonei (p<0.05% by chi-square test).
    A cavity or cavities with non-sclerotic wall which appeared as thin -walled cavities was observed more frequently in diseases due to M. intracellulare and M. chelonei than in lung tuberculosis. Approximately 60% of Japanese tuberculous patients being hospitalized at present showed cavities in sclerotic lesion, while this form was absent in disease due to M. chelonei. The form was observed in ca. 40% of patients with disease due to M. intraellulare.
    Thin-walled cavities in diseases due to atypical mycobacteria almost lacked or showed only a few bronchogenic spread, whereas thin-walled cavities in lung tuberculosis were usually accompanied by infiltrative or fibrocaseous lesion in other lung field. Since thin-walled cavities without pericavitary lesion were not observed in lung tuberculosis, the presence of such cavities may be regarded as a sign of disease due to atypical mycobacteria.
    As reported previously, Tsukamura divided X-ray pictures of lung disease due to M. intracellulare into two groups. The first showed a marked tendency to caseation and lacked fibrotic process, and the second showed cavities in sclerotic lesion. Tsukamura suggested to correlate the former with the primary infection to healthy lungs and the latter with the secondary infection to open-negative cavities after healing of tuberculosis. This grouping of X-ray features was recognized also in the present study
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  • Comparison between the Results of Cases Operated in 1973 and 1974
    Jiro GOMI, Masatoshi SHIOZAWA
    1977 Volume 52 Issue 9 Pages 435-445
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    It is likely that the duration of chemotherapy after sur ical treatment for pulmonary tuber culosis is shortened in accordance with the development of chemotherapy, however, it is not clear whether this is true or not. The Subcommittee on Sur ical Treatment of RYOKEN carried out this study to clarify the present duration of postoperative chemotherapy and to prepare a material for determinin the appropriate duration of postoperative chemotherapy for pulmonary tuberculosis.
    Out of 1325 cases who were treated sur ically durin 1973 and 1974 at 47 institutions belon in to Tuberculosis Research Committee, 492 cases in which the duration of postoperative chemothe rapy, pre- and postoperative back round factors were known, were subjected to this study.
    Cases were divided into two roups; a group operated in 1973 and a group operated in 1974. The duration of postoperative chemotherapy in both roups were classified into four cate ories; within 6 months, 6 to 12 months, 12 to 18 months and 18 to 24 months. In each cate ory, the proportion of cases by several factors such as pre- or postoperative back round factors, sur ical procedures applied, postoperative complication or sputum findin and duration of postoperative hospitalization were calculated. Then these rates in group 1973 and in group 1974 were compared. Moreover, the rates in each cate ory were calculated on all cases operated in both years. Finally, the main purposes of postoperative chemotherapy were investi ated.
    The results were as follows: 1) Duration of postoperative chemotherapy in group 1974 was shorter than that in group 1973. Accordin to analysis by District, duration of postoperative chemotherapy in KANTO district was remarkably shortened durin one year. In the other districts, however, it did not show si nificant decrease during one year. 2) Duration of postoperative chemotherapy was remarkably shortened in the cases with favourable background factors such as youn er a e, ne ative sputum before operation, good lung function before operation, without residual lesion and resection except pneumonectomy. 3) Even among cases who developed post operative complications or positive sputum, about two thirds of them completed chemotherapy within one year after operation. 4) It is likely that the duration of postoperative chemotherapy will be shortened further due to the following reasons; the duration of postoperative chemotherapy was proportional to the duration of postoperative hospitalization, about one fourth of cases without residual lesion continued postoperative chemotherapy for more than 12 months, postoperative chemotherapy was administrated for prevention of postoperative complications or as a routine practice in 71% of all cases, and the difference in the duration of postoperative chemotherapy by district became smaller.
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  • Kazuhiko KAMEDA, Nobu KUCHI, Fujiko HORII, Jyunko OTSUKA, Sumiko SATO, ...
    1977 Volume 52 Issue 9 Pages 447-453
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Under the recent declining trend of tuberculosis in Japan, the examination of family contacts of newly registered active tuberculosis patients is the most important procedure for tuberculosis case-finding.
    The purpose of this study is to know to what extent the family contacts examination was performed at the time of registration of new cases at the health center and the results of these examinations.
    2, 392 household members of 815 newly registered patients (Table 1, 2) at 12 health centers in Osaka prefecture during the period from January to June, 1976 were subjected to the study.
    The examination was performed for 1303 persons (54.5%). According to the age group, the rates were 62.8%, 50.3% and 53.8% in infants, school-children and adults, respectively (Table 3a).
    26 active cases (2% to the total number examined) were discovered. Among 212 children aged 0-14 years and receiving tuberculin testing, 62 (29.2%) were positive and 22 were regarded as primary infection and chemoprophylaxis with INH was given (Table 3a) Out of 150 nonreactors BCG vaccination was performed to 131 (87.3%) (Table 3a).
    Observing by the bacteriological status of source cases, the detection rate of new cases was higher among contacts of bacilli positive (smear and/or culture) patients as compered with bacilli negative patients (Table 3 b, c, d) (Fig. la).
    The detection rate of new cases was higher among infants and contacts with source cases of types II, III and Pl (Fig. lb, c).
    As the examination rate of family contacts was as low as about 50% in this survey, the number of patients to be discovered will be doubled if the examination is thoroughly carried out.
    The priority of contacts examination should be focussed to intimate contacts of bacilli positive patients and contacts of primary infected children.
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  • Michio TSUKAMURA
    1977 Volume 52 Issue 9 Pages 455-457
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    1. Numerical classification of mycobacteria
    The numerical classification introduced to the field of microbiology by Sneath was first applicated by Bojalil and his associates to the study of mycobacteria. However, the number of characters used by them remained 30. It was much less than 50 which were considered as appropriate to obtain reliable results (Sneath; Lockhart). The present author carried out numerical classification first using a large number of characters. As the result of this study, the genus Mycobacterium was divided into two subgenera, which approximately corresponded to slowly growing mycobacteria and rapidly growing mycobacteria. The subgenera were divided by the following characters: (1) growth rate; (2) tolerance to picric acid; (3) tolerance to nitrite; (4)-(6) utilization of succinate, malate and fumarate as sole carbon source.
    According to the results of our studies, the following taxa were regarded as independent species:
    A. Slowly growing mycobacteria. M. tuberculosis, M. bovis, M. kansasii, M. marinum, M. gastri, M. simiae, M. asiaticum, M. xenopi, M. gordonae, M. avium-intracellulare-scrofulacaum complex, M. nonchromogenicum, M. triviale, M. shimoidei, M. szulgai.
    B. Rapidly growing mycobacteria. M. smegmatis, M. phlei, M. fortuitum, M. chelonei (M. chelonei subsp. chelonei), M. abscessus (M. chelonei subsp. abscessus), M. thermoresistibile, M. vaccae, M. chitae, M. parafortuitum, M. rhodesiae, M. obuense, M. agri, M. aichiense, M. chubuense, M. gilvum, M. duvalii.
    Among the above, M. nonchromogenicum, M. thermoresistibile, M. chitae, M. parafortuitum, M. obuense, M. rhodesiae, M. agri, M. shimoidei, M. chubuense and M. aichiense were proposed by Tsukamura or Tsukamura and his associates. M. szulgai was proposed by Marks, Jenkins and Tsukamura in 1972.
    2. Tests useful for differentiation among mycobacteria
    (1) Tests useful for differentiation of M. tuberculosis and M. bovis from other mycobacteria: (a) salicylate medium, (b) para-nitrobenzoic acid medium.
    (2) Tests useful for differentiation between slowly growing and rapidly growing mycobacteria: (a) picric acid (0.2%)-Sauton agar, (b) nitrite (0.1%)-Sauton agar.
    (3) Test useful for differentiation between pathogenic and non-pathogenic species of Group II and Group III mycobacteria: ethambutol (5μg/ml)-Ogawa egg medium.
    (4) Tests useful for differentiation of M. fortuitum, M. chelonei and M. abscessus from other mycobacteria: (a) PAS degradation test, (b) salicylate degradation test.
    (5) NH2OH · HCl-Ogawa egg medium (0.125, 0.25 and 0.5mg/ml).
    (a) No growth at 45°C and growth on NH2OH (0.5 mg/ml) show that the test strains belong to either M. fortuitum, M. chelonei or M. abscessus. Hence, all pathogenic ones of Group IV are distinguished by these characters.
    (b) M. xenopi and M. gastri of Group III are susceptible to 0.25 mg/ml NH2OH, whereas M. avium complex and M. nonchromogenicum complex are resistant to this.
    (c) M. kansasii is susceptible to 0.25 mg/ml whereas M. marinum is resistant to it.
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  • Teruo AOYAGI
    1977 Volume 52 Issue 9 Pages 459-468
    Published: September 15, 1977
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Studies on the protein binding of antituberculous drugs were carried out by using equilibrium dialysis method to clarify several clinical problems on the interaction between drugs and protein.
    The results were as follows:
    1) The factors related to the protein binding rates of sera to PAS were the concentration of drugs and protein in sera, the ratio of the volume in external and internal compartments, etc. As nearly the same binding rates of serum protein to PAS were obtained both in vivo and in vitro under the same PAS concentration, the data in this report were obtained mainly by in vitro method.
    2) The binding rates of sera to antituberculous drugs were generally low values, while RFP and PAS showed relatively higher rates than other drugs.
    3) Marked individual variations were observed in the binding rates of sera to PAS and. RFP, and the binding rates of sera to PAS significantly correlated with the concentration of albumin in sera, while such a significant correlation was not seen in the case of RFP. The significant correlation however, was found between the binding ratio of RFP and the concentration of cholesterol in sera. The binding rates and binding index of sera to PAS in patients showing PAS-allergy were significantly higher than that in patients showing no PAS-allergy.
    4) Eight drugs were tested as serum binding displacing agents and it was found that PAS was displaced only by phenylbutazon and dichlorfenack Na in high concentration of 300μg/ml.
    5) Significant negative correlation was seen between the binding rates of sera to PAS and the rates of acetylation of PAS.
    6) EB scarcely bound to sera, while it showed relatively high binding rates to blood cells. As EB concentration in cells was higher and its duration was longer than those in sera when EB was administered orally, it was suggested that the maintenance of EB concentration in blood was attributed to the binding of EB to cells. There were some individual variations on the RFP binding rates to cells, and a case of tuberculosis showing the highest rate had attack of pancytopenia.
    7) No marked correlation was found between the drug concentration in tissues and the binding rates of EB or RFP to each tissue in rat, administered orally these drugs, while the concentration of several chemotherapeutic agents in tissues could be estimated by measuring the binding rates of drugs by in vitro experiment.
    8) The binding rates of EB to tissues in rat administered EB orally increased markedly with time. This facts suggested that the binding rate of EB metabolite were markedly higher than that of EB, and it was necessary to measure the binding rates of drug metabolite to tissues for the purpose of studying the mechanism of side effect from the standpoint of protein binding.
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