巻号一覧
53 巻, 12 号
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金井 興美1978 年 53 巻 12 号 p. 557-567
発行日: 1978/12/15
公開日: 2011/05/24
ジャーナル フリーIn the chronic stage of tuberculous infection, the bacilli reside in host tissue keeping analmost constant level of viable counts for a long period of time. This interpreted to be due tothe static equlibrium between host and parasite, which means that resting (or dormant) tuberclebacilli survive in the lesions without appreciable multiplication.
This physiological state of the bacilli make them insensitive to most of antituberculousdrugs, thus producing so-called “microbial persistence”. The literatures so far available suggestthat such persisters have the altered metabolic pattern and sometimes even a morphologicalchange. They will take the glycolytic pathway rather than the oxidative ones to obtain energyin the tissue environment of low oxygen tension. The conversion to L-forms in the lesions isalso suggested as a particular morphology of persisters, by which they can escape from theattack of chemotherapy.
It is a general rule that the bactericidal activity of chemotherapeutic agents works onlyagainst the bacilli in multiplication. In vitro and in vivo experiments show that this is alsothe case with SM, KM, and INH, but RFP is rather exceptional. RFP is active in killing theresting bacilli, though the degree of activity is a little lower than that against the multiplyingbacilli. In view of this fact, regimens containing RFP are recommended as an improved chemotherapy to eliminate persistent bacilli, or to sterilize them.抄録全体を表示PDF形式でダウンロード (1800K) -
束村 道雄1978 年 53 巻 12 号 p. 569-573
発行日: 1978/12/15
公開日: 2011/05/24
ジャーナル フリーPreviously, the present author (Tsukamura, M.: Kekkaku, 51: 35, 1976; 53: 367, 1978) reported on three cases of ‘transient lung infection’ due to M. avium-intracellulare complex, inwhich acid-fast organisms disappeared from sputum within three months and cavities withinsix months. In this paper, additional three cases of such infection have been presented. Thesepatients (cases 1 to 3) showed a solitary thin-walled cavity or cavities in infiltrative lesion byX-ray picture, which disappeared within six months, and showed negative conversion of acidfast organisms from their sputum within three months. The ‘transient infection’ is consideredas an intermediate form between transient colonization of the organisms which appear as sporadicisolates in sputum specimens without showing any significant clinical symptom, and establishedlung disease due to these organisms, which shows permanent presences of cavities and ofexcretion of acid-fast organisms. The presence of infection of this transient type is understoodas a form of opportunistic infection.
The key of detection of the ‘transient infection’ is apparently daily examinations of sputumspecimens carried out immediately after hospitalization or appearance of clinical symptoms.Otherwise, the cases may be misdiagnosed as lung tuberculosis or sporadic isolation of theorganisms without clinical significance.
In this paper, other two cases (cases 4 and 5) have been presented, which showed disappearance of acid-fast organisms in a few months but retained cavities. It was observed in suchcases that acid-fast organisms reappear in a further observation period.
In X-ray pictures, the process of ‘transient infection’ belonged to the primary infectiontype, and that of the cases 4 and 5 belonged to the secondary infection-type (Tsukamura, M.: Kekkaku, 50: 17, 1975).抄録全体を表示PDF形式でダウンロード (567K) -
松島 正視, 増村 雄二郎, 木村 利定, 佐藤 和雄, 高橋 宏1978 年 53 巻 12 号 p. 575-588
発行日: 1978/12/15
公開日: 2011/05/24
ジャーナル フリーA 3 3/12-year-old boy was admitted to Tomo Hospital with remittent fever on March 16, 1973.In June, 1972 he suffered from measles and a few weeks later an abscess with a dischargingsinus developed at his left axillar groove, successively spreading to another regions such asparotid and submandibular areas. The chest roentgenogram taken four months later exhibitedlung infiltrations and the biopsy of left axillar lymphnode aroused the suspicion of reticulohistiocytosis histologically (Fig.9). In his past history, he tolerated to variola and polio vaccinesand showed negative to Montoux reaction when he was one year old, but it is uncertainwhether he received BCG inoculation or not.
On admission, the boy had several abscesses with discharging sinuses at axillar, preauricular, parotid, submandibular and tibial regions and was in ill condition. X-ray revealed several lyticlesions of the skull and extremity bones (Fig.1&2) and pulmonary infiltrations (Fig.3&4).The acid-fast bacilli isolated from pus, sputum and gastric juice, were indistinguishable fromBCG by bacteriological investigations (Table 1). The biopsy specimens from cervical and tibialsinuses and a lymphnode revealed an inflammatory granulomatous tissue infiltrated chiefly byhistiocytes and lacked epithelioid tubercle, giant cell and caseation (Fig. 10). By Ziel-Neelsen'sstain, numerous acid-fast bacilli were detected in the cytoplasma of histiocytes (Fig.11) and thegreenish staining by Murohashi's differential staining with marachite-green and fuchsin suggestedthat they were living organisms.
While he was treated with kanamycin, isoniazid, rifampicin and ethambutol, the remittentfever subsided gradually but his deteriorated condition persisted till 3 months later when hereceived the transfusion of 200 ml of blood. Thereafter his condition became better gradually.The acid-fast bacilli were not detected on culture in May, 1973, but positive on smear untilDecember, 1973 (Fig.5). At his discharge on September 15, 1974, X-ray film revealed a markedregression of bony and pulmonary lesions (Fig.6, 7&8).
In immunological examination, serum irnmunoglobulins were within the normal range. Thedelayed skin reaction against DNCB and PPD or SK-SD which were negative on admissionconverted to positive nine months and 1 5/12 years later, respectively. The decreased percentageof E-rosette forming cells (T-cells) examined in May, 1973 restored to normal range in August, 1973 and September, 1974. 3H-thymidine incorporation into lymphocytes in April, 1974 whenhis condition had ameliorated, revealed normal with PHA and SK-SD, but slightly decreasedwith PPD (Table 2).抄録全体を表示PDF形式でダウンロード (8611K) -
島村 喜久治1978 年 53 巻 12 号 p. 589-612
発行日: 1978/12/15
公開日: 2011/05/24
ジャーナル フリーIn Japan today, where long-term chemotherapy for pulmonary tuberculosis has been popu- larly routinized, the time is not yet ripe for accepting readily short-course chemotherapy whichis of British and French origin. As a matter of fact, long-term chemotherapy had severalshortcomings specific for its prolonged administration. Therefore, if short-course chemotherapyhas been proved not inferior to long-term chemotherapy in its therapeutic efficacy, the durationof chemotherapy for pulmonary tuberculosis should undoubtedly be shortened.
In this symposium, therapeutic results of short-course chemotherapy for experimentaltuberculosis were presented by Drs. Kondo and Toyohara, while those of clinical studies werereported by 4 workers including Dr. Aizawa, all of which support and reconfirm the efficacyof short-course chemotherapy.
The greatest anxiety manifested by the Japanese phthisiologists for the trial of short-coursechemotherapy has been nothing but the anxiety about the possibility of occurring relapse afterdiscontinuation of chemotherapy, -in particular, anxiety for the fate of remaining cavitiesand other unstable lesions, yet existing at the time of terminating the chemotherapy. Follow- up studies shall clarify these questions eventually. Drs. Aizawa, Kino, and Uragami showedon the basis of their respective data that the radiological improvements continued consistentlyafter the termination of chemotherapy.
To ease their anxiety, reporters have elaborated their respective regimens, without stoppingchemotherapy indiscriminately within a fixed period but regulating the duration of treatment inaccordance with the rates of improvement in radiological findings and of bacteriological negative conversion.
Nevertheless, attending physicians used to prolong the duration of chemotherapy in some20% of cases. This is the actual status of chemotherapy in Japan.抄録全体を表示PDF形式でダウンロード (3096K)
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