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Volume 55, Issue 7
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Analysis on Reasons of Defaulting from Treatment of Tuberculosis PatientsShinji SHISHIDO, Abdul Moquim SAADAT1980 Volume 55 Issue 7 Pages 315-322
Published: July 15, 1980
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThe defaulter rate of tuberculosis patients from treatment at Kabul Tuberculosis Centre (KTC) was 39.8% at the end of third month and reached 80.7% at the end of twelve month according to the survey made in 1975. As the defaulting rate was so high that it was necessary to find out measures to improve the attendance rate of tuberculosis patients and to increase the treatment regularity.
A survey on reasons of defaulting was made in 1978 by the authors for three months. The existing home visiting system at KTC was utilized. Home visitors made home visit to patient's home and interviewed with the case, his or her family member, and friends or neighbours if necessary. If the cases did not live there, moved out or died, they were classified as “not found” group. Possible default ing reasons were listed up, and they were divided into 12 categories. If some reasons other than the above 12 were found, they were coded as No.13, and details were described. All cases with some reasons of defaulting were classified as “found” group.
Out of total 384 cases surveyed, 251 (65.4%) were “found” group and 133 (34.6%) were “not found” group. In “found” group, the reasons of defaulting related to the lack of health education to patients in 219 cases (87.3%). In 37 cases (9.6%), the reasons were coded as No.13. Less than 10% pointed out bad or wrong services at KTC for reasons of defaulting, though the necessity of improving services were strongly felt by the authors. Out of “not found” group, 75 moved out, 51 were unknown of their address and 7 had died already. Out of 251 “found” group, 236 (92.2%) came back to the treatment after making a survey by home visit.
The fact that main reason of defaulting was the lack of health education to patients was a useful lesson to improve the regularity of drug-taking in the future. Bad and wrong services for patients at KTC should also be improved.View full abstractDownload PDF (994K) -
Hideo INAGAKE, Hideyo YAMADORI, Noboru INOUE, Hisakatsu MABUCHI, Nobua ...1980 Volume 55 Issue 7 Pages 323-330
Published: July 15, 1980
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe already reported on the cross-resistance among aminoglucoside and polypeptide antibiotics, (SM, 1KM, VM, CPM, EVM), and examined in vitro continuously the various degree of resistance from lower to higher level of tubercle bacilli by the successive transfer in drug containing medium with serially increasing concentration.
The most interesting phenomena observed in this series of experimental processes were the crossresistance of CPM-R to KM; the growth of tubercle bacilli was (++) from the first to the 12th series test tubes, and thereafter (+++) from the 13th to the 20th series test tubes. The same phenomena were observed in the 5th generation of experiment regarding the cross-resistance of VM-R to KM and CPM. From these experiments, it is suspected that there is no bacilli showing various degree of cross-resistance to KM among strains with corresponding grade of resistance to CPM and VM.
We employed H37Rv strain and Kirchner liquid media, and the sensitivity was measured by the silicone-coated slide culture method. The interpretation was done after three weeks by macroscopical observation. In conclusion, it can be said that the cross-resistance of CPM-R (resistant to 15.6-7.8μg/ml, ) to KM divided into the complete cross-resistance and the incomplete cross-resistance by the growth of tubercle bacilli determined by the contents of cross-resistant bacilli of more than 1, 000μg/ml to KM.
Moreover, there existed no bacilli showing cross-resistance of various degree to corresponding KM concentrations among CPM-R strains. The same can also be said about the cross-resistance of VM-R to KM and CPM.View full abstractDownload PDF (998K) -
1. Clinical Effect of REP, INH and EB Regimen for 9 Months in the Original Treatment for Pulmonary Tuberculosis[in Japanese]1980 Volume 55 Issue 7 Pages 331-339
Published: July 15, 1980
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWith the recent development of new potential anti-tuberculous drugs, such as rifampicin and -ethambutol, it has become easier to treat tuberculosis patients. The high level of efficacy of several short-course chemotherapy regimens for pulmonary tuberculosis has been established in East Africa, Hong Kong and India. In this paper, the results of a 9-month regimen with rifampicin, ethambutol and isoniazid in the original treatment for pulmonary tuberculosis are reported.
Materials & methods: The patients over 15 years of age, with pulmonary tuberculosis and no previous history of antituberculous chemotherapy were admitted to our hospitals for the study. Treatmentregimen consisted of 450 mg rifampicin, 1, 000 mg ethambutol and 400 mg isoniazid daily for 9 months. By August 1979, 93 patients had completed this regimen and 72 had been re-examined for 6 months after the termination of treatment. Sixty-five out of 93 cases (69.9%) had pretreatment sputum positive for tubercle bacilli on either smear or culture. Sputum specimens were collected monthly during the study for examinations by smear and culture, and the sensitivity tests were done on each isolate. Chestroentgenograms with or without tomograms were taken for all patients approximately every 4 weeks in the early stage of treatment.
Results: Within four months after starting treatment sputum culture became negative in all cases. Seventy-six (81.7%) out of 93 cases showed over 50 percent decrease in the size of shadow on chest roentgenogram and 49 out of 62 (79.0%) showed improvement in cavities of roentgenogram at the end of chemotherapy. All except one case showed continuous improvement of chest roentgenogram findings including basic and cavitary lesions even after the discontinuation of treatment.
Only one case of 66-year-old male with pneumoconiosis had an enlargement of cavity and reexcretion of tubercle bacilli 6 months following the end of chemotherapy. In this case, by the readministration of the same regimen, tubercle bacilli converted to negative and roentgenologic findings were improved. Two patients showed increase of shadows in roentgenograms without excretion of tubercle bacilli in sputum. These shadows disappeared after readministration of the same drugs.
There were fourteen drop-out cases in addition to the above 93 cases. Eight out of them had been given anti-tuberculous drugs for more than 9 months mainly because of physician's worry on short-course chemotherapy. One stopped to visit the out-patient department and one could not continue on the drugs because of liver function disorder.
Conclusion: As seen from the results mentioned above, the short-course chemotherapy for 9 months with RFP, INH and EB is considered to be quite effective and useful in lightening a load of long-term chemotherapy both for physicians and patients.View full abstractDownload PDF (1239K) -
II. Species within the Genus Mycobacterium-Trial of New GroupingMichio TSUKAMURA1980 Volume 55 Issue 7 Pages 341-347
Published: July 15, 1980
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSSpecies of the genus Mycobacterium and their synonyms with their bibliography are shown. Grouping of Runyon has not been used in this paper, and the system shown in Table 1 has been adopted. This is due to the resaon that the pigment production is not always correlated with proper taxonomicr elationships.
In slowly growing mycobacteria, three complexes have been set up: M. tuberculosis complex, M. avium complex, and M. nonchromogenicum comples.
The fact that M. avium, M. intracellulare, and M. scrofulaceum form a cluster in numerical classification was shown previously by the present author (Tsukamura, M.: J. Gen. Microbiol., 45: 253, 1966), and thereafter it was shown that M. asiaticum also enters the same group (Tsukamura, M.: Int. J. Syst. Bacteriol., 26: 409, 1976). Use of the term M. avium complex is simpler than the term M. aviumintracellularescrofulaceum complex, and can include M. asiaticum.
The term M. fortuitum complex, which contains M. fortuitum and M. chelonei, is adequate when considered the taxonomic relationship between these two species (Tsukamura, M. et al.: Japan. J. Micro iol., 11: 243, 1967; Tsukamura, M.: Amer. Rev. Resp. Dis., 101: 426, 1970). It is also convenient and practical to set up the M. parafortuitum complex as proposed by Saito et al. (Int. J. Syst. Bacteriol., 27: 75, 1977), for rapidly growing, scotochromogenic mycobacteria, because there are many such mycobacteria and they are non-pathogenic.View full abstractDownload PDF (971K)
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