Kekkaku(Tuberculosis)

The molecule of long-chain fatty acids consists of two moieties, hydrophobic hydrocarbon chain and hydrophilic carboxyl group. Because of this chemical structure, long-chain fatty acids are surface-active, membrane-active, and cytotoxic. However, such toxicity is usually masked in vivo by being coupled with proteins or being esterified to triglycerides, phospholipids, and cholesteryl esters. In triglycerides, fatty acids serve as an energy reservoir. In phospholipids, the acyl chains of fatty acids give the membrane the properties of hydrophobicity and fluidity which interfer in many ways with the physiology of the cell.
The 3rd part of this review is concerned with the dual effects of long-chain fatty acids on tubercle bacilli, growth-supporting or growth-inhibitory depending upon the concentration and other physicochemical factors in the environment. Particular interest was directed in the in vivo condition where free long-chain fatty acids may have a chance to act directly on the bacilli without being interfered by neutralizing activity of host proteins.

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As immunopotency including PPD skin test is suppressed in dialysis patients, they might belong to the high risk group for developing tuberculosis. A study was made on tuberculosis in dialysis patients treated at our dialysis unit.
For the past 11 years we treated 194 chronic dialysis patients in Keio University Hospital, and 10 cases developed tuberculosis. The incidence of tuberculosis was enormously high, 4, 065 per 100, 000, which was 58 times higher than that of the general population in 1978. Three of 10 patients died and the fatality was 30%. The type of the disease was lymphadenitis in 5, miliary in 2, respiratory tract and peritoneal in 1, urinary tract in I and lung tuberculosis in 1. Nine of 10 cases had extrapulmonary lesions and 4 had pulmonary lesions. This data revealed remarkably high frequency of extrapulmonary tuberculosis in dialysis patients. Past history of tuberculosis was obtained from 5 cases. Another one case was found at autopsy to have an old tuberculous lesion in the lung. Two patients developed tuberculosis just before the initiation of dialysis therapy and 4 in the first year. The patients might have been infected with tubercle bacilli in the past, and had occult hematogenous spread to some organs. It was suggested that under certain circumstances such as uremia and being treated with dialysis, the bacilli might begin to grow again after a long time dormancy, leading to the development of extrapulmonary tuberculosis. Among persons who have the quiescent tuberculous foci, tuberculosis may develop when they face such conditions as mentioned above. Consequently, the majority of onset of tuberculosis were seen soon after the initiation of dialysis therapy, and thereafter, the number of new cases was reduced according to the decrement of such persons. The remarkably high incidence of tuberculosis observed in dialysis patients suggests that they are mainly due to recurrence or endogenous reactivation.
Fever, symptoms arising from involved organs, accelerated erythrocyte sedimentation rate were useful for the diagnosis. Chest X-ray films are also sometimes useful information. The skin test to PPD was stronger among tuberculosis cases than among non-tuberculous dialysis patients. The patients responded well to anti-tuberculous drugs when used timely in proper combination and dosage.

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