Dialysis patients showed a high susceptibility to miliary tuberculosis and if once affected, the fatality was high. In order to clarify the characteristics of miliary tuberculosis in dialysis patients, a statistical study was done. The subjects were 7274 dialysis patients in 161 institutions including 150 cases complicated with tuberculosis. Among them 9 males and 6 females were miliary tuberculosis. They were between 30 to 69 years of age. Seven males and six females died of it. As to the causative diseases for renal failure, pyelonephritis and polycystic kidney were seen more frequently among the patients with milialy tuberculosis than among all tuberculosis patients receiving dialysis. The attack rate of miliary tuberlcuosis showed a rise from 3 months prior to the initiation of dialysis therapy, and it was highest during the initial 3 months of dialysis therapy, then it went down gradually, although it remained much higher during dialysis therapy than that of the general population. Lung was involved most frequently, next liver and spleen, then followed by bone-joint, lymphnode, kidney and urinary tract, pancreas, pleura, gut, bone marrow, peritoneum, trachea, adrenal, meninges and pericardium. Almost all organs except muscle, brain and thyroid were involved. Fever was the most common one among the symptoms and signs which lead to the diagnosis, then followed by anorexia, weakness, fatigue, weightloss, cough, abdominal pain, etc. Chest X-ray was useful for diagnosis in 6 cases among 11 patients. Tubercle bacilli were detected in 3 cases. Autopsy was perfomed in 11 cases. Among them 7 cases were proved to be miliary tuberculosis at autopsy. Seven patients had 8 episodes of tuberculosis in total. They occurred 22. 1 years ago in average. The present study demonstrated the characteristics of miliary tuberculosis among dialysis patients.
We conducted a study on the possible mutual relationship between pulmonary tuberculosis and diabetes. Out of 479 patients with pulmonary tuberculosis (male 351, female 128) who were admitted to Aisei Hospital between January, 1978 and December, 1981, 27 cases were associated with diabetes (5.6%). We investigates these 27 cases and obtained the following results: 1) The onset of tuberculosis preceded the onset of diabetes in 13 patients (48.2%), the onset of diabetes preceded that of tuberculosis in 12 patients (44.4%) and the onset occurred almost simultaneously in 2 patients (7.4%). 2) Parallel improvement for both diseases was observed in 9 out of 27 patients (33.3%), and following therapy, the blood sugar curves (GTT) in these patients approached normal patterns where as insulin in plasma (IRI) exhibited abnormally low levels with a small variation. We also measured the insulinogenic index (Δ/ΔBS). In the healthy group (n=50), the mean was 0.797±0.053; in the non-diabetic tuberculosis group (n=20), this mean was 0.444±0.055; and in the group with tuberculosis associated with diabetes (n=27), this mean was 0.204±0.042. Difference in the insulinogenic index among these 3 groups was statistically significant (t-test, p<0.001). Based on the above results, we concluded that pulmonary tuberculosis may be a factor that influences glucose metabolism.
In the previous paper, it was reported that DNCB reaction as immunological skin test showed marked reduction in active pulmonary tuberculosis. In the present study, it was tried to clarify the clinical significance of the reduction of DNCB reaction, and the results were summarized as follows: 1) Seventy-four percent of patients showed reduced reaction to DNCB. Among them, 77% showed normal reaction to PPD and 23% were negative. 2) Those with reduced DNCB reaction showed a tendency of increased immunoglobullins (IgG and IgM). 3) There was significant correlation (p<0.05) between the extent of lesions on chest roent genogram and the rate of negative reaction to DNCB. The more the extent of lesion the higher the negative reaction to DNCB. 4) When clinical improvement was achieved with antituberculous drug therapy, DNCB reaction was enhanced in 26 (79%) out of 33 cases with reduced DNCB reaction before treatment. These results suggest that reduced DNCB reaction indicates the hypofunction of cellular immunity in pulmonary tuberculosis, and DNCB test could be used as an important indicator to estimate the clinical prognosis.
Muramyl dipeptide (MDP) of bacterial cell walls, a minimal structure responsible for their adjuvant activity, was found to induce massive epithelioid granulomas indistinguishable from those induced by tubercle bacilli in rats, guinea pigs and rabbits, when injected incorporated in a water in-oil emulsion. MDP was stronger than tubercle bacilli in granulomageneicity. Conjugates of MDP with branched chain fatty acids, but not with a linear chain fatty acid, were capable of evoking granulomas. Peptidoglycan fragments of S. epidermidis incorporated into the water-in-oil emulsion became granulomagenic. On the basis of these findings I propose that an essential structure in tubercle bacilli responsible for epithelioid granuloma formation is probably the conjugated form of branched chain fatty acids (mycolic acid) and MDP, a structure found uniquely in wax D or cell walls of tubercle bacilli. The formation of MDP-induced epithelioid granuloma was found not to require allergic reactions but require macrophage activation. These findings may contribute to our understanding of epithelioid granuloma in general.
This syposium, entitled “Recent Advances in the Research of Tubercle Bacilli”, was held to commemorate the Centenary of the discovery of tubercle bacilli by Dr. Robert Koch in 1882. Since the discovery of tubercle bacilli, enormous amounts of knowledge have been accumulated. Various species of acid fast bacteria other than human and bovine tubercle bacilli (Mycobacterium tuberculosis and M. bovis), which have been found by Dr. Koch, were isolated from various sources and identified as members of genus Mycobacterium, and the relatedness of Mycobacterium with Corynebacterium and Nocardia were also established. The development of highly sophisticated instruments, such as electron microscopy and gass chromatography-mass spectrometer (GC/MS), enabled us to observe the ultrafine structures of tubercle bacilli and to analyze the detailed chemical structures of very complicated mycobacterial constituents. Despite the many difficulties in experimental procedures, the studies on the metabolic activities and genetics of tubercle bacilli have achieved the steady progress. The Japanese researchers have made great contributions for such advances in the fundamental researches of tubercle bacilli, as summarized in “50 Years in Tuberculosis Research” which was published to commemorate the Jubilee of the Japanese Society for Tuberculosis. In this symposium, four symposists presented the most up-to-date results of their brilliant works. Dr. Kazue Fukushi, Hirosaki University, showed many beautiful electron microscopic photographies of the ultrathin section of whole bacilli, cell wall, cytoplasmic membrane, mesosomes, chromosomes, nucleus, polyphosphate granules and pili of mycobacteria. From these observations, he proposed the schema of the ultrafine structures of mycobacteria. Dr. Yasuo Mizuguchi, University of Occupational and Environmental FIealth, developed the method for spheroplast formation and its reversion to bacillary form. Budding and elementary body formation were observed in the reversion process, and also a filamentous or mycelium-like growth accompanying branching and occasional septation were noticed in the regeneration process. These methods to induce spheroplast and to convert them to bacillary form may provide a way for the new manipulation system to study the genetics in Mycobacteria.