結核
Online ISSN : 1884-2410
Print ISSN : 0022-9776
ISSN-L : 0022-9776
69 巻, 10 号
選択された号の論文の7件中1~7を表示しています
  • 中園 智昭, 杉江 琢美, 尾形 英雄, 水谷 清二, 杉田 博宣, 木野 智慧光, 和田 雅子
    1994 年 69 巻 10 号 p. 587-592
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    Mycobacterium kansasii infection responds well to antituberculous drugs, and in the initial phase of treatment, many patients with M. kansasii infection are regarded as tuberculosis. This study was carried out to know whether the regimen ofchemotherapy be continued or changed after the confirmation of diagnosis as M. kansasii infection. The treatment result of 107 cases with M. kansasii infection of the lung encountered at Fukujuji Hospital was compared with that of pulmonary tuberculosis. Sputum culture of all patients treated with drug regimens containing RFP converted to negative within 3 months after starting chemotherapy, while sputum culture of many patients treated with regimens not containing RFP converted to negative 4 months or later after the start of chemotherapy. Hence, the effectiveness of RFP in treating M. kansasii infection was confirmed. Among 65 patients with no relapse during a follow-up period of at least one year after the completion of chemotherapy, 58 patients (89.2%) were treated with drug regimens containing INH and RFP, and the treatment of 40 patients (61.5%) was finished within 12 months. Among three patients deteriorated during chemotherapy or relapsed within one year after the completion of chemotherapy, two patients were treated with drug regimens containing RFP and one of them had serious complications. The chemotherapy regimen for tuberculosis is considered to be sufficient for the initial treatment of pulmonary disease caused by M. kansasii.
  • 青木 正和, 片山 透, 山岸 文雄, 横田 総一郎, 亀田 和彦, 斎藤 肇, 原 耕平, 江崎 孝行, 河合 忠, 四元 秀毅, 関口 ...
    1994 年 69 巻 10 号 p. 593-605
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    Recently, a new kit to detect and indentify mycobacteria in clinical specimens was developed by Japan Roche Co. Limited. The new method is based on amplification of DNA of mycobacteria in clinical specimens by PCR and hybridization of amplified DNA b. microwell plate hybridization method, which is the “AmplicorTM Mycobacteria, Roche. (AMP-M) ”. Cooperative study was organized with 15 tuberculosis hospitals and institu tions throughout Japan, and 349 clinical specimens from newly admitted tuberculosis patients and/or suspects were collected during July and August, 1993. All the specimens were examined by smear microscopy (Ziehl-Neelsen's staining), culture on Ogawa egg media, culture on variant 7H9 liquid media and by AMP-M. Excluding 25 specimens which had failed to identify the species of mycobacteria because of contamination, disability to multiply on the transplanted solid media and so on, the results of the examinations in 324 specimens consisting of 167 specimens from previously untreated cases and those of 157 specimens from previously treated cases were analysed. Main results obtained were as follows;
    1. Of 70 smear positive specimens from previously untreated cases, culture positive on Ogawa media and 7H9 media, and by AMP-M positive were 59 (84.3%), 61 (87.1%) and 66 (94.3%), respectively. Of 97 smear negative specimens, culture positive were 20 (20.6%), 22 (22.7%) and 27 (27.8%), respectively. The AMP-M showed the highest positive rate in both groups.2. The sensitivity and the specificity of AMP-M in previously untreated cases were calculated by assuming that positive on Ogawa and/or variant 7H9 media is “positive”. The sensitivity was 95.8% (68/71) and the specificity was 94.8% (91/96) for M. tuberculosis in previously untreated cases. The sensitivity and the specificity for M. avium and M. intracellulare were all 100%, although the numbers observed were small.
    3. So-called false positive of the AMP-M were observed in 5 cases out of 96 culture negatives on both Ogawa and variant 7H9 media. However, all 5 cases were positive by repeated AMP-M, 3 become culture positive later, and another 2 showed clinical findings consistent with tuberculosis. Hence, the authors considered that the false positive rate of the AMP-M method is to be very low in previously untreated cases.
    4. Of 86 smear positive cases with history of previous chemotherapy, the positive culture on Ogawa media, variant 7H9 media and that by AMP-M method were 64 (74.4%), 77 (89.5%) and 85 (98.8%), respectively. In the smear negative cases, culture positive was 10 out of 71 (14.1%), 13 (18.3%) and 24 (33.8%), respectively.
    5. The sensitivity and the specificity of the AMP-M were 98.7% (77/78) and 81.0% (64/79) for M. tuberculosis in previously treated cases calculated by the same method as in previously untreated cases. They were 77.8% (7/9) and 100% (148/148) for M. avium, and 100% (4/4) and 100% (153/153) for M. intracellulare.
    Based on these results, the authors concluded that the AMP-M is a very efficient and rapid method to detect and identify M. tuberculosis, M. avium and/or M. intracellulare in clinical specimens. This method will be useful to diagnose tuberculosis and diseases caused by mycobacteria other than M. tuberculosis rapidly.
  • 川上 和義, 照屋 勝治, 當山 雅樹, 久手堅 憲史, 斎藤 厚
    1994 年 69 巻 10 号 p. 607-613
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    It has been well documented that IFN-γ plays an important role in the host defense against Mycobacterium tuberculosis infection through activating macrophages to kill the organism. In the present study, we studied the effects of in vivo injection of monoclonal antibody against IFN-γ (anti-IFN-γ mAb) on the mycobacterial infection to confirm the role of this cytokine.
    The injection of anti-IFN-γ mAb suppressed the enhanced expression of MHC class II and ICAM-1 on pulmonary parenchymal macrophages induced by intravenous injection of Mycobacterium bovis BCG. The number of bacilli recovered from lung of mice treated with anti-IFN-γ mAb and injected with Mycobacterium tuberculosis H37Rv was significantly larger than that of the control infected mice. From these results, it was indicated that anti-IFN-γ mAb blocked the activities of endogenously synthesized IFN-γ, thus inhibited the activation of macrophages to kill the bacilli. Next, CD4+ T cell-depleted mice were prepared by injecting anti-CD4 mAb and used as immunocompromised animal. When infected with M. tuberculosis, the multiplication of the bacilli within the lungs of such immunocompromised mice was much more enhanced in comparison with the control mice with intact CD4+ T cells. Administration of IFN-γ signi ficantly reduced the number of the bacilli in lung.
    Further, in an in vitro study with human lung macrophages, IFN-γ enhanced the killing activity of macrophages against M. tuberculosis in a dose dependent manner, and suboptimal dose of la, 25-dihydroxyvitamin D3 synergistically augmented the effect of IFN These results suggest that an adjuvant therapy with IFN-γ may be hopeful in the treatment of tuberculosis caused by multi-drug resistant bacilli in immunocompromised patients.
  • 小宮 武文, 松島 敏春, 木村 丹, 安達 倫文
    1994 年 69 巻 10 号 p. 615-619
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    A 43-year-old female was admitted to our hospital with mild cough, sputum and right chest pain. The chest X-ray revealed an inhomogeneous shadow in the right upper lung field and mediastinal lymphadenopathy. At first we considered the patient had bronchogenic carcinoma, as her serum CA19-9 and SLX levels were high and the right upper bronchus was obstructed by necrotic tissues. However bronchoscopic specimen showed necrotizing epithelioid cell granulomas and Mycobacterium tuberculosis was detected, and her disease was diagnosed as endobronchial tuberculosis. The case responded well to anti-tuberculosis chemotherapy. The differential diagnosis between bronchogenic carcinoma and endo bronchial tuberculosis was very difficult in this case because of high serum level tumor marker and endoscopic findings, which turned to normal after treatment. We discussed the cause of high serum level of CA19-9 and SLX in nonmalignant lung disease.
  • 古賀 宏延, 河野 茂, 福田 美穂, 橋本 敦郎, 原 耕平
    1994 年 69 巻 10 号 p. 621-625
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    A 75-year-old female was admitted to our hospital for further examination of the cause of blood-stained sputum and abnormal shadow on chest radiogram which had developed immediately after an injury of right chest wall. The bacteriological examination of sputum on admission revealed negative Gaffky score, but positive PCR, and Mycobacterium tuberculosis was isolated by culture. Her symptoms and chest radiogram were improved by the administration of isoniazid, ethambutol and rifampicin. Although development of pulmonary tuberculosis induced by chest wall injury is rare, in case of the aged persons such possibility should be considered. PCR may be useful for rapid diagnosis of tuberculosis, even in such case.
  • 河端 美則, 赤川 清子
    1994 年 69 巻 10 号 p. 627-649
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
    1. Differentiation of human macrophages and cytokines: Kiyoko AKAGAWA (Depart ment of Immunology, National Institute of Health)
    2. Human Langerhans cell granulomatosis: Yuu FUKUDA (Department of First Pathology, Nippon Medical School)
    3. Epithelioid cell granuloma formation: Yasutaka INA (Department of Second Internal Medicine, School of Medicine, Nagoya City University) et al.
    4. Necrotizing granuloma formation in tuberculosis: Shouichi SAKAMOTO (Division of Pathology, the Research Institute of Tuberculosis)
    5. Leprosy-review and pathogenesis of leprous neuritis: Masamichi GOTO (Division of Laboratory Medicine, National Leprosarium Hoshizuka-Keiaien)
    6. Research of granuloma formation in parasitic disease-Mechanism of Schistosoma mansoni Egg-induced granuloma formation: Tamotu KANAZAWA (Department of Parasitology, National Institute of Health)
  • 1994 年 69 巻 10 号 p. 657-659
    発行日: 1994/10/15
    公開日: 2011/05/24
    ジャーナル フリー
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