We investigated the serum level of IL-8 and TNF-α using ELISA in 16 patients with active pulmonary tuberculosis before administration of antituberculous drugs and in age-, smoking habit-matched 20 healthy controls.
The mean level of serum IL-8 in patients with active pulmonary tuberculosis was significantly higher than that in healthy controls (P<0.001). The mean level of serum TNF-α in tuberculosis patients was also high, while TNF-α was not detectable in the sera of healthy controls.
We also examined the relationship between clinical pictures mainly defined by radio graphic findings and the serum levels of IL-8 and TNF-α. The serum IL-8 level of 9 patients with tuberculous cavity is significantly higher than that of 7 patients without cavity. (P<0.05)
We classified the patients with cavities into two subgroups according to the radio graphic classification of the Japanese Society of Tuberculosis. Four patients with advanced lesions on chest X-ray showed higher serum IL-8 level than 5 patients with moderate lesions (P<0.05). On the other hand, there was no correlation between serum TNF-α level and radiographic findings.
These results suggest that IL-8 appears to be involved in the formation of tuberculous cavitary lesion.

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The Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) is a rapid test for the detection of Mycobacterium tuberculosis, utilizing the rRNA amplification method. For assessing the reliability and reproducibility of the method, a co-operative blind study was conducted among 6 laboratories. Materials for test were sputum and water samples containing known numbers of Mycobacterium bovis BCG or Mycobacterium avium, and samples without bacteria. From three of 6 laboratories, false-positive results were reported for bacteria negative samples, however, the ratio was below 10% 8.3% (3/36 samples), 5.6% (2/36), and 2.8% (1/36), respectively. It indicates the indispensability of negative controls for sample pretreatment and RNA extraction stages in the routine MTD test. In every laboratory, all the samples with 10² BCG in water and 10⁴ BCG in sputum were found to be MTD positive. For the sputum samples with 10² BCG, positive results with the ratio above 80% were reported from 4 laboratories. These results indicate that the MTD test based on rRNA amplification method is quite useful for the rapid diagnosis of M. tuberculosis infection.

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A 33-year-old woman had been on hemodialysis since she was 25 years old. In September, 1993, she had cough, which gradually increased in severity, and was accompanied by slight fever. No abnormality was observed on the chest radiograph taken on November 2. However, bilateral diffuse miliary shadows were observed on the radiograph taken on November 30. Tubercle bacilli were detected by the examination of sputum smear. As she was pregnant 20 weeks, therapeutic abortion was done on December 8.
A case of miliary tuberculosis occurring during pregnancy in a patient on hemodialysis has not been documented in Japan to date, and the first case in Japan was reported with a review of the literature.

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A 47-year old woman was admitted to our hospital with complaints of headache and right occipital swelling. Brain CT scan showed right occipital bone defect with a sequestrum and soft tissue swelling. T1 weighted MRI enhanced by GD-DTPA revealed several nodules. A right occipital craniotomy was performed. Subcutaneous pus and a well-circumscribed yellowish, firm mass which existed under the bone defect was extirpated. Pathologically, this mass was considered to be a tuberculoma and intracanial nodules were suspected to be cerebral tuberculosis. Anti-tuberculous therapy was started. Since her admission fecal occult blood continued and endoscopic examination with biopsy revealed sigmoid colon cancer. Sigmoidectomy was performed and she has been well during 1 year post-operative follow up. Although tuberculous disease are decreasing in number in our country, we must take into account of the existance of skull tuberculosis.

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Acute increase in tuberculosis mortality between 1885 and 1910 could be explained by rapidly increased birth rate, consequently large expansion of noninfected population, and gradual increase in opportunity of contact with infectious patients by changing working environments and living conditions. Prevalence of tuberculosis patients was not so few in the beginning of Meiji era. Vicious spiral of increased young susceptibles, many infectious sources and increased opportunity of infection had been continued for long. Lower nutrition from infant to adult, hard work and poor living conditions had worsen prognosis of the patients.
Nation-wide tuberculosis control campaign, mainly avoiding contact with patients and contaminated materials had started around 1910 and then issued Factory act which had been improved working conditions in the factories, although the speed was very slow. Tuber culosis mortality began to decrease in 1910s, but sharp temporary rise of tuberculosis mortality was marked in 1918-19 by epidemic of influenza, then the mortality had been declined again. Excess mortality by influenza caused temporary reduction of infectious sources, which had affected mortality rate of tuberculosis in the younger ages after 1920. Large raise-up of wages for factory workers around 1920 and increase trend in income for other workers by economic growth since 1900 had been improved not only working and living conditions, but also dietary life with increased higher intake of animal foods.
Female excess deaths from tuberculosis comparing those of males had continued until 1930, then male mortality exceeded females. Mobilization of young women to spinning and textile industries in Meiji and Taisho eras forced to increase in tuberculosis mortality among them. Lower social status for females than males might contribute to the higher mortality rate, but gradual improvement of socioeconomical conditions seemed to induce a declining trend in female tuberculosis mortality in the 1910s. While male excess mortality had been started after 1931 by changing working conditions and lifestyles.
The reasons why women in puberty show higher incidence of tuberculosis even in better living conditions are not clear yet. Specific endocrinal changes in puberty may contribute to lower resistance to tuberculosis. Lower volumes of bone marrow and blood cells and other constituents and some different metabolic processes were shown as suggestion suggestive sex differences in puberty related to tuberculosis immunity. Periodical desquamation of epithelial layers of tracheobronchial trees at the time of menstruation was discussed in view of association with development of tuberculous processes.
Geographical differences in female tuberculosis mortality or in declining trend might be associated with prevalence of tuberculosis in the early period of the Meiji era, and socioeconomic and living conditions Migration of young population to urban areas might be one of the affecting factors in mortality or declining speed in the rural areas.
Japan experienced three big peaks of tuberculosis mortality in 1910, 1918-19 and 1944-45, and the above epidemiological findings may indicate that similar epidemic of tuberculosis can occur in the future when similar social, demographic and economical conditions be set in a community, where epidemic of tuberculosis have had before. Concept of herd immunity in tuberculosis may be better to be recognized as sociomedical than biological.
Tuberculosis epidemic affected by various factors except three major factors of infectious resource, susceptibels and way of infection, should carefully be analyzed from interdisciplinary standpoints.

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