巻号一覧
71 巻, 9 号
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検体前処理法の基礎検討および臨床評価豊田 丈夫, 大角 光彦, 青柳 昭雄, 阿部 千代治, 倉島 篤行, 片山 透, 藤野 忠彦1996 年 71 巻 9 号 p. 495-503
発行日: 1996/09/15
公開日: 2011/05/24
ジャーナル フリーThe Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) has been widely used as a rapid test for the identification of Mycobacterium tuberculosis complex in clinical samples, and several research groups have verified its clinical usefulness. How ever, most of the specimens they tested were sputum, and there have been few reports on other specimens. In particular, there have been no reports on assessments of methods of preparing samples other than sputum for the MTD.
We assessed methods of preparing samples other than sputum and the influence of a local anesthetic and an anticoagulant that may be present in samples, and also evaluated the MTD as a means of detecting M. tuberculosis in pleural fluid, bronchial lavage fluid, cerebrospinal fluid, urine and ascitic fluid.
1. Assessment of three sample preparation methods, i.e., the NALC-NaOH method, the GuSCN-Diatom nucleic acid extraction method, and the ultrasonication method, revealed that the combination of the NALC-NaOH method and the ultrasonication method, wide ly used to prepare sputum samples, is also a valid method of preparing other samples. 2. The local anesthetic and the anticoagulant used clinically and remained in specimens did not affect the results of the MTD.
3. Seven (36.8%) of 19 pleural fluid samples from patients diagnosed as tuberculous pleurisy were positive for M. tuberculosis by the MTD, while five (27.8%) of 18 pleural fluid samples cultured for bacteria were positive for M. tuberculosis complex. None of the 20 pleural fluid samples from patients diagnosed as non-tuberculous pleurisy were positive for M. tuberculosis complex either by MTD or culture.
4. Eight (32.0%) of 25 bronchial lavage samples from patients diagnosed as pulmonary tuberculosis were positive for M. tuberculosis complex by the MTD, while 3 (12.%) were positive by culture. None of the 18 bronchial lavage samples from patients diagno sed as non-tuberculous disease were positive for M. tuberculosis complex either by the MTD or culture.
Based on these results, it is concluded that the MTD is a very useful method of detecting M. tuberculosis in clinical samples other than sputum because it is more sensitive than culture on Ogawa's egg medium in detecting M. tuberculosis complex in pleural fluid samples, bronchial lavage samples, and so on, with the same preparation method as used for sputum.抄録全体を表示PDF形式でダウンロード (1134K) -
髄液中多核球優位の細胞数増加を示す例の意義について大瀬 寛高, 斎藤 武文, 田嶋 美香, 遠藤 健夫, 渡辺 定友, 深井 志摩夫, 柳内 登, 長谷川 鎮雄1996 年 71 巻 9 号 p. 505-512
発行日: 1996/09/15
公開日: 2011/05/24
ジャーナル フリーIt has been well known that tuberculous meningitis cases have moderate pleocytosis with mononuclears as predominating cell type in cerebrospinal fluid (CSF). But there are some reports of tuberculous meningitis in which polymorphonuclears was predomi nant in CSF. In this study, we investigated differential cell counts of CSF in 4 tuberculous meningitis cases. In 3 of the 4 cases, the CSF had a polymorphonuclears preponderance on admission. The elevated ratio of polymorphonuclears seemed to relate with the severity of the disease, and the ratio declined promptly after the initiation of chemotherapy. The 2 cases, which showed extremely high ratio of polymorphonuclears, showed poor prognosis, one died and the other had the severe sequelae such as notable disturbances of consciousness with hydrocephalus. This study suggests that differential cell counts of CSF is a useful measures to predict the prognosis and to follow up patients with tuber culous meningitis. The finding of a polymorphonuclears preponderance in CSF would suggest the severity and activities of the disease and should be considered as an alarm sign in tuberculous meningitis.抄録全体を表示PDF形式でダウンロード (863K) -
現状と将来予測の試み重藤 えり子, 佐藤 裕恵, 河原 伸, 倉岡 敏彦, 宮澤 輝臣1996 年 71 巻 9 号 p. 513-518
発行日: 1996/09/15
公開日: 2011/05/24
ジャーナル フリーThe patients of diseases caused by nontuberculous mycobacteria (NTM) newly diagnosed in 1993 in Hiroshima Prefecture were investigated retrospectively.
During 1993, 59 newly diagnosed patients of NTM disease, who were the resident of Hiroshima Prefecture were reported from 6 hospitals. Mycobacterium avium complex (MAC) disease was most frequent (53 patients, 90%) and M. kansasii (MK) disease, which accounts for more than 20 percent of all the NTM diseases in the national survey of Japan, was found only in 3%. Other pathogenes were M. chelonae and M. fortuitum. Incidence rate for all NTM disease per 105 population was 2.1. Age-specific incidence rate calculated from the estimated population of Hiroshima Prefecture was; less than 0.4/105 under the age 40, 4.0/105 in the age group 50 to 59, 4.5/105 in the age group 60 to 69 and 9.4/105 in the age group over 70. Thirty-one patients (57%) had underlying pulmonary disease such as previuous lung tuberculosis (TB) and previous history of TB was found in 41 percent of patients over 60yr. of age.
The data suggest that epidemiological picture of NTM diseases may change in the future. Relative increase of elder population will lead to the increase of NTM diseases as a whole; the incidence rate calculated from the age specific incidence rate and predicted population of Japan in 2025 is 3.1/105, which is 1.5 fold higher than the present rate. However, secondary NTM diseases with healed TB will decrease because of the sharp decline of TB morbidity in Japan. Assuming that secondary NTM disease with healed TB decreases to one-fourth, estimated incidence rate will be 2.3. Further, the upward tend of MK disease in Japan should be taken into consideration. Thus, the future trends of NTM diseases will increase fairly due to the increase of elder population as well as the MK disease.
It was pointed out that many NTM disease cases had been counted as tuberculosis in the surveillance system of Japan. In our present study, 52 (82%) were registered as tuberculosis in the biginning and only 19 cases were reported later to health centers as NTM disease. As tuberculosis classification and surveillance system in Japan were chang ed from 1996 to separate NTM disease from TB, NTM disease cases will be counted separately in the tuberculosis statistics. This revision in the management of NTM diseases should be taken into account when discussing the ternd of tuberculosis statistics in Japan.抄録全体を表示PDF形式でダウンロード (813K) -
森田 祐二, 本田 泰人, 田中 裕士, 阿部 庄作1996 年 71 巻 9 号 p. 519-522
発行日: 1996/09/15
公開日: 2011/05/24
ジャーナル フリーA 56-year-old female with the chief complaint of conjunctival injection was referred to our hospital after treatments with oral and topical corticosteroid under the diagnosis of episcleritis without any therapeutic efficacy. Possible causes of the episcleritis such as collagen vascular disease were not found, but a chest CT revealed centrilobular nod. ules, branching linear lesions and bronchial wall thickening which were not detected in a plain X-ray picture. We suspected pulmonary tuberculosis and tuberculous episcleritis based on these CT findings, strongly positive tuberculine skin test result and a history of contact with a smear positive tuberculosis patient. The pulmonary lesios disappeared and the episcleritis healed after the treatment with systemic antituberculous agents.抄録全体を表示PDF形式でダウンロード (4088K) -
久世 文幸1996 年 71 巻 9 号 p. 523-549
発行日: 1996/09/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (3581K)
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