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Volume 72, Issue 12
Displaying 1-5 of 5 articles from this issue
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Toru MORI, Masako WADA, Yoshiko KAWABE, Fujiya KISHI, Hironobu KOGA, T ...1997 Volume 72 Issue 12 Pages 649-657
Published: December 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTo observe the reported cases of tuberculosis (TB) with HIV infection in Japan, in terms of their main clinical features and related factors.
Methods: A voluntary reporting network has been organized by the authors who are specialists of TB or respiratory medicine in tuberculosis institutions located roughly all over the country. The members have been encouraged to report not only their own cases but cases seen by their friends or in other institutions.
Results: By the end of 1996, a total of 71 cases have been reported of which 59 were TB and 12 NTM cases. Nationality of the cases were Japan 48, Other Asian countries 16, Others 7. All of the NTM cases were Japanese. 30% of the cases were aged less than 30 years, 24% were thirties, 24% forties, 17% fifties and 6% were those aged 60 years or older. The cases were clearly younger than the TB cases in the national TB registry, and older than HIV-infected persons as known from the HIV surveillance system. 97% of the TB cases were bacteriologically confirmed cases. Eight of NTM cases were positive for MAC, others for M.kansasii. 42% of the cases had extra-pulmonary disease, including disseminated infections seen among 19%. Of TB cases 25% were excreting bacilli resistant to any of the anti-TB drugs which was higher than in the case of general TB population (10-15%). 11% of TB cases had past history of TB treatment. The cases had severe immunological impairment, 79% of the cases having CD 4+cell count less than 100. The route of HIV infection were; 51% heterosexual, 13% homosexual, 13% through blood preparations. etc.
Discussion: Although there may be many cases not included in this observation, it is considered to well reflect the real situation of the problem of Japan. More attention should be paid to HIV infection of the patients in the clinical practice of TB in Japan.View full abstractDownload PDF (1082K) -
Chiyoji ABE1997 Volume 72 Issue 12 Pages 659-672
Published: December 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTwo systems, the newly developed Mycobacteria Growth Indicator Tube (MGIT) and biphasic Septi-Chek AFB based on liquid media, proved to be significantly better than the egg-based solid media for the isolation of mycobacteria from clinical specimens. The difference in the rates of isolation of bacteria between the two groups of media was more remarkable with smearnegative specimens. The isolation of the Mycobacterium tuberculosis complex by MGIT occurred 8 days previous to the isolation by the conventional Ogawa method. The mean time for detecting M. tuberculosis complex by Septi-Chek AFB was similar to those of the Ogawa method. A greater difference in isolation time was observed for mycobacteria other than M. tuberculosis (MOTT) isolates. These results indicate that the MGIT and Septi-Chek AFB systems based on liquid media are efficient for the recovery of mycobacteria.
PCR and other nucleic acid amplification methods are widely used for the detection of M. tuberculosis in clinical specimens. Although the sensitivities of the Gen-Probe Amplified Mycobacteria Direct Test (MTD) and Amplicor Mycobacteria for the detection of the M. tuberculosis complex appear to be similar to the sensitivity of the culture method using the Septi-Chek AFB, the two methods should be quite useful for rapid detection of M. tuberculosis infections. On the other hand, two cooperative blind studies conducted between 6 to 9 laboratories to estimate the reliability and reproducibility of these two commercially available kits revealed the necessity of good laboratory practice and development of reference reagents to monitor the performance of the whole assay, including pretreatment of clinical specimens.
Considerable progress has been made in recent years toward understanding the molecular basis of the resistance to antituberculosis drugs, isoniazid (katG, inhA, ahpC), rifampin (rpoB), pyrazinamide (pncA), streptomycin (rpsL, rrs), ethambutol (embB), and fluoroquinolones (gyrA). Most cases of resistance are related usually to simple nucleotide substitutions rather than to acquisition of new genetic elements. Multidrug-resistant isolates of M. tuberculosis arise as a consequence of sequential accumulation of mutations conferring resistance to single therapeutic agents. The basis of resistance is not able to be explained yet in a substantial percentage of strains (> 90%) for other antituberculosis drugs than rifampin. Further studies are required to fully understand the molecular mechanisms of resistance.View full abstractDownload PDF (1733K) -
Takeshi YOSHIDA, Izuo TSUYUGUCHI1997 Volume 72 Issue 12 Pages 673-696
Published: December 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS1. Mechanisms of host defense and granulomatous inflammation in acid-fast bacilli Infection: Kazuo KOBAYASHI (Leprosy Res. Ctr., Ntnl. Inst. Infec. Dis.)
2. Induction and function of Th 1 cells as the effector cells in anti-tuberculosis immunity: Masao MITSUYAMA (Niigata Univ. Sch. Med.)
3. Role of γ/δ cells in tuberculous infection: Chisato UETA (Osaka Perfectural Habikino Hospital)
4. Role of immune responses in tuberculosis: Discussion from clinical observations: Katsuhiro SUZUKI (Chest Dis. Res. Inst., Kyoto Univ.)
5. Merit and demerit of cytokines in the prevention and treatment of tuberculosis: Kazuyoshi KAWAKAMI (Ryukyu Univ. Sch. Med.)
Tuberculosis is considered in general a chronic infectious disease caused by Mycobacterium tuberculosis. However, major pathological lesions of the disease are induced by host immune responses to tubercle bacilli. In most other infectious diseases, the interaction between invading pathological organisms and host defense mechanism would determine the outcome of the invasion; whether or not the onset of illness does follow the infection. In tuberculosis, however, this pattern of the pathogenesis is not necessarily followed. In fact, a highly immunogenic epitope from tubercle bacilli does not necessarily represent the best candidate of the effective vaccines for tuberculosis. Thus, this symposium was now organized when the detailed immune responses in human tuberculosis have not yet been revealed completely. In other words, our aim of the symposium is to understand how much the studies on tuberculous immunity have revealed the host defense mechanisms against tuberculosis.
We have asked both Drs. Kobayashi and Mitsuyama to present their views to what extent we could extrapolate the data obtained from in vitro and in vivo studies on murine experimental infection with acid-fast bacilli for future prevention and treatment of the tuberculosis in man. Firstly, Dr. Kobayashi presented the data indicating that murine strain susceptible to MAC infection are not capable of generating IL12 and also that the death due to MAC infection can be prevented by administration of exogenous IL12 to these susceptible mice. In discussion for the implication of these data, he has suggested that the future challenge in establishing anti-tuberculous immunotherapies with IL12 would be how to control the organ damages induced by such treatment.
Dr. Mitsuyama has shown that NK cell-dependent IFN- γ appeared to be critically important in the generation of antigen- specific (protective) TH 1 cells at the early stage of immune response to viable virulent bacteria. Several cytokines such as IL12 and IL18 released from macrophages seem to be essential in the stimulation of NK cells to produce IFN γ. He strongly suggested that these experimental findings should be confirmed by studies in man using human clinical samples.View full abstractDownload PDF (5745K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...1997 Volume 72 Issue 12 Pages 697-700
Published: December 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (346K) -
1997 Volume 72 Issue 12 Pages 701-703
Published: December 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (317K)
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