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72 巻, 4 号
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北原 義也, 原田 泰子, 原田 進, 丸山 正夫, 加治木 章, 高本 正祇, 石橋 凡雄1997 年 72 巻 4 号 p. 173-180
発行日: 1997/04/15
公開日: 2011/05/24
ジャーナル フリーWe investigated the distribution and the characteristics of the lung lesions of patients with primary Mycobacterium avium complex (MAC) infections mainly by computed tomography (CT). They admitted to our hospital during the period from 1984 to 1995 and none of them had a medical history of tuberculosis or other lung diseases. The subjects consisted of fifty patients: fourteen male (average age±SD was 66.4±14.0 year old) and thirty six female (69.0±11.9 year old). Of 50 patients 24 were M. intracellulare infection, 10 were M. avium infection and others were not identified.
First, by using the ratio of slices with lesions on CT to all CT slices from the apex to the base of the lungs, all the patients were divided into two groups a slight group with less than 15.0% (n=19) and a severe group with 15.0% or more (n=31).
Next, the density of abnormal shadows in each segment as divided into 5 grades none (-), minimal (±), slight (+), moderate (++) and severe (+++).
The grading was done by taking into account the grade of distribution, density of lesions and destruction of lung parenchym found mainly on CT, and in addition by a standard roentogenographic and tomographic features supplementally.
The characteristics frequently observed findings on CT in primary MAC infection patients were nodular (94%), cavitary (74%), bronchiectatic (62%), infiltrative (74%), atelectatic (56%), and pleural-thickened (36%) shadows.
Comparing the incidence of segmental lesions in MAC infection patients by segment, it was higher in right than in left lung, but the difference was statistically not significant.
As to the number of segments with lesions graded from (±) to (+++), many segments were infected unexpectedly: the mean value was 7.7±1.5 even in the slight group.
The proportion of segments with relatively severe lesions graded from (++) to (+++) in each segment was observed, and the rate in the slight group was 52.6% in S5, 28.9% in S4, 16.7% in S1 (S1+2a, b), and 16.7% in S2 (S1+2c).
In severe group, it was 54.8% in S5, 45.2% in S4, 46.8% in S1 (S1+2a, b), 54.8% in S2 (S1+2c), 27.4% in S3 and 26.2% in S6, respectively.
The rate of segments with lesions in the lower lobes were less frequent especially in the slight group while it was slightly higher in the severe group.
Speculating the initial lesions in the slight group, it was assumed that there might be two types of foci the one is relatively locazized in the beginning and the other is a diffuse type with lesions in many segments even from its early stage.
As to the location of initial lesions, the middle lobe and lingula were the most important sites, and the right upper lobe and the left upper division were the next.抄録全体を表示PDF形式でダウンロード (988K) -
阿部 千代治, 斎藤 由美子, 本山 禎二, 宇田川 宏和, 小林 郁夫, 矢島 秀章, 土屋 香織, 松嶋 広, 鵜木 恵美, 芦原 義久 ...1997 年 72 巻 4 号 p. 181-186
発行日: 1997/04/15
公開日: 2011/05/24
ジャーナル フリーThe Amplicor Mycobacteria, a PCR-based assay, is a rapid test for the detection of Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium intracellulare in clinical samples. To estimate the reliability and reproducibility of the method, a cooperative blind study was conducted among 9 laboratories. Materials used for testing consistedof 105 sputum and 30 water samples containing known numbers of M. bovis BCG, M. avium, M. intracellulare, and samples without bacteria. Only 2 out of the 9 laboratories correctly identified the presence or absence of mycobacterial DNA in all 135 samples. In sputum samples, 6 out of the 9 laboratories detected mycobacterial DNA in all positive samples, and 4 out of the 9 laboratories correctly reported the absence of DNA in the negative samples, indicating the need for good laboratory practice and development of reference reagents to monitor the performance of the whole study, including pretreatment of clinical samples. The main problem was lack of specificity rather than lack of sensitivity. From about half of the laboratories, false-positive results were reported, however, the ratio was below 6% ; 1% (1/105 sputum samples) in 3 laboratories, 1.9% (2/105) in 2 laboratories, and 5.7% (6/105) in one laboratory, respectively. These results indicate that the Amplicor Mycobacteria is quite useful for a rapid diagnosis of tuberculosis.抄録全体を表示PDF形式でダウンロード (798K) -
鈴木 克洋, 露口 一成, 松本 久子, 新実 彰男, 田中 栄作, 村山 尚子, 網谷 良一, 久世 文幸1997 年 72 巻 4 号 p. 187-192
発行日: 1997/04/15
公開日: 2011/05/24
ジャーナル フリーFifty six clinical isolates of Mycobacterium tuberculosis were tested for drug susceptibility in Mycobacteria Growth Indicator Tube (MGIT) containing 0.1μg/ml of INH, 1.0μg/ml of RFP, 3.5μg/ml of EB and 0.8μg/ml of SM. These results were compared with those obtained by testing the same M.tuberculosis isolates by the absolute concentration method using 1% Ogawa egg slant containing 0.1μg/ml of INH, 10μg/ml of REP, 2.5μg/ml of EB and 20μg/ml of SM. Fifty six isolates consisted of 18 pansensitive strains, 27 multidrug resistant strains and 11 single drug resistant strains. The results for individual drugs showed excellent agreement between the MGIT and the Ogawa methods, and overall agreement rate of the two methods were 96.4%. The results were just the same for all drugs in 48 out of 56 strains studied. The drug resistance could be observed much earlier by the MGIT method (mean 5.9 days) than by the Ogawa method (more than 21 days). In conclusion, the MGIT system could be a promising new drug susceptibility test which might become available in Japan replacing the Ogawa method.抄録全体を表示PDF形式でダウンロード (922K) -
藤原 永年1997 年 72 巻 4 号 p. 193-205
発行日: 1997/04/15
公開日: 2011/05/24
ジャーナル フリーTuberculosis is a chronic disease caused by Mycobacterium tuberculosis infection. The major pathological changes are immunologically hypersensitive granuloma formation due to the local proliferation or infiltration of immune cells. However, the mechanism for the development of the disease has not been fully understood. The first step of infection is intracellular survival in the phagocytic cells and this process has been reported to be regulated by cell surface glycolipid virulence factors. As genetical heterogeneity of M. tuberculosis among strains has been reported recently based on DNA fragmentation pattern, I have examined the distribution of cell surface glycolipids (cord factor, sulfolipids and penta acyl trehaloses) among the virulent (M. tuberculosis H37Rv and M. tuberculosis Aoyama B) and avirulent (M. tuberculosis H37Ra) strains by two dimensional thin-layer chromatography of silica gel. Seven characteristic glycolipid components of the virulent strains were detected and separated by thin-layer chromatography of silica gel. Each glycolipid was identified by fast-atom-bombardment mass-spectrometry (FAB/MS) analysis of the intact lipid and gas-chromatography mass-spectrometry (GC/MS) analysis of the fatty acid or the carbohydrate moiety. As the result, molecular weight (m/z 1, 200-3, 000) of each glycolipid was determined clearly by FAB/MS analysis. The structure of fatty acids (C16-C40) or mycolic acids (C76-C88) were determined by GC/MS analysis. Cord factor (TDM, trehalose 6, 6'-dimycolate) and trehalose 6-monomycolate (TMM) showed strong granuloma forming activity, but other glycolipids practically did not. On the other hand, cord factor and trehalose 6-monomycolate showed phagocytosis inhibition (but showed promotion in the presence of complement) and marked inhibition of phagosome-lysosome fusion, while sulfolipids showed strong phagocytosis promotion and marked inhibition of phagosome-lysosome fusion. Penta acyl trehaloses showed phagocytosis promotion but no effect on phagosome- lysosome fusion. Cord factor and trehalose 6-monomycolate existed ubiquitously among virulent and avirulent strains, while sulfolipids and penta acyl trehaloses were detected in only virulent strains (M. tuberculosis H37Rv and M. tuberculosis Aoyama B). These results indicate that the existence of these toxicglycolipids contributes to the virulence of M. tuberculosis, profoundly. It is suggested. that these glycolipids play an important role as virulence factors in the early stage of infection and expression of pathogenicity.抄録全体を表示PDF形式でダウンロード (1795K) -
1997 年 72 巻 4 号 p. 217-219
発行日: 1997/04/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (355K)
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