The relationship between streptomycin (SM) susceptibility and rpsL mutations of Mycobacterium tuberculosis strains was studied. Of 18 clinically isolated SM-resistant. M. tuberculosis strains, mutation was suspected in 9 strains (50%) with SM MICs of≥256μg/ml by PCR-single strand conformation polymorphism targeting rpsL gene. On the other hand, using PCR-direct sequence method, amino acid substitution caused by single nucleotide point mutation in rpsL gene was demonstrated in 11 out of 18 strains (61%). The same amino acid substitution at codon 43 (Lys→Arg) was observed in all 11 strains with SM MICs of≥256μg/ml. In addition, PCR products obtained from these 11 strains could not be cut by a restriction enzyme, Mbo II, while H137Rv strain and the other 32 strains with SM MICsof<256μg/ml were cutinto 2 fragments. In conclusion, ourresults suggest that highly SM-resistant M. tuberculosis strains with MICs of≥256μg/ml could be rapidly and easily detected by the restriction enzymatic method.

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A 55 year-old man was admitted to the department of the gastroenterology of the hospital because of severe weakness and appetite loss for the past one month. In the last two months, he has been suffering from recurrent fistula of the anus. He left his symptoms without therapy. A gastric ulcer was found out with gastric endoscopy. At the same time, chest X-ray film showed bilateral abnormal shadows, which were suspected of severe pulmonary tuberculosis by a chest physician. After the admission, the patient immediately developed respiratory failure. Both sputa and discharge from anal fistula were positive for acid fast bacillus. Despite of anti-tuberculosis therapy and mechanical ventilation, he died of respiratory failure. At the autopsy, severe pulmonary tuberculosis, tuberculous fistula of the anus, intestinal tuberculosis with perforation, miliary tuberculosis and peptic ulcer of the stomach were defined. We suspected that the extensive disease caused by hematogeneous spread and the late diagnosis of tuberculosis was owing to patient's delay.

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Patients with respiratory failure based on pulmonary tuberculosis sequelae are second in number among some fifty thousand patients receiving home oxygen therapy in Japan. Its 5 year survival rate is 47% in man and 56% in woman. The prognosis is better in woman than in man and may be dependent, at least partially, on younger age in woman. The influence of arterial blood gases on the prognosis is quite different between tuberculosis sequelae and chronic obstructive pulmonary disease: Pa₀₂ scarcely influence the prognosis while higher Pa_CO2 is beneficial for tuberculosis sequelae. Patients with hypercapnia have better nutrition as estimated by serum albumin and this fact may cause the longer survival. Pulmonary hypertension is more frequently observed. but is less strongly related to arterial blood gases and ventilatory function in tuberculosis sequelae than chronic obstructive pulmonary disease.

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