Seventy-four cases of miliary tuberculosis were studied retrospectively. The mean age of the patients was 45.3 years. Twenty |two patients suffered from another underlying diseases. Six were infected with human immunodeficiency virus. Twelve had been treated with corticosteroids. Fever was present in 97.3 per cent of patients. Elevation of serum alkaline phosphatase was found in 67.6 per cent of cases. The skin reaction to tuberculin was positive in 61.2 per cent. Nodular shadows were found in the chest X|ray in 98.6 percent of cases. The nodules were smaller than 2mm in diameter in 52.7 per cent of cases. Other findings were enlargement of mediastinal lymph node (17.6%), cavities (23.0%), pleural effusion (27.0%), and consolidation (35.1%). Sputum cultures and urine cultures were positive for Mycobacterium tuberculosis in 76.8 per cent and 58.6 per cent of cases respectively. The diagnosis was confirmed by histopathological findings in some cases. The rate of positive biopsies was 61.5 per cent by bone marrow aspiration, 83.3 per cent by lymph node biopsy, 100 per cent by liver and lung biopsy.
Antituberculosis therapy was successful in most of the patients. Seven patients died of miliary tuberculosis, 4 of them had adult respiratory distress syndrome

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To clarify features of lung cancer in patients with tuberculosis sequelae, we analyzed data on 15 cases (5.1%) who were diagnosed with lung cancer before death among 294 deceased cases with tuberculosis sequelae at our hospital. There were 12 men and 3 women, with a mean age of 64 years. Most of the 15 patients had pulmonary dysfunction, and 4 had received home oxygen therapy. All 12 men had a history of smoking, and 10 of them had squamous cell carcinoma of the lung. There was no definite correlation between the locations of the tuberculosis lesion and those of lung cancer lesion on chest X-ays. Twelve patients had had thoracoplasty for tuberculosis, and in 6 of these patients the lung cancer occurred in the same lung. Lung cancer was apt to be diagnosed in an advanced stage. However, in patients who received home oxygen therapy, diagnosis had been made at an early stage because of the frequent chest X-ray follow up. We conclude that lung cancer is an important complication in patients with tuberculosis sequelae, and early diagnosis of lung cancer by careful follow up is essential in the care of cases with tuber-culosis sequelae who have poor pulmonary function and/or systemic conditions.

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School teachers are regarded as one of the danger groups in contracting tuberculosis infection and are subjected to strict tuberculosis controls, since when they develop tuberculosis, many school children are exposed to infection to the disease. However, the recent decrease in the incidence of tuberculosis in Japan has led to disputes concerning the significance of routine mass health examinations for tuberculosis.
In this study, the significance of routine health examinations for tuberculosis in teachers was investigated by the analysis of the results of extraordinary health examinations carried out for tuberculosis in teachers as the index cases.
A total of 496 extraordinary health examinations were carried out by Nagoya City from 1975 to 1986 and by Aichi Prefecture from 1980 to 1995. In 49 instances of these examinations, teachers were regarded as index cases, which included 25 teachers of public primary, middle or high schools and 14 teachers of private schools, including private instructors for piano, painting or calligraphy, and teachers for supplementary education.
The results of these examinations in both groups were compared, regarding the routes of notification, the disease status of the index cases, and the frequency and the scale of the infections of tuberculosis observed among contacts with the index cases.
“Group infections of tuberculosis” was defined as instances the infection in which 20 or more cases were infected by the index case, “gsmall scale group infection” as 5-19 infected cases, and “gcases with infection” as 1-4 infected cases.
The result obtained were as follows.
1. The response rates to routine health examinations were 99.9% in the teachers of public primary, middle or high schools, and about 20-30% in the teachers of private schools.
2. The proportion of the cases notefied by routine examinations were 68.0% in the former group and 21.4% in the latter group. The cases notefied before the onset of the symptoms in the former group was significantly more frequent than in the latter group.
3. In the former group, no far advanced cases were identified, whereas 2 (14.3%) far advanced cases were identified in the latter group. The cases with amount of tubercle bacilli in sputum exceed 3 on the Gaffky scale were 32.0% in the former group and 61.5% in the latter group.
4. One (4.0%) case of the “ggroup infections of tuberculosis” was observed in the former group, and 2 (14.3%) cases in the latter group. “Small scale group infection”was obserted in 4.0% of the former group and in 21.4% of the latter group, and “ cases with infection” in 8.0% of the former group and in 35.7% of the latter group. The frequency and the scale of the infections of tuberculosis observed among contacts with the index cases was significantly smaller in the former group than in the latter group.
In conclusion, routine health examinations for tuberculosis for teachers seems valuable for the early diagnosis of tuberculosis cases and for the prevension of the infection of tuberculosis in schools.

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This paper describes with two patients with pulmonary disease due to Mycobacterium, szulgai. The first patient was a 67-year-old man who consulted a doctor at the outpa tient clinic of the Internal Medicine of our hospital, complaining with hemosputum. A chest X-ray showed an infiltrative shadow in the right upper lobe. A smear test of the sputum was negative but a culture was positive for mycobacteria. Second patient was a 37-year-old man who was admitted to our hospital, complaining with cough and fever. A chest X-ray showed an infiltrative shadow with cavity in the right upper lobe. A smear test was positive and culture was positive for mycobacteria. Cultured isolates of the two cases were indentified as M. szulgai. These two patients were treated with isoniazid, rifampicin and ethambutol daily. Their clinical symptoms improved and their sputum smears and cultures converted to negative for mycobacteria.

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The induction of anti-tuberculous immunity highly depends on the cytokines produced endogenously at the initial stage of immunization. Among several cytokines, IFN γ appears to be the most important to generate antigen specific Thl type of protective T cells in mice. IL-12 and IL-18, which are produced by macrophages in response to virulent mycobacteria, are responsible for stimulating NK cells to produce IFN γ Once antigen-specific Thl cells are generated, Thldependent macrophage activation was effective in the elimination of infected bacteria through enhanced production of reactive oxygen intermediates and reactive nitrogen intermediates. In Listeria monocytogenes, one of the intracellular bacteria, listeriolysin O (LLO) appeared to be responsible for the induction of endogenous IFN γ from NK cells. The possible mechanisms operating in the induction and expression of anti-tuberculous immunity are discussed with special reference to cytokine responses. An application of LLO to the induction of protective immunity is also discussed.

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