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Volume 73, Issue 7
Displaying 1-5 of 5 articles from this issue
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Teruo AOYAGI1998 Volume 73 Issue 7 Pages 459-470
Published: July 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThe discovery of streptomycin in 1944 had given rise to great flowering of chemotherapyfor tuberculosis.
The times which triple treatment of SM-PAS-EINH after the temporal time of SM-PAS had been standard regimens on initial treatment had continued for more thantwenty years. The shortening of duration for chemotherapy had become possible by theintroduction of RFP, and the duration had reduced to one fourth compared with that ofthe regimens till then by the addition of PZA for two months at the beginning of treatmenton the initial treatment cases.
In thispaper, historical aspects ofearly and present-day chemlotherapy of tuberculosisand the reports of main studies have been summarized, andpharmacokinetics of INH, actionof antituberculous drugs in short-course chemotherapy, MDR-TB and biological responsemodifiers for treatment of tuberculosis, etc. has been reviewed.
It is urgently awaited that more new drugs without cross resistance to previous drugswill bedeveloped for the more shortening of the duration and the improvemlent of thetreatment for MDR-TB.View full abstractDownload PDF (1861K) -
Tadahiko FUJINO, Naoki HASEGAWA, Reiko SATOU, Hirokazu KOMATSU, Kanemi ...1998 Volume 73 Issue 7 Pages 471-476
Published: July 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThirty six cases with multidrug-resistant tuberculosis were retrospectively studied todefine the causes attributable to the emergence of multidrug-resistant M. tuberculosis.
All these tuberculosis cases were microbiologically confirmed and resistant to at leastisoniazid and rifampicin.
Data analysis using matched-pair sampling methods (1: 3) demonstrated that the followingsare the significant risk factors for the emergence of multidrug-resistant tuberculosis; incompliance to treatment (Odds ratio 21.0: 95%Cl 4.10-107.63), alcohol abuse (Odds ratio 15.0: 95%Cl 2.34-96. 1) and the history of previous treatment (Odds ratio 5.0: 95%Cl 2.04-12.21), while diabetes mellitus is not statistically significant.
The incompliance to treatment which is primarily thought to be patient's responsibilityresults in non-optimal administration of antituberculous agents, leading to the multidrugresistant tuberculosis. Other factors that may have contributed to the emergence of resistanceincluded the unnecessary change of regimen before completion of chemotherapy.This is patient-unrelated situation where responsibility lies in the medical side.
A clinical case presented here is an example. In this case RFP was replaced withethambutol 3-months after the initiation of regimen including SM, INH and RFP becauseof abnormal elevation of GOT and GPT without any supporting evidence that RFP wascausative. The readministration of RFP after 1-year cessation did not induce liver dysfunction, while the drug resistance was observed not only to RFP but also to INH. Thiscase suggests unnecessary interruption of RFP could lead to the emergence of resistanceto INH as well as RFP.
One known mechanism of drug resistance is random mutation and the selection bydrugs administered during the course of chemotherapy. The cases with advanced cavitarylesions would have a higher probability of the occurrence of mutation. The more thenumber of mutant bacilli, the higher the probability of emergence of multidrugresistance. Those cases in which longer period of time is needed for the negative conversionof M. tuberculosis should be treated with potent chemotherapy regimens under theintensive supervision.
Since both INH and RFP are the most potent among currently available antituberculousagents. It is crucial to preserve the potency of these essential agents before novel antituberculousare developed.View full abstractDownload PDF (756K) -
Makoto TOYOTA1998 Volume 73 Issue 7 Pages 477-483
Published: July 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSRecent Mongolian political, social and economic changes have had a great impact onits health care system and tuberculosis control program. The objective of this study is toassess time trend in incidence and mortality of tuberculosis and characteristics of notifiedtuberculosis cases in Mongolia.
1) Data on statistics of tuberculosis are obtained from reports of the National Tuberculosis Center in Mongolia. The mortality of tuberculosis in Mongolia shows a downward. trend during 1985-1995. The number of notified tuberculosis cases had gradually decreasedduring 1985-1989. It suddenly dropped in 1990 and was the lowest in 1993. Afterthat, about two fold increase in the notified cases was observed in recent three yearsfrom 1993 to 1995. Such a large fluctuation in the number of notified cases after 1990 isunlikely to be associated with the epidemiologic situation of tuberculosis, but rather dueto a reporting bias. The shortage of drugs and economic hardship prevented patientsfrom consulting medical facilities. The shortage of drugs also prevented doctors from notifyingpatients to the tuberculosis registry, because the notification did not lead totreating the disease. The improvement of health care system and the supply of essentialdrugs since 1994 seems to contribute to the increase in the number of notified cases.
2) The study subjects include 618 patients who were diagnosed as active tuberculosis atten tuberculosis specialized facilities in Ulaanbaatar, Mongolia from May 1995 to March1996. Patients were interviewed about their demographic factors and their medicalrecords were reviewed. Fifty one percent of the cases were female. The mean age was 26.9years old. Ninety percent of the cases underwent chest X-ray examination, while 72% ofthe cases underwent bacteriological examination and only 21% were confirmed bacteriologically.
It is necessary to improve the quality control of sputum smear examinationand the validity of diagnosis of tuberculosis in Mongolia. As for teratment regimens, only 29% of the cases were being treated with at least four drugs (isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin). It is needed to provide directly observedtreatment using the WHO recommended standard regimen to at least smear positive tuberculosiscases.View full abstractDownload PDF (980K) -
Yoshihiro KOBASHI, Yoshihito NIKI, Hiroshi KAWANE, Toshiharu MATSUSHIM ...1998 Volume 73 Issue 7 Pages 485-490
Published: July 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe experienced adverse reactions to antituberculous agents in 17 patients (53%) out of 32 patients treated for tuberculosis and nontuberculous pulmonary mycobacteriosis.
Side effects were seen in 15 patients (47%), and abnormal laboratory findings were observed in 9 patients (28%). Most side effects mostly appeared within two weeks after theadministration, and were of short duration. However, there were also side effects such asneurological symptoms, arthralgia, and general fatigue which appeared after one monthand lasted for a long duration. These results suggest that careful observation for adversereactions in antituberculous treatment is required. Finally, 11 patients with adverse reactionswere successfully treated by changing antituberculous agents or readministrationafter temporary stop of the administration. Four patients improved even with continueduse of agents causing side-effects. However, in the case of two patients who had tochange antituberculous agents, adverse reactions to all antituberculous agents appearedand the treatment for tuberculosis and nontuberculous pulmonary mycobacteriosis had tobe stopped.View full abstractDownload PDF (729K) -
Koji OHTOMO, Isamu SUGAWARA, Atsuko MASUNAGA1998 Volume 73 Issue 7 Pages 491-495
Published: July 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA case of 24-year-old male patient with AIDS complicated with pleuropulmonary tuberculosiswas presented. It was difficult initially to make a definite diagnosis of tuberculosisby routine sputum culture and pleural biopsy. DNA diagnosis of tuberculosis using PCR is useful in some clinical cases.View full abstractDownload PDF (1557K)
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