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74 巻, 7 号
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佐々木 結花, 山岸 文雄, 水谷 文雄, 八木 毅典, 黒田 文伸, 和田 暁彦1999 年 74 巻 7 号 p. 549-553
発行日: 1999/07/15
公開日: 2011/05/24
ジャーナル フリーWe experienced a small outbreak of multidrug-resistant Mycobacterium tuberculosis infection (MDR-TB) among persons of in the middle and advanced age. The index case was 48-year-old man, and had complained productive cough since January 1996. He visited a doctor due to his symptom, and chest X-ray revealed cavitary lesion and sputum smear was positive for tubercle bacilli. He could not continue his admission because of his absence without leave and drinking, he was discharged on Day 54. The drug resistance was observed for INH (0.1μg/ml), RFP, and SM.
Later, case 2, 52-year-old male, and case 3, 43-year-old-male, who were companions in mah-jongg with the index case, were diagnosed as pulmonary tuberculosis. The analysis of restriction fragment length polymorphism (RFLP) was done on 3 strains, and all showed the same pattern. Among other companions in mah-jongg with the index case, case 4, 28-year-old male, was treated as MDR-TB, and the drug resistance pattern was the same to that of the index case, but the details were unknown. Case 5, 65-year-old male, was diagnosed as drug sensitive pulmonary tuberculosis, thus he might incidentally suffer from pulmonary tuberculosis at the same time. Case 6, 46-year-old male, who had been treated for alcoholic liver cirrhosis, was introduced to our hospital as his sputum smear was positive, and the drug resistance pattern was observed similar to that of the index case.
All the companions in mah-jongg suffered from MDR-TB except case 5. The RFLP analysis showed that the index case, case 2, and case 3 were caused by the same strain of M. tuberculosis. The drug resistance pattern of, case 4 and case 6 was the same to that of the index case. Based on these findings, it is highly suspected that this small outbreak was originated from the index case.抄録全体を表示PDF形式でダウンロード (1004K) -
田丸 亜貴, 鈴木 定彦1999 年 74 巻 7 号 p. 555-561
発行日: 1999/07/15
公開日: 2011/05/24
ジャーナル フリーRestriction fragment length polymorphism (RFLP) analysis was performed with 13 events considered as microepidemics of tuberculosis occurred in Osaka prefecture from July 1995 to July 1998. In 7 out of 13 events, isolates from patients involved in each event showed identical RFLP patterns, hence these events were verified as microepidemics. Out of 7 microepidemics, three were intrafamily infection, the other three occurred in work places and the remaining one was in a school occurred among students. The total number of patients who were involved in microepidemics was 19 and their ages distributed in the wide range from 18 to 69 years old, but 11 were at twenties or forties. The total delay in case-finding was 2 months in the shortest case, and more than 14 months in the longest. In the remaining 6 of 13 events, the isolates from patients were showed different RFLP patterns, although they were suspected as microepidemics. Furthermore, in the 2 microepidemics, one isolate showed different RFLP pattern from the other isolates involved in each events. These facts suggest that there could be many overlooked sources of tuberculosis infection in Osaka.抄録全体を表示PDF形式でダウンロード (1761K) -
佐野 千晶, 清水 利朗, 佐藤 勝昌, 小笠原 圭子, 冨岡 治明1999 年 74 巻 7 号 p. 563-570
発行日: 1999/07/15
公開日: 2011/05/24
ジャーナル フリーSecretory leukocyte protease inhibitor (SLPI), a serine protease inhibitor abundantly found in mucous secretions of lung, is thought to serve as an important protective component in the secretory fluids at sites of degenerative and inflammatory diseases. In this study, we examined the effects of SLPI on the production of a proinflammatory cytokine, TNF-α, and immunosupressive cytokines, IL-10 and transforming growth factor-β (TGF-β) by macrophages (Mφs), in response to lipopolysaccharide (LPS)-mediated stimulation and M. avium complex (MAC) infection, using recombinant half-sized SLPI (1/2 SLPI) consisting of C-terminal domain (Arg55-Ala107) of intact SLPI. In addition, effects of SLPI on the production of nitric oxide radicals (NO), important antimicrobial effectors of Mφs against micro-organisms, by these Mφs were studied. First, when the number of TNF-α producing cells in the LPS-stimulated Mφ population was counted by the ELISPOT assay, more than half of the Ms acquired TNF-α secreting ability at 24 hr after LPS stimulation. On the other hand, MAC-inefected Mφs produced detectable amounts of TNF-α into culture fluid during the first 24 hr. In both cases, 1/2 SLPI did not affect the LPS-or MAC-induced TNF-α production by Mφs. Second, when the production of IL-10 and TGF-β by Mφs was determined by measuring the amounts of these cytokines accumulated in MO culture fluids by ELISA, the following was observed. Mφ IL-10 production was rapidly increased in the early phase of cultivation after LPS stimulation or MAC infection, peaking on day 1 and thereafter declining to normal level by day 14. Half-sized SLPI did not affect IL-10 production of LPS-stimulated Mcbs, while it caused slight enhancement of IL-10 production by MAC-infected Mφs. M95 TGF-β production was initiated in the middle phase (day 7) of Mφ cultivation and continued until day 14. Notably, 1/2 SLPI markedly potentiated the TGF-β producing ability of the LPS-stimulated Mφs. Moreover, 1/2 SLPI caused moderate increase in the TGF-β production by MAC-infected Mφs. Third, significantly potentiated NO production was observed in Mcbs during the first 2 days after LPS stimulation and MAC infection. Half-sized SLPI did not affect the NO production by LPS-stimulated or MAC-infected Mφs. These findings indicate that SLPI up-regulates the production of some immunoregulatory cytokines including IL-10 and TGF-β, particularly the latter, by Mcbs in response to LPS stimulation or MAC infection, thereby suggesting the possibility that SLPI may exhibit antiinflammatory effects in vivo, especially patients with bacterial infections including MAC diseases, through the modulation of Mφ expression of some immunosuppressive cytokines.抄録全体を表示PDF形式でダウンロード (957K) -
佐藤 勝昌, 小笠原 圭子, 赤木 竜也, 冨岡 治明1999 年 74 巻 7 号 p. 571-577
発行日: 1999/07/15
公開日: 2011/05/24
ジャーナル フリーIn this study, we determined the MICs and MBCs of levofloxacin (LVFX), clarithromycin (CAM), and KRM-1648 (KRM) for Mycobacterium tuberculosis (MTB) strain Kurono and M. avium complex (MAC) strain N-444 residing in MONO-MAC-6 human macrophage-like cells (MM6-Mφs) and A-549 human type II alveolar epithelial cells (A-549 cells). First, the MICs of LVFX for MTB replicating in MM6-Mφs (1μ/ml) and A-549 cells (2 μg/ml) were 4 to 8 times higher than its MICs for extracellular MTB growing in 7HSF medium. In contrast, the MICs of CAM for intracellular MTB residing in both the cells (2-4μg/ml) were 4 to 8 times less than its MICs for extracellular MTB organisms. On the other hand, the MICs of KRM for extracellular MTB were nearly the same as its MICs for intracellular MTB residing in both types of the cells. Secondly, the MICs of LVFX and CAM for extracellular MAC were not significantly different from their MICs for intracellular MAC residing in MM6-Mφs and A-549 cells. The MIC of KRM for MAC residing in A-549 cells was 0.25μg/ml, and this value was 32 times higher than its MIC for MAC residing in MM6-Mφs (0.008μg/ml). Thirdly, the MBCs of test drugs for intracellular MTB and MAC residing in both types of the cells were somewhat longer than their MBCs for extracellular organisms. These findings indicate that, in the case of pulmonary infections with MTB or MAC, the therapeutic efficacy of a given drug, especially KRM, is more or less influenced by the bacterial location in the host lung tissues where the mycobacterial pathogens survive and multiply, i. e., either alveolar Mφs, type II alveolar epithelial cells, or surrounding environment.抄録全体を表示PDF形式でダウンロード (861K) -
竹下 啓, 左近允 智啓, 高安 博之, 石井 公道, 菊地 敬一, 山口佳 寿博1999 年 74 巻 7 号 p. 579-584
発行日: 1999/07/15
公開日: 2011/05/24
ジャーナル フリーThe present study described 2 cases of patients with duodenal tuberculosis. Case 1 was a 55 year-old Japanese male patient with pulmonary tuberculosis and past medical history of subtotal gastrectomy (Billroth II reconstruction). Tubercle bacilli were positive both on smear and culture from his sputum and feces. Because of complaining right hypochondralgia, upper gastrointestinal endoscopy was performed and revealed multiple ringed ulcers in the afferent limb of duodenum. Histopathological study of biopsy specimen demonstrated granulomatous inflammation as well as acid-fast bacilli confirmed by Ziehl-Neelsen staining. Tissue culture was positive for M. tuberculosis. Colonic tuberculosis was demonstrated by barium enema. Case 2 was a 45 year-old male patient with pulmonary tuberculosis in association with severe uncontrolled diabetes mellitus. Sputum polymerase chain reaction test was positive for M. tuberculosis. Granulomatous inflammation and positive acid-fast bacilli in biopsy specimen obtained from ulcers in the descending portion of the duodenum made a diagnosis of duodenal tuberculosis. No other intestinal tuberculous lesion was recognized. Since 1988, 11 cases of duodenal tuberculosis including the presented two cases have been reported in Japan. Most of the recent cases had tuberculous lesions in the descending portion of the duodenum and were diagnosed as duodenal tuberculosis by endoscopic examinations, while the majority of the cases reported before 1987 had tuberculosis in the more distant portions of the duodenum and were diagnosed mainly by surgical procedures.抄録全体を表示PDF形式でダウンロード (1640K)
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