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Volume 75, Issue 10
Displaying 1-8 of 8 articles from this issue
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Yuka SASAKI, Fumio YAMAGISHI, Takenori YAGI, Hideki YAMATANI, Fuminobu ...2000 Volume 75 Issue 10 Pages 569-573
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThe study subjects consisted of 14 pulmonary tuberculosis (PTB) patients with collagen disease. They are under corticosteroid treatment and the mean age is 56.4 years. The length of time from the development of collagen disease to the development of PTB averaged 4.1 years. The breakdown of collagen disease are SLE (6 patients), MCTD (3 Patients), PN (2 patients), and PSS, PM, Sjogren syndrome (1 case, each).
Thirteen cases were bacilli positive by the sputum examination on admission to our hospital. Chest X-ray findings on admission revealed cavitation in 3 cases and noncavitation in 11 cases, of which 5 cases had miliary tuberculosis. Corticosteroid preparation had been administered to all of the 14 cases for more than one year. The mean dose of corticosteroid preparation administered when PTB developed was 13.9mg (predonisolone) and it was more than 20mg in 8 cases. The median duration from the start of the respiratory symptoms to diagnosis was 39.2 days. The delay in the discovery exceeding 1 month were seen in 9 cases.
In the cases of collagen disease, when the disease course extends over a long period of time, and even when the dose of corticosteroid preparations are decreased, there is a need to be note on the risk of developing PTB. There are many non-cavitary cases with sputum smear positive. The fact suggested that an appropriate diagnosis is need so that the discovery of PTB should not be delayed.View full abstractDownload PDF (600K) -
Chiyoji ABE, Hideo OGATA, Kanemitsu KAWATA, Toru HIRAGA, Tetsuya TAKAS ...2000 Volume 75 Issue 10 Pages 575-581
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA recently described reverse hybridization-based line probe assay is used for the rapid detection of the mutations in the rpoB genes of rifampin-resistant Mycobacterium tuberculosis and for the identification of the M. tuberculosis complex. A multicenter study that included 5 laboratories was performed to evaluate the line probe assay in comparison with the in vitro susceptibility test. A total of 406 mycobacteria isolates which were composed of 103 rifampin-resistant and 230 rifampin-susceptible M. tuberculosis isolates, and 73 mycobacteria other than tubercle bacilli (MOTT), were subjected to this study. All 333 M. tuberculosis isolates were discriminated correctly from MOTT bacilli by a line probe assay. Concordance rates with sequencing results for five wild-type probes (Sprobes) and four specific mutations (R probes) for detecting the mutations in the rpoB genes were both 100%. The overall concordance rate with the in vitro susceptibility testing results was 98.5% (328 of 333 isolates). These results indicate that a line probe assaykit may be useful for the rapid diagnosis of rifampin-resistant tuberculosis.View full abstractDownload PDF (2010K) -
Susumu HARADA, Yasuko HARADA, Sanae OCHIAI, Yukari IKEDOH, Yoshiya KIT ...2000 Volume 75 Issue 10 Pages 583-588
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIt is very difficult to treat pulmonary infection with MAC, because we have few effective drugs against this organism. In this situation, an early diagnosis and treatment are very important to manage this disease. We evaluated chest CT scans of the primary pulmonary MAC infection which had no underlying lung diseases and no immuno compromised diseases such as HIV infection. We defined suspected cases of pulmonary MAC infection as cases in which abnormal features of chest CT scans were recognized but frequency of detection of organisms of MAC did not fulfil the diagnostic criteria for atypical mycobacteriosis according to Japanese Mycobacteriosis Research Group of the National Chest Hospitals. CT scans of suspected cases were compared with the definite cases.
Results obtained were as follows:
1. In classification by CT scans of primary pulmonary MAC infection, the proportion of localized type and diffuse type was the same both in suspected and definite cases. Iiilocalized type, more tuberculosislike pattern was seen in definite cases.
2. In suspected cases, characteristic features of CT scans of primary pulmonary MAC infection were recognized in the same frequency as in definite cases.
3. In pulmonary tuberculosislike type, definite cases showed more cavitary lesions than suspected cases.
These results showed that a careful long term followup of suspected cases with frequent bacteriological tests of sputum and chest CT scannings was important for early diagnosis of primary pulmonary MAC infection.View full abstractDownload PDF (737K) -
Toshio SUGANE, Noriaki TAKAHASHI, Toshiya KOURA, Kouichi ICHIMURA, Yos ...2000 Volume 75 Issue 10 Pages 589-593
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe reported a rare case of tuberculous aneurysm of the aorta managed successfully with urgent surgical therapy. A 35yearold woman was admitted to our hospital complaining of fatigue and hemoptysis. Laboratory tests showed severe anemia, slight liver dysfunction, elevated level of Creactive protein, and negative syphilis serologies. The chest roentgenogram revealed widening of right upper mediastinum, two nodular shadows in right middle lobe, and leftsided infiltration shadow with pleural effusion. The pleural effusion was bloody and its level of adenosine deaminase was normal. Culture of pleural effusion specimen remained negative. A computed tomography scans of the chest revealed an aortic aneurysm on the aortic hiatus. Rapid increase in pleural effusion was followed by hemothorax a few hours later. After operation, she received antituberculosis therapy. Histopathologically, the resected lung showed inflammatory process including granulation of giant cells and epithelioid cells. The specimens of the aortic aneurysm revealed rupture of whole layer of aortic wall and inflammatory cell infiltrations. These findings suggested that the case to be a tuberculous aneurysm of the aorta. Therefore, we diag nosed the case as the rupture of tuberculous aneurysm of the aorta.View full abstractDownload PDF (4493K) -
Progress Made in Research on Infectious and Immunological DiseasesTadamitsu KISHIMOTO2000 Volume 75 Issue 10 Pages 595-598
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThe new era of the modern medicine was opened 100 years ago by Robert Koch and Louis Pasteur who demonstrated that various infectious diseases were caused by their respective microbes. Koch discovered Mycobacterium tuberculosis, the causative agent of tuberculosis.
The first breakthrough in the modern medicine to combat against infectious diseases was the discovery of anti-diphtheria toxin antibody by E.A. von Behring and S. Kitasato. The concept of immunity-immune from disease-has thus been established. The immune response between antigen and antibody sometimes provides the host with a harmful effect. The concept of allergy was introduced by Richet and later by Prausnitz and KUstner. Why the same immune response leads to the different outcome, immunity or allergy had not been made clear until the discovery of IgE by Drs. Kimishige and Teruko Ishizaka in 1968: The IgG antibody plays a role in immunity whereas IgE anti body is involved in allergy.
Tuberculin skin reaction which is well known as the diagnostic tool for mycobacterial infection was studied by M. Chase in 1945 demonstrating that it was able to be transferred to the healthy individual by immune cells but not by antibody. The immune response is now categorized into two ; soluble immunity-immediate type allergy and cell-mediated immunity-delayed type allergy.
The rapid progress in the molecular biology in the past decades has also accerelated the progress in immunology, several of which include discovery of two types of lymphocytes; T and B cells; concept of two T cells, Th 1 and Th 2 cells; and the discovery of cytokines which regulate immune cell responses. The mechanism of the immune response is now understood at the gene level. Several immunological diseases can now be successfully treated by controlling the levels of cytokines involved. For example, refractory rheumatoid arthritis is now under control by the administration of recombinant soluble TNF receptor molecules to the patients.
The complete human genome sequence is currently under investigation. We can nowenvisage the advent of the days when every disease can be diagnosed and intervened at the gene level.View full abstractDownload PDF (587K) -
Satoshi OMURA2000 Volume 75 Issue 10 Pages 599-602
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS“Golden Era in Chemotherapy” has begun with the discovery of penicillin in the early 1940's and lasted for two decades during which many antibiotics were discovered. However, the once-believed bright prospect that every infectious disease could be eliminated on the earth by the discovery of antibiotics had to be canceled owing to the emerging of drug-resistant microbes. It was indeed a rat race.
We are now at the point when we have to seek another way to combat infectious diseases: One possible way might be not to eradicate the microbes but to coexist with them so long as they do no harm to the human hosts. The first step of infection with pathogens to the host is the adherence of the microbes to the surface of host cells. Therefore, the method how to inhibit this adhesion of microbes to the host cells may provide a new tool to prevent the development of infectious diseases without elimination of microbes from the host. This is just an example of strategy by which humans and pathogens coexist at peace and should be taken into consideration for the development of new-type antibiotics or “anti-infective drugs” in the 21st century.
The analysis of genome sequences has been accelerated recently for various pathogenic bacteria one by one. New targets in the pathogenic microbes for the development of new antibiotics can, therefore, be determined from the genetic point of view.
The discovery of antibiotics has indeed been the history of collection of innumerable species and/or strains of bacteria from the soils to search for the biologically active antipathogenic agents. The current progress in the technology of molecular genetics, however, will certainly make it possible to search for active molecules by DNA technology bacterial DNA but not whole microorganisms from the soil is to be transformed into the conventional bacteria and searched for active molecules with combat against pathogens.View full abstractDownload PDF (607K) -
Izuo TSUYUGUCHI2000 Volume 75 Issue 10 Pages 603-609
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis is indeed an infectious disease caused by Mycobacterium tuberculosis. However, only a small percentage of individuals infected develops overt disease, tuberculosis whereas the infected bacilli persist alive years long within the vast majority of persons infected but remained healthy.
There are several riddles or enigmas in the natural history of M. tuberculosis infection in humans. Some of them are as follows:
1. What is the virulence of M. tuberculosis?
2. How does M. tuberculosis persist dormant within the host?
3. What determines the development of disease from remaining healthy after infection with M. tuberculosis?
4. What is the mechanism of “endogenous reactivation” of dormant M. tuberculosis within the host?
5. Can we expect more potent anti-TB vaccine than BCG in near future?
Most of these issues cited above remain unsolved. What is urgently needed today to answer correctly to these questions is the production of appropriate animal model of tuberculosis infection which mimics human tuberculosis. Murine TB does not reflect human TB at all.
What characterizes the mycobacterial organism is its armour-plated unique cell wall structure which is rich in lipid and carbohydrate. Cord factor or trehalose dimycolate (TDM), the main component of cell wall, has once been regarded as the virulence factor of mycobacteria. Cord factor is responsible for the pathogenesis of TB and cachexia or even death of the patients infected. However, cord factor in itself is not toxic but exertsits detrimental effect to the host through the excessive stimulation of the host's immune system to produce abundant varied cytokines including TNF-α.
How to evade this embarrassing effect of mycobacterial cell wall component on the host immune system seems very important for the future development of better TB vaccine than the currently used BCG.View full abstractDownload PDF (977K) -
2000 Volume 75 Issue 10 Pages 611-623
Published: October 15, 2000
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (1760K)
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