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Volume 77, Issue 11
Displaying 1-9 of 9 articles from this issue
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Emiko TOYOTA, Shigeki MINOURA, Hirofumi MIYAZAWA2002 Volume 77 Issue 11 Pages 703-708
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe reported 22 cases with tuberculosis in pregnancy and puerperium, who were treated in our hospital from 1993 to 2001. Nine out of 22 cases were foreign women and the onset of tuberculosis was not clear and the diagnosis tended to be delayed in most cases. In the reports from industrial countries, most of those patients are foreign bone and the delay in diagnosis is common because symptoms are apt to be mixed up those for pregnancy and puerperium. In 10 of 22 cases, extrapulmonary lesions were noted.
Most of our cases were treated with INH, RFP and EB, and in some severer cases PZA was added. WHO and BTS recommend standard therapy with PZA but ATS recommends INH, RFP and EB without PZA. Generally SM is contraindicated because of adverse effect of hearing loss for all pregnant periods, and the data for PZA and other second line drugs are insufficient. Our cases and their neonates showed normal course and no malformation nor congenital tuberculosis. 2 cases could not keep adherence for drugs and 2 babies got active tuberculosis.
Precaution for infection is one of most important problem to deal with cases with tuberculosis during pregnancy and postpartum in the hospital. If she is still infectious on delivery, we should consider prevention for transmission and manage her in isolated manner.
CDC recommends not to treat for latent tuberculosis during pregnancy because of high frequency of hepatic damage due to INH. It is the best way to check and treat latent tuberculosis before gestation if she is at high risk with tuberculosis.View full abstractDownload PDF (797K) -
In Contrast with Survived Cases Followed-up for 5 Years or LongerSusumu HARADA, Yasuko HARADA, Sanae OCHIAI, Mikiko EMORI, Akira KAJIKI ...2002 Volume 77 Issue 11 Pages 709-716
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe performed a clinical study of pulmonary M. avium complex (MAC) disease comparing deceased cases and survived cases followed-up for 5 years or longer.
The results were as follows:
1.At the time of starting the initial medical treatment for pulthonary MAC disease, the deceased cases were older than the survived cases, and the deceased cases were severer than the survived cases in clinical conditions. The spread of the lesions was more extensive and cavities were more frequently observed in the deceased cases than in the survived cases.
2.We classified the clinical pattern of pulmonary MAC disease into a primary infection type and a secondary infection type. Then, we subclassified the primary infection type into a localized type, which contained a tuberculosis-like type and middle, lingular or other lobar pneumonia type, and a diffuse type. The secondary infection type was more frequent in the deceased cases than in the survived cases, and any middle, lingular or other lobar pneumonia type was not observed in the deceased cases.
3.We classified the mode of progression of pulmonary MAC disease in the deceased cases into a tuberculosis-like progression and a diffuse progression. The tuberculosis-like type and the secondary infection type frequently showed the tuberculosis-like progression and the diffuse type frequently showed the diffuse progression. The patients who showed the tuberculosis-like progression were frequently sputum culture positive for MAC, while all patients showing the diffuse progression were culture negative at the time of death. An interval from the estimated onset of the disease to death was shorter in the tuberculosis-like progression type than in the diffuse progression type.View full abstractDownload PDF (1800K) -
Pathological Findings in Two CasesMasao OKUMURA, Kazuro IWAI, Hideo OGATA, Seiji MIZUTANI, Kouzou YOSHIM ...2002 Volume 77 Issue 11 Pages 717-723
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSHistopathological examinations were carried out on 2 cases of Mycobacterium avium complex (MAC) disease of nodular bronchiectasis (NB) type on radiograms. The removed lung specimens revealed histological findings of granulomatous bronchiolopneumonia, consisting of epithelioid cell granulomas with lymphocytic infiltrations without exudation in the alveolar areas surrounding the respiratory bronchiole. The central bronchiolar walls were also affected by epithelioid cell granulomas with lymphocytic infiltration, occasionally showing polypoid protrusion into the bronchiolar lumen accompanying emphysema in the peripheral alveolar area. Bronchial lesions seemed to progress from peripheral to central airway with consequent atrophy and disappearance of intramural smooth muscles, resulted in bronchioloectasis. These histological findings well correspond to radiographical ‘nodular bronchiectasis’. Large histiocytic granulomas without caseous necrosis developed in some area, which are not usually found in tuberculosis lesions. Epithelioid cell granulomas were occasionally found in the hilar lymph nodes as well as in the walls of lymphatic vessel in the pulmonary interlobular tissues, indicating intrapulmonary lymphatic spread of the mycobacteria.View full abstractDownload PDF (7992K) -
Kanako KOBAYASHI, Shuichi YANO, Kazuhiro KATO, Shinji SAITO, Takeshi T ...2002 Volume 77 Issue 11 Pages 725-728
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSNontuberculous mycobacterial infection is seldom complicated with pleural involvement. We report a very rare case of M. avium pulmonary disease accompanied with pleural effusion. A 76-year-old man was admitted to our hospital because of cough and low-grade fever. A chest radiograph and computed tomograph showed centrilobular nodules in the right middle lobe and left lingula, and right pleural effusion. The patient had had a right spontaneous pneumothorax 50 days before his admission. The sputum smear was negative for acid fast bacilli. The smear of pleural effusion was positive for acid fast bacilli, the level of adenosine deaminase in the effusion was markedly elevated, and pleural effusion was positive for M. avium as assessed by polymerase chain reaction (PCR). The pleural biopsy specimen showed fibrous change without granuloma, while the transbronchial biopsy specimen showed noncaseous epithelioid granulomas. We considered that the pneumothorax was caused by the spread of pulmonary M. avium infection to the visceral pleura with its perforation.View full abstractDownload PDF (1607K) -
Yuko ITO, Noritaka YAMADA, Kunihiko GOTO, Takayuki ANDO, Kenji OGAWA, ...2002 Volume 77 Issue 11 Pages 729-733
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 20-year-old woman was admitted to our hospital because of cough and dyspnea in April 2001. On admission, laboratory data showed positive inflammatory signs. A chest roentogenogram revealed infiltrated shadow in the bilateral lung fields. Sputum smear examination showed acid-fast bacilli identified as Mycobacterium tuberculosis by DNADNA PCR method. Four days after admission, she had an acute respiratory distress syndrome (ARDS) and serious liver dysfunction. Moreover, drug sensitivity test revealed that this case was multidrug-resistant tuberculosis (MDR-TB), and she was treated with sensitive anti-tuberculous drugs (PZA, SM, LVFX). Three months later, her sputa converted to negative for tubercle bacillis, however, a chest computed tomogram (CT) revealed multiple giant cysts in the bilateral lung fields, which developed during treatment. Pneumothorax of both sides was repeatedly observed, and it was difficult to treat. At present (1 year after admission), multiple giant cysts stopped its progression and treatment for tuberculosis is being continued.View full abstractDownload PDF (1444K) -
Sang Jae Kim2002 Volume 77 Issue 11 Pages 735-740
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS -
Mitsuyoshi TAKAHASHI2002 Volume 77 Issue 11 Pages 741-752
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIn the traditional study of tuberculosis epidemiology, information about social contact of persons and patient's illness history used to be an only relevant basis for elucidating transmission of tuberculosis infection. Therefore, it was very difficult to give a clear conclusion of whether isolates from different patients derived from a common source of infection or not. Recently, the subspecies typing of M. tuberculosis strains has become possible, based on the visualization of multiple loci of an insertion sequence (IS6110) that is a relatively stable gene fragment existing in a specific region of the genome. The variability of the number of copies and locations of this IS6110 in a genome is the basis that enables this technique to be used for the above purpose, which is a unique tool applicable to the analysis of M. tuberculosis. Generally, this technique, i.e., restriction fragment length polymorphism (RFLP) analysis, depends on the diversity of pattern of any polymorphic marker found in a genome of a strain. Among various markers so far developed and examined, IS6110 has been proved most appropriate for the purpose of typing strains of M. tuberculosis complex, especially in such circumstances as in Japan where isolated strains' RFLP patterns are similar each with others so that finer subtyping is needed.
In this lecture, I would like to review the following topics based on the world literature of molecular epidemiology and the findings of our own that we have achieved during 1992 through 2001 in our Institute; 1) typing of the isolates for the identification of the infection source, 2) pathogenesis of tuberculosis under low incidence situation, 3) predominance of certain genotypes endemic in an area, 4) cross-contamination of isolates in the laboratory, 5) the stability of IS6110 patterns, 6) phylogeny of M. tuberculosis complex, and 7) differentiation between M. tuberculosis and M. bovis BCG.View full abstractDownload PDF (3494K) -
Akira OSHIMA2002 Volume 77 Issue 11 Pages 753-757
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis morbidity and mortality statistics show that tuberculosis control efforts in Japan have recently borne little fruit. Almost a similar situation has occurred in cancer control efforts in Japan. To overcome these difficul ties, we should introduce the principles of evidence-based healthcare into control activities and each activity of tubercu losis control and cancer control should be evaluated strictly by technology assessment.
The most important issue to be discussed is that screening programs for tuberculosis and various cancers have been eagerly conducted in Japan as a public health policy since 1951 and 1961 and there has been no change of“Early diag nosis/early treatment is best”policy although many changes have occurred around the diseases and the society since then.
From the viewpoint of a cancer epidemiologist, the signifi cance of screening tests for tuberculosis, the completeness of tuberculosis registries, the significance of tuberculosis regis tries as a monitoring system for tuberculosis treatment and the role of health centers in the new programs of tuberculosis control are discussed.View full abstractDownload PDF (877K) -
2002 Volume 77 Issue 11 Pages 759-761
Published: November 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (475K)
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