Kekkaku(Tuberculosis)
Online ISSN : 1884-2410
Print ISSN : 0022-9776
ISSN-L : 0022-9776
Volume 77, Issue 7
Displaying 1-7 of 7 articles from this issue
  • Kunihiko ITO
    2002 Volume 77 Issue 7 Pages 499-502
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    The decision when to make chest X-ray examina-tion is important for early diagnosis of pulmonary tuberculo-sis and community-acquired pneumonia as well. And for early diagnosis of pulmonary tuberculosis, differential diagnosis with community-acquired pneumonia is important. For this reasons, guideline for the diagnosis and treatment of commu-nity-acquired pneumonia should include when to make chest X-ray examination, and how to exclude the possibility of pul-monary tuberculosis. For example, empiric choice of anti-microbial for apparent pneumonia should be an agent without anti-tuberculosis effect. Clinical evaluation of the effect of anti-microbial should be done carefully, because pulmonary tuberculosis can be clinically improved spontaneously. In the guideline for the diagnosis and treatment of community-acquired pneumonia could include the above-mentionedviews on early diagnosis of pulmonary tuberculosis, the guideline could be much more helpful for the tuberculosis program.
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  • Naohiro NAGAYAMA, Motoo BABA, Akihiro HORI, Atsuhisa TAMURA, Hideaki N ...
    2002 Volume 77 Issue 7 Pages 503-512
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    To study recurrence rate over a long period after recovery from previous tuberculosis history, we examined the frequency of previous tuberculosis history in patients who were admitted to our hospital in 1980-83 and in 1997-99 and the comparison was made between cases with and without culture-positive tuberculosis. The tuberculosis groups com-prised of 297 patients in 1980-83 and 688 patients in 1997-99. The non-tuberculosis groups (control groups) comprised of 373 patients in 1980-83 and 1092 patients in 1997-99 with non-tuberculosis diseases other than the tuberculosis-related diseases such as non-tuberculosis mycobacteriosis, pulmonary aspergillosis, bronchiectasis, chronic bronchitis and tubercu-losis sequelae. The patients with viral chronic hepatitis previ-ously operated and transfused were also excluded as they might be operated because of pulmonary tuberculosis in the era of surgical treatment for tuberculosis.
    In both tuberculosis and control groups, they had previous tuberculosis history most frequently when they were twenties. In the control groups, the frequency of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39, 40-49 were 15/84 (17.9%), 22/93 (23.7%), 11/77 (14.3%) and 3/43 (7.0%), respectively, and those admitted in 1997-99 were 11/70 (15.7%), 30/231 (13.0%), 28/288 (9.7%), and 10/230 (4.3%), respectively. In these 4 birth year groups, frequency of previous tuberculosis history among cases admitted in 1997-99 were significantly lower than that admitted in 1980-83 (p<0.05, one-sided paired t-test), and the fact suggests that persons with tuberculosis history died earlier than those without it.
    In the tuberculosis groups, the frequencies of previous tu-berculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39 and 40-49 were 20/35 (57.1%), 31/58 (53.4%), 19/48 (39.6%), and 11/53 (20.8%), re-spectively, and those among cases admitted in 1997-99 were 30/99 (30.3%), 58/125 (46.4%), 22/102 (21.6%) and 17/136 (12.5%), respectively. The frequency of previous tuberculosis history among cases admitted in 1997-99 was significantly lower than that admitted in 1980-83 (p<0.01) as was the case in the control groups. As recurrence within 5 years had oc-curred in only 4 out of 113 tuberculosis patients (3.5%) in the above-mentioned 4 birth year groups, almost all tuberculosis patients were assumed to have recovered completely from previous tuberculosis.
    Comparison between the recurrence rate from previous tu-berculosis and the incidence rate from the remotely infected persons without previous tuberculosis history in the same birth year group can be done by calculating the prevalence of tuberculosis infection for each birth year group using a model of annual risk of tuberculosis infection appropriate for Japa-nese. The ratios between the recurrence rate from previous tuberculosis patients and the incidence rate from remotely infected persons without previous tuberculosis history were 4.71, 2.33, 1.78 and 1.11 in 1980-83 and 1.84, 3.99, 1.80 and 1.11 in 1997-99 for groups born in 1910-19, 20-29, 30-39 and 40-49, respectively. The ratio did not change systemati-cally with time in these groups, indicating the recurrence rate did not change with time more than ten years after recovery from previous tuberculosis. The ratio was about 3 for groups born in 1910-19 and 20-29 and 1 for group born in 1940-49. Almost all patients born in 1940-49 could receive chemo-therapy for tuberculosis in their twenties, while most of the patients born in 1910-29 could not. Therefore, the above-mentioned fact may reflect the reccurrence rate of patients treated successfully with chemotherapy is almost the same as the incidence rate from remotely infected persons, while that the recurrence rate from previous tuberculosis patients sponta-neously recovered is 3 times higher than the incidence rate from remotely infected persons.
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  • Yasuhiro YAMAZAKI, Hiroyuki MATSUMOTO, Satoru FUJIUCHI
    2002 Volume 77 Issue 7 Pages 513-519
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Based on the results of a questionnaire for the tuberculosis specialists in the whole country, we investigated whether the standard short course chemotherapy containing pyrazinamide (four drugs regimen: HRZE/S) were given for adequate duration.
    The results of a questionnaire revealed that the duration of treatment was prolonged in 60 % of 848 cases due to several reasons. The reasons for the longer duration of treatment were (1) complication of other disease, (2) delay in the improve-ment on chest X-ray, (3) delay in negative conversion of bacilli, (4) drug resistance, (5) patient's request, and (6) others.
    According to our own experience in the National Dohoku Hospital for the past four years, the duration of therapy was prolonged in 86 % of cases treated with the four drugs regi-men, and in 64 % of cases with the three drugs regimen (HRE/S). Four drugs regimen was preferred for severer cases and the three drugs regimen for older patients. The reasons for the prolonged duration of treatment in our hospital were simi-lar to those in the results of a questionnaire in the whole coun-try. We recognized that the treatment was prolonged due to several meaningless reasons such as “no particular reason”, “anxiety on relapse” and “patient's request”.
    In order to decide the adequate duration of treatment, it is needed to know the relapse rate in cases with the short course chemotherapy and its relationship with complications. It is hoped to establish the guideline for tuberculosis treatment including the duration of treatment based on the results of detailed clinical studies.
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  • Hideko ISHII, Satori ODAUCHI, Kaori FUNABASHI, Kazuko OHTA, Takeko YAM ...
    2002 Volume 77 Issue 7 Pages 521-526
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Tuberculosis control in big cities should be focused on preventing defaulting from treatment, and the prevention of the emergence of multi-drug resistant tuberculo-sis, and the improvement of treatment success rate. Since it is needed to organize continued case management system start-ing from hospitalization, discharge, management of regular drug taking at outpatient clinics and final cure, close collabo-ration should be made between hospital nurses and public health nurses. For this purpose, there should be no difference about the understanding on tuberculosis control between clinical and public health nurses.
    This research was aimed to examine “How much interest and recognition do hospital nurses have about tuberculosis control.” The Aichi Nursing Association cooperated with this research. The results showed that 60 % of tuberculosis ward nurses were more than forty years old, and they have served more than ten years in TB word. The levels of understanding on tuberculosis among nurses working in tuberculosis hospitals were much higher than those in general hospitals. However, it is necessary to organize a collaboration system between hospitals and public health center to improve TB case management.
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  • Yasuo ITOH, Tadashi ISHIGUCHI, Yuji HIGASHIMOTO, Hisashi FUJIMOTO, Mas ...
    2002 Volume 77 Issue 7 Pages 527-531
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    The patient was a 74 year-old male presenting right pleural effusion with mild fever. His temperature was 37.0°C. Culture of a pleural biopsy specimen revealed Mycobacterium tuberculosis, although culture of sputum and pleu-ral effusion were negative. Therapy was begun with 300 mg of isoniazid (INH) per day, 600 mg of rifampicin (RFP) per day, and 1200 mg of pyrazinamide (PZA) per day. His tem-perature improved temporarily. One week after beginning of the therapy he had a fever over 38.0°C. On the 17 th day after starting chemotherapy, a chest radiological examination showed left pleural effusion in which numerous lymphocytes were found but Mycobacterium tuberculosis was negative. We assumed that the left pleural effusion was due to a para-doxical reaction to the anti-tuberculosis chemotherapy. After 3 days'discontinuation, the same regimen was resumed with an addition of prednisolone, but bilateral pleural effusion remained and the case finally fell into chronic respiratory failure.
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  • Hiroko YOSHIDA, Hiromi ANO, Chieko ISHIDA, Nobuko TANIGAWA, Masanori K ...
    2002 Volume 77 Issue 7 Pages 533-535
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    In the antimycobacterial susceptibility test for INH using the egg-based Ogawa media, 3 concentrations (0.1, 1, or 5μg/ml) of INH were used, and 1μg/ml was used as a critical concentration for INH resistance. However, it was controversial whether INH 0.1μg/ml resistant M.tuberculosis was clinically significant or not. We investigated the MIC values of INH 0.1μg/ml resistant strains by using BrothMIC MTB-1 method, and 115 strains of M.tuberculosis confirmed by DNA-prove test were used. The distribution of MIC values of 115 strains determined by Ogawa INH susceptibility test was shown in figure. By BrothMIC MTB-1 method, they were classified into 3 groups; susceptible, low resistant and high resistant groups. The mean MIC value of INH 0.1μg/ml resistant M.tuberculosis was estimated to be 4.53μg/ml with its 95 % confidence interval 3.21-5.85μg/ml, and they were determined as “resistant” in BrothMIC MTB-1 method.
    These results supported the idea that patients with INH 0.1μg/ml resistant M.tuberculosis strains should be regarded as clinically “resistant”.
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  • [in Japanese]
    2002 Volume 77 Issue 7 Pages 537-538
    Published: July 15, 2002
    Released on J-STAGE: May 24, 2011
    JOURNAL FREE ACCESS
    Download PDF (298K)
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