Since 1951 tuberculosis advisory committee, established according to the tuberculosis control law, has played an important role in improving the quality of tuberculosis control programme in Japan.
The management of tuberculous patients has changed markedly in the past ten years due to advances in chemotherapy and changes in the epidemiological situation of tuberculosis.
In this paper, several suggestions were made on better management of the tuberculosis advisory committee intending to judge cases by unified criteria.

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MPT63 is a secretory protein first isolated from a culture fluid of M. tuberculosis H₃₇Rv by Nagai et al. In this study, this protein was isolated from an 8-day-culture fluid (Sauton synthetic medium) of M. bovis BCG Tokyo 172 according to Nagai's method. It was shown that M. bovis BCG Tokyo 172 secreted this protein in the medium. The mpt63 gene was detected only in the species of M. tuberculosis complex by polymerase chain reaction (PCR) among 40 different mycobacterial species. Therefore, it is appropriate to designate this protein as MPB63 or MPB/T63 from M. bovis BCG, in similar way as other major secretory proteins of Mycobacteria, such as MPB59 and MPB64. Comparison of the nucleotide sequences of the genes encoding MPB63 protein of M. bovis BCG and MPT63 protein of M. tuberculosis showed only single nucleotide difference at the position 474 where thymine (T) in the former was replaced by adenine (A) in the latter. Amino acid sequences of both proteins were completely identical. MPB63 didn't show delayed-type hypersensitivity (DTH) skin reaction in the sensitized guinea pigs with live or heat-killed M. bovis BCG or heat-killed M. tuberculosis.
However, the measurements of serum IgG antibody titers of active tuberculosis patients by enzyme-linked immunosorbent assay (ELISA) showed 74% sensitivity and 96% specificity compared to healthy subjects. Therefore, MPB63 seems to be a promising candidate as an antigen for serodiagnosis of active tuberculosis.

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In 1996, six-month short course regimen containing PZA was adopted as the standard method of chemotherapy for tuberculosis. According we reevaluated discharge criteria for patients with pulmonary tuberculosis and tried to shorten the duration of hospitalization. We investigated retrospectively the duration of hospitalization for patients with pulmonary tuberculosis who were admitted to the Tenri Hospital.
PZA was used for 23.3% of patients who were admitted during 1992 to 1996 (group A, N =200), and 80.1 % of patients who were admitted during 1996 to 2000 (group B, N=234). The time needed to bacterial negative conversion was significantly shortened from 2.5 months in group A to 1.8 months in group B. The mean duration of hospitalization for patients with pulmonary tuberculosis was significantly shortened from 133.8 days in group A to 63.7 days in group B. Moreover, the mean duration of hospitalization for patients with smear positive pulmonary tuberculosis was significantly shortened from 147.5 days in group A to 73.0 days in group B. There was no significant difference between group A and group B as to the rate of adverse reactions, discontinuation of drug taking and recurrence of the disease.
We concluded that the duration of hospitalization for patients with pulmonary tuberculosis could be shortened by applying PZA in the initial phase of tuberculosis chemotherapy.

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To know the prevalence of resistance to four firstline anti-tuberculosis drugs, we reviewed the results of drugsusceptibility tests of patients with tuberculosis who were admitted to our hospital from 1994 to 2001. Among patients with no prior chemotherapy against tuberculosis, the complete resistance rate was 1.9% for INH, 0.81% for RFP, 5.1% for SM, 0.81 % for EB, and 0.32% for multiple drug-resistance (MDR). The acquired resistance rate was 9.7% for INH, 11.5% for RFP, 7.3% for SM, 2.4% for EB, and 6.1% for MDR. There was no significant increase in the prevalence of drug resistance between the first half (1994-1997) and the latter half (1998-2001) of the investigation periods. Compared with the previous reports, our results indicated no increase in the prevalence of drug resistance in tuberculosis patients with no prior treatment and the decrease of prevalence in patients with prior treatment of tuberculosis. A multi-drug regimen consisted of INH, RFP, PZA and EB or SM, which is currently considered as a standard regimen of tuberculosis chemotherapy and used quite widely, does not seem to induce the increase of drug-resistant tuberculosis.

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We retrospectively evaluated the clinical and laboratory data of children with tuberculous meningitis (TBM) treated at our hospital from 1990 to 1999 to determine the optimal method of diagnosing TBM. The evaluated diagnostic criteria for TBM were as follows: (1) fever and malaise as symptoms of acute/subacute inflammation, (2) positive cerebrospinal fluid and/or gastric aspirate cultures for Mycobacterium tuberculosis, (3) pleocytosis of cerebrospinal fluid, and (4) a good response to anti-tuberculous therapy. The data for eleven patients (6 boys, 5 girls) with TBM (mean age, 10.7 months) were reviewed. Three patients (27%) were previously vaccinated with BCG. A known contact with tuberculosis was established at the time of admission in four patients (36%). Symptoms related to tuberculosis appeared on the average 14.8 days before the diagnosis. Three patients (27%) were diagnosed as clinical stage I, three (27 %) as stage II, and five (46%) as stage III ; all patients had fever (100%). With regard to the cerebrospinal fluid examinations, pleocytosis with mononuclear predominance was noted in all patients but one (91%), and mycobacterial staining was positive in three patients (27 %). Tuberculin skin test was positive in four out of 10 patients (40%). Mycobacterial staining of gastric aspirate was positive in four patients (36%). Chest radiological examinations showed a swelling of the mediastinal lymphonodes and/or parenchymal infiltration in all patients (100%). A cranial CT examination demonstrated a basal meningeal enhancement in all patients (100%), hydrocephalus in nine patients (82%), and infarction in eight patients (73%). These results suggest that chest and cranial CT examinations are useful adjunct methods for diagnosis of TBM in infants and young children suffering from meningitis with pleocytosis of the cerebrospinal fluid and mononuclear predominance, in addition to conventional methods such as the tuberculin skin test, plain chest radiography, and staining for mycobacteria in body fluids.

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Brief review is made of the interconnections between tuberculosis and poverty and other social factors, with special emphasis on the current Japan's tuberculosis situation. In pre-war Japan, the tubeculosis had apparently an aspect of a socioecomic problem which led to lively discussions. With the progress in medical technology and control measures after the war, such aspect of the disease has become more masked and difficult to see. Often, it is viewed merely as a problem of a small and special fragment of the population such as homelesses, and its wide and diffuse connections with the society and economy are likely to be overlooked. Studies in tuberculosis, both basic and epidemiological, as well as multidisciplinary, should be further encouraged from such a point of view, in order to lay such interconnections bare, on which the new control strategy should be based.

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The prognosis is very poor in patients with acute respiratory failure (ARF) due to active pulmonary tuberculosis, especially in those who necessitate mechanical ventilation. The underlining factors of ARF are low nutrition, old age and severity because of patient's delay and doctor's delay. So, management consists of two parts, one, early patient detection considering of tuberculosis and early treatment, the other, focused control to high risk groups.
Patients with chronic respiratory failure due to pulmonary tuberculosis sequelae have long insidious period and mainly restrictive, sometimes mixed pulmonary dysfunction. Hypercapnea, pulmonary hypertension and respiratory disorder during sleep are seen in high percentage in them. In acute on chronic failure the principles of therapy are treatment of precipitating factors such as respiratory infection or congestive heart failure, controlled (low flow) oxygen therapy, bronchial hygiene and maintaining adequate pulmonary and circulatory condition. In chronic stage patient education is very important. Management of chronic stage is constructed of nutrition control, long-term oxygen therapy, pharmacological therapy, pulmonary rehabilitation including controlled breathing technique, physical chest therapy and exercise training. Noninvasive positive pressure ventilation is effective on improvement of prognosis in chronic respiratory failure, and on treatment in acute on chronic failure.

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