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Volume 79, Issue 11
Displaying 1-7 of 7 articles from this issue
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Motohisa TOMITA, I-Iana TAKENO, Katsuhiro SUZUKI, Mitsunori SAKATANI, ...2004 Volume 79 Issue 11 Pages 625-630
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Objective] The BACTEC MGIT 960 drug susceptibility system (MGIT AST) has been recently introduced in Japan. The issue of discordant MGIT results compared with the conventionally used Ogawa method has been raised. It has been speculated that discordant results might be due to MGIT inoculum density since there is no standardization step other than dilution of growth for tubes beyond 2 days after MGIT turns out to be positive. In this study, we examined the reproducibility of the MGIT AST system.
[Materials and Methods] Nineteen sputum specimens from drug-resistant and susceptible pulmonary tuberculosis patients were processed with CCE pretreatment reagent (Japan BCG), inoculated into 3 MGIT tubes, and loaded into the MGIT 960. Inocula for MGIT AST were prepared 1, 3, and 5 days after MGIT tubes became positive. Cultures on day 3 and 5 were diluted 1: 5 with saline. Ten-fold dilutions from each positive culture were plated on Middlebrook 7H11 agar plates for CFU determination. MGIT AST results were compared with those of the conventional proportion method on Ogawa egg and Vite-spectrum (Kyokuto), or Pyrazinamidase (Pzase) assay and Kyokuto PZA test.
[Results and Conclusion] A total of 15 specimens were culture positive in all 3 tubes. Four of 19 cases were removed from the analysis because of negative cultures in one or moretubes. Three of 4 culture negative cases were MDR-TB. Colony counting showed the mean CFU/ml of inocula prepared from tubes 1, 3, and 5 days after MGIT tube became positive were 3.6×106, 1.6×106, 3.1×106, respectively. There was no significant difference although the CFU range was wide (8×104-2×107). MGIT AST results were consistent among 3 inocula. Moreover, overall concordance rates between MGIT AST and the conventional methods were over 90% for 5 first-line antituberculosis drugs. These results indicate that the BACTEC MGIT 960 system is very useful for rapid diagnosis of drug resistant tuberculosis.View full abstractDownload PDF (904K) -
Kunihiko ITO, Noriko KOBAYASHI, Yoko NAGATA, Takashi YOSHIYAMA, Masako ...2004 Volume 79 Issue 11 Pages 631-635
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Purpose] To evaluate the function status of TB advisory committee to assess treatments of tuberculosis.
[Object and Method] Estimate by questionnaire sheets to public health nurses attending to seminars on tuberculosis at Research Institute of Tuberculosis.
[Result] 137 answers are available for analysis. Of these, 57 (41.6%) TB advisory committees are estimated not to assess treatments of tuberculosis at all and/or to assess treatments without necessary informations on drug sensitivity in more than around half of the cases. In 13 (16.3%) committees of the other 80, many cases are in fact self-assessed. Number of committees that are estimated to functioning well is only 44 (32.1%).
[Conclusion] Many TB advisory committees are estimated to be malfunctioning from the stand point of assessments of treatment. As TB advisory committee is one of key agency tocontrol drug-resistant tuberculosis, its reform and revitalization are urgently needed. [Purpose] To evaluate the function status of TB advisory committee to assess treatments of tuberculosis.
[Object and Method] Estimate by questionnaire sheets to public health nurses attending to seminars on tuberculosis at Research Institute of Tuberculosis.
[Result] 137 answers are available for analysis. Of these, 57 (41.6%) TB advisory committees are estimated not to assess treatments of tuberculosis at all and/or to assess treatments without necessary informations on drug sensitivity in more than around half of the cases. In 13 (16.3%) committees of the other 80, many cases are in fact self-assessed. Number of committees that are estimated to functioning well is only 44 (32.1%).
[Conclusion] Many TB advisory committees are estimated to be malfunctioning from the stand point of assessments of treatment. As TB advisory committee is one of key agency tocontrol drug-resistant tuberculosis, its reform and revitalization are urgently needed.View full abstractDownload PDF (876K) -
Nobuyuki HARADA, Toru MORI, Shinji SHISHIDO, Kazue HIGUCHI, Yukie SEKI ...2004 Volume 79 Issue 11 Pages 637-643
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Objective] The purpose of this study was to evaluate QuantiFERON® TB-2G (QFT), a novel method of detecting tuberculosis infection among contacts of a tuberculosis patient by determining the whole-blood interferongamma response to the specific antigens.
[Subjects and Methods] A teacher of a college who had been coughing for the preceding two months was diagnosed with smear-positive tuberculosis. About 270 students of the college were considered to have been exposed to tuberculosis infection, of whom 73 were in closer contact with the index case because they participated in a one-week group excursion attended by the teacher. Two of the contact students developed active tuberculosis shortly thereafter. Tuberculin tests were conducted to almost all students, and QFT was performed for only those with tuberculin reactions having erythema diameters of 30 mm or larger.
[Results] Tuberculin tests of students, all of whom had been vaccinated with BCG at least once, revealed that the distribution of the close contact group was slightly shifted to right (larger side) than those with less close contacts. The QFT positive rate for close contacts was 45.5%, while that for less close contacts was only 7.1%, which obviously indicates that QFT is hardly affected by the tuberculin allergy due to past BCG vaccination. The distribution of interferon-gamma measurements (log-transformed) of the close contacts showed typical bimodality, one mode representing the infected, another the non-infected. This was not clear for the less close contacts. The correlation of interferon-gamma measurements (log-transformed) with tuberculin reaction erythema size was weak, if not non-significant.
[Conclusion] It was concluded that QFT was a useful method for diagnosing tuberculosis infection and was unaffected by the BCG-caused tuberculin allergy. In the case of the outbreak mentioned above, QFT greatly reduced the indication of chemoprophylaxis, from 28% of all the contacts solely based on tuberculin test to only 7%.
Although there remains some problems to be overcome for QFT to be widely used with high confidence, this technology will provide a high possibility for wider and more accurate indication of chemoprophylaxis and will be one of the essential tools of tuberculosis control of the 21st century in Japan.View full abstractDownload PDF (1417K) -
Toshihiko KURAOKA2004 Volume 79 Issue 11 Pages 645-653
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSI have been engaged in the diagnosis and treatment of pulmonary tuberculosis for about 25 years. I have presented many interesting tuberculosis cases such as cavity, nodule, infiltration, miliary pattern, and bronchial tuberculosis.
I summarized that the key point of the diagnosis for pulmonary tuberculosis is, 1) X-ray diagnosis shows no specific findings, so it is important to remind pulmonary tuberculosis as not unusual disease. I will make a proposal to insert pulmonary tuberculosis in the guideline for the diagnosis of pneumonia by the Japanese Respiratory Society. 2) Sputum PCR examination is very rapid and useful diagnostic method. The diagnostic evaluation of PCR is equal or over that of AFB culture. 3) CT diagnosis is useful for the detection of minimal pulmonary shadow or cavity lesion. 4) Brocho-fiberscopic examination is useful for the detection of the Mycobacterium in the bronchial brushing smear or washing samples. We should suspect bronchial tuberculosis in the cases with strongly positive sputum smear without cavity shadow. 5) The rate of complication with diabetes mellitus is significantly higher than that of 10 years ago in adult male tuberculosis patients. Recently 1 of 4 patients complicated with diabetes mellitus in adult male patients.View full abstractDownload PDF (4420K) -
Mahito FUKUDA2004 Volume 79 Issue 11 Pages 655-658
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis (TB) has a long history. Regarding terminology, TB has, roughly speaking, three stages. These are, PHTHISIS, CONSUMPTION and TUBERCULOSIS. Each stage has its own meanings and characteristics. In the second stage consumption, TB was thought to be responsible for the patients' beauty and creativity. This kind of romanticization can be seen both in the West and East, not only in literature but also in paintings.View full abstractDownload PDF (1525K) -
Koh NAKATA, Yoshihiko HOSHINO, Yoshihiro HONDA, Naohiko TANAKA, Akira ...2004 Volume 79 Issue 11 Pages 659-667
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSHIV-1 infection is a major cause of worldwide epidemic of tuberculosis. There is increasing clinical evidence that coinfection with M. tuberculosis accelerates progression of AIDS. We found that, in vivo, HIV-1 load and mutation increase in involved lung segments in patients with pulmonary tuberculosis. We also reported that Mycobacterium tuberculosis stimulates HIV-1 replication by enhancing transcription on the 5' LTR in a macrophage cell line, THP-1, in vitro. In contrast, HIV-1 replication is suppressed by M. tuberculosis infection of monocytes derived macrophages (MDM) or differentiated monocytic THP-1 cells. We observed that HIV-15' LTR function was repressed in PMA differentiated THP-1 cells after co-infection with M. tuberculosis. Point mutations in C/EBPβ binding domains of the HIV-1 LTR negative regulatory element (NRE) abolished promoter repression. Monocyte-derived macrophages and differentiated THP-1 cells increased expression of the 16kDa inhibitory form of C/EBP after M. tuberculosis co-infection. Bronchoalveolar lavage cells obtained from normal controls and alveolar macrophages from uninflamed lung of tuberculosis patients also expressed the 16 kDa inhibitory form of C/EBP. However, alveolar macrophages from lung segments involved with pulmonary tuberculosis had markedly reduced C/EBP expression. These data suggest that 16kDa isoform of C/EBP plays an important role for the control of HIV-1 replication in macrophages. We propose derepression of HIV-1 LTR mediated transcription as one mechanism for enhanced HIV-1 replication observed in pulmonary tuberculosis. Since the cellular immune response in pulmonary tuberculosis requires lymphocyte/macrophage interaction, a model system was developed in which lymphocytes were added to A M. Contact between lymphocytes and AM reduced inhibitory C/EBP β, activated NF-κB and enhanced HIV-1 replication. If contact between lymphocytes and macrophages was prevented, inhibitory C/EBP β expression was maintained and the HIV-1 long terminal repeat (LTR) was not maximally stimulated although NF-κB was activated. Antibodies which cross-linked macrophage expressed B-7, VCAM and CD-40 were used mimic lymphocyte contact. Cross-linking antibodies abolished inhibitory C/EBP β expression; however, the HIV-1 LTR was not maximally stimulated and NF-κB was not activated. Maximal HIV-1 LTR stimulation required both lymphocyte derived soluble factors and cross-linking of macrophage expressed co-stimulatory molecules. These results demonstrate that neither contact nor soluble factor (s) are sufficient to maximally enhance HIV-1 LTR activity in macrophages. Contact between activated lymphocytes and macrophages is necessary to downregulate inhibitory C/EBP β, thereby derepressing the HIV-1 LTR. Lymphocyte derived soluble factor (s) activate NF-κB, further enhancing the HIV-1 LTR.View full abstractDownload PDF (1413K) -
2004 Volume 79 Issue 11 Pages 669-687
Published: November 15, 2004
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (3334K)
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