結核
Online ISSN : 1884-2410
Print ISSN : 0022-9776
ISSN-L : 0022-9776
79 巻, 11 号
選択された号の論文の7件中1~7を表示しています
  • 富田 元久, 竹野 華, 鈴木 克洋, 坂谷 光則, 木下 幸保, 小林 郁夫
    2004 年 79 巻 11 号 p. 625-630
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    [目的] 結核菌の迅速薬剤感受性検査であるミジットシリーズでは分離用MGITが陽性になってから, 1~2日後はそのまま, 3~5日後は5倍希釈液を接種菌液とすることになっており, 菌量が安定せず, 薬剤感受性検査の結果が変動する危険性が考えられた。今回われわれは, 分離用MGIT陽性チューブから調製した接種菌液を用いて, 主要5薬剤 (INH, RFP, SM, EB, PZA) の感受性結果を比較した。 [対象・方法] 当院で結核の治療中に依頼された19例の検体を用いた。分離用MGITが陽性を示した後1日目, 3日目, 5日目の菌液での再現性とミジットシリーズと従来法との比較を行った。 [結果・考察] 分離用MGITが陽性を示した後1日目, 3日目, 5日目のチューブから調製した接種菌液の平均菌量 (CFU/ml) はそれぞれ3.6×106, 1.6×106, 3.1×106であった。3接種菌でミジットシリーズの結果は完全に一致した。さらに主要5薬剤についてミジットシリーズと従来法の全体の一致率は90%以上であった。これらの結果は, バクテックMGIT960システムは薬剤耐性結核の迅速診断に有用であることを示している。
  • 伊藤 邦彦, 小林 典子, 永田 容子, 吉山 崇, 和田 雅子, 尾形 英雄
    2004 年 79 巻 11 号 p. 631-635
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    [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.
  • 原田 登之, 森 亨, 宍戸 眞司, 樋口 一恵, 関谷 幸江
    2004 年 79 巻 11 号 p. 637-643
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    [目的] 結核接触者健診における結核感染診断の目的のために, 結核菌特異抗原 (ESAT-6およびcFP-10) を用いた全血インターフェロンγ応答を定量する方法 (QuantiFERoN®TB-2G) がどのように有効であるかを検討するために本研究を行った。 [対象と方法] ある若年者集団 (専門学校生) における結核患者の発生に際して, ツ反とともに本法を適用し, その知見をツ反と比較分析した。 [結果] 初発患者との接触が濃厚な群とそれ以外の接触者とでは本法の陽性率に大きな差が見られたが, ツ反では違いはわずかで, 本法がBCG接種の影響を受けずに結核感染診断が正確に行えることを示唆していた。 [結論] ツベルクリン反応検査との比較から, この方法は従来のツベルクリン反応検査とその便宜的な診断基準による方法で回避できない不必要に過剰な化学予防の指示を大幅に節減し, また適用方法を工夫することによって必要な対象者を最大限補足することが可能になると考えられる。いっそう信頼性のある方法として広範に利用できるものとなるために克服すべきいくつかの課題が残されているものの, この方法は今後の結核対策のなかで重要な手段のひとつとなるであろう。
  • 倉岡 敏彦
    2004 年 79 巻 11 号 p. 645-653
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    I 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.
  • 福田 眞人
    2004 年 79 巻 11 号 p. 655-658
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    Tuberculosis (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.
  • 中田 光, 星野 芳彦, 本田 芳広, 田中 直彦, 蛇澤 晶, Michael WEIDEN
    2004 年 79 巻 11 号 p. 659-667
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
    HIV-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.
  • 2004 年 79 巻 11 号 p. 669-687
    発行日: 2004/11/15
    公開日: 2011/05/24
    ジャーナル フリー
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