[Purpose] To study the frequency and degree of adverse effect, other than liver dysfunction, of isoniazid (NH) preventive therapy in Japanese people.
[Object and Method] Chart re view of Japanese persons who started isoniazid preventive chemotherapy in the two clinics in Tokyo, from 2003/1/1 to 2004/12/31,
[Result] There were 779 cases who did not transiently or completely stop INH preventive therapy because of adverse effect, and 20 cases who stopped INH transiently or completely because of adverse effect other than liver damage (total 799 cases). Of those cases, 153 cases (153/799=19. 1%) experienced one or more adverse effect other than liver damage, and 20 cases (20/799=2. 5%) of these 153 cases stopped INH transiently (12 cases) or completely (8 cases). For each category of adverse effect, digestive system symptoms were most frequent (5. 9 % ), and then in frequency order, lethargy or easy-fatigability (4. 6%), central nervous symptoms (4. 5%), skin eruptions (2. 6%), acne (2. 5%), alcohol intolerance-like symptoms (2. 5%), peripheral neuropathy (0. 4%), arthralgia or limb pain (0. 3%). Adverse eff ect requiring stopping INH transiently or completely were skin eruption (1. 3%), digestive system symptoms (1. 1 %), central nervous symptoms (0. 6%), acne (0. 1%). Most of the adverse effect were not serious, and not required hospitalization. In isoniazid (INH) preventive therapy in Japanese people, adverse effect other than liver damage were not infrequent, but most of them are not serious, and do not disturb continuation of preventive therapy in most cases.

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[Objectives] To find a new method to predict the result of the egg based Ogawa medium using the Mycobacterium Growth Indicator Tube (MGIT) system and to evaluate the usefulness of a new discharge criterion that uses the new prediction method for smear positive pulmonary tuberculosis patients.
[Materials and Methods] We compared mycobacterial growth of sputum specimens weekly between the Mycobacterium Growth Indicator Tube (MGIT) and the egg based Ogawa solid media, using a total of 3952 sputum specimens of patients with pulmonary tuberculosis (TB) who underwent chemotherapy in our hospital from September 2001 to March 2006 to find relationship between the results of the two culture methods and to utilize the findings to new discharge criteria of pulmonary TB patients. And we compared the duration of hospitalization between two patients' group: one group using the new discharge criterion, the other the old one.
[Results] We found that if a specimen shows negative culture on the MGIT system within the first two weeks, the same specimen shows negative or scant growth on the Ogawa media in the 8th week. Introducing this fact as a part of new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened from 121 days to 71 days and no patient showed treatment failure.
[Discussion] We have used the result of sputum culture on Ogawa medium as a standard when we judge infectivity of patients with pulmonary tuberculosis in Japan, but it was one of the reasons why Japanese pulmonary tuberculosis patients stay long in TB hospital. Using our finding, we can predict the results of Ogawa system six weeks earlier, when a specimen shows negative culture on the MGIT system in the first 2 weeks. After we introduced this fact into new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened and no patient shows treatment failure until now. We highly recommend the usefulness of the MGIT system (especially when a specimen shows negative growth in the first two weeks) as a reliable method of predicting infectivity of patients with pulmonary tuberculosis and propose that the new TB discharge criterion should be widely confirmed and used in other hospitals.

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[Purpose] To clarify the status of tuberculosis and its control measures for homeless people.
[Object an Methods] Chest X-ray examinations were conducted for 1, 309, 1, 545, 1, 546 homeless people, annually between 2003 and 2005.
[Results] Home less people with old tuberculous foci accounted for about 30%, and about 2% were judged to need immediate medical treatment. Thirty cases needed treatment in 2005, and thirteen of these twenty cases had shown healed tuberculous shadows at the previous examinations. The annual incidence rate (3/20) of tuberculosis cases among persons with Type IV (inactive) lesions in 857 participants in both 2004 and 2005 was 11. 2 times higher than the rate (8/597) among those who did not show chest X-ray abnormalities.
[Conclusion] The annual incidenc e of tuberculosis among persons with Type IV lesions was higher than those who did not show chest radiographic abnormalities. It is thus necessary to establish prophylactic treatment criteria for persons with Type IV lesions by using a new method such as QFT.

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A 27-year-old man admitted for high fever, wet cough and abnormality on his chest radiograph. He was diagnosed as pulmonary tuberculosis, and started treatment with INH, RFP, EB, and PZA. After other examinations, he was diagnosed as having a acquired immunodeficiency syndrome, too. We gave him zidovudine and lamivudine/ abacavir sulfate to treat HIV infection. After starting treatment with anti-tuberculosis drugs his fever alleviated, but after 10 days from the start of anti-HIV drugs, he showed high fever, and abnormality of his chest radiograph exacervated. We diagnosed him as immune reconstitution syndrome, and gave him prednisolone 30 mg/day. His symptoms improved gradually.

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A 30 years-old-male was referred to our hospital for surgical treatment of multidrug-resistant tuberculosis in April 1998, three years after diagnosis of tuberculosis. All first-line anti-tuberculosis drugs and second-line anti-tuberculosis drugs were resistant on drug susceptibility tests by Ogawa medium. The right upper lobectomy was done because of massive hemoptysis and enlargement of cavitary lesion in June 1998, but this surgical operation was complicated with bronchial fistula and chronic empyema. Open drainage surgical treatment for chronic empyema was done one month after lobectomy. Sputum culture for M. tuberculosis converted 4 months after the lobectomy, but bacteriological relapse occurred 17 months after initial operation. The new cavitary lesion on middle left lung field developed and sputum smear and culture were continuously positive. Immunotherapy with interferon-γ via aerosol didn't show any clinical effect. Thiacetazone, sparfloxcin, pyrazinamide, cycloserine was prescribed after 21 months of the initial operation. Four months after changing the regimen sputum smear and culture converted to negative. Chemotherapy was terminated in June 2003, two years after negative conversion. Three years after the termination of treatment no relapse occurred. We considered thiacetazone was effective in this case, because all of the drugs was companied with thiacetazone were resistant by the drug susceptibility tests and were previously used.

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