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Volume 82, Issue 5
Displaying 1-6 of 6 articles from this issue
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Satoshi MITARAI, Ikuo KOBAYASHI, Chiyoji ABE, Masako WADA, Katsuhiro S ...2007 Volume 82 Issue 5 Pages 449-454
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Objective] To evaluate the accuracy of drug susceptibility testing to isoniazid with BACTEC MGIT 960(MGIT AST) comparing with the standard proportion method using Ogawa medium.
[Method] A total of 1, 109 M. tuberculosis strains, which were selected from the collection of RYOKEN drug resistance survey in 2002, were selected and subjected to the susceptibility testing to isoniazid using MGIT AST and 1% Ogawa standard methods. The results from MGIT AST were compared with the judicial diagnosis by Ogawa. The sensitivity to detect drug resistance, the specificity for susceptible strain, the efficiency of overall agreement, and kappa coefficient were calculated to evaluate the performance. The treatment process, outcome and prognosis were analysed for the patients on whom the tests showed discrepant results.
[Results] Compared with the judicia l results, the sensitivity, specificity, efficiency, and kappa coefficient of MGIT AST were 100%, 97.1%, 97.3%, and 0.798, respectively. The strains, which showed discrepant results between MGIT AST and Ogawa, were all susceptible by Ogawa and resistant by MGIT AST. A total of 11 out of 30 discrepant cases were followed clinically and no relapse cases were identified, irrespective of the modification of the treatment regimen. As for the proportion of primary INH drug resistance in the present study, it was 5.3% with MGIT AST but was 2.7% with Ogawa, and the difference was statistically significant (p =0.005).
[Discussion] The discrepancies on the results of drug susceptibility testing of M. tuberculosis strains to isoniazid between MGIT AST and 1% Ogawa proportion method have been reported. In the present study, the sensitivity, specificity, and overall efficiency of MGIT AST on the prevalent strains in Japan were all beyond 95 %, and considered sufficient as the anti-tuberculosis drug susceptibility testing (AST), though 2.7 % of discrepancy was observed. Even for the discrepant cases, there was no difference in the treatment outcome and prognosis. Thus, MGIT AST was confirmed as a reliable AST method comparable to Ogawa standard. However, MGIT AST might increase the proportion of INH resistance if it was used as a major AST method, compared with Ogawa.View full abstractDownload PDF (1359K) -
SIGNIFICANCE OF TUBERCULOSIS SCREENING OF OUTPATIENTS IN AREAS WITH HIGH PREVALENCE OF TUBERC ULOSISNobuaki NAKATA, Fumiaki INORI, Fusao NAKAMURA, Shigeyoshi HARIHARA, Yu ...2007 Volume 82 Issue 5 Pages 455-458
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Objective] The Osaka Socio-Medical Center Hospital is a medical care facility located in the Airin area of Osaka city where the prevalence of tuberculosis is high, and treats day laborers and homeless people mainly, either free of charge or with a small fee. To investigate whether this hospital can play a role to reduce the prevalence of tuberculosis in this area, we investigated the case rate of active tuberculosis in outpatients of the hospital.
[Subjects and M ethods] Of 1, 673 patients who first visited the Orthopaedic Outpatient Clinic between March 31, 2005and June 15, 2006, 538 patients consented to undergo screening and underwent chest X-ray examination (screening group). We also analyzed chest X-ray examination in 2, 000 patients examined at the Department of Internal Medicine during the same period (control group).
[Results] Of the 5 38 patients in the screening group (523males and 15 females), 13 male patients (2.4%) requiring treatment were detected. Of the 2, 000 patients in the control group, 85 patients (84 males and 1 female) (4.3 %) requiring treatment were detected.
[Conclusion] The tuberculosis case rate (2.4%) in the screening group was similar to that of tuberculosis screenings (1.1-1.8%) in the Airin area in 2004. The case r ate in the control group was two times higher. Since the prevalence is very high in patients of this hospital, the hospital should play a significant role in the health care of tuberculosis patients in this community by reinforcing the screening system and enriching the outpatient clinic system.View full abstractDownload PDF (803K) -
Eri TSUKISHIMA, Yuu MITSUHASHI, Koichi YANO, Aiko TAKASE, Arisu KAMADA ...2007 Volume 82 Issue 5 Pages 459-466
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Objective] Isolates of M. tuberculosis were analyzed for their DNA fingerprints to facilitate understanding of ongoing transmission of tuberculosis in Sapporo (population 1.87 million), Japan, where the incidence rate of tuberculosis was 15.0 per 100, 000 in 2004,
[Subject] Out of all tu berculosis patients registered in the city from November 1998 to December 2003, isolates from culture-positive respiratory tuberculosis cases for whom written informed consent had been obtained, were analyzed by restriction fragment length polymorphism (RFLP). The study included 345 cases (249 men and 96 women) whose isolates were available for DNA patterns.
[Method] Using stan dard IS 6110-RFLP typing, cases whose isolates shared identical fingerprints were considered to belong to the same cluster. Proportions of clustered cases were evaluated according to their clinical and socio-economical characteristics.
[Results] Out of 345 cases, 207 (60.0%) were classified into 59 clusters, and 15% of clustered cases having definite epidemiological links. Multiple logistic regression analysis in men showed that age and infectiousness were significantly related to clustering. The adjusted odds ratios (OR) [95%confidence intervals (CI)] were 0.17 [0.03-0.79] for 30-59years, 0.15 [0.03-0.69] for 60 years or over and 2.35 [1.17?4.70] for those cases assigned as the highest level of transmission of tuberculosis from the infectiousness index of cases. For women the final model showed the adjusted OR [95%CI]were 0.52 [0.22-1.22] for those with previous history of tuberculosis and 0.33 [0.06-1.85] for diabetics. In male cases with a previous history of tuberculosis, most highly infectious cases were significantly associated with clustering (OR [95%Cl], 4.53 [1.16-17.68]).
[Co nclusion] The results suggest that highly infectious male tuberculosis cases with endogenous reactivation have contributed to recent transmission of tuberculosis in the studied area.View full abstractDownload PDF (1628K) -
Eriko SHIGETO2007 Volume 82 Issue 5 Pages 467-473
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Purpose] To clarify the incidence and clinical significance of anti-tuberculosis drug-induced liver injury.
[Subjects and Methods] Questionnaire was sent o ut by mail to 114 hospitals, to ask whether there were patient(s) from 1994 to 2003 with liver injury induced by anti-tuberculosis drugs with alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level of more than 1, 000 IU/l and/or total bilirubin level of more than 2 mg/dl. As for the cases of severe hepatic injury, their backgrounds and clinical courses were investigated.
[Re sults] Seventy cases were reported from 24 out of 68hospitals which treated at least 8, 095 tuberculosis patients in 2003. Incidence rate of severe liver injury by anti-tuberculosis drugs was 0.50 to 0.59 percent in three hospitals with good surveillance system, and overall incidence was estimated to be between 0.1 to 0.5 percent. We could analyze 33 cases; one was HB antigen positive, one had HCV positive liver cirrhosis, 2 had other hepatic disease, and 17 had other underlying disease including diabetes mellitus. Twenty-three were treated by regimens with isoniazid (INH), rifampicin (RFP) and pyrazinamide (PZA), and 8 by regimens without PZA but with INH and RFP and one was a multidrug-resistant case and was treated by regimen with ethionamide and PZA. The onset of liver injury was within 2 months after starting anti-tuberculosis chemotherapy in 28 (85%) cases. In twentyeight cases which both ALT and total bilirubin level are known, total bilirubin level at the onset of liver injury was more than 2 mg/dl in 14 cases and most of the cases were hepatocellular type of liver injury. Six out of 10 cases with total bilirubin level more than 5 mg/dl died by liver failure. Total birilubin was less than 2 mg/gl in two of the dead cases; in one case antituberculosis drug were continued despite elevated level of ALT and another case complicated with gastric bleeding. Treatment for liver injury was conservative in most cases, 6 were treated by plasmapheresis and no liver transplantation was carried out. Eight cases died of liver failure, one died of tuberculosis and only 15 were treated successfully for tuberculosis.
[Conclusion] Incidence rate was high comparared with that by other drugs reported previously. The risk factor of liver injury by antituberculosis drugs was not detected, but elevated total bilirubin level more than 5 mg/dl was an alarming sign for poor prognosis.View full abstractDownload PDF (1535K) -
Takeshi KAWASAKI, Yuka SASAKI, Aya SHINOZAKI, Rei BEKKU, Tomohiro HASH ...2007 Volume 82 Issue 5 Pages 475-479
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis is seen in every part of the body, but stemoclavicular joint tuberculosis is rare. We report a case of tuberculosis of the sternoclavicular joint in 70-year-old woman having complained of the right sternoclavicular joint swelling. She had a previous history of pulmonary tuberculosis, and visited her doctor for right stemoclavicular joint swelling on February 2006. A chest CT scan showed a low density area with destructive osseous changes in the right stemoclavicular joint. Definite diagnosis could not be done by twice needle biopsy, but we diagnosed her as tuberculosis of the sternoclavicular joint based on the clinical course and the findings of the examination. As her condition did not improve after 3months treatment with anti-tuberculous drugs, we conducted therapeutic surgical procedure. Definite diagnosis of stemoclavicular joint tuberculosis was made on the basis of the presence of mycobacteria in the histological specimen and PCR-TB positive result. We kept the wound opened and continued administration of anti-tuberculous drugs, and her condition does not deteriorate. Tuberculosis should be considered in case of a patient with arthritis and previous history of tuberculosis, even if it is seen in rare location. Diagnostic and therapeutic surgical procedure should be taken into consideration, if there is no improvement of the condition after a diagnosis of bone and joint tuberculosis, and the administration of chemotherapy for tuberculosis.View full abstractDownload PDF (5318K) -
Eishi KATO, Noriko YAMADA, Takahiko SUGIURA2007 Volume 82 Issue 5 Pages 481-485
Published: May 15, 2007
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 30-year-old man suffered from a chest-pain on his left side and was also having a low-grade fever though he actually neglected these symptoms for a while. Later, he was referred to our hospital due to the detection of chest abnormal shadows through the mass examination of chest X-ray taken on 18th October, 2005. His chest X-ray showed bilateral pleural effusion and it was confirmed that the right pleural effusion was encapsulated by his chest CT. The patient's hematological examination performed during his initial visit, showed an increased level of WBC with blood eosinophilia. He also had a puncture of pleural effusion at the time of admission to the center. Moreover, pleural effusion on both sides was exudative and elevations of ADA and eosinophil count as well were traced. In the patient's right pleural effusion, mycobacterium tuberculosis direct (MTD) test was positive.
As there were no findings suggesting collagen disease, malignancy, parasite infection, and other complications, he was diagnosed as tuberculous pleurisy with eosinophilic pleural effusion and blood eosinophilia. He was treated with four antitubercular agents, namely, INH, RFP, EB and PZA. As the result, his pleural effusion and blood eosinophil counts were decreased along with an improvement in inflammatory reaction. The most common conditions associated with eosinophilic pleural effusion are described as malignancy, collagen disease, paragonimiasis, drug induced pleurisy, asbestosis, pneumothorax, and trauma, while there are only a few reports about such eosinophilic pleural effusion caused by tuberculous pleurisy. In this case, he also showed blood eosinophilia. Based on these findings, we finally came to the conclusion that the case is a very rare and significantly unique case of eosinophilic pleurisy with blood eosinophilia.View full abstractDownload PDF (5200K)
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