Kekkaku : [Tuberculosis]最新文献

[Objective] To evaluate the specificity of TRC- Ready® MTB and TRCReady® MAC (Tosoh Bioscience, Japan) for identifying M.tubercidosis complex (MTC), M.avium and M. intracellulare. [Method] We tested TRCReady® MTB and TRCReady® MAC using TRCReady®-80 (Tosoh Bioscience, Japan), which is an automated nucleic amplification test instrument, with 151 Mycobacterium species (4 MTC and 147 Non-tuberculosis Mycobacterium (NTM) type strains). [Results] The specificity of TRCReady® MTB was 100%, however, TkCReady® MAC misidentified a total of six NTMs, M.arosiense, M.chimaera, M.colombiense, M.marseillense, M. vulneris and M.yongonense, as M. intracellulare. Then, the specificity for TRCReady® MAC was 96.0% (145/151). [Discussion] TRCReady® MTB and TRCReady® MAC are highly specific for identifying MTC, M.avium and M. intracellulare. Six NTM species which have been rarely isolated in Japan showed false-positive results as M.intra- celludare. However, when a sample was identified as M.in- tracellulare, the phenotypic characteristics like colony mor- phology would be carefully examined.

[Purpose] To conduct a literature review on clin- ical studies and national guidelines in various countries, for the purposes of facilitating discussion regarding whether latent tuberculosis infection (LTBI) treatment regimens com- posed of isoniazid and rifampicin should be introduced in Japan. [Methods] For clinical studies, 23 non-randomized studies and 10 randomized studies in the literature were reviewed. [Results] In patients who had received treatments com- posed of isoniazid and rifampicin ([HR]; largely 3 months), compared with those who had received isoniazid monother- apy ([H]; largely 6 to 9 months), both frequency and sever- ity of liver dysfunction tended to be reduced, but adverse drug effects increased in general. Treatment completion rate tended to be higher in those who had received HR than in those who had received H. Preventive effects of HR seemed to be at least equivalent, or somewhat superior, to H. Many national guidelines of the European Union and other coun- tries reviewed in this study recommended HR as an LTBI treatment regimen, and generally provided a high level of evidence. [Conclusion] 3HR treatment has been well studied in many clinical and randomized studies, and seems to have garnered a high level of merit in order to be introduced as one of the LTBI treatment regimens in Japan.

A symposium entitled "Legacies of surgery for tuberculosis and succession to the next generation" was held at the 89th annual meeting of The Japanese Society for Tuberculosis in Gifu. The purpose of the symposium was to look back at the history of surgery for tuberculosis and development of surgical techniques. The contribution of those techniques to the next generation was also discussed. Many unique and universal techniques such as segmentectomy, thoracoplasty, muscle flap plombage, greater omental plom- bage, open window thoracotomy, cavernostomy, and decortication have matured during a long history. Based on the development of antituberculous drugs, surgery seems to have a less important role. However, surgical techniques are still required for multi-drug resistant tuberculosis and non- tuberculous mycobacteriosis. Core techniques are apjlied in the surgery for many thoracic diseases, such as lung cancer, mycosis, pyothorax, and mesothelioma. This manuscript summarizes the presentations.

Purpose: We experienced a tuberculosis outbreak in a business establishment. Contact investigation was carried out using both the QFT-3G and T-SPOT tuberculosis (TB) tests on the same subjects and the test results were compared.

Method: The QFT-3G and T-SPOT tests were performed simultaneously at three time points during the contact inves- tigation, so just after tuberculosis registration (n =14), at 3 months post registration (n=24), and at 2 years post regis- tration (n=22). Chest radiography was also performed for all subjects (n = 3 1) just after the registration.

Results: From the contact investigation results, 2 cases of pulmonary tuberculosis and 14 of latent tuberculosis infection (LTBI) were detected. It was considered that the TB infection rate was high in the investigated group. The QFT-3G and T-SPOT positive rates, respectively, were 71 % (10/14) and 29% (4/14) just after registration, 38% (9/24) and 4% (1/24) at 3 months post registration, and 27% (6/22) and 5% (1/22) at 2 years post registration, and deviated from each other significantly (concordance rate, Ic 0.16 - 0.27). The positive rate of QFT-3G was significantly higher than that of T-SPOT, and QFT-3G could detect TB infection earlier than T-SPOT. The differences of test characteristics had no little impact on the diagnostic rate of LTBI.

Discussion: It is important that the diagnosis and treat- ment of LTBI be evaluated in a comprehensive manner, after considering test characteristics of the interferon-gamma release assay and epidemiological information of TB.

Objectives: Our aim was to investigate the clini- cal effects of levofloxacin (LVFX) administered intravenously to patients with pulmonary tuberculosis.

Methods: We studied 65 patients hospitalized at The National Hospital Organization Tokyo National Hospital between January 2010 and December 2012. The patients did not have human immunodeficiency virus (HIV) infection, and received anti-tuberculous drugs intravenously due to the inability to receive drugs orally.

Results: Twenty-seven patients were intravenously treated with isoniazid (INH), streptomycin (SM) and LVFX (HLS), and 38 patients were treated with INH and SM (HS). For both groups, mean age was very high (80.6±15.0 years, HLS group; 81.0± 12.1 years, HS group) and serum albumin levels were low (2.0 ± 0.62 mg/dl and 2.1 ± 0.42 mg/dl, respectively). Most patients were administered oxygen (81.5%, HLS; 78.9 %, HS). In radiological findings, most patients had bilateral (92.6%, HLS; 92.1%, HS) and widely spread (55.6%, HLS; 57.9%, HS) shadows. No significant differences were found between both groups in terms of the above data, except for sex. Almost 70% of all patients died; 51.9% of patients in the HLS group and 50.0% of those in the HS group died of tuberculosis, while 18.5% of patients in the HLS group and 18.4% of those in the HS group died of the other diseases. There were no significant differences in the causes of death and the survival rates of both groups.

Conclusion: Patients with pulmonary tuberculosis who were administered intravenous drugs were elderly and in poor general health. As such, mortality of these patients was very high. In this study, no clinical effects were found in the patients administered intravenous LVFX with INH and SM compared with patients treated with INH and SM.

Subjects and methods: We report five cases of surgical treatment for pulmonary nontuberculous mycobac- teriosis (NTM) resisting chemotherapy in twenties. Of the five, one was male and four were female. They had cavitary or nodular lesion in their lung. After chemotherapy, partial resection or lobectomy was performed.

Result: Though postoperative chemotherapy had contin- ued for only 6 months or 1 year, there was no relapse/recurrence at more than 86 months in average after surgery. Consideration. In younger patients, NTM lesions in the lung are sometimes more localized than senior patients, therefore they can be removed as a smaller portion by the operation, and we can sometimes keep more pulmonary function of the patient.

Conclusion: Surgical treatment for twenties patients with pulmonary nontuberculous mycobacteriosis resisting chemo- therapy should be carried out aggressively at an early stage to resect a smaller portion of the lung and also decrease relapse/ recurrence after surgery.

In this article, we reviewed data regarding the previous treatment history, regimen types, and hospitalization status of tuberculosis (TB) patients newly notified in 2014. The duration of treatment and hospitalization, and the treat- ment outcomes of TB patients notified in 2013 were also eval- uated by using a cohort analysis. Of the 19,615 newly notified TB patients in 2014, 1,179 had a previous history of TB treatment. Approximately 90% of all TB patients aged 15-49 years were treated with isoniazid, rifampicin, pyrazinamide, and ethambutol (or strepto- mycin), which is the globally recommended regimen for initial treatment. However, the proportion of patients receiv- ing the standard regimen decreased with their increasing age, and sharply dropped for those aged ≥80 years. Of 15,149 patients with pulmonary TB (PTB), more than 50% of those aged 50 years were hospitalized at the beginning of the TB treatment; the proportion of those hospitalized in each age group increased with the increasing age of the patients. At the end of 2014, the median durations of hospitalization and treatment for all forms of TB notified in 2013 were 62 and 273 days, respectively. For cases notified in 2013, the rates of treatment success for patients with new sputum smear-positive PTB (n=7,600) and for those on re-treatment (n= 529) were 49.6% and 41.8%, respectively. In addition, the treatment success rates for foreign-born patients with new sputum smear-positive PTB (n=289), and those on re- treatment (n= 19) were 59.5% and 36.8%, respectively. The rates lost to follow-up for patients with new sputum smear- positive PTB and those undergoing re-treatment were well below 5% when considering the total number of patients (both foreign-born and Japan-born), as well as only the foreign-born patients. The death rate among all new sputum smear-positive PTB patients was 21.6%, and the rates were relatively higher in the age groups 60-69, 70-79, 80-89, and ≥90 years (13.1%, 21.6%, 33.0%, and 46.7%, respectively).

[Purpose] To investigate the frequency and risk factors of severe liver dysfunction in patients receiving isoniazid (INH) mono-therapy for latent tuberculosis infection (LTBI). [Objectives and Methods] A retrospective study of patients receiving INH mono-therapy for LTBI in the single medical institute in Japan. [Results] A total of 845 subjects, aged between 20 and 70 years old, were enrolled in this study. Grade 3 liver dysfunction (the highest value between AST and ALT [=M], 500 IU/L≤ and less than 1000 IU/L) was found in 1.9% (16/845) of cases. Grade 4 liver dysfunction (M≥ 1000 IU/L) was found in 1.4% (12/845) of cases. The frequency of Grade 3-4 liver dysfunction increased with age, in patients above 40 years of age. The frequency of Grade 3 and Grade 4 liver dysfunc- tion was 2.0% (4/202) and 1.0% (2/202), respectively, in patients aged between 40 and 49 years, and 2.4% (3/123) and 3.3% (4/123), respectively, in patients aged between 60 and 69 years. The following factors were associated with an increased risk of severe liver dysfunction: hepatobiliary abnormalities, consumption of alcohol 5 times or more per week before commencing INH, and abnormal high values of ALP before commencing INH. [Conclusion] Severe liver dysfunction is not rare in patients above 40 years of age, and the indication for LTBI treatment in these patients should be evaluated carefully, balancing the risk of severe liver dysfunction and the benefits of preven- tive effects.

A 52-year-old woman was referred to our hospital presenting with epigastric pain and weight loss. A contrast- enhanced abdominal computed tomography (CT) scan showed a low-density mass in the body of the pancreas, indicative of a malignancy. Endoscopic ultrasound-guided fine needle aspiration of the pancreatic mass was performed three times and showed no specific findings. A distal pancreatectomy was performed, and a pathological examination revealed epitheli- oid cell granulomas and necrosis. Ziehl-Neelsen staining did not reveal acid-fast bacilli in the pancreatic mass. A diagnosis of tuberculosis or sarcoidosis of the pancreas was con- sidered; however, the patient chose to undergo a follow-up examination without therapeutic intervention because the pancreatic mass had been removed completely and she had recovered well. Four months after the operation, the patient was readmitted to our hospital for insulin therapy for pancreatic diabetes. She presented with a fever and a productive cough, and a chest CT scan showed multiple nodules in both upper lobes. A bronchoscopy was performed and bronchoalveolar lavage fluid cultures for Mycobacterium tuberculosis were positive. The patient received antitubercular quadri-therapy and showed symptomatic and radiologic improvement. At the initial examination, we had been unable to establish the correct diagnosis; however, the detection of pulmonary lesions led to the time-delayed diagnosis of pancreatic tuber- culosis. Owing to its rarity, it is difficult to diagnose pancreatic tuberculosis using clinical symptoms and radiological imaging modalities; thus, pathologic and bacteriologic confirmation is essential. To avoid performing an unnecessary laparotomy in patients with pancreatic tuberculosis, increased vigilance and an accurate diagnostic approach are required.

A 72-year-old man was admitted to our hospital in November 201X- 1 because of fever and left cervical lymph node swelling. Chest computed tomography (CT) confirmed left swelling in the cervical lymph node and the axillary lymph node. We performed a lymph node biopsy and diagnosed tuberculosis of the lymph nodes (the left cervical region and the axilla). The patient was treated with anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) in December 14, 201X-1. After initiating the therapy, the fever resolved, and his general conditions gradually improved. Thus, the patient recovered well because of the anti-tubercu- losis therapy. Despite maintaining good general conditions, the patient experienced increasing swelling in his left hemi- thorax around the end of January 201X. A chest CT showed a clear fluid-filled mass in the left thoracic wall. Microscopic examination of the specimen obtained by CT-guided needle biopsy showed positive results for acid-fast bacteria and polymerase chain reaction for Mycobacterium tuberculosis indicated that the anti-tuberculosis therapy had failed. How- ever, the patient's general conditions remained good, and the results of blood laboratory tests were stable. Thus, we concluded that the mass was the result of a paradoxical response to the anti-tuberculosis therapy, and we reinstated the same therapy. Although the fluid-filled mass recurred in the same region less than a month following the first anti-tuberculosis therapy, the mass spontaneously regressed when the therapy was reinstated. Thus, we confirmed that a paradoxical response was the cause of the clinical course in this patient.