著者
重藤 えり子
出版者
JAPANESE SOCIETY FOR TUBERCULOSIS
雑誌
結核 (ISSN:00229776)
巻号頁・発行日
vol.65, no.11, pp.701-709, 1990-11-15 (Released:2011-05-24)
参考文献数
23

To reveal the possibility of differentiating diseases caused by M. tuberculosis and M. intracellulare, simultaneous tuberculin testing by PPDs and PPD-B was carried outamong X-ray suspects of tuberculosis and healthy persons.PPD-B was prepared by Dr. Tasaka (Department of Bacteriology, Hiroshima University) from M. intracellulare (ATCC13950).For tuberculin testing, 0.05μg of PPDs from M. tuberculosis (Nihon BCGCo.) and 0.1, μg of PPD-B were used.The study included61patients with disease caused by M. tuberculosis (TB), 23 patients with that of M. avium complex (MAC) and 40 healthy persons with no roentgenologicalabnormality (H).Forty healthy persons had been vaccinated with BCG. Statisticalanalysis of the diameter of reaction (redness) in each antigen in each group has been doneby Boxplotting method.The results were as follows: 75% upper quartile point, median, 25%lower quartile point/mean S. D.: PPDs in TB (41.8, 30.0, 19.0/32.0-17.7) PPDB in TB (15.0, 10.5, 5.0/10.9 8.1) PPDs in MAC (26.0, 10.0, 7.0/16.4-13.9) PPDB in MAC (20.5, 17.5, 12.5/19.1-11.4) PPDs in H (18.0, 12.0, 6.0/13.5-10.9) PPDB in H (7.0, 2.8, 0.0/4.4-5.4).Mean of PPDs in TB patients and PPD-B in MAC patients were significantly (P<0.01) larger than those in other groups. Significant differences of reaction by age distribution, previous history of mycobacteriosis or other diseaseswere not observed.In each patient, larger skin test reaction correlated with the infected organism in 71 (85%) of the 84 cases.In 61 patients with M. tuberculosis infection, reaction to PPDs waslarger than that of PPD-B in 58, and the reaction to PPD-B was larger than that of PPDs in only one subject, and the reaction to PPDs and PPD-B were smaller than 5mm in 2. In 23 patients with MAC infection, the reaction to PPD-B was larger than that of PPDs in 13, the reaction to PPDs was larger than that of PPD-B in8and the reaction to PPDs and PPD-B were smaller than 5mm in 2.It is concluded that simultaneous skin test with PPDs and PPD-B is useful in thedifferential diagnosis of mycobacterial disease due to M. tuberculosis and M. aviumcomplex prior to bacteriologic confirmation by culture.
著者
小橋 吉博 沖本 二郎 松島 敏春 重藤 えり子 倉岡 敏彦 竹山 博泰 江田 良輔 矢野 修一 小林 賀奈子 大西 隆行 森 健一 上田 暢男 森高 智典 西村 一孝 阿部 聖裕
出版者
JAPANESE SOCIETY FOR TUBERCULOSIS
雑誌
結核 (ISSN:00229776)
巻号頁・発行日
vol.77, no.6, pp.435-441, 2002-06-15
被引用文献数
8

MAC症に対して, ATSおよび日本結核病学会が提言した治療ガイドラインが臨床上適切かどうか, 過去の治療法との比較も併せ検討した。対象は, 1995年4月から2001年3月までに6カ月以上治療がなされ, 治療開始から12カ月以上経過観察を施行できた肺MAC症159例とした。治療状況は, 抗結核薬。CAM102例, 抗結核薬のみ33例, その他24例であった。治療効果は, 抗結核薬.CAMが菌陰性化率45.1%, 再排菌率39.1%, 臨床的改善率29.4%であった。一方, 抗結核薬のみは菌陰性化率30.3%, 再排菌率70.0%, 臨床的改善率12.1%と不良で, CAMが含まれた治療法で優れた成績が得られていた。次に, 抗結核薬.CAMの治療が行われた102例ではガイドラインに一致した RFP, EB, SM, CAMの治療が41例に施行され, 菌陰性化率58.5%, 再排菌率37.5%, 臨床的改善率36.6%であった。一方, 他の抗結核薬.CAMは61例に施行され, 菌陰性化率36.1%, 再排菌率40.9%, 臨床的改善率24.6%と, ガイドラインに沿った治療法が最も優れた成績であった。<BR>しかし, いまだ肺結核に対する治療効果と比較すると不十分であり, 今後新しい非定型抗酸菌に有効な治療薬の開発が望まれる。
著者
重藤 えり子 佐藤 裕恵 重藤 紀和 鎌田 達 阿部 千代治 高橋 光良 森 亨
出版者
JAPANESE SOCIETY FOR TUBERCULOSIS
雑誌
結核 (ISSN:00229776)
巻号頁・発行日
vol.70, no.5, pp.347-354, 1995
被引用文献数
6

A twenty-four year old male Peruvian of Japanese origin, who came to Japan in September 1990 and had been working in a minor factory in a rural area, was admitted to a hospital in March '91 with severe cough. Smear examination of his sputum smear was positive for acid-fast bacilli and his chest X-ray showed multiple cavities (Index case). Subsequent contact examination identified further four patients with pulmonary tuber culosis among his colleagues in the factory, all of whom lived in the same house with the index case.<BR>During following three years, further six patients with mycobacteriosis, two Peruvians and four Japanese, were found among the employee of that factory. M. tuberculosis was cultured from the sputa obtained from seven of these eleven patients. Another patient was diagnosed as non-tuberculous mycobacteriosis.<BR>Restriction fragment length polymorphism (RFLP) analysis carried out with five strains of M. tuberculosis isolated from these patients revealed the identical RFLP pattern which is uncommon in Japan. Still more, an isolate from another patient was subjected to RFLP analysis by chance, and was found to show the same RFLP pattern. Later epidemiological study revealed that the last patient, a 53 year-old saleswoman of boxlunch, might have some contact with the index case at her booth.<BR>Though RFLP analysis was not done for the isolate from the index case, from the identity of RFLP patterns of other isolates, clinical course and epidemiological study, it is considered that six patients were certainly, and two others were probably infected from the index case. One of the patients had a history of surgical treatment for pulmonary tuberculosis and, as RFLP analysis could not be carried out, it is not possible to determine whether his disease was due to reactivation or re-infection.<BR>Tuberculin skin test survey of 133 workers in the factory was carried out in March '91. The diameter of erythema showed bimodal distribution pattern for the Japanese workers. Considering that most of the young Japanese have been vaccinated with BCG, it is assumed that at least 40% (10/23) of Japanese workers younger than thirty years old were infected in this epidemic. All the Peruvians, who had not been vaccinated with BCG, showed positive reaction to PPD (mean diameter was 41.9mm) and were assumed to had been infected newly in this epidemics or in the past. Chemoprophylaxis were indicated for two young Peruvians only. Subsequent patients were diagnosed among the strong tuberculin reactors (For Japanese ≥50 mm, for Peruvians ≥30mm in diameter).<BR>Total delay in the diagnosis of the index case was considered to be about six months. Though he was coughing on his entrance to Japan on September '90, no reliable medical checkup was done until he was pointed out the abnormal findings on his chest X-ray image at a routine medical checkup in November '90. At that time he was recommended to go to some hospital or clinics, but he did not obey this recommendation promptly. Such a delay may cause this outbreak.