著者

中西 好子 大山 泰雄 高橋 光良 森 亨

出版者

日本公衆衛生学会

雑誌

日本公衆衛生雑誌 (ISSN:05461766)

巻号頁・発行日

vol.44, no.10, pp.769-778, 1997-10-15

被引用文献数

25

著者

伊藤 邦彦 高橋 光良 吉山 崇 和田 雅子 尾形 英雄

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.79, no.6, pp.387-390, 2004-06-15

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症例は47歳男性, 住所不定者。4歳時肺門リンパ節結核で治療歴あり。特記すべき合併症なくHIV陰性。病型b II 2, 喀痰塗抹Gaffky 4号全剤感受性の肺結核の診断で複十字病院命令入所し標準的化学療法開始。治療開始2力月目に一度喀痰培養陰性化するも, 内服は規則的と考えられたにもかかわらずその約2週後の喀痰で再排菌し, それ以降治療終了後も喀痰培養が断続的に続いた。薬剤感受性試験では再排菌以降の菌が多剤耐性化していたことが繰り返し確認された。RFLP分析では再排菌時以降の多剤耐性菌と治療開始時から排菌停止までの菌で菌株が全く異なることが判明し, Double-strain infectionによる多剤耐性肺結核と判断された。

著者

鹿住 祐子 大友 幸二 高橋 光良 御手洗 聡 菅原 勇 和泉 純子 安藤 昭子 長谷川 秀浩

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.79, no.7, pp.437-441, 2004-07-15 (Released:2011-05-24)

参考文献数

12

被引用文献数

2

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[目的] 同定困難であったMycobacterium skinskuenseの細菌学的解析を行った。 [対象と方法] 37歳女性, 右下肢皮膚潰瘍より分離された抗酸菌 (被検株753) とM.marinum (ATCC927), M.ulcmns (ATCC19423), M.skinskuense (ATCC33728) をDDH, 16SrRNA法, rpoB法, 薬剤感受性試験, 生化学的・生物学的検査を用いて比較した。 [結果] DDH法によって上記の4株はM.marinumとして判定されたが, 遺伝子配列の検索方法 (16SrRNA法・rpoB法) ではこの被検株 (753) が3菌種のうち, いずれであるかを決定できなかった。しかし, 16S rRNA法の中のPortaelsらの方法によってこの3菌種を分類することが可能であった。この方法によって被検株 (753) はM.skinskuenseと同定された。薬剤感受性試験と生化学的・生物学的性状検査においても被検株はM.skinskuenseと同定された。 [考察] DDHにてM.msrinumと同定された抗酸菌で, 発育条件が28℃ 培養で2週間かかり, 暗所培養にて黄色のコロニーを形成するScotochromogenであった場合, 塩基配列レベルの検査と従来法の実施が必要である。

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

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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.