著者

大森 正子 和田 雅子 吉山 崇 内村 和広

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.78, no.6, pp.435-442, 2003-06-15

参考文献数

19

被引用文献数

6

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老人保健施設における結核の早期発見方策を検討する目的で, 1都4県358の老人保健施設にアンケート調査を実施し, 169 (47.2%) から回答を得た. 施設は併設病院あり36.1%, 診療所あり12.4%, どちらもなし51.5%で, 平均年齢は入所者83.2歳, 通所者79.6歳, 平均利用期間は入所者7ヵ月, 通所者13ヵ月だった. 施設利用時に胸部X線検査を実施していた施設は入所者42.6%, 通所者23.7%, 利用期間中に結核検診を実施していた施設は入所者45.6%, 通所者15.4%だった. 職員への定期結核検診は94.7%の施設で実施していた. 入所者の食欲低下や全身倦怠といった症状は, 67.5%の施設で毎日点検していると答えたが, 呼吸器症状は18.9%と少なかった. 2週間以上続く呼吸器症状で病院を受診させる際, 入所者では93.5%の施設が文書を持たせ, 63.9%が胸部X線と喀痰検査を依頼すると答えたが, 通所者では医療機関受診を勧めるだけで特に症状を説明する文書を持たせず結果を確認することもしないと答えた. 結核患者発生率は, 施設利用者10万対104.6で, 調査地域の一般住民 (同年齢) の結核発生率よりやや高かったが有意の差は見られなかった. 老人保健施設は医療機関とみなされ結核予防法で健診の対象にはなっていない. 法的措置の基に効果的な患者発見方策を確立する必要がある.

著者

山中 克己 明石 都美 宮尾 克 石原 伸哉

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.74, no.2, pp.99-105, 1999-02-15 (Released:2011-05-24)

参考文献数

20

被引用文献数

1

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An Investigation by questionnaire was conducted in 1996 to know the tuberculosis (TB) status and living conditions of 50 homeless people registered as TB patients at one of Nagoya city's 16 health centers.1. All patients had one or more symptoms of TB, 64% of them showed positive TB bacilli on smear, and 35.3% of them had a previous history of TB treatment. However, only 15.2% suspected they had TB at the onset of symptoms.2. Main reasons of seeking medical treatment: 28.6% arrived by ambulance after falling down from exhaustion, 25.7% had consulted with welfare agencies after the onset of symptoms, and 20.0% had been diagnosed during the treatment of other diseases.3. When they were admitted to the hospital they had many concerns 29.0% loss of income, 19.4% living expenses, 19.4% smoking prohibition, 12.9% admission fee, and 9.7% privacy.4. They lived in the following: 42.9% construction camps, 20.0% parks or streets, 17.1% single room occupancy hotels, 17.1% daily or monthly paid apartments, and 11.4% sauna baths.5. Past medical histories of the subjects included 40.6% injuries by labor accidents, and 25.0% stomach ulcers. Current diseases were 15.6% mental diseases, 15.6% liver diseases, 15.6% diabetes mellitus, and 9.4% alcoholic dependance. Seventy percent of them consumed alcohol daily (average pure ethanol 125m1 per day).6. From the results outlined above, the following proposals relating to TB control of the homeless should be considered.1) Educating the homeless as to the need for a health check when TB symptoms are present.2) Opening a clinic for the homeless for easy access to consultation on TB.3) Directly observed therapy, short-course, for TB in the homeless.4) Health examination of the employees of single-room occupancy hotels and sauna baths which are used frequently by the homeless.5) A fundamental countermeasure to deal with alcoholic dependancy among the homeless.

著者

倉澤 卓也 佐藤 敦夫 中谷 光一 池田 雄史 吉松 昭和 池田 宣昭 井上 哲郎 金井 廣一

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.75, no.5, pp.389-394, 2000-05-15 (Released:2011-05-24)

参考文献数

18

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We report an outbreak of pulmonary tuberculosis (TB) in a dormitory of construction labors, and this outbreak is suspected to have been caused by exogenous reinfection, based on the restriction fragment length polymorphism (RFLP) analysis and other findings.After a patient entered our hospital with active TB, 12 new other patients were discovered by contacts examination. These patients lived together in the same dormitory. They were all male and single, and were aged from 43 to 63 years old. Except one patient (No.3) previously treated for TB for three months about 2 years ago and was suspected to be the index case of this outbreak, 12 other patients did not have a medical history of TB.The bacilli cultured from 11 patients (No.1-11) were tested by RFLP analysis, three patterns were identified, and the fingerprints from 9 patients (No.1-9) were identical, and the patterns of incomplete resistance of some antituberculous drugs were quite similar between No.1-9 and No.12 and between No.10 and No.13, respectively.The locations of the main lesions of TB on chest X-ray pictures were the apico-posterior segments of bilateral upper lobes. No signs suspected to indicate primary tuberculosis were detected.Considering the rate of tuberculous infection in Japan among the middle age and above as well as the identical RFLP results, most of patients in this outbreak except the index case No.3 were suspected to have TB due to the exogenous reinfection.

著者

溝口 大輔 松島 敏春 副島 林造

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.54, no.6, pp.351-355, 1979

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An autopsy case of acute tuberculous pneumonia and miliary tuberculosis in a 79-year-old man, was reported.<BR>He was admitted to the hospital because of high fever and dyspnea. Chest X-ray films showed diffuse confluent air-space opacities throughout both lung fields with small nodular and ground-glass lesions.<BR>Transbronchial lung biopsy of the right lower lobe was performed eight days after admission. The biopsy specimen was caseous granuloma with infiltrations of epithelioid cells and giant cells. Therefore, intensive anti-tuberculous chemotherapy with INH, RFP and SM, and tapering of predonisolone was started. Rapid tapering of corticosteroid gave rise to flare up of acute tuber culous pneumonia, and resulted in respiratory failure. The findings at autopsy were widely disseminated miliary tuberculosis, acute tuberculous pneumonia, interstitial pneumonitis, and multiple gastric ulcers.<BR>The use of corticosteroid in tuberculosis was discussed.

著者

斎藤 肇 佐藤 勝昌 冨岡 治明 井上 圭太郎 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.67, no.2, pp.89-95, 1992-02-15 (Released:2011-05-24)

参考文献数

18

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Fourty-five sputum specimens collected at the National Sanatorium Hiroshima Hospital were subjected to cultivation using either BACTEC 460 TB System (BACTEC method; Becton Dickinson Co., Towson, Md., U.S.A.) or 3% Ogawa egg medium. Test suptum was treated with four volumes of 4% NaOH for approximately two minutes, after which 0.1ml of the treated sputum was immediately inoculated onto 3% Ogawa egg medium. After neutralizing the remaining pretreated sputum with 1N HCl, and diluting with 1/15 M phosphate buffer PB; pH 6.8), it was then centrifuged at 3, 000rpm for 20min and the sediment was suspended in 1.5 ml of PB. Volumes of 0.5 ml each were inoculated into BACTEC 12B medium (4ml), containing PANTA for prevention of contamination and POES for promoting the growth of mycobacteria.In the BBCTEC method, bacterial growth was measured in terms of increases in the Growth Index (GI) values which were determined by the amount of 14CO2 released from the 14C -labelled palmitate during cultivation at 37°C (positive growth;GI≤50). Moreover, ρInitro-α-acetylamino-β-hydroxy-propiophenone (NAP)-sensitivity testing was done by transferring a part of the BACTEC 12B culture showing positive growth to a NAP vial, and thereafter subjected to further cultivation.Among the 45 sputum specimens, the number of positive specimens for mycobacterial growth in the afore mentioned cultivation methods and time required for growth were as follows: 3% Ogawa egg medium, 12 specimens (27%), seven M. tuberculosis complex strains at 12-35 days (average 21 days), five M. avium complex strains at 14-21 days (average 18 days): BACTEC method, 18 specimens (40%), 11 M. tuberculosis complex strains at 3-28 days (average 14 days), six M. avium complex strains at 3-10 days (average 6 days) and one M. scrofulaceum strain at 28 days. There were no specimens that tested positive for mycobacterial growth on 3% Ogawa egg medium but negative in BACTEC 12B medium. The BACTEC method was most efficacious in cultivating acid-fast bacilli from smear-negativeWhen NAP-sensitivity testing was done using the BACTEC method, mycobacteria in 11 test sputa were deteremined as NAP-sensitive, thereby belonging to M. tuberculosis complex. The fact that all of the organisms determined as NAP-sensitive using the BACTEC method were rough and nonphotochromogenic, and identified as M. tuberculosis complex by AccuProbeTM testing, confirmed the reliability of NAP-testing. sputa.The mycobacteria in seven sputum specimens detected using the BACTEC method were determined as NAP-resistant. Six of them were smooth and nonphotochromogenic, and identified as M. avium complex by AccuProbe testing. The one remaining strain was a scotochromogen with a smooth colony morphology, and had no reaction to either the M. tuberculosis complex- or M. avium complex-AccuProbe tests. This strain was identified as M. scrofulaceum using an α-antigen analysis.These results indicate the usefulness of the BACTEC 460 TB system in the rapid diagnosis of mycobacteria including M. tuberculosis complex and M. avium complex.

著者

戸井田 一郎

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.68, no.6, pp.435-444, 1993-06-15 (Released:2011-05-24)

参考文献数

42

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Bacille Calmette-Gubrin (BCG) has been widely used as a safe and effective vaccine for the protection of tuberculosis, but recent epidemic of human immunodeficiency virus (HIV) infection evoked serious concerns about the safety of BCG when vaccinated to HIV-infected persons: that is, because BCG is a live, though avirulent, bacterial vaccine, it might grow in immunocompromized host and might cause dissemination and/or exacerbated local adverse reactions. In fact, during the decade since the first report on AIDS in 1981, several reports were published on the adverse reactions, systemic or local, induced by BCG in HIV infected persons. In this paper, the present author attempted to review such reports as comprehensively as possible.From critical examinations of the literatures, it was concluded that:1) None of the reports dealing with dissemination of BCG provided satisfactorily enough evidence to identify the isolated mycobacteria as Mycobacterium bovis BCG. In some cases, infection with wild strain of M. bovis, instead of BCG, should be considered as more plausible pathogen. Especially, two reports, which suggested the late reactivation and dissemination of BCG vaccinated 30 years ago, could not be accepted without more detailed description of the procedures and results of the identification tests. In some cases, application of BCG were considered to be inappropriate. According to the present author's judgement, when BCG was applied appropriately as an anti-tubercul2) As for the local adverse reactions, many reported cases of outbreak of local adverse reactions, such as local ulceration and supprative lymphadenitis, were not related to HIV infection at all, but were due to the usage of an inferior vaccine produced by a specified manufacturer (Pasteur Institute, Paris). Conclusion was that BCG could be safely vaccinated to children born from HIV-seropositive mothers, even if children themselves were also infected with HIV, so long as BCG vaccine of good quality was used.osis vaccine, generalized infections were most plausively induced by BCG only in 4 cases during this decade.3) Positive conversion rate of post-vaccination tuberculin skin-test seemed to be lower in HIV-infected children than in children born from HIV-seronegative mothers. But, about 30% of the HIV-infected children converted to tuberculin-positive after BCG vaccination suggesting the effectiveness of the vaccination for the considerable fraction of the babies at the highest risk of tuberculosis infection. Positive conversion rate was much higher in HIVnoninfected children born from HIV-seropositive mothers.From these considerations, recommendations from WHO, which recommended to vaccinate BCG to HIV-infected babies, babies born from HIV-seropositive mothers as well as babies born from HIV-seronegative mothers so long as babies are asymptomatic, are completely justified.

著者

下方 薫

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.79, no.9, pp.541-545, 2004-09-15 (Released:2011-05-24)

参考文献数

38

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The characteristics and function of human lymphocytes in tuberculous morbid sitewere studied. Exudativesensitized lymphocytes in tuberculous pleural fluid reacted tothe specific antigen more effectively and produced highertiters of cytokines including interferon γ (IFN -γ) than circulating lymphocytes. CD4+/CD8-T-cellsubset is responsible for the antigen-specific IFN -γ production in pleural T lymphocytes of patients with tuberculous pleurisy. Thus, activated T lymphocytes concern the production of cytokinesat the morbid site and they effectively exert local cellularimmunity through the action of such cytokines. Immuno fluorescence study showed increased production of inducible nitric oxide synthase (i NOS) and peroxynitrite in BCG-inocu lated human alveolar macrophages (AM). Reverse transcrip tase-polymerase chain reaction methods also revealed the higher expression of i NOS-coding m RNA. Colony assay dem onstrated that human AM effectively killed BCG in their cyto plasm. However, treatment of AM with NG-monomethyl-L arginine monoacetate resulted in markedly reduced killing activity. These results clearlyshow that BCG-induced NO and its reactive product with the oxygen radical, peroxynitrite, could play an important role in BCG killing in human AM.We measured the pleural concentrations of IFN -γ inter feron -γ-inducing cytokines; interleukin (IL)-12 and IL-18 and interferon -γ-inducible chemokines; IFN-γA-inducibleprotein of 10 k Da (IP-10), monokine induced by IFN-γ (Mig), and IFN-inducible T cell a chemoattractant (I-TAC). These cytokines and chemokines in tuberculous pleural effusions were much higher than those in malignant pleural effusions. These findings indicate that IFN ? A plays an important role in the cell mediated immunity in tuberculosis.

著者

岩永 知秋 横田 欣児 岸川 禮子 池田 東吾 鶴谷 秀人 広瀬 隆士 西間 三馨

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.72, no.1, pp.9-13, 1997-01-15 (Released:2011-05-24)

参考文献数

10

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A 53-year-old man with multidrug resistant tuberculosis (MDR-TB) had been persistently positive for acid-fast bacilli (AFB) both on sputum smear and also on culture with the Ogawa egg medium for 30 years since 1951. The case had been treated previously with isoniazid, rifampin, streptomycin, ethambutol, kanamycin, ethionamide, paraaminosalicylate and cycloserine; however, M. tuberculosis strains isolated from this patient acquired a high resistance to all of these agents. Then, a new regimen of chemotherapy, INH combined with ofloxacin (OFLX) and amoxicillin-clavulanic acid (AMPC/CVA), was applied to the case. He was successfully treated with this regimen, and a marked decrease in the amount of AFB on smear as well as on culture was observed during the course of chemotherapy. No adverse effects were seen meanwhile. These data suggest that it is worth while to try a regimen containing AMPC/CVA and OFLX in the treatment of MDR-TB.

著者

安藤 勝也 山中 克己 明石 都美

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.77, no.9, pp.589-595, 2002-09-15

被引用文献数

1

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高校教諭に肺結核が発症し, それにより同高校の教職員2名ならびに生徒4名の結核患者と75名 (教職員3名, 生徒72名) の予防内服の患者が集団発生した。初発患者は27歳の男性教諭で, 1年3・6組2年4・5組に簿記を教え, 3年1組の副担任であり, バドミントン部の顧問もしていた。平成11年11月より軽い咳があり, 近医を数回受診し, 平成12年1月N病院受診しガフキー8号学会分類bII2と診断され入院治療となった。当保健所は, 教職員63名, 学生153名の合計216名を対象とした定期外検診を行った。直後の定期外検診にて, 1名の生徒が<I>l</I>III1肺結核と診断された。ツ反検査のヒストグラムから40mm以上の発赤径を示した27名の生徒が感染を受けたとして, 予防内服のため病院に紹介した。2カ月後の定期外検診のX-Pにより2名の生徒が肺結核 (<I>l</I>III1・<I>l</I>III1), 1名の生徒が結核性胸膜炎と診断され, 1名の職員が肺結核γIII1と診断された。ツ反検査により直後の発赤径に比して17mm以上大きくなった45名の生徒と職員3名の合計48名が感染を受けたとして, 予防内服のため病院に紹介した。12カ月後の定期外検診にて職員1名がγII1肺結核と診断された。初発患者の家族検診において兄が結核性胸膜炎, 母が<I>l</I>III1肺結核と診断され, 親戚の子供1名が予防内服となった。ツ反を判断するにあたり, 結核病学会の「結核医療の基準」に従って画一的に予防内服を決めることは, 危険であり, 事例に応じて柔軟に対応すべきとの示唆を得た。

著者

中村 玲子

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.60, no.10, pp.523-529, 1985-10-15 (Released:2011-05-24)

参考文献数

16

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Tuberculin skin reaction is one of phenotypes of the immune responses to mycobacteria, which is mediated by the sensitized T cells and expressed as a delayed-type hyperse nsitivity. In mycobacteria-infected mice, this response is recognized as a footpad reaction specific to PPD. There are high and low responders in this reaction among various strains of mice. The difference in the responsiveness is controlled genetically. High respon siveness is dominant over low responsiveness. The results of linkage test using SWM/Ms, C3H/ He, and their hybrids, showed that this gene links to neither H-2, coat color, norIgh allotype.Strain differences in the resistance against virulent mycobacterial infection does not coincide with the natural resistance to BCG which is regulated by Ity-Bcg-Lsh gene on chromosome 1. Rather, the acquired immunity is related to delayed-hypersensitivity to BCG, although it is not mapped yet.Suppression of the immune response to BCG is observed in BCG-low-responder mice. The mechanism was found to be due to the induction of suppressor T cells which inhibit the induction of effector T cells. The surface antigens on macrophages and T cells are necessary to induce suppressor T cells. It seems that the suppressor T cell induction is regulated genetically. However, it is not clear what gene regulates the suppressor T cell induction and how it is related with the gene for delayed-type hypersensitivity.Genetic analysis of immunity to tuberculosis in human beings is difficult because the population is highly heterogeneous. Statistical analysis in a large scale would be a good way of the study. There is a report that HLA-Bw 15 might be related to tuberculosis, but accumulation of more information is necessary.

著者

藤野 忠彦

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.51, no.9, pp.381-388, 1976-09-15 (Released:2011-05-24)

参考文献数

18

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Risk of developing miliary tuberculosis is increased in a variety of disorders in which host defence mechanisms are impaired. We are presenting four cases of miliary tuberculosis which developed during dialysis therapy for chronic renal failure.The patients' age ranged from 34 to 59 years. None of them received corticosteroids or immunosuppressive therapy during their hospital treatment. These four patients had been treated at different time and different hospitals except cases 2 and 3. A previous histry of tuberculosis was recorded only in case 2. The clinical symptoms of these cases were fever of unknown origin, and cough and sputum during the period of dialysis therapy. Fever was the most frequently observed sign, which raised to 37-39°C after the dialysis or in the evening. The intermittent fever persisted without response to various antibiotics including CER, CEZ, TC, PC, etc. Two of them complained headache and became comatose in the final stage. Miliary lesions were not visible on the chest radiograms, even just before the time of death. The infiltrative shadows in S6 and pleural effusion were found in some cases temporarily on the chest radiograms during the clinical course. The duration of fever ranged from one month to 3 years. In case 2, the smear examination of sputum for acid-fast bacilli was negative, but positive culture was obtained one month after the death of patient. In case 3, one colony of acid-fast bacilli was cultured from the pleural effusion which disappeared without any antituberculous treatment. The serum BUN and creatinine levels were well controlled by the dialysis therapy in these four cases. The diagnosis of miliary tuberculosis were finally obtained by postmortem examination in all cases.The tuberculine skin test was not performed in these patients. It is well established that chronic uremia may influence certain immunological reactions and depress tuberculin skin test. This experience suggests that patients under dialysis therapy have a greater risk of developing miliary tuberculosis, and if fever of unknown origin is observed or tuberculosis is suspected, the prompt institution of antituberculous therapy including prophylactic ones is requested.

著者

鈴木 克洋 露口 一成 松本 久子 新実 彰男 田中 栄作 村山 尚子 網谷 良一 久世 文幸

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.72, no.4, pp.187-192, 1997-04-15 (Released:2011-05-24)

参考文献数

10

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Fifty six clinical isolates of Mycobacterium tuberculosis were tested for drug susceptibility in Mycobacteria Growth Indicator Tube (MGIT) containing 0.1μg/ml of INH, 1.0μg/ml of RFP, 3.5μg/ml of EB and 0.8μg/ml of SM. These results were compared with those obtained by testing the same M.tuberculosis isolates by the absolute concentration method using 1% Ogawa egg slant containing 0.1μg/ml of INH, 10μg/ml of REP, 2.5μg/ml of EB and 20μg/ml of SM. Fifty six isolates consisted of 18 pansensitive strains, 27 multidrug resistant strains and 11 single drug resistant strains. The results for individual drugs showed excellent agreement between the MGIT and the Ogawa methods, and overall agreement rate of the two methods were 96.4%. The results were just the same for all drugs in 48 out of 56 strains studied. The drug resistance could be observed much earlier by the MGIT method (mean 5.9 days) than by the Ogawa method (more than 21 days). In conclusion, the MGIT system could be a promising new drug susceptibility test which might become available in Japan replacing the Ogawa method.

著者

関 なおみ

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.78, no.5, pp.395-399, 2003-05-15 (Released:2011-05-24)

参考文献数

17

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近年わが国において成人集団における集団感染リスクは増加傾向にあるが, これらの事例は感染経路の同定が難しく, 予想外に感染が拡大している可能性があり, 対応に苦慮することが多い。今回当保健所が経験した中小企業での集団感染事例について, 対象年齢を60歳未満まで引き上げたツベルクリン反応検査 (以下, ツ反), 換気測定, 聞き取り調査等をもとに検討した。初発患者は38歳男性で病型班bII3pl, 喀痰検査はGaffky8号, 培養+ (INH耐性) であった。調査対象の事業所は2・7階に分かれ職務内容ごとに配置が異なっていた。30歳未満を対象としたツ反により, 両階合わせて感染者3名, リンパ節結核1名が発見された。このため, 対象年齢を60歳未満まで引き上げツ反を実施したところ, さらに13名が感染の疑いと判断された。当初の情報では, 初発患者の出入りは2階のみで7階職員との接触はほとんどないとのことであったが, 現場視察と聞き取り調査等から感染状況が推測された。都市部中小企業職員はデインジャーグループに属さないが, 定期外検診において積極的な調査の重要性が示唆された。

著者

高橋 了造

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.8, no.3, pp.330-339, 1930-03-24 (Released:2011-05-24)

参考文献数

9

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Verfasser untersuchte das Verhältnis der Alt-tuberkulinintrakutane Reaktion zur Tuberkulose der Meerschweinchen, welche sich verschieden entwickelt und gewägt hatten, und hieraus ergab sich folgendes:Häufigerer negativer oder geringgradi ger Ausfall der Reaktion findet sich bei den unter 200 g. gewägten jungeren Tieren, obgleich sie deutliche tuberculöse Affektion bei der Obduktion zeigen; dagegen beobachtet man ausnahmslos positives Ausfall bei den vollgereif ten.Somit ist es unzweckmässig, dass jungere, unter 200 g. gewägte Meerschweinchen zur Alt-tuberkulin-intracutane Reaktion, urn damit derren tuberculöse Affektion zu diagnostieren, angewandt werden.

著者

奥村 吉文

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.14, no.6, pp.511-525, 1936 (Released:2011-05-24)

参考文献数

3

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Wir haben BCG aus einer 1, 5 Monate alten Bouillonkultur möglichst homogen in 0, 85 proz. NaCl-Losung suspendiert und 5 verschiedene Aufschwemmungen hergestellt: und zwar so, dass 1.0 ccm Medium 0.5, 3.0, 5.0, 10.0 und 20.0 Präzipitometeilstriche Erreger enthalt.

著者

阿児 博文 三上 理一郎 坂口 泰弘 堅田 均 沢木 政好 前川 純子 米田 三平 成田 亘啓

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.60, no.12, pp.609-616, 1985-12-15 (Released:2011-05-24)

参考文献数

20

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Alcoholics are known to have a high frequency of pulmonary tuberculosis. There have been no report concerning to the relationship between tuberculosis and alcoholism in Japan.147 male patients with active pulmonary tuberculosis were studied for alcohol consumption. Patients were classified into three groups: “habitual” drinkers, “heavy” drinkers, and “non-habitual” drinkers on the basis of the extent of alcohol consumption. Habitual drinkers were defined by those who drink 540 ml or more of sake daily over five years or an equivalent amount of alcohl in other beverages. Heavy drinkers were defined by those who drink 900ml or more of sake daily over ten years. The remainder were defined as non habitual drinkers.Of 147 patients, 16 patients were habitual drinkers, 19 were heavy drinkers, 112 were non habitual drinkers. No statistically significant differences were observed in chest Xray findings and response to therapy. Heavy drinkers were found to smoke much more than non habitual drinkers. In heavy drinkers there was high incidence of negative reaction of immunological skin tests than that on non habitual drinkers. The incidence of both diabetes mellitus and chronic liver disease in heavy drinkers was significantly higher than that in non habitual drinkers.Humoral and/ or cellular immunity were known to be depressed in diabetes mellitus and liver cirrhosis. Many investigators have tried to determine why tuberculosis is common among alcoholics. However, no predisposing factors were demonstrated conclusively. Our data suggest that complications such as diabetes mellitus and/or liver cirrhosis may play a role in the pathogenesis of pulmonary tuberculosis in alcoholics.

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

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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

黒丸 五郎

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.10, no.4, pp.196-211, 1932-04-24 (Released:2011-05-24)

参考文献数

3

被引用文献数

1

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Der Verfasser stellte eine eingehende Untersuchung der tuberkulösen Veränderungen des Darmes an 208 Sektionsfällen von Lungentuberkulösen an. Darunter wurden tuberkulöse Veränderungen insgesamt makroskopisch bei 184 Fällen (88.5%) und tuberkulöse Geschwüre bei 168 Fällen (80.8%) festgestellt.Es ist schwer, die Darmtuberkulöse vom Standpunkt der pathologischen Anatomie in bestimmten Krankheitsformen schematisch einzuteilen, da bei jedem einzelnen Fall die Veränderungen in Darmabschnitten, ja selbst in einem Darmabschnitte, vielfältig waren und keine Einheitlichkeit zeigten. Die Herde lässt sich doch nach ihrem Gestalt und Grösse in gewissen Gruppen oder Typen anordnen.

著者

橋本 達一郎

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.72, no.11, pp.629-637, 1997-11-15 (Released:2011-05-24)

参考文献数

11

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The BCG vaccines will celebrate the 100th anniversary of their discovery in a decade at the beginning of the next century since Albert Calmette and Camille Guebrin had presented it before the Academie des Sciences in 1908. At present tuberculosis kills more people than any other infectious disease about 3 million people a year, including almost 300, 000 children under 15, and is producing over 7, 000 deaths and over 24, 000 new cases every day. Therefore, WHO declared a global ealth emergency in 1993. More worse, recently multi-drug resistant tubercle bacilli are emerging rapidly making TB patients incurable.Under these situations we need a potent anti-tuberculosis vaccine. So first of all, we must check the century-old BCG before proceeding further.At moment, the BCG vaccines are being used worldwide in the largest quantities in the world, but still most controvercial vaccines anywhere.I would like to describe here their success and failure in the combat against the white plague.1. The Expanded Programme on Immunization (EPI).In 1974, when the EPI was launched by WHO, less than 5% of the world children were immunized against six infectious deseases including tuberculosis. In 1995 statistics, BCG gave the highest vaccination coverage, 87% higher than any other 5 vaccines of EPI for children. The BCG in EPI must have saved a lot of infants as the vaccine, has been proved to be most effective against the blood-born tuberculosis of child type.2. The efficacy of BCG vaccination against tuberculosis.Results of each 10 of randomized controlled trials (RCT) and Case-control studies (CCS) showed the protective efficacy against tuberculosis as uncertain, unpredictable, as protective efficacy varied from 80% to 0%.More recently, a Meta-analysis of selected papers on BCG field trials which were so far collected. They recalculated vaccine protective effect separately for pulmonary TB and for meningeal/miliary TB in the trials.As the result, it was found that protective effect against pulmonary TB could not be calculated, but protective effect against meningeal and miliary TB was calculated as 86%, 75% respectively, in RCT and CCS, being higher than against pulmonary TB.3. The duration of BCG efficacy against tuberculosis was confirmed to continue for 15 years after vaccination. The incidence of every form of tuberculosis decreased steeply during the 15 years following vaccination.4. BCG revaccination.A WHO statement was issued in 1995 mentioning that there is no definitive evidence that repeated BCG vaccination confers additional protection against tuberculosis.Therefore WHO has not recommended to repeat BCG vaccination because of no scientific evidence to support this practice. Multiple BCG revaccinations are not indicated in any persons.5. Complications with BCGSecond IUATLD study (1988) on complications induced by BCG was reviewed, especially following two points:1-2) Regional suppurative lymphadenitis3) Generalized lesions: fatal cases 1-2 Several Afirican regions had experienced that the risk of outbreak of suppurative BCG lymphadenitis was low for vaccines with Glaxo and Japanese strains, but much higher for vaccines with Pasteur. This experience in nineteen eighties has led EPI to replace the Pasteur BCG vaccine with less reactogenic BCG, Japanese or Glaxo BCG to solve the outbreak of suppurative adenitis complication.3 At moment, the only contra-indication of EPI BCG vaccination is symptomatic HIV infection (AIDS), but in the future asymptomatic HIV infection should be placed on alert, because fatal BCG generalized disseminations have already been experienced by HIV positive vaccinees although in a few cases in USA.

著者

露口 泉夫

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.70, no.5, pp.335-346, 1995-05-15 (Released:2011-05-24)

参考文献数

28

被引用文献数

1

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One of the unique features characterizing human tuberculosis (TB) is its pathogenesis. The pathogenesis of TB involves cell-mediated immune responses against Mycobacterium tuberculosis. Concisely, macrophages activated by various soluble mediators or cytokines released through the cellular interactions after infection with M. tuberculosis play a pivotal role in the pathogenesis of human TB. In fact, very complex cellular interactions are going on within the host after infection with or endogenous reactivation of M. tuberculosis. Cells communicate by cell-cell contact and by the release of mediators which may originate locally, called cytokines.In TB infection, macrophages can be activated by two ways directly with mycobac terial organisms or lipid fractions of their cell walls at the earlier phase of infection, and indirectly with cytokines produced by CD4+ T cells specifically activated by mycobacterial peptide antigens at the later phase of infection. The various clinical features of TB are the summarized outcome of cell to cell interactions mediated by diverse cytokines produced by various immune cells which are initially triggered by M. tuberculosis infection.CD4+ T cells can be classified into two subsets according to the patterns of cytokines they produce Thl cells give rise to cell-mediated immunity and are characterized by the production of IL-2 and IFN-γ, whereas Th2 cells are more efficient in mediating antibody production and secrete IL-4, IL-5, IL-6 and IL-10. Th2 cells can control Thl cells and vice versa. Th2 cells therefore inhibit the production of cytokines by Thl cells by releasing IL-4 and IL-10.Infection with mycobacteria stimulates macrophage IL-12 production which appears to act directly on naive CD4+ T cells to induce Thl development and initiation of cell-mediated immunity. IL-12 is a critical component in the development of cell-mediated immunity. In addition, IL-12 also activates NK cells and γ/δ T cells, both of which secrete various macrophage-activating factors to kill M. tuberculosis.One of the structural characteristics of M. tuberculosis is the cell wall rich in lipid components. Of importance among various biological activities of the cell wall lipids is the stimulation of mononuclear phagocytes to produce a certain number of cytokines or monokines including IL-12 and IL-10, both of.which play important roles in regulation of immune responses in mycobacterial infection and in pathogenesis of TB. Considering the biological characteristics of mycobacterial lipid components, we need take these lipids into consideration in the future research of TB immunology, particularly in the strategy for development of a potent TB vaccine