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PubMed2002

[Interpretive compatibility of antimycobacterial susceptibility for Mycobacterium tuberculosis determined by proportion test method on egg-based Ogawa media and broth microdilution test, BrothMIC MTB].

The antimycobacterial susceptibility test method newly proposed by the Japanese Society for Tuberculosis, a proportion method on egg-based Ogawa media, was evaluated in comparison with microdilution test for Mycobacterium tuberculosis complex, BrothMIC MTB-1 (Kyokuto Pharmaceutical Inc., Tokyo). In the evaluation, five antimicrobial agents, streptomycin, ethambutol, kanamycin, isoniazid and rifampicin were included. Through repeated testings of the three reference strains against five antimicrobial agents, both test methods were found to be highly precise. All the minimum inhibitory concentrations (MICs) determined by BrothMIC MTB fell within 3 log2 dilutions, however a total of 11 MICs resulted in indeterminate(I) interpretations. Whereas, all the test results by a proportion method on Ogawa media were comparable to the expected interpretations. However, three of 48 testings resulted in undeterminable interpretations due to insufficient growth on the growth control media. A total of 127 clinical isolates of M. tuberculosis complex were tested by both methods, and 89 to 90% of the test results were comparable with each other in category interpretations. However, 7.1 to 9.4% of MICs determined by BrothMIC MTB resulted in indeterminate(I), and 0.8 to 3.1% of discrepant interpretations were observed. In conclusion, both test methods were highly precise and comparable in determining antimycobacterial susceptibility for M. tuberculosis complex. Several advantages and disadvantages in each test method were discussed.

Antitubercular Agents↗
PubMed1998

[Education and training for tuberculosis in medical schools and in hospitals].

The recent decrease of the number of tuberculosis patients in Japan, by the economical development and the establishment of standard regimen with INH, RFP, SM/EB and PZA, have brought decrease of concern to tuberculosis not only in the masses but also in the medical personnel, and the worsening of the medical economy by the advancing of the ages in the nations is forcing to close the tuberculosis wards. On the other hand, the recent situation of tuberculosis in Japan, such as the increase of HIV infection, the additional inflow of the foreign tuberculosis patients, the increase of tuberculosis patients in the younger population by the increase of mass-infection, and recent progress of the maldistributions of the tuberculosis patients realized the efforts of the education and training for tuberculosis to the medical students and medical personnel, even in the increase of items that they must learn. The Japanese Society for Tuberculosis set a Symposium "How Tuberculosis be Taught in Medical Education" in 1986. It will be worth to have Round Table Discussion concerning to the education and training for the tuberculosis, after 11 years. Doctor Sato from Nagoya City University reported as follows. To survey the actual condition of tuberculosis education before graduation, a nationwide medical school questionnaire survey was carried out. Answers were received from 80 institutions (100%). It was found that 58 institutions (72%) lacked tuberculosis ward. When the results from this survey, in the area of medical school lecture, were compared to the previous survey of 11 years ago, it showed a decrease in the time and frequency that tuberculosis covered during lecture. This tendency was clearly seen, with the exception of internal medicine, in surgery, in plastic surgery, in urology and in public health. Furthermore, medical schools lacking tuberculosis ward were found to have a lesser percentage of clinical lectures and bed-side teaching when compared to ones with tuberculosis ward. He concluded that in the medical school without tuberculosis ward, the tuberculosis education is virtually impossible, and it is necessary to carry out with hospitals that have tuberculosis ward. Doctor Honda from Sapporo Medical University reported that in the University Hospital, the Third Department of Internal Medicine holds 6 isolation sick-beds for tuberculosis (3 for men and 3 for women) which containing an exclusive day room and bath room, in 52 beds alloted to their department. They always give 2 or 3 lectures about tuberculosis to medical students and also give bed-side teaching using these beds. He concluded education on tuberculosis is necessary for the protection of doctor's delay, and the tuberculosis ward in the university is very useful in the education of tuberculosis to medical students, even the economical efficiency of these beds are low. Doctor Nakabayashi from Sapporo National Hospital reported that his hospital is a general hospital with 513 beds but has no tuberculosis-bed, and that this hospital is combined with Hokkaido Cancer Center and 91.7% of in-patients of pulmonary division are lung cancer and one or two residents are trained in pulmonary division by 6 months rotation. He also reported that in his hospital, 18 mycobacteria positive cases were treated through 1996, however the training for tuberculosis to residents are mainly by the differential diagnosis of tuberculosis with lung cancer through case conferences with staff doctors. Doctor Yosikawa from Daido Hospital reported as follows. In his hospital, tuberculosis-beds and other respiratory-beds are in the same nursing unit managed with the same standard for nursing, although tuberculosis-beds are separated from other respiratory-beds by door and have exclusive toilets and bath-room. The doctors could study general respiratory diseases and tuberculosis at the same time. Thirteen doctors have finished this training, and all of them could deepen their knowledge to tuberculosi

Education, Medical, Graduate↗
PubMed1998

[Multidrug-resistant tuberculosis. 1. Drug susceptibility testing and its standardization].

Drug susceptibility testing is one of the most difficult procedures to standardize in mycobacteriology laboratories. International standardization of the test is needed for comparative evaluation of controlled chemotherapeutic trials, for epidemiological surveys on the prevalence of drug resistance, and for guidance in the treatment of tuberculosis patients. In 1996, a new procedure for drug susceptibility testing was proposed by an ad hoc committee of the Japanese Society for Tuberculosis. The proposal is for a test with the proportion method using an Ogawa egg medium similar to those recommended by the WHO. Resistance is expressed as the percentage of colonies that grow on critical concentrations of the drugs, i.e. 0.2 microgram/ml for isoniazid, 40 micrograms/ml for rifampicin, 10 micrograms/ml for streptomycin and 2.5 micrograms/ml for ethambutol. Strains of tubercle bacilli which are grown on drug-containing media represents more than 1% of the number of colonies that develop on drug-free media are considered to be clinically resistant to that agent. The results are recorded as susceptible (S) or resistant (R) on the laboratory forms. The proportion method using agar- and liquid-based media is used worldwide. In the near future a test with agar- or liquid-based media will be discussed for standardization of the test in Japan, as described by the National Committee for Clinical Laboratory Standards of the United States.

Humans↗
PubMed1991

[Twelve cases of laryngeal tuberculosis].

Between 1986 and 1990 we had twelve patients (ten males, two females, 19-65 years of age) with laryngeal tuberculosis who complained hoarseness and whose larynges were examined by fiberscopes. Chest roentgenograms revealed cavities in ten and in seven the lesions were extensive (Grade 3 according to the classification of Japanese Society for Tuberculosis). In all patients sputum smears were positive. Both patient's and doctor's delays were longer than those of patients with pulmonary tuberculosis without laryngeal involvements. Group infection was the source of infection in one patient. Since the diagnosis of laryngeal tuberculosis is difficult to make on clinical basis, it is important to make fiberscopic examinations of the larynx and do biopsies in patients with pulmonary tuberculosis who complain hoarseness.

Adult↗
PubMedDate not supplied

[Donato G Alarcón, founder of institutions devoted to respiratory diseases in Mexico].

Dr. Donato G. Alarcón was the founder director of the National Institute of Respiratory Diseases recently named "Ismael Cosío Villegas ", officially established on December 31, 1935. He was also the first president of the Mexican Society of Tuberculosis Studies, and the first director of its journal: the Mexican Journal of Tuberculosis and Respiratory Diseases, both starting in 1939 and the first general director of the National Committee of Fight Against Tuberculosis. In Mexico only Dr. Donato G. Alarcón, in the respiratory diseases, and Dr. Ignacio Chávez, in the cardiovascular diseases, took the initial responsability of the three equivalent institutions: the National Institute, the Society of Specialists and the journal of the specialty. He was also the first pulmonologist elected director of the National Academy of Medicine of Mexico and director of the Faculty of Medicine of the National Autonomous University of Mexico.

Academies and Institutes↗
PubMed2005

[Chemoprophylaxis for tuberculosis].

In Japan, a person who is 29 or younger, contacted a tuberculosis patient recently and judged to have received infection is the object of the chemoprophylaxis by the public expenditure. On the other hand, in ATS/CDC, they call chemoprophylaxis as the treatment of latent tuberculosis infection, and if there is a strong possibility that a person may appear tuberculosis, they start chemoprophylaxis, regardless of age. We usually prescribe isoniazid for latent tubercular infection. The period of prescription is at least 6 months, which is effective, but 9 months is more desirable. Recently, in the West, tuberculosis are frequent among patients who are administered Infliximab, anti-tumor necrosis factor-alpha. In Japan, after 6 months' evaluation period for Infliximab medication to rheumatoid arthritis, 11 out of 2,000 became tuberculosis (100,000 to 550). As for the tuberculin reaction before Infliximab medication, 2 were un-carrying out and 4 were negative. Moreover, even in positive examples, many of them were small redness. From this result, the Japanese Society for Tuberculosis and the Japan College of Rheumatology advised jointly. Those who are using immunosuppressant drugs and a doctor judged that they need chemoprophylaxis are supposed to the start medication if they are positive in tuberculin reaction, or there are some proof of tubercular infection on chest X-ray film, or there are high possibility of having received tubercular infection. By carrying out active chemoprophylaxis regardless of age, tuberculosis from high risk group is expected to decrease.

Adolescent↗
PubMed1992

[Short course chemotherapy and relapse in pulmonary tuberculosis in Japan].

As far as short course chemotherapy of pulmonary tuberculosis is concerned, Japan is considered to have been a little behind the trend of the world in the past. However, since 1978 the concept of the chemotherapy has begun to be adopted in some hospitals and research councils (Cooperative Study Unit of Chemotherapy of Tuberculosis of National Sanatoria, Tuberculosis Research Committees, Ryoken), and then seems to be prevailing in other hospitals as the results of their gradual understanding. This movement has likely been accelerated since Dr. W. Fox came to Japan in 1978 at the invitation of Japanese Society of Tuberculosis and gave us much information and suggestion through his special lecture on short course chemotherapy of tuberculosis. Fifteen years have past since short course chemotherapy started in Japan. At this opportunity, I would like to review the results of short course chemotherapy studies reported by Japanese investigators. Bacteriological relapse rates in cases followed-up for three years and for from five to nine years after the end of short course chemotherapy were 1.9% (20 out of 1067) and 3.3% (26 out of 783), respectively. According to the analysis of the time of relapse after completion chemotherapy, bacteriological relapses could be divided into two types. One was early relapse which occurred within one year after completing treatment, and the other was late relapse which occurred two or three years after completing treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitubercular Agents↗
PubMed1992

Chest roentgenogram classification and clinical parameters in patients with active pulmonary tuberculosis.

The relationship between the clinical parameters and chest film appearance was studied in patients with active pulmonary tuberculosis. Patients with extended disease were often malnourished and had weak tuberculin reaction accompanied by lymphopenia. They excreted a large amount of mycobacterial bacilli and a longer period was required for negative conversion of sputum culture. We confirmed that the criteria for chest roentgenogram classification established by the Japanese Society for Tuberculosis ("Gakkai Classification") is useful in the estimation of the risk of infection and the prognosis of tuberculosis patients.

Adolescent↗
PubMed1996

[Study of erythrocyte sedimentation rate in patients with pulmonary tuberculosis].

We studied the erythrocyte sedimentation rate (ERS) and related factors that influence ESR in 326 patients with Pulmonary tuberculosis. The ESR tended to be higher for aged subjects and showed a difference between patients under 59 years old and patients over 60 years old. Besides, patients under 30 years old tended to present lower ESR. It is suggested that they may be under the influence of inapparent infection. For The Japanese Society for Tuberculosis Classification, a significant difference was noted in the extent, but there was no difference about the presence of cavity. A significant correlation was detected between ESE and Gaffky scale, ESR and CRP, and ESR and period until sputum culture became negative. But CRP negative cases were observed in about 28%. CRP alone was not sufficient for the evaluation of the morbid condition of Mycobacterium infection. Receiver-Operator Characteristic curve analysis confirmed that ESR is useful among patients with pulmonary tuberculosis. Therefore evaluation of ESR together with CRP was needed.

Adult↗
PubMed1996

[Epidemiologic study of the actual investigation of chronic excretors of Mycobacterium tuberculosis bacilli].

Of 1,295 patients with tuberculosis who were admitted in 33 Japanese national sanatoriums from September to October, 1994, actual investigation of patients with persistent expectorate tubercle bacilli continuously for more than 12 months was carried out by questionnaire. From the result, numbers of patients who had persistently expectorated bacteria were 85 (6.6% of inpatient). The rate of male and female was 3:1, and mean age was 63.5 years old. Many slim type patients (less than 90% of the standard body weight) were observed at the rate of 55.8%. The rate of the inpatient whose admission period was for more than 10 years were found in 22%. The past history of the tuberculosis and surgical therapy were existent at the rate of 83.3% and 18.8% respectively. The chief complications such as diabetes mellitus (12.4%), pyothorax (10.1%), alcoholism (10.1%) and hepatic dysfunction (6.7%) were observed at the respective rate. As chest X-ray findings on admission, severe cases with cavity of I or II 3 by the classification of the Japanese society for tuberculosis were found in 32.2%, and many cases with much amount persistently excreted bacteria such as more than number 7 of Gaffky scale (24.7%) or 3+ by culture (55.8%) were detected by sputum-test on admission. From the result drug-resistance, resistance of the main drugs early found from initial medication, and high degree resistance of isonicotinic acid hydrazide (INH; 80%), rifampicin (RFP; 94.4%), ethambutol (EB; 85.6%) and streptomycin (SM; 76.4%) was found. As intractable causes which were indicated by doctor in charge, drug-resistance, drug allergy, disorder of life, unfavorable medication-compliance and unsuitable treatment were considered.

Adult↗