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PubMed2005

[The clinical study on efficacy of clarithromycin, levofloxacin, and streptomycin for pulmonary Mycobacterium avium-intracellulare complex infection].

OBJECTIVE: The purpose of this study was to elucidate retrospectively the clinical effects of using RFP, EB, CAM, LVFX, and SM for pulmonary Mycobacterium avium-intracellulare complex infection. MATERIALS AND METHODS: During 9-year (1995-2003) period, 72 patients diagnosed according to the criteria of the Japanese Society for Tuberculosis Guidelines and treated for at least 6 months were available for this study. RESULTS: The age averaged 68 (range, 32-92) years. The male to female ratio was approximately 2 : 3. The follow-up period averaged 344 (190-365) days. 59 of 72 patients were treated for the first time. 58 of 72 patients were diagnosed as primary infection type. Among them, 20, 38, and 14 patients were treated by RFP, EB, and CAM (REC group), RFP, EB, CAM and LVFX (LVFX group), and RFP, EB, CAM, and SM (SM group), respectively. Comparing the baseline patient characteristics among three groups, we found significant difference (measured by ANOVA) in gender (male/female, REC group: 8/12, LVFX group: 20/18, and SM group: 2/12, p < 0.05), age (REC group: 75.2 +/- 9.1, LVFX group : 66.5 +/- 12.5, and SM group: 63.9 +/- 11.9, p < 0.01) and body mass index (REC group: 17.2 +/- 2.9, LVFX group: 18.9 +/- 2.8, and SM group: 19.7 +/- 2.4, p < 0.05). However, we did not find any significant difference in the clinical outcomes (improving rate of the symptoms, change of the erythrocyte sedimentation rate, improving rate of the chest X-ray, and the results of follow-up on bacteriological effect). In the 60 of 72 patients treated for 1 year, the results were superior to those of some previous reports (1-year improving rate of the symptoms, 1-year improving rate of the chest X-ray, 1-year improving rate of the sputum conversion, and 1-year rate of the relapse were 54.3%, 65.0%, 60.0%, and 15.3%, respectively). CONCLUSION: Further study was warranted that no advantage was shown by an additional use of LVFX or SM on REC from the point of view of the clinical effects for pulmonary Mycobacterium avium-intracellulare complex infection, in spite of the higher age and deteriorated nutritional status of REC group.

Aged↗
PubMed2005

[The non-tuberculous mycobacteriosis].

The Japanese Society for Tuberculosis officially announced that public name of "atypical mycobacteriosis" was changed to the Nontuberculous Mycobacteriosis, on April 2003. We sent out questionnaires on number of nontuberculous mycobacteriosis (NTM) to 2051 respiralogists. The number of newly diagnosed NTM patients from Apr. 2001 to Sep. 2001 were 1522 cases, those were 29.2% of all mycobacteriosis containing TB. The M. avium-intracellulare (MAC) disease took up 82.8% of all NTM, and M. kansasii disease took 8.1%. The rare species were M. gordonae, M. abscessus, M. fortuitum, M. chelonae, M. szulgai, M. scrofulaceum and M. xenopi. The former investigations noted that in the northan half of Japan, M. avium disease predominated M. intracellulare disease in MAC, and M. intracellulare disease overwhelmed in the southern half of Japan. Our newest examination revealed that in the northan half, M. avium is predominant but, in the southern half, the rate of two species is almost the same. Dr. Kobashi and his group surveyed the effect of combined chemotherapy following the guidelines on treatment for MAC disease. They revealed that the clinical effect of the combined chemotherapy (RFP, EB, SM and CAM) was better than that of the other regimens. However the efficacy of this therapy was unsatisfactory compared with the effect for pulmonary TB.

Adult↗
PubMed2005

Talking about TB: multicultural diversity and tuberculosis services in Waikato, New Zealand.

AIM: To explore the diversity of opinion amongst different refugee and minority group representatives about tuberculosis, and to examine the provision of services and their effectiveness in the Waikato Health District, New Zealand. METHODS: Open-ended qualitative interviews with the representatives of seven minority populations were undertaken. The interviews focused on the cultural differences in the approach of minority populations to health issues and on the accessibility of health services to these population groups. Participants expressed their opinions about how health services, and more specifically about how tuberculosis (TB) health services could be improved. RESULTS: Important cultural differences between the minority populations were elucidated by community representatives that may determine the interpretation of symptoms and timing of presentation at medical services, the appropriate cultural processes to be followed in the consultation, and adherence to prescribed treatment. CONCLUSIONS: The absence of health services oriented towards specific minority and refugee groups, and communication difficulties with healthcare providers, are important cultural barriers to TB control in Waikato. Recognition of the diversity of these populations, and the cultural and structural barriers that they face in accessing health services in Waikato and other similar health districts in New Zealand, is needed. The development of strategies is required to reduce barriers to TB treatment so that patients from diverse cultural backgrounds can be diagnosed early and effectively treated.

Attitude of Health Personnel↗
PubMed1989

Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison.

The International Union against Tuberculosis and Lung Disease (IUATLD) Bronchial Symptoms Questionnaire (1984) was developed for use in studies of asthma and its reliability measured in an earlier survey in England. The association of the symptoms elicited by this questionnaire to bronchial response to histamine has also been described. This paper presents the results of studies of the questionnaire in four clinical centres in Europe. The reliability of the questionnaire and its ability to predict the bronchial response to histamine were compared for English, Finnish, French and German translations of the questionnaire in samples of diagnosed asthmatics and controls in Nottingham, Berlin, Helsinki and Paris. The answers to questions showed good repeatability, especially in Finland and Germany, particularly those questions on asthma and wheeze. The most sensitive symptom for predicting hyperresponsiveness was the question on wheeze, the most specific questions were those on waking at night with shortness of breath (Paris and Nottingham) and morning tightness (Helsinki and Berlin). This study shows that the IUATLD (1984) questionnaire may provide useful, valid and comparable data even in translation but these studies will need to be repeated in representative samples before such a possibility is accepted as fully demonstrated.

Adult↗
PubMed1988

AIDS WHO and IUATLD.

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Acquired Immunodeficiency Syndrome↗