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PubMed2000

Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society.

This statement provides new recommendations for targeted tuberculin testing and treatment regimens for persons with latent tuberculosis infection (LTBI) and updates previously published guidelines (1,2). This statement is issued in recognition of the importance of these activities as an essential component of the TB Elimination Strategy promoted by the U.S. Public Health Service Advisory Council on the Elimination of Tuberculosis, and reports the deliberations of expert consultants convened by the American Thoracic Society (ATS) and Centers for Disease Control and Prevention (CDC). Isoniazid for 6-12 mo has been the mainstay of treatment for LTBI in the United States for more than 30 yr. However, the application of isoniazid for LTBI has been limited because of poor adherence, due to the relatively long duration of treatment required, and because of concerns about toxicity. Therefore, there has been interest in the development of shorter, rifampin-based regimens as alternatives to isoniazid for the treatment of LTBI. During the past decade, a series of studies of "short-course" treatment of LTBI in persons with human immunodeficiency virus (HIV) infection has been undertaken. The results of these trials have recently become available, and the in-depth analyses of these and prior studies of isoniazid form the scientific basis of the treatment guidelines presented in this report. In addition, many changes to previous recommendations regarding testing for and treatment of LTBI are presented (Table 1).

Antitubercular Agents↗
PubMed2000

[Why there were few isolations of tubercle bacilli in young children with pulmonary tuberculosis?].

We retrospectively evaluated the factors influencing the isolation of tubercle bacilli in 51 children under 14 years of age with pulmonary tuberculosis who were admitted to Yokohama City University Hospital from 1975 to 1998. Young children (0-6 years of age) with pulmonary tuberculosis were significantly less positive by smear and culture than elder children (7-14 years of age) with pulmonary tuberculosis. According to the Japanese Society for Tuberculosis classification of finding on chest X-ray film for pulmonary tuberculosis, the culture-positive patients with type II (cavitary lesions) were found in all, the culture-positive patients with type III (non-cavitary lesions) in 39.3%, and the culture-positive patients with type H (hilar and mediastinal lymphadenopathys) in 35.3%. Patients with cavitary lesions (type II) were significantly more positive by smear and culture than patients with non-cavitary lesions (type III + type H). Only 15.8% of the young children with pulmonary tuberculosis had received BCG vaccine and all had non-cavitary lesions (type III and type H). But, 84.6% out of the older children had received BCG vaccine and half had cavitary lesions. Taken together, the result was that there were few isolation of tubercle bacilli in young children with pulmonary tuberculosis because they had non-cavitary tuberculosis without delayed-type hypersensitivity to tubercle bacilli.

Adolescent↗
PubMed1992

[The study of pulmonary tuberculosis in the elderly].

A clinical study of 52 patients diagnosed as having pulmonary tuberculosis at National Chiba-Higashi Hospital between 1988 and 1990 was performed. The cases ranged in age from 80-89 years; mean male patient age was 82.5, and mean female patient age was 84.3. Diagnosis of the cases were as follows: 19 discovered when checking into hospital because of chest symptoms; 14 diagnosed during the treatment of other diseases; 14 diagnosed during admission to the hospital for other diseases; and five cases were detected by chest X-rays. A total of 38 cases, had received primary treatment for pulmonary tuberculosis, 11 cases had received secondary treatment, and three cases were receiving treatment for tuberculosis. Upon admission to the hospital after the detection of tuberculosis, 19 cases tested positive to sputum smear examinations, six cases tested positive to culture examinations but negative to smear examinations, and culture examinations were negative in 27 cases. Regarding the chest X-ray findings, using the criterion of roentgenological classification for pulmonary tuberculosis established by the Japanese Society for Tuberculosis, two cases revealed type I, 29 cases revealed type II, and 21 cases revealed type III. Cavitary cases were observed in 60% of the chest X-ray findings. Upon hospital admission, 18 cases were observed to have circulatory diseases, 16 cases had central nervous diseases, 12 cases had digestive diseases and 11 cases had respiratory diseases. Nine cases had malignant neoplasm, five cases had diabetes mellitus and 14 cases had other diseases. A total of 18 cases ended in death; six cases died of pulmonary tuberculosis, and 12 cases died of other diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Investigation of the cases due to Mycobacterium kansasii in our hospital].

A clinical study of 23 patients with Mycobacterium kansasii infection of the lung encountered at National Chiba Higashi Hospital from 1988 to 1990 was carried out. All 23 cases were male, aged from 25 to 81 years-old. Diagnoses were confirmed by sputum culture. The cases consisted of 15 primary infections and 8 secondary infections. Out of the 23 cases, 11 were detected by mass screening with chest X-ray findings, 10 cases were discovered when visiting the hospital because of chest complications and two cases were diagnosed during the observation of other diseases. On admission, sputum smear examinations were positive for 15 patients and negative for 8 patients. Chest X-ray findings using the roentgenological classification criterion for pulmonary tuberculosis established by the Japanese Society for Tuberculosis, 20 cases revealed a Type II shadow and three cases revealed a Type III shadow. One patient has died from another disease, two are undergoing chemotherapy, two have ceased chemotherapy treatment, and 18 patients have completed the treatment, Sputum cultures rapidly turned to negative for mycobacterium detection after chemotherapy treatment. The prognosis is considered to be quite good.

Adult↗
PubMed2006

[Comparison of sputum positive rate between bilateral and unilateral lung tuberculosis].

PURPOSE: Comparing sputum smear/culture positive rate between unilateral lung tuberculosis and bilateral ones with similar extent of lesion. SUBJECT AND METHOD: Retrospective review of patients' records in the author's hospital from Jan. 1/2002 to Sep. 30/2003. RESULTS: In unilateral (N=58) and bilateral (N=82) lung tuberculosis of "Gakkai classification" (= chest X-ray classification of lung tuberculosis according to the Japanese Society for Tuberculosis). II 2 (cavitary lung tuberculosis with moderate extent), positive rates of the initial sputum investigation by smear/Ogawa culture/MGIT were, 84.6% vs. 74.0%/ 88.5% vs. 93.2%/93.5% vs. 97.1%, respectively, and no significant difference was found. Similarly, in Gakkai classification III 1 (non-cavitary lung tuberculosis with minimal extent) and in Gakkai classification III 2 (non-cavitary lung tuberculosis with moderate extent), no significant differences were found in sputum bacilli positive rates between unilateral and bilateral lung tuberculosis. CONCLUSION: Sputum smear and culture positive rates of bilateral lung tuberculosis showed no significant differences with that of unilateral one with similar extent.

Humans↗
PubMed1996

[The characteristics of clinical features of pulmonary tuberculosis in female].

We studied the clinical features of culture-positive, previously untreated patients with pulmonary tuberculosis (77 in females and 200 in males), with special reference on the gender differences in clinical features. The mean age was 50.8 y.o. for female and 54.4 y.o. for male, and the age distribution was almost similar to that of newly-registered patients of whole Japan in 1993, namely, small peak in 20s decade and large peaks in the age group over 50 in female, and gradual increase up to 50 years and get to plateau in male. Thirty-nine % in female and fifty-four % in male had various past histories and/or complications which might affect to the deterioration of tuberculosis, such as diabetes mellitus, liver function distress, respiratory failure, malignancy, stomach resection and so on. The rates with each complication were, in general, higher in male than in female. The positive rate to Mantoux reaction was higher in female than in male, and stronger reactions were observed in female than in male. According to the classification of pulmonary tuberculosis designed by the Japanese Society for Tuberculosis (GAKKAI classification), the site(s) of affected lung, the stage and the extent of lesions were more advanced in male than in female, and the positive rate and the amount of bacilli on smear were higher in male than in female. The most marked difference was the location of the main lesions, 80% in the apical and posterior segments of upper lobe (S1,2) and 8% in the superior segments of lower lobe (S6) in male, while 60% in S1,2 and 25% in S6 in female. The rate of complete resistance against to anti-tuberculosis agents was higher in male than in female, but the combination chemotherapy of isoniasid and refampicin with streptomycin or ethambutol was almost equally effective both in males and females, and almost all patients converted to bacilli negative within three months after the initiation of the chemotherapy, except in a few male patients.

Adult↗
PubMed2005

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States.

During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.

Adolescent↗
PubMed1996

Smoking and health: a physician's responsibility. A statement of the Joint Committee on Smoking and Health. American College of Chest Physicians, American Thoracic Society, Asian Pacific Society of Respirology, Canadian Thoracic Society, European Respiratory Society, International Union against Tuberculosis and Lung Disease.

Tobacco use, particularly cigarette smoking, is widely recognized by the medical community and the general public as a major public health problem. Physicians and medical organizations share a public health duty to address this problem. Physicians and their professional organizations must contribute effectively to measures undertaken to deal with cigarette smoking. The issues involved are complex and affect medical practice in a number of ways. The following statement developed by six international organizations--the American College of Chest Physicians, the American Thoracic Society, the European Respiratory Society, the Asian Pacific Society of Respirology, the Canadian Thoracic Society, and the International Union Against Tuberculosis and Lung Disease--is intended to state the physician's responsibilities both to patients and to the community with regard to these general issues.

Adult↗