4 5

387Mass Screening Medical Examination /Y.Kobashi et al.

Abstract　Five hundred twenty-one patients with pulmonary tuberculosis were diagnosed in our three affiliated hospitals during past 10 years. Among them, 43 cases (22 men and 21 women ; mean age 54.8 years) who were detected by active case-finding were clinically evaluated. Most of them were detected in an annual mass screening examination, but seven cases were found by contacts examination which was per-formed on subjects who were contacted with newly diag-nosed patients with pulmonary tuberculosis. Fifteen of them were socially jobless on admission. Eighteen cases (41.9％)had underlying diseases, and gastrointestinal diseases and diabetes mellitus were most frequently observed. The final diagnosis was confirmed through bronchoscopic specimens in 18 cases in which Mycobacterium tuberculosis could not be detected from the sputum. Regarding radiological findings according to the criteria of the Japanese Society of Tuberculo-sis, most cases had unilateral distribution, and were classified as type Ⅲ (active, non-cavitary) for characteristics and l (mini-mal) for the extent of lesions. Treatment using combination therapy with four drugs including pyrazinamide was perform-ed for over half of these cases and subsequently the clinical efficacy was good except in one case who died due to worsen-

ing of the underlying disease.　Anti-tuberculous drugs were generally administered to cases suspected of having pulmonary tuberculosis on chest X-ray. However, early diagnosis using bronchoscopy and early treatment seems to be useful, when Mycobacterium tuberculosis is not detected in the sputum.

Key words : Mass screening medical examination, Periodical medical examination, Nonperiodical medical examination, Bronchoscopic examination

1Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, 2Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School Kawasaki Hospital, 3Department of Internal Medicine, Asahigaoka Hospital

Correspondence to : Yoshihiro Kobashi, Division of Respira-tory Diseases, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama 701_ 0192 Japan. (E-mail : resp＠med. kawasaki-m.ac.jp)　

－－－－－－－－ Original Article－－－－－－－－

CLINICAL ANALYSIS OF PULMONARY TUBERCULOSIS FOUND BYMASS SCREENING MEDICAL EXAMINATION

1Yoshihiro KOBASHI, 1Naoyuki MIYASHITA, 1Yoshihito NIKI,1Toshiharu MATSUSHIMA, 2Niro OKIMOTO, and 3Yoshito HARA

10 11

393MGIT for Quantification of AFB / K. Tsuyuguchi et al.

Abstract　The Mycobacteria Growth Indicator Tube (MGIT) system, a broth system for detection of mycobacterial growth, has been shown to be more sensitive and rapid compared with the egg-based Ogawa solid media, while the lack of ability to quantitate bacterial growth is the problem. We compared mycobacterial growth in the MGIT and the Ogawa systems, and evaluated the relationship between detection time in the MGIT system and bacterial CFU on Ogawa egg medium. A total of 413 respiratory specimens from 245 patients were included in the study, of which Mycobacterium tuberculosis (MTB), M. avium complex (MAC) and M. kansasii were recovered from 127, 42 and 6 specimens, respectively. Recov-ery rates were significantly higher and detection time was significantly shorter in the MGIT than in the Ogawa for MTB and MAC. Detection time in the MGIT was significantly shorter in smear positive specimens than in smear negative ones for MTB and MAC. There was a significant negative

correlation between CFUs on Ogawa egg medium and detec-tion time in the MGIT system for the MTB, therefore, this system may have an ability to quantitate live mycobacteria according to the detection time.

Key words : Mycobacteria Growth Indicator Tube (MGIT), Culture techniques for mycobacteria, Quantification of mycobacteria

1Department of Respiratory Disease, National Minami-Kyoto Hospital, 2Clinical Research Center, National Kinki-Chuo Hospital for Chest Diseases

Corresponding to : Kazunari Tsuyuguchi, Clinical Research Center, National Kinki-Chuo Hospital for Chest Diseases,1180 Nagasone-cho, Sakai-shi, Osaka 591_ 8555 Japan. （E-mail : tsuyuguchi＠kch.hosp.go.jp）

－－－－－－－－ Original Article－－－－－－－－

EVALUATION OF THE MYCOBACTERIA GROWTH INDICATOR TUBE SYSTEMFOR DETECTION AND QUANTIFICATION OF MYCOBACTERIA

FROM CLINICAL SPECIMENS

1,2Kazunari TSUYUGUCHI, 1Takeshi IKEDA, 1Koichi NAKATANI, 1Tomomasa TSUBOI, 1Atsuo SATO, and 1Takuya KURASAWA

Respir Crit Care Med. 1997 ; 156 : S1_S25．10） Epstein MD, Schluger NW, Davidow AL, et al. : Time to

detection of Mycobacterium tuberculosis in sputum culture correlates with outcome in patients receiving treatment for pulmonary tuberculosis. Chest. 1998 ; 113 : 379_386.

11） 鈴木克洋，露口一成，松本久子，他：Mycobacteria

Growth Indicator Tube (MGIT) による結核菌の迅速薬剤感受性検査 . 結核. 1997 ; 72 : 187_192.

12） 斉藤　宏，山根誠久：抗酸菌の培養検出法の比較検討（第2報）－全自動抗酸菌培養システム，BACTEC MGIT 960 Systemを中心として－. 臨床微生物迅速診断研究会誌. 2000 ; 11 : 19_26.

16 17

Suspected TB Outbreak in 2 Floors/N.Seki

あるが，年齢や BCG接種歴などさまざまなバイアスが

存在するため，結果については慎重な判断を要すると思

われた。また，保険所が定期外検診を実施する際には，

現場視察ときめ細かい情報収集が不可欠であると思われ

た。

文　　　献

1） 青木正和：「結核集団感染」. JATA BOOKS No.13，結核予防会, 1998.

2） 厚生省保健医療局結核・感染症対策室監修：「結核定期外健康診断ガイドラインとその解説」. 結核予防会, 1993, 66_67.

3） Lincoln EM : Epidemics of tuberculosis. Adv Tuberc Res.　　1965 ; 14 ; 157_201.4） Reffalli J, Seplpwitz KA, Armstrong D : Community-based outbreaks of tuberculosis. Arch Intern Med. 1996 ; 156 : 1053_1060.

5） 鈴木公典，山岸文雄，佐々木結花，他：若年者の多い事業所における集団感染事例の検討. 結核. 1997 ; 72 : 331.

6） 犬塚君雄：コンピューター関連職場での集団感染について. 結核. 1997 ; 72 : 333.

7） 田寺　守：職域における結核発病の長期観察から. 結核. 1988 ; 63 : 806_808.

8） 石畠英昭，鬼塚黎子：2つの酒場を舞台にした肺結核集団発生の事例. 結核. 1997 ; 72 : 623_628.

9） Kline SE, Hademark LL, Davies SF : Outbreak of tuberculo-sis among regular patrons of a neighborhood bar. New Eng J Med. 1995 ; 333 : 222_227.

10） 神山智子，遠藤忠昭，佐藤和雄：事業所における結核集団感染事例. 日本公衛誌. 1997 ; 44 : 474_480.

11） 佐々木結花，山岸文雄，水谷文雄：中高年者を中心に生じた多剤耐性結核菌による集団感染事例. 結核. 1999 ; 74 : 549_553.

12） 田丸亜貴，鈴木定彦：RFLP分析による結核小規模感染事例の疫学的研究. 結核. 1999 ; 74 : 555_561.

13） 佐々木結花，山岸文雄，八木毅典，他：若年者の交遊関係を中心に感染が拡大した肺結核集団感染の 1事例. 結核. 1999 ; 74 : 849_854.

14） 成田友代，永田容子，上間和子：中年齢層を中心とした事業所における集団感染. 結核. 1999 ; 74 : 863_868.

15） 末安禎子，力丸　徹，大泉耕太郎：某事業所における結核集団発生事例の検討. 日胸. 2000 ; 1 : 1_8 .

16） 宍戸真司，山根聖子，斉藤誠一郎，他：広領域圏に発生した結核集団感染の 1事例. 日胸. 2000 ; 1 : 9_15.

17） Syed Q, Bellis MA, Beeching NJ, et al.：Tuberculin testing in two Liverpool social club : the effect of a tuberculosis outbreak on background positivity. Thorax. 1996 ; 51(6) ; 624_627.

Abstract　 The number of tuberculosis outbreak among adult groups has increased. In some of them, it is difficult to identify the route of infection and sometimes many people are involved in the outbreak. We experienced a suspected case of mass outbreak in a small company separated into 2 floors.　The first patient, who lived in another city, was diagnosed as pulmonary tuberculosis in April with bilateral extensive cavitary lesions complicated with pleurisy on chest X-ray, and his sputum smear was Gaffky No. 8 and culture (＋) (resistant to isoniazid).　We conducted tuberculin skin test (TST) for those under-30 year-old. In TST, 4 persons showed strong positive reaction. After consulting with tuberculosis specialists, three were diagnosed as newly infected with tuberculosis and one as hilar lymph node tuberculosis. So we added 25 staffs under 60s for TST and found that another 13 people were suspected to be infected with tuberculosis.　From the initial information, the index cast was said to work only in the 2nd floor, so the staffs in 7th floor were

excluded from the survey. Through the interview with staffs by a public health nurse and an inspection of the work place with sanitary inspectors, it was concluded to expand the survey to the staffs working in the 7th floor, and another newly infected persons were found. Staffs in a small company do not belong to "danger group", but the importance of investigations by public health officials was suggested in the case of suspected outbreak.

Key words : Outbreak, Air born disease, Small company staff, Tuberculin skin test

1Ikebukuro Public Health Office, Toshima City, 2Department of Public Health, Juntendo University of Medicine

Correspondence to : Naomi Seki, Ikebukuro Public Health Office, 1_20_9 , Higashi-Ikebukuro, Toshima-ku, Tokyo 170_0013 Japan. (E-mail:QYK15400＠nifty.ne.jp)

－－－－－－－－ Report and Information－－－－－－－－

A SUSPECTED CASE OF MASS OUTBREAK OF TUBERCULOSIS INFECTION IN A SMALL COMPANY SEPARATED INTO TWO FLOORS

1, 2Naomi SEKI

399

24

結核 第78巻 第 5号 2003年 5月406

Abstract　A 71-year-old male was admitted to our hospital with dyspnea on effort. He had been prescribed rifampicin, isoniazid sodium methanesulfonate (IHMS), and ethambutol for pulmonary tuberculosis, and ursodesoxycholic acid for alcoholic liver dysfunction. The chest HRCT revealed diffuse ground-glass attenuation with interlobular interstitial thicken-ing. BALF showed lymphocytosis, and TBLB revealed organizing pneumonia. All medications were interrupted, and his respiratory failure and chest HRCT findings were improved. He started again medications excluding IHMS, his condition continued to improve further. DLST to causative IHMS was negative with peripheral blood lymphocytes, but was positive with lymphocytes from BALF. Therefore, we diagnosed this case as having IHMS induced interstitial pneumonia. In the past, 5 cases of isoniazid induced interstitial pneumonia were reported, but IHMS induced interstitial

pneumonia has not been reported. Clinicians need to be aware of drug induced interstitial pneumonia by anti-tuberculosis drugs including IHMS in patients receiving anti-tuberculosis drugs.

Key words : Drug-induced interstitial pneumonia, Isoniazid sodium methanesulfonate, Isoniazid, Bronchoalveolar lavage fluid, Drug lymphocyte stimulation test

Department of 1Pulmonary Medicine, and 2Surgery, Saitama Cardiovascular and Respiratory Center

Correspondence to : Hidekazu Matsushima, Department of Pulmonary Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kohnan-machi, Ohsato-gun, Saitama 360_

0105 Japan. (E-mail : a0198690＠pref.saitama.jp)

－－－－－－－－ Case Report－－－－－－－－

A CASE OF ISONIAZID SODIUM METHANESULFONATEINDUCED INTERSTITIAL PNEUMONIA

1Hidekazu MATSUSHIMA, 1Yutaka SUGITA, 1Tsutomu YANAGISAWA, 1Mikio UBUKATA,2Tomonori KUROSAWA, 1Fumika YOSHIDA, and 1Minoru KANAZAWA

28

Abstract　An 81-year-old man was admitted to our hospital because of pericardial effusion and sputum PCR positive for Mycobacterium (M.) tuberculosis. Since adenosine deaminase (ADA) value of the pericardial effusion was not high and the sputum smear and culture were negative, anti-tuberculous therapy was not started. Two months later he was admitted again because of high fever and cardiomegaly. Chest com-puted tomography showed deterioration and the sputum culture revealed M. tuberculosis. The ADA value of the pericardial effusion which was not high at the first admission, was elevated in the second admission, and the diagnosis was made as tuberculous pericarditis two months later. We had better start anti-tuberculous therapy at the first admission, in

spite of low value of ADA, as his pericardial effusion showed lymphocyte predominance.

Key words : Tuberculous pericarditis, Pericardial effusion, Adenosine deaminase

Department of Pulmonary Medicine, National Matsue Hospi-tal

Correspondence to : Shuichi Yano, Department of Pulmonary Medicine, National Matsue Hospital, 5_8_31, Agenogi, Matsue-shi, Shimane 690_8556 Japan. (E-mail : yano＠matsue. hosp.go.jp)

－－－－－－－－ Case Report－－－－－－－－

A CASE OF TUBERCULOUS PERICARDITIS, THE DIAGNOSIS OFWHICH WAS COMPLICATED BY THE DELAY IN THE RISE OFADENOSINE DEAMINASE IN THE PERICARDIAL EFFUSION

Shuichi YANO, Kanako KOBAYASHI, Kazuhiro KATO, and Shinji SAITO

1994 ; 89 (6) : 2728_2735.4） Burgess LJ, Reuter H, Carstens ME, et al. : The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis. Chest. 2002 ; 122 (3) : 900_905.

5） Martinez-Vasquez JM, Ribera E, Ocana I, et al. : Adenosine deaminase activity in tuberculous pericarditis. Thorax. 1986 ; 41 : 888_889.

6） Rooney JJ, Crocco JA, Lyons HA: Tuberculous pericarditis. Ann Intern Med. 1970 ; 72 : 73_78.

7） Crocco JA : Cardiovascular tuberculosis. In : Tuberculosis and nontuberculous mycobacterial infections, 4th ed., Schlossberg D, ed., W. B. Saunders Co., Philadelphia, 1999,

221_228.8） Strang JIG, Kakaza MMS, Gibson DG, et al. : Controlled clinical trial of complete open surgical drainage and of predonisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet. 1988 ; 2 : 759_764.

9） Hakim JG, Ternouth I, Mushangi E, et al. : Double blind randomized placebo controlled trial of adjunctive predoniso-lone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart. 2000 ; 84(2) : 183_188.

10） Strang JI : Rapid resolution of tuberculous pericardial effu-sion with high dose prednisone and antituberculous drugs. J Infect. 1994 ; 28 : 251_254.

結核 第78巻 第 5号 2003年 5月410