• Korean Journal of Head & Neck Oncology
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• v.33 no.2
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• pp.39-42
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• 2017

Tuberculosis is primarily a pulmonary disease and extrapulmonary involvement of the oral cavity is an infrequent occurrence accounting for 0.2 - 1.5% of all extrapulmonary sites. The authors report a case of primary tuberculosis of the oral tongue in a 60-years-old male patient who visited the clinic for ongoing tongue pain that he experienced for several months. The lesion was initially indistinguishable from the malignancy, but differential diagnosis was performed on the biopsy with Ziehl-Neelseen stain. After treatment with anti-tuberculosis, the oral lesion healed completely without surgery.

• Tuberculosis and Respiratory Diseases
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• v.63 no.1
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• pp.67-71
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• 2007

결핵은 일차적으로 폐에 주로 발생하지만 혈행성 전파를 통하여 모든 기관에 나타날 수 있으며 면역 억제자의 경우 특히 가능성이 높다. 저자들은 평소 건강했던 속립성 폐결핵 환자에서 간, 비장, 신장, 뇌막 및 뇌실질에 동시에 나타난 다발성 결핵을 보고한다.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.129-133
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• 2008

Although the incidence of tuberculosis has been decreased due to new anti-tuberculous agents, improved socioeconomic status and development of multimodal preventive methods, in recent that is increased due to low vaccination rate and appearance of multidrug resistence organism. And the incidence of pyogenic shoulder joint arthritis is increasing due to frequent injection therapy as primary treatment. We have managed the mixed shoulder joint arthritis-pyogenic and tuberculous-with arthroscopic debridement and antituberculous medication successfully and then we report this case with relevant literatures.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.325-333
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• 2001

Background : This study aimed to estimate the clinical outcome and identify the characteristics of a group of patients with pulmonary tuberculosis who completed anti-tuberculosis therapy with the First-line drugs in spite of having positive smear results with negative sputum culture results over the previous six months. Method : A retrospective chart review of 21 patients who fulfilled the above criteria between 1995 and 1999 was performed. The laboratory data as well as the clinical data of the patients with positive smear results and negative culture results over a six months period were reviewed. Results : The negative conversion of sputum culture results was achieved within $1.3{\pm}1.2$ months and the negative conversion of the sputum smear results was accomplished during $9.5{\pm}3.3$ months. Chest X-rays at 5 months following the institution of anti-tuberculosis therapy from all patients revealed improvements. Four out of 21 patients(19%) relapsed during the follow up, $15.2{\pm}13.4$ months after administering anti-tuberculosis therapy for $13.3{\pm}3.1$ months. Relapses were confirmed from between 3 months and 4 months after the treatment completion. Only one of the four relapses had no past history of anti-tuberculosis therapy and the others had prior treatment twice (p<0.01). The period of anti-tuberculosis treatment was extended to a mean of $4.6{\pm}2.6$ months in 12 patients. However, prolongation of anti-tuberculosis therapy had no affect on the relapse rate (odds ratio, 95% CI 0.18, 2.15). Conclusion : Prolongation of therapy with the First-line drugs is not necessary for patients with persistently positive smear results over 6 months and negative culture results. A patient who has had prior anti-tuberculosis therapy more than twice should be paid the closest attention.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.767-774
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• 1999

Background : Tuberculous mediastinal lymphadenitis (TML) is a relatively commonly encountered in Korea. However, there were no datas available on TML without other combined tuberculous infections in Korea. We retrospectively analyzed clinical manifestations, radiologic findings, Chest CT scan findings, the duration of treatment, and follow up Chest CT scan findings of 23 cases who had only TML. Method : 23 cases from 1991 to 1997 with TML confirmed by biopsy and had no other combined tuberculous infections were studied retrospectively. Results : Of the 23 cases, 7 cases were male and 16 female. The male to female ratio was 1 : 2.4. Mean age was 31 years and the most prevalent age group was the 3rd decade(43%). The most common presenting symptoms were fever(39%) followed by no symptom, cough, swallowing difficulty, and chest discomfort. On simple chest X-ray, mediastinal enlargement were noted in 20 cases(90%). The most frequently involved site was the paratracheal node in 11 cases with the right to left side involvement ratio being 4.6 : 1. On chest CT scan, the most commonly enlarged node was the paratracheal node(33%) followed by the subcarinal(20%), hilar(13%), tracheobronchial (8%), subaortic(8%), supraclavicular(8%) and anterior. mediastinal nodes. 6 cases were dropt out due to incomplete follow up. Thirteen cases were treated with HERZ regimen and the mean duration of treatment was 14 months. Three cases were treated with second line drug regimens(Tarivid, Pyrazinamide, Streptomycin plus Ethambutol or Para-aminosalicylic acid) for 18 months. In HERZ groups, one case was recurred after 10 months later and retreatment was done by same HERZ regimen during 12 months. Follow up chest CT scan after completion of treatment were done in 13 cases and that revealed more than a 50% decrease in size in 77% of the cases and no interval change in 23% of the cases. Conclusion : In cases of TML without other combined tuberculous infection, the minimal duration of treatment was required 12 months by HERZ regimen and 18 months by a 2nd line regimen or more. Further studies will be needed to confirm the treatment duration for TML without other combined tuberculous infections.

• Journal of agricultural medicine and community health
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• v.30 no.2
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• pp.127-135
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• 2005

Objectives: This study was conducted to investigate the trend of tuberculosis mortality rate by years and by areas. Methods: We calculated raw and age-adjusted mortality rate of tuberculosis from 1995 to 2002. The calculation was based on the data from resident registration data and death certification registration data gathered by 232 basic local authority. We used direct age standardization method for calculating age-adjusted mortality rate. We compared patterns of change in tuberculosis mortality rate of metropolitan areas, cities, and countryside by determinating the comparability of medels to explore linear relationship. We also analyzed the data of mortality rate between urban and rural area by comparing ANOVA and post-hoc by two periods: one from 1995 to 1998, and the other from 1999 to 2002. Results: In national mortality rate, both raw and age-adjusted mortality rate showed negative linear relationship. However, the graph become more horizontal: the slope line is close to zero. From 1995 to 1998, countryside showed significantly higher age-adjusted mortality rate than in metropolitan areas and cities. Ever after considering more horizontal graph in national mortality rate, the data shows that the countryside still have significantly higher mortality rate from 1999 to 2002. In model diagnostic checking, metropolitan areas and cities showed apparently linear pattern on the decrease of age-adjusted mortality rate. Pattern of mortality rate in countryside was decreased initially, but became flat. Conclusions: Further research is necessary to explore the characteristics of quality of tuberculosis control program in rural area. Different approach and strategies should be considered to decrease tuberculosis mortality rate in rural areas.

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.155-165
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• 2000

Background: The phagolysosomal function of alveolar macrophage against M. tuberculosis infection is influenced by Nramp1, which is encoded by the NRAMP1 gene. There are several genetic polymorphisms in NRAMP1, and these polymorphisms affect the innate host resistance through the defect in production and function of Nramp1. To investigate this relationship, the NRAMP1 genetic polymorphism in patients with primary tuberculous pleurisy was determined. Methods: Fifty-six primary tuberculous pleurisy patient, who were diagnosed by pleural biopsy, were designated to the pleurisy group and 45 healthy adults were designated to the healthy control group. Three genetic polymorphisms of NRAMP1, such as a single point mutation in intron 4(469+14G/C, INT4), a nonconservative single-base substitution at codon 543 that changes aspartic acid to asparagine(D543N) and a TGTG deletion in the 3' untranslated region(1729+55delI4, 3'UTR), were determined. Polymerase chain reaction(PCR) and polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) were used. Results: The frequencies of mutant genotypes of INT4 and 3'UTR were significantly high in pleurisy group(p=0.001, p=0.023). But the frequencies of D543N were not significantly different between the two groups(p=0.079). The odds ratios, which are a comparison with wild genotype for determining mutant genotypes, were 8. 022(95% confidence interval=2.422-26.572) for INT4 and 5.733(95% confidence interval = 1.137~28.916) for 3'UTR ; these were statistically significant But the ratio for D543N was not significant In the combined analysis of the INT4 and 3'UTR polymorphisms, the odds ratios were 6.000(95% confidence interval = 1.461~24.640) for GC/++ genotype and 14.000(95% confidence interval=1.610~121.754) for GC/+del when compared with GG/++ homozygotes ; these were statistically significant. Conclusion: Among the NRAMP1 genetic polymorphisms, a single point mutation in intron 4(469+14G/C, INT4) and a TGTG deletion in the 3' untranslated region(1729+55del4, 3'UTR) were closely related to the primary tuberculous pleurisy.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.484-488
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• 1994

Background : The antigen-specific receptor on the surface of most peripheral T lymphocytes is a disulfide-linked heterodimer composed of $\alpha$ and $\gamma$ subunits, noncovalently associated with CD3 polypeptides. Recently, a novel type of CD3-associated heterodimer was described on a T cell subset that does not express CD4 or CD8 molecules. This second type of TCR dimer is composed of chains encoded for by the $\gamma$- and $\delta$-TCR genes. These cells may exert both cytotoxic and lymphokine producing functions. Although it was reported that some ${\gamma}{\delta}$-TCR might recognize an MHC-linked determinant, the funεtion or physiologic ligand for this new receptor is not yet clear. It was found that ${\gamma}{\delta}$-TCR can react with 65 kD heat shock protein of M. tuberculosis, which suggests the possible protective role of ${\gamma}{\delta}$ T lymphocytes against tuberculosis. In our previous study, there was neither the increase in number nor the functional activation of ${\gamma}{\delta}$ T cells in the peripheral blood from patients with pulmonary tuberculosis. Now we report the distribution of ${\gamma}{\delta}$ T cells in the regional sites of M. tuberculosis infection, especial1y tuberculous lymphadenitis. Methods : Lymph nodes from patients with pathologically-proven tuberculous lymphadenopathy (n=5) and reactive hyperplasia (n=3) were used. Tissues were frozen in liquid nitrogen immediately after removal and stored below $-70^{\circ}C$. The cryostat sections of these frozen specimens were stained with anti-Leu-4 Ab, Identi-T TCR ${\delta}1$, and Identi-T ${\beta}F1$. The number of positively stained cells were counted at high power field. Results : The infiltration of ${\gamma}{\delta}$ T cells was significantly higher in the lymph nodes from patients with tuberculous lymphadenopathy than that with reactive hyperplasia ($16.3{\pm}10.3%$ vs. $1.7{\pm}1.5%$). Conclusion : These results suggest that ${\gamma}{\delta}$) T cells may play a role in the defense against M. tuberculosis infection, especially in the regional sites of infection.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.55-84
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• 2015

The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.

• Tuberculosis and Respiratory Diseases
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• v.64 no.3
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• pp.230-235
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• 2008

We described herein the first case of primary $Sj{\ddot{o}}gren^{\prime}s$ syndrome in Korea which presented with multiple cysts caused by only peribronchiolar lymphocytic infiltration, a rare pulmonary manifestation in $Sj{\ddot{o}}gren^{\prime}s$ syndrome, and was confirmed by surgical lung biopsy. A brief review of the literature has been included.