• Tuberculosis and Respiratory Diseases
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• 제67권4호
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• pp.318-324
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• 2009

Background: A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. The aim of this study was to collect information on the optimal treatment for CWTB. Methods: The clinical features, radiographic findings, and treatment outcomes of 26 patients, who underwent surgery and were diagnosed histopathologically, were retrospectively analyzed. Results: The most common presenting symptom was a palpable mass found in 24 patients (92.3%). In all patients, CT revealed a soft tissue mass that was accompanied by a central low density, with or without peripheral rim enhancement. The sensitivity and specificity of the bone scintigram for bone involvement were 87.5% and 100%, respectively. CWTB was diagnosed preoperatively by aspiration cytology and smear for acid-fast bacilli in five out of 11 patients. Twenty-three patients (88.5%) underwent a radical excision and three underwent incision/drainage or an incisional biopsy. The duration of antituberculous medication was 7.5${\pm}$3.98 months with a follow-up period of 28.2${\pm}$26.74 months. Among the 20 patients who completed their treatment, nine received chemotherapy for six months or less and 11 received chemotherapy for nine months or more. Two patients had a recurrence four and seven months after starting their medication. Conclusion: A 6 month regimen may be appropriate for CWTB patients who have undergone a complete excision.

• Tuberculosis and Respiratory Diseases
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• 제69권3호
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• pp.163-170
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• 2010

Background: Pulmonary tuberculosis remains a health concern in Korea despite major progress in the development of new strategies for diagnosing and treating tuberculosis. In particular, the diagnosis of newly developed pulmonary tuberculosis is on the rise in elderly persons. The aim of this study was to investigate the clinical, radiographic characteristics, and treatment outcomes of pulmonary tuberculosis in the elderly. Methods: The medical records of 113 young (<65 years old) and 112 elderly (${\geq}65$ years old) pulmonary tuberculosis patients diagnosed at Chungnam National University hospital between January 2007 and December 2008 were reviewed. Results: There was no difference in the prevalence of typical symptoms between the younger and the elderly group. Dypsnea was the only symptom that occurred more frequently in the elderly group (16.8% vs 5.5%, p=0.008). On radiological study, pneumonic infiltration type was more common in the elderly group (28.6% vs 16.8%, p=0.035). Sputum Acid fast bacilli smear positivity rate was similar between the 2 groups. Elderly patients with anti-tuberculosis medication had more frequent adverse drug reactions; however, there was no significant difference between the 2 groups in the number of patients required to stop medication due to an adverse drug reaction. There were more patients lost to follow-up in the elderly group (22/112, 19.6% vs 11/113, 9.7%, p=0.036). Conclusion: The majority of elderly patients did not complete the treatment, resulting in a poorer outcome. Therefore, we need to make an effort to support the continued screening of elderly patients by making this economically feasible.

• Pediatric Infection and Vaccine
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• 제18권1호
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• pp.80-84
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• 2011

흉벽 천공성 농흉(Empyema necessitatis)은 농흉이 흉막 외의 공간으로 확장되어 나간 것을 말한다. 결핵성 흉벽 천공성 농흉은 결핵의 드문 합병증으로서 특히 소아에서는 더욱 드물다. 본 저자들은 결핵에 노출된 병력이 없던 21개월 남자아이에서 7번째 늑골의 골수염에 동반된 결핵성 흉벽천공성 농흉을 경험하여 이에 대해 보고한다. 우리는 환자의 진단과 치료를 위해 수술적 치료를 시행하였고, 조직을 이용한 PCR 및 분자생물학적 검사에서 M. tuberculosis complex를 확인하여 항결핵제를 이용해 합병증 없이 치료하였다.

• Tuberculosis and Respiratory Diseases
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• 제75권6호
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• pp.238-243
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• 2013

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

• Tuberculosis and Respiratory Diseases
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• 제52권4호
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• pp.411-418
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• 2002

저자 등은 폐결핵재발 후에 진행성의 호흡곤란과 만성기침을 호소하며 입원하여 흉부전산화 단층촬영 상에 폐포단백증의 특징적인 소견을 보이는 환자를 개흉 폐생검으로 확진하여 항결핵제 투여와 기관지폐포세척술로 임상적 호전을 보인 1예를 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.280-285
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• 2010

Background: $QuantiFERON^{(R)}$-TB Gold In Tube (QFT-G IT) has been used for diagnosing latent tuberculosis infection and active tuberculosis (TB) since 2007. However, there has not been enough data on QFT-G IT for universal use in children. In this study, we evaluated the clinical usefulness of the QFT-G IT in pediatric practice. Methods: We retrospectively reviewed the clinical records of 70 patients younger than 18 years of age who had taken QFT-G IT and had a tuberculin skin test (TST) between July 2007 and July 2009 at Wonju Christian Hospital. The subjects were divided into two groups, asymptomatic TB exposure group and disease group. Four patients who were taking immunosuppressants during the study period were excluded. Results: A total of 66 immunocompetent children were included in this study. Among 27 asymptomatic children who had contact histories of TB, 6 (22.2%) were found to be positive by QFT-G IT. Eleven (40.7%) and 5 (18.5%) children were found to be positive by TST with cutoff values of ${\geq}5mm$ and ${\geq}10mm$, respectively. Agreement was fair to good between QFT-G IT and TST (${\kappa}=0.59$: cutoff value ${\geq}5mm$, ${\kappa}=0.7$: cutoff value ${\geq}10mm$). In disease group, 14 patients (35.9%) were diagnosed with active tuberculosis, 8/14 (57.1%) were positive on TST and 9/14 (64.3%) on QFT-G IT. The positive rate of acid-fast bacilli smear, TB-polymerase chain reaction, and culture for tuberculosis was 11% (1/9), 27.3% (3/11) and 33.3% (3/9), respectively. Conclusion: Our data support that the QFT-G IT can be used as an additional diagnostic tool for latent and active tuberculosis infection in children.

• 대한두경부종양학회지
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• 제12권2호
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• pp.169-176
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• 1996

결핵의 진단은 특징적 병리조직양상, 항산균 염색에 의한 균 증명과 M. tuberculosis균 배양으로 이루어지나 형태적으로는 결핵이 의심되더라도 항산균이 조직표본이나 도말에서 검출되지 않거나 M. tuberculosis가 배양되지 않아 정확한 원인적 진단이 불가능할 경우가 많다. 이에 저자들은 경부 결핵성 임파선염으로 적출되어 보내어진 경부 임파선 조직의 신선한 조직이나 통상적으로 처리되어 제작된 파라핀 블록을 이용하여 M. tuberculosis에 특수한 반복성 DNA sequence인 IS986를 표적으로 한 primers을 사용하여 nested PCR방법을 이용하여 예민도가 높은 M. tuberculosis 검출로 빠른 시간 내에 결핵을 진단하고자 본 연구를 실시하였다. 최근 유전자 기술의 진보로 M. tuberculosis의 여러 항원들의 유전자가 클론화되고 그 염기 배열이 밝혀졌으며 이에 저자들은 결핵의 확진을 위하여 파라핀 포매조직을 대상으로 nested PCR에 의한 188bp의 DNA를 증폭한후 증폭한 DNA분절의 염기 배열을 결정한 후 Bst UI와 Hha I 효소를 이용한 소화과정을 거친 후 restriction fragment length polymorphism(RFLP)을 은염색에 의해 그 패턴에 의해 M. tuberculosis를 확인하고 또한 다른 종의 Mycobacteria를 배제시킬 수 있었다. 본 방법은 1$\sim$2일에 끝나며, 방사선물질을 사용하지 않으면서도 감도 및 특이성이 우수하여 일반 병리실힘실에서도 M. tuberculosis를 포함한 각종 항산균의 신속한 검출법으로 손쉽게 사용할 수 있다고 생각되어 이에 보고하였다.

• Journal of Yeungnam Medical Science
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• 제32권2호
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• pp.71-79
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• 2015

Background: Recent studies have shown that the nontuberculosis mycobacterium (NTM) recovery rate in clinical cultures has increased within Korea. However, another study conducted by a secondary hospital within Daegu reported different results. Therefore, the purpose of this study is to understand and evaluate the microbiological distribution and clinical features of NTM in Daegu. Methods: A retrospective study was conducted on 11,672 respiratory specimens undergoing acid fast bacilli (AFB) culture from 6,685 subjects who visited Yeungnam University Respiratory Center from January 2012 to December 2013. Results: Of the 11,672 specimens undergoing AFB culture, 1,310 specimens (11.2%) showed positive results. Of these specimens, NTM was recovered from 587 specimens, showing a recovery rate of 44.8%. Identification test for NTM was performed on 191 subjects; the results were as follows: M. avium-intracellulare complex (MAC) 123 (64.4%), M. abscessus 20 (10.5%), M. kansasii 12 (6.3%), and 33 other NTM germ strains. Of the 382 subjects with NTM, 167 were diagnosed with pulmonary NTM disease (43.7%), however virulence differed depending on NTM strain. Multivariate analysis showed that nodular bronchiectasis, the nodules, and finding consistent with cavity under imaging study were statistically significant for triggering pulmonary NTM disease. AFB culture showing MAC and M. abscessus was statistically significant as well. Positive predictive value for NTM polymerase chain reaction (NTM-PCR) was 88.6%. Conclusion: Results for NTM recovery rate within the Daegu area were similar to those for the Seoul metropolitan area. We can assume that NTM infection is increasing in our community, therefore AFB-positive subjects (1) should undergo NTM-PCR, (2) should have their culture results checked for differentiation of mycobacterium tuberculosis complex (MTB) from NTM, and (3) undergo NTM identification test to confirm its type. Administration of treatment with the above results should be helpful in improving the patients' prognosis.

• 대한수의학회지
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• 제16권2호
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• pp.151-158
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• 1976

The tuberculin test have been widely utilized to diagnose tuberculosis of the dairy cattle. It was reported that approximately 70% of the dairy cattle with positive tuberculin reaction in Korea had been non-pathogenic lesion. So the studies on the specific method to diagnose tuberculosis of them is really need in Korea. Therefore this study investigated upon the diagnostic method for cattle tuberculosis in the aspect of cellular-immunology. The results obtained in this investigation are summarized as follows: 1. All the tuberculin tests to the swine inoculated with BCG.(B group), Mycobacterium avium (A group) and Mycobacterium smegmatis (S group), respectively, were represented high positive reaction and were no differences in the species of inoculated bacteria. 2. In the migration inhibition test using Iymphocyte in circulating blood of the swine inoculated with three species of acid-fast bacteria respectively, the test to A group was represented slight positive for migration in the presence of $15{\mu}g/ml$-PPD and the other reaction were clear and total positive for migration inhibition in the presence of $25{\mu}g/ml$-PPD or more, and the test to B group was the same results as to A group approximately. The test to S group was represented slight positive for migration inhibition in the presence of $15{\mu}g/ml$-PPD, but the results were the same in the presence of $25{\mu}g/ml$-PPD and $35{\mu}g/ml$-PPD. These results showed that there were remarkable differences between group A, B and group S in the presence of $25{\mu}g/ml$-PPD and $35{\mu}g/ml$-PPD. 3. The transformation rates of lymphocyte in PPD treated tissue culture had no significance without any relation between PPD treatment and non-treatment but A group and B group showed significance. And A group and B group showed high significance in comparison with N group and S group in the LSD examination. 4. The infection rated in lymphocyte of BCG inoculated after 3 days tissue culturing were represented those of high infection but its cellular degeneration rates almost did not change. The infection rates in bacilli in N group and S group were low but after 3 days inoculation it shewed higher cellular degeneration.

• 미생물학회지
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• 제45권3호
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• pp.281-285
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• 2009

본 연구에서는 객담 내 결핵균의 배양시험과 약제 감수성 시험 방법으로서 BacT/Alert 액체 배지, Ogawa 배지 및 $L\ddot{o}wenstein$-Jensen 배지 배양법을 비교하였다. 신속 액체배양시스템은 기존의 Egg-based media (Ogawa, $L\ddot{o}wenstein$-Jensen 배지)에 비해 높은 민감도와 빠른 배양으로 결핵환자의 초기 객담 검사와 약제 감수성 시험에 널리 사용되어 왔다. 객담은 N-Acetyl-L-cystine과 4% NaOH로 처리한 후 BacT/Alert 액체 배지 시스템과 Ogawa 배지에 접종하고 배양하여 비교하였다. 결핵환자 객담 검체 135개 중 도말검사결과 양성은 95개였고, Ogawa 배지 배양결과 양성으로 확인된 수는 89개(65.9%)였으며, BacT/Alert 액체 배지에서는 97개(71.9%)가 양성으로 확인되었다. 결핵균 배양 양성 검체의 평균배양일은 Ogawa 배지에서 22.4일, BacT/Alert 액체 배지는 11.3일로 단축되는 것을 확인하였다. 약제 감수성 시험에는 32개 결핵균주를 이용하였으며, isoniazid를 첨가한 BacT/Alert 액체 배지와 $L\ddot{o}wenstein$-Jensen 배지에서의 약제 감수성 시험 검사결과 일치률은 87.5%를 보였고, rifampicin에서의 일치률은 90.6%로 나타났다.