• 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.

• Pediatric Infection and Vaccine
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• 제26권1호
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• pp.32-41
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• 2019

목적: 결핵 전파를 조기에 차단하기 위해서는, 활동성 결핵 환자와 접촉한 사람들을 조사하여 결핵 질환 및 잠복결핵감염을 진단하고 치료하는 것이 매우 중요하며, 국내에서는 민간-공공협력 결핵관리사업을 통해 적극적인 접촉자 조사 활동을 지원하고있다. 본연구에서는최근 3년간단일기관에서이루어진소아청소년연령에서의접촉자검진과소아잠복결핵감염치료 현황에 대해 조사하였다. 방법: 2014년 7월 1일부터 2017년 6월 30일까지 충남대학교병원에서 활동성 결핵 환자로 진단받은 환자들을 대상으로 가족 내 소아청소년 접촉자에 대한 검진을 시행하여 접촉자 검진 완료율 및 결과를 분석하였고, 이와 함께 동일 기간 동안 잠복결핵감염으로 치료 받은 소아청소년 환자들의 치료 현황을 후향적으로 검토하였다. 결과: 연구 기간 동안 본 기관에서 활동성 결핵 환자는 총 1,002명 진단되었고, 그 중 소아청소년 가족접촉자가 있는 환자는 171명이었다. 소아청소년 접촉자 269명 중 20명(7.4%)은 검진을 전혀 받지 않았다. 1차 검진을 받은 249명 중 폐결핵이 1명(0.4%) 진단되었고, 7명(2.8%)은 과거의 결핵 감염 병력이 있었으며, 42명(16.9%)이 잠복결핵감염으로 진단되었다. 2차 검진 시 29명(11.6%)이 추가로 잠복결핵감염으로 진단되었으며, 2차 검진까지 필요하였으나 검진을 완료하지 않은 사람이 61명으로 총 접촉자 269명 중 188명(69.9%)만이 필요한 검진을 완료하였다. 잠복결핵감염으로 치료받은 소아청소년 환자는 90명이었으며 83명(92.2%)이 치료를 완료하였고, 이 중 18명이 발진(8명), 피로(5명), 위장장애(5명) 등의 부작용을 호소하였으나 치료 중단이 필요한 심각한 부작용은 없었다. 결론: 민간-공공협력 결핵관리사업 도입 및 보편화 후에도 소아청소년 연령에서의 결핵 접촉자 검진 완료율은 낮았으며, 잠복결핵감염으로 진단받은 소아의 항결핵제 치료 시 심각한 부작용의 발생 없이 투약 완료율이 높게 나타났다. 향후 결핵 전파의 예방 및 관리를 위해 더욱 적극적인 민관 협동 노력 및 환자, 보호자 교육이 필요하겠다.

• Tuberculosis and Respiratory Diseases
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• 제79권3호
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• pp.153-157
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• 2016

Background: Vitamin D is known to have diverse effects on various systems in the body. There is evidence to suggest that a link exists between the serum vitamin D status and tuberculosis. The present study was designed to assess the alterations in serum 25-hydroxyvitamin D levels in newly diagnosed sputum acid fast bacilli (AFB) positive pulmonary tuberculosis patients and to study the association, if any, between serum vitamin D levels and different levels of sputum smear positivity. Methods: Serum 25-hydroxyvitamin D levels were estimated in 65 sputum AFB positive pulmonary tuberculosis patients and 65 age and gender-matched healthy controls. Results: The levels of serum 25 hydroxy-vitamin D in tuberculosis patients were not statistically different from the levels of serum 25 hydroxy-vitamin D in healthy controls. However, among patients with pulmonary tuberculosis, there was a significant negative correlation between the levels of serum 25 hydroxy-vitamin D and levels of sputum positivity. Conclusion: Serum vitamin D levels negatively correlates with bacterial load in patients with active pulmonary tuberculosis.

• Journal of Preventive Medicine and Public Health
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• 제52권1호
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• pp.66-70
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• 2019

Objectives: In the Republic of Korea (ROK), the notified incidence of tuberculosis in foreign-born individuals (NITFBI) has increased recently, as has the rate of multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis in foreigners staying in the ROK. As Jeju Province in ROK has a no-visa entry policy, control programs for NITFBI should be consolidated. The aim was to evaluate the status of NITFBI, with a focus on the distribution of MDR/RR tuberculosis by nationality. Methods: Data on tuberculosis incidence in individuals born in Jeju Province and in foreign-born individuals were extracted from the Korean Statistical Information Service of Statistics Korea, and the Infectious Disease Surveillance Web Statistics of the Korea Centers for Disease Control and Prevention, respectively. Results: Among all notified incident cases of tuberculosis, the proportion of NITFBI increased from 1.46% in 2011 to 6.84% in 2017. China- and Vietnam-born individuals accounted for the greatest proportion of the 95 cases of NITFBI. Seven cases of MDR/RR tuberculosis were found, all involving patients born in China. Conclusions: In Jeju Province, ROK, NITFBI might become more common in the near future. Countermeasures for controlling active tuberculosis in immigrants born in high-risk nations for tuberculosis should be prepared in Jeju Province, since it is a popular tourist destination.

• Tuberculosis and Respiratory Diseases
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• 제84권1호
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• pp.1-12
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• 2021

Mycobacterium tuberculosis has infected more than two billion individuals worldwide, of whom 5%-10% have clinically active disease and 90%-95% remain in the latent stage with a reservoir of viable bacteria in the macrophages for extended periods of time. The tubercle bacilli at this stage are usually called dormant, non-viable, and/or non-culturable microorganisms. The patients with latent bacilli will not have clinical pictures and are not infectious. The infections in about 2%-23% of the patients with latent status become reactivated for various reasons such as cancer, human immunodeficiency virus infection, diabetes, and/or aging. Many studies have examined the mechanisms involved in the latent state of Mycobacterium and showed that latency modified the expression of many genes. Therefore, several mechanisms will change in this bacterium. Hence, this study aimed to briefly examine the genes involved in the latent state as well as the changes that are caused by Mycobacterium tuberculosis. The study also evaluated the relationship between the functions of these genes.

• Tuberculosis and Respiratory Diseases
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• 제65권4호
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• pp.339-342
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• 2008

본 증례에서 폐결핵의 치료 중에 발생한 일시적인 방사선학적 악화의 초기 CT 소견은 폐 주변부에 발생한 폐소엽간 혹은 폐소엽 내 중격비후, 그리고 미세결절들이었다. 후기 CT 소견은 폐 주변부에 위치하고 내부에 저음영을 가지며 조영 증강이 잘되는 폐결절이었다. 폐결핵을 처음 치료하는 젊은 환자에서 임상적인 악화 없이 이러한 CT 소견이 보일 때 일시적인 방사선학적 악화를 의심해야 한다.

• Journal of Preventive Medicine and Public Health
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• 제52권4호
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• pp.272-275
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• 2019

The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette-$Gu{\acute{e}}rin$ vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.

• Journal of Yeungnam Medical Science
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• 제38권3호
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• pp.251-257
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• 2021

Vedolizumab (VDZ) has been approved for the treatment of inflammatory bowel diseases (IBDs) in patients aged ≥18 years. We report a case of a pediatric patient with Crohn disease (CD) who was successfully treated with VDZ. A 16-year-old female developed severe active pulmonary tuberculosis (TB) during treatment with infliximab (IFX). IFX was stopped, and TB treatment was started. After a 6-month regimen of standard TB medication, her pulmonary TB was cured; however, gastrointestinal symptoms developed. Due to the concern of the patient and parents regarding TB reactivation on restarting treatment with IFX, VDZ was started off-label. After the second dose of VDZ, the patient was in clinical remission and her remission was continuously sustained. Ileocolonoscopy at 1-year after VDZ initiation revealed endoscopic healing. Therapeutic drug monitoring conducted during VDZ treatment showed negative antibodies to VDZ. No serious adverse events occurred during the VDZ treatment. This is the first case report in Korea demonstrating the safe and effective use of VDZ treatment in a pediatric CD patient. In cases that require recommencement of treatment with biologics after recovery of active pulmonary TB caused by anti-tumor necrosis factor agents, VDZ may be a good option even in pediatric IBD.

• Tuberculosis and Respiratory Diseases
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• 제53권4호
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• pp.389-400
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• 2002

배 경 :결핵의 조기치료와 전염방지를 위해서 신속하고 간편한 결핵진단법의 개발이 요구되고 있는 실정에서 결핵균에 특이한 38-kDa단백을 포함하여 금 콘쥬게이트에 결합된 유전자재조합 항원을 혈청과 반응시켜 항결핵 항체를 발견하도록 고안된 카드형태의 혈청학적 진단기법인 Xeniss Rapid TB kit가 결핵의 진단에 유용하게 이용될 수 있는 지를 알아보고자 하였다.방 법 :188명의 결핵환자(폐결핵 177명, 폐외결핵 11명)와 82명의 접촉자, 그리고 57명의 건강한 성인을 대상으로 하였으며, 연구대상자의 혈청을 이용하여 Xeniss Rapid TB kit의 민감도, 특이도, 양성예측율, 그리고 음성예측율을 조사하였다. 결 과 : 전체적인 민감도는 73.9%, 특이도 81.3%, 양상예측율 84.2%, 그리고 음성예측율은 85.8%였다. 진단시점부터 검사시점간의 시간간격에 따라서는 1개월 이내에서 61.5%로 가장 낮고 점차 증가하여 4-6개월 시점에 94.4%로 가장 높았으며 이후 점차 감소하여 12개월 이상 경과한 시점에서는 67.4%의 양성반응율을 보였다. 페외결핵 환자(90.9%)에서는 폐결핵 환자(72.8%)보다 양성반응율이 높았다. 객담도말양성 (76.2 대 68.4%), 방사선 사진상 중증 (79.3 대 63.3%), 공동성 병소(75.7 대 70.0%), 과거 치료력 (76.3 대 73.3%)이 있는 환자군에서 상대적으로 높은 양성반응율을 보였으며, 당뇨병을 동반한 환자군(69.0 대 74.8%)과 노인환자군(68.l 대 100%)에서는 상대적으로 낮은 양성반응율을 보였다. 건강성인군 7.0%, 환자가족군 17.5%에 비해 병원직원군에서 57.9%의 양성반응율을 보여 활동성 결핵환자와 장기간 지속적으로 접촉한 군에서 높은 양성반응율을 보였다. 결 론 : Xeniss Rapid TB kit는 신속하고 간편하며, 민감도와 특이도가 비교적 높고 특히, 폐외결핵에서는 높은 양성반응율을 보여 폐결핵, 폐외결핵, 그리고 감염자의 진단에 보조적 검사법으로 유용하게 이용될 수 있을 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제78권3호
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• pp.286-288
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• 2015

Endobronchial tuberculosis is defined as a tuberculous infection of the tracheobronchial tree and has a prevalence of up to 50% in active pulmonary tuberculosis cases. The most common complication of endobronchial tuberculosis is bronchial stenosis; benign fistula formation by endobronchial tuberculosis is rare, especially inter-bronchial fistula formation. We reported a rare case of a 73-year-old woman with a fistula between the right upper bronchus and bronchus intermedius. A diagnosis of inter-bronchial fistula caused by endobronchial tuberculosis was based on the results of chest computed tomography scans, bronchoscopy, and microbiological and pathological tests. The patient was treated with anti-tuberculous medication, and her symptoms gradually improved.